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Trada Y, Lee MT, Jameson MG, Chlap P, Keall P, Moses D, Lin P, Fowler A. Mid-treatment 18F-FDG PET imaging changes in parotid gland correlates to radiation-induced xerostomia. Radiother Oncol 2023; 186:109745. [PMID: 37330056 DOI: 10.1016/j.radonc.2023.109745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The aim of this study was to measure functional changes in parotid glands using mid-treatment FDG-PET/CT and correlate early imaging changes to subsequent xerostomia in mucosal head and neck squamous cell carcinoma patients undergoing radiotherapy. MATERIALS AND METHODS 56 patients from two prospective imaging biomarker studies underwent FDG-PET/CT at baseline and during radiotherapy (week 3). Both parotid glands were volumetrically delineated at each time point. PET parameter SUVmedian were calculated for ipsilateral and contralateral parotid glands. Absolute and relative change (Δ) in SUVmedian were correlated to moderate-severe xerostomia (CTCAE grade ≥ 2) at 6 months. Four predictive models were subsequently created using multivariate logistic regression using clinical and radiotherapy planning parameters. Model performance was calculated using ROC analysis and compared using Akaike information criterion (AIC) RESULTS: 29 patients (51.8%) developed grade ≥ 2 xerostomia. Compared to baseline, there was an increase in SUVmedian at week 3 in ipsilateral (8.4%) and contralateral (5.5%) parotid glands. Increase in ipsilateral parotid Δ SUVmedian (p = 0.04) and contralateral mean parotid dose (p = 0.04) were correlated to xerostomia. The reference 'clinical' model correlated to xerostomia (AUC 0.667, AIC 70.9). Addition of ipsilateral parotid Δ SUVmedian to the clinical model resulted in the highest correlation to xerostomia (AUC 0.777, AIC 65.4). CONCLUSION Our study shows functional changes occurring in the parotid gland early during radiotherapy. We demonstrate that integration of baseline and mid-treatment FDG-PET/CT changes in the parotid gland with clinical factors has the potential to improve xerostomia risk prediction which could be utilised for personalised head and neck radiotherapy.
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Affiliation(s)
- Yuvnik Trada
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Mark T Lee
- Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia
| | - Michael G Jameson
- GenesisCare, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, University NSW, Australia
| | - Phillip Chlap
- Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Paul Keall
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Image X Institute, University of Sydney, Sydney, NSW, Australia
| | - Daniel Moses
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia; Department of Medical Imaging, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Peter Lin
- South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia; Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia
| | - Allan Fowler
- Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia
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Management of radiotherapy-induced salivary hypofunction and consequent xerostomia in patients with oral or head and neck cancer: meta-analysis and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:595-607. [PMID: 24650370 DOI: 10.1016/j.oooo.2014.01.229] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/27/2014] [Accepted: 01/29/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyze the efficacy of various treatment options for radiation-induced hyposalivation in patients with head and neck cancer. STUDY DESIGN A literature review and meta-analysis was performed on all appropriate literature identified via MEDLINE/PubMed. RESULTS Fourteen articles were identified that met inclusion criteria for review, and 8 articles qualified for inclusion in the meta-analysis. The available literature addressed both objective and subjective responses of hyposalivation, xerostomia, or both to cholinergic agonists (such as pilocarpine and cevimeline), salivary substitutes, hyperbaric oxygen, and acupuncture. CONCLUSIONS This analysis indicated that cholinergic agonists were more effective in treating radiation-induced hyposalivation compared with salivary substitutes, hyperbaric oxygen, and acupuncture. However, other treatment modalities, such as salivary substitutes and hyperbaric oxygen, were also found to subjectively improve patients' perception of xerostomia.
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