Importance of the initial volume of parotid glands in xerostomia for patients with head and neck cancers treated with IMRT.
OBJECTIVE
Our aim was to evaluate predictors of xerostomia in patients with head and neck cancers treated with intensity-modulated radiation therapy (IMRT).


METHODS
Thirty-three patients with pharyngeal cancer were evaluated for xerostomia after having been treated with IMRT. All patients were treated with whole-neck irradiation of 46-50 Gy by IMRT, followed by boost IMRT to the high-risk clinical target volume to a total dose of 56-70 Gy in 28-35 fractions (median, 68 Gy). For boost IMRT, a second computed tomography (CT-2) scan was done in the third to fourth week of IMRT. Xerostomia was scored 3-4 months after the start of IMRT.


RESULTS
The mean doses to the contralateral and ipsilateral parotid glands were 24.0 +/- 6.2 and 30.3 +/- 6.6 Gy, respectively. Among the 33 patients, xerostomia of grades 0, 1, 2 and 3 was noted in one, 18, 12 and two patients, respectively. Although the mean dose to the parotid glands was not correlated with the grade of xerostomia, the initial volume of the parotid glands was correlated with the grade of xerostomia (P = 0.04). Of 17 patients with small parotid glands (< or =38.8 ml) on initial CT (CT-1), 11 (65%) showed grade 2 or grade 3 xerostomia, whereas only three (19%) of 16 patients with larger parotid glands showed grade 2 xerostomia (P < 0.05). The mean volume of the parotid glands on CT-1 was 43.1 +/- 15.2 ml, but decreased significantly to 32.0 +/- 11.4 ml (74%) on CT-2 (P < 0.0001).


CONCLUSIONS
Initial volumes of the parotid glands are significantly correlated with the grade of xerostomia in patients treated with IMRT. The volume of the parotid glands decreased significantly during the course of IMRT.
Department of Radiation Oncology, Kinki University School of Medicine, Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan. ynishi@med.kindai.ac.jp
Yasumasa
Y
Nishimura
Kiyoshi
K
Nakamatsu
Toru
T
Shibata
Shuichi
S
Kanamori
Ryuta
R
Koike
Masahiko
M
Okumura
Minoru
M
Suzuki
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D010306:Parotid Gland / Q000473:pathology / Q000528:radiation effects*; D011379:Prognosis; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D014987:Xerostomia / Q000175:diagnosis / Q000209:etiology*