title: Anatomical and dose changes of gross tumour volume and parotid glands for head and neck cancer patients during intensity-modulated radiotherapy: effect on the probability of xerostomia incidence.
abstract: OBJECTIVE
  To quantify the changes in dose as well as in the prediction of parotid gland toxicity due to anatomical changes during therapy of head and neck cancer patients.
  
  
  METHODS
  Fifteen patients with advanced locoregional head and neck cancer, with no evidence of distant metastasis, were enrolled in a prospective study. All patients were treated with intensity-modulated radiotherapy. Multiple computed tomography scans were repeated at the end of each treatment week. The original treatment plans were copied to the per-treatment scans to create hybrid plans. The normal tissue complication probability (NTCP) was calculated assuming the end point to be grade ≥3 xerostomia according to the Radiation Therapy Oncology Group late toxicity scale.
  
  
  RESULTS
  The gross tumour volume dose coverage was slightly affected by the anatomical changes, whereas the mean dose (D(mean)) to the parotids changed from 26.1 ± 6.0 to 27.4 ± 7.4 Gy, with a mean increase of 0.22 Gy/treatment week. Consequently, the mean NTCP increased from 0.15 ± 0.06 to 0.18 ± 0.10, primarily due to a few patients exhibiting a marked increase. The absolute gross tumour volume shrinkage and the percentage parotids shrinkage were the best independent predictors for the NTCP variations.
  
  
  CONCLUSIONS
  On average, the increase in the parotids D(mean) as well as in NTCP during treatment is limited, and the observed variations were strongly patient-dependent.
authors.affiliation: Medical Physics Laboratory, Regina Elena Cancer Institute, Rome, Italy. marzi@ifo.it
authors.forename: S
authors.initials: S
authors.lastname: Marzi
authors.forename: P
authors.initials: P
authors.lastname: Pinnarò
authors.forename: D
authors.initials: D
authors.lastname: D'Alessio
authors.forename: L
authors.initials: L
authors.lastname: Strigari
authors.forename: V
authors.initials: V
authors.lastname: Bruzzaniti
authors.forename: C
authors.initials: C
authors.lastname: Giordano
authors.forename: G
authors.initials: G
authors.lastname: Giovinazzo
authors.forename: L
authors.initials: L
authors.lastname: Marucci
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010306:Parotid Gland / Q000000981:diagnostic imaging / Q000473:pathology / Q000528:radiation effects*; D011446:Prospective Studies; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D014987:Xerostomia / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult