Salivary gland-sparing helical tomotherapy for head and neck cancer: Preserved salivary function on quantitative salivary gland scintigraphy after tomotherapy.
OBJECTIVE
Prospective evaluation of salivary gland preservation, overall survival and local recurrence-free survival after head and neck cancer treated by helical tomotherapy (HT).


METHODS
From March 2007 to February 2009, 30 patients with head and neck cancer were treated by HT. The salivary excretion fraction (SEF) was assessed by technetium salivary gland scintigraphy before, and 6, 12 and 18 months after HT to define salivary gland preservation rates. Patients were reviewed every 3 months to assess clinical toxicity.


RESULTS
The median follow-up was 4.3 years. The mean dose to the ipsilateral parotid gland (IPG) was 25.4Gy. Good preservation of parotid gland function was observed in 84% of the 19 patients evaluated by scintigraphy at 18 months. The 5-year local recurrence-free survival (LRFS) was 100% among the 6 patients who received a dose of more than 26Gy to the parotid gland. The 28-month LRFS was 33% in the group that received a dose of less than 20Gy versus 91% in the group that received a dose of more than 20Gy to the IPG.


CONCLUSIONS
Helical tomotherapy reduced the incidence and severity of xerostomia. A mean dose to the parotid between 20 and 26Gy allowed preservation of salivary function without compromising treatment efficacy. However, parotid-sparing HT requiring a mean dose less than 20Gy is associated with an increased risk of recurrence.
Université Paris Descartes, Paris Sorbonne Cité, hôpital européen Georges-Pompidou, Service d'oncologie-radiothérapie, 20, rue Leblanc, 75015 Paris, France. Electronic address: sarah.kreps@egp.aphp.fr.
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Kreps
Université Paris Descartes, Paris Sorbonne Cité, hôpital européen Georges-Pompidou, Service d'oncologie-radiothérapie, 20, rue Leblanc, 75015 Paris, France.
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Berges
Institut Curie, Département de biostatistique, 26, rue d'Ulm, 75005 Paris, France.
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Belin
Institut Curie, Département d'oncologie-radiothérapie, 26, rue d'Ulm, 75005 Paris, France.
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Zefkili
Institut Curie, Département de médecine nucléaire, 26, rue d'Ulm, 75005 Paris, France.
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Petras
Université Paris Descartes, Paris Sorbonne Cité, hôpital européen Georges-Pompidou, Service d'oncologie-radiothérapie, 20, rue Leblanc, 75015 Paris, France.
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Giraud
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D059351:Organ Sparing Treatments; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D012469:Salivary Glands / Q000000981:diagnostic imaging*; D014987:Xerostomia / Q000517:prevention & control
Parotid glands; Preservation of the salivary glands; Salivary gland scintigraphy; Submandibular glands; Tomotherapy