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Japanese Journal of Clinical Oncology Advance Access published online on June 23, 2005
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyi108
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© 2005 Foundation for Promotion of Cancer Research
Received March 16, 2005
Accepted May 8, 2005

Original Article

Importance of the Initial Volume of Parotid Glands in Xerostomia for Patients with Head and Neck Cancers Treated with IMRT

Yasumasa Nishimura 1*, Kiyoshi Nakamatsu 1, Toru Shibata 1, Shuichi Kanamori 1, Ryuta Koike 1, Masahiko Okumura 2, and Minoru Suzuki 3

1 Department of Radiation Oncology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan
2 Central Radiological Service, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan
3 Radiation Oncology Research Laboratory, Research Reactor Institute, Kyoto University, Sennan-gun, Osaka, Japan

* To whom correspondence should be addressed.
Yasumasa Nishimura, E-mail: ynishi{at}med.kindai.ac.jp


  Abstract

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 (≤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.

Keywords: IMRT; xerostomia; parotid glands; head and neck cancer.
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