Treatment planning constraints to avoid xerostomia in head-and-neck radiotherapy: An independent test of QUANTEC criteria using a prospectively collected dataset Journal Article
| Authors: | Moiseenko, V.; Wu, J.; Hovan, A.; Saleh, Z.; Apte, A.; Deasy, J. O.; Harrow, S.; Rabuka, C.; Muggli, A.; Thompson, A. |
| Article Title: | Treatment planning constraints to avoid xerostomia in head-and-neck radiotherapy: An independent test of QUANTEC criteria using a prospectively collected dataset |
| Abstract: | Purpose: The severe reduction of salivary function (xerostomia) is a common complication after radiation therapy for head-and-neck cancer. Consequently, guidelines to ensure adequate function based on parotid gland tolerance dose-volume parameters have been suggested by the QUANTEC group and by Ortholan et al. We perform a validation test of these guidelines against a prospectively collected dataset and compared with a previously published dataset. Methods and Materials: Whole-mouth stimulated salivary flow data from 66 head-and-neck cancer patients treated with radiotherapy at the British Columbia Cancer Agency (BCCA) were measured, and treatment planning data were abstracted. Flow measurements were collected from 50 patients at 3 months, and 60 patients at 12-month follow-up. Previously published data from a second institution, Washington University in St. Louis (WUSTL), were used for comparison. A logistic model was used to describe the incidence of Grade 4 xerostomia as a function of the mean dose of the spared parotid gland. The rate of correctly predicting the lack of xerostomia (negative predictive value [NPV]) was computed for both the QUANTEC constraints and Ortholan et al. recommendation to constrain the total volume of both glands receiving more than 40 Gy to less than 33%. Results: Both datasets showed a rate of xerostomia of less than 20% when the mean dose to the least-irradiated parotid gland is kept to less than 20 Gy. Logistic model parameters for the incidence of xerostomia at 12 months after therapy, based on the least-irradiated gland, were D 50 = 32.4 Gy and and γ = 0.97. NPVs for QUANTEC guideline were 94% (BCCA data), and 90% (WUSTL data). For Ortholan et al. guideline NPVs were 85% (BCCA) and 86% (WUSTL). Conclusion: These data confirm that the QUANTEC guideline effectively avoids xerostomia, and this is somewhat more effective than constraints on the volume receiving more than 40 Gy. © 2012 Elsevier Inc. |
| Keywords: | adult; aged; major clinical study; treatment planning; cancer radiotherapy; radiation dose; follow up; prospective study; logistic models; radiotherapy; patient monitoring; practice guideline; head and neck cancer; radiation effects; xerostomia; intermethod comparison; negative predictive value; parotid gland; diseases; data sets; mean dose; statistical tests; dose-volume effects; salivary function; salivation; british columbia; dose-volume parameters; parotid glands; salivary flow; validation test; washington university |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 82 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2012-03-01 |
| Start Page: | 1108 |
| End Page: | 1114 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2011.04.020 |
| PROVIDER: | scopus |
| PMCID: | PMC3192313 |
| PUBMED: | 21640505 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 March 2012" - "CODEN: IOBPD" - "Source: Scopus" |
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