Parotid Gland Stem Cell Sparing Radiation Therapy for Patients With Head and Neck Cancer: A Double-Blind Randomized Controlled Trial
| Autor: | Peter van Luijk, Maria C A Kramer, Roel J H M Steenbakkers, Robert P. Coppes, Hendrik P. Bijl, Johanna G M van den Hoek, Maria I van Rijn-Dekker, Roel G J Kierkels, Arjen van der Schaaf, Monique A. Stokman, Johannes A. Langendijk |
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| Přispěvatelé: | Guided Treatment in Optimal Selected Cancer Patients (GUTS), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE) |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Cancer Research
medicine.medical_specialty medicine.medical_treatment SALIVARY-GLANDS Urology XEROSTOMIA Salivary Glands law.invention Double blind Mice Randomized controlled trial stomatognathic system law medicine Clinical endpoint Animals Humans Parotid Gland Radiology Nuclear Medicine and imaging IMRT RISK Radiation Salivary gland integumentary system business.industry Stem Cells Head and neck cancer RECOVERY medicine.disease DYSFUNCTION Parotid gland Rats Radiation therapy INTENSITY-MODULATED RADIOTHERAPY DELINEATION stomatognathic diseases NCIC CTG EORTC medicine.anatomical_structure Oncology Head and Neck Neoplasms Stem cell business |
| Zdroj: | International Journal of Radiation Oncology, Biology, Physics, 112(2), 306-316. ELSEVIER SCIENCE INC |
| ISSN: | 0360-3016 |
| Popis: | Purpose Radiation therapy for head and neck cancer frequently leads to salivary gland damage and subsequent xerostomia. The radiation response of the parotid glands of rats, mice, and patients critically depends on dose to parotid gland stem cells, mainly located in the gland's main ducts (stem cell rich [SCR] region). Therefore, this double-blind randomized controlled trial aimed to test the hypothesis that parotid gland stem cell sparing radiation therapy preserves parotid gland function better than currently used whole parotid gland sparing radiation therapy. Methods and Materials Patients with head and neck cancer (n = 102) treated with definitive radiation therapy were randomized between standard parotid-sparing and stem cell sparing (SCS) techniques. The primary endpoint was >75% reduction in parotid gland saliva production compared with pretreatment production (FLOW12M). Secondary endpoints were several aspects of xerostomia 12 months after treatment. Results Fifty-four patients were assigned to the standard arm and 48 to the SCS arm. Only dose to the SCR regions (contralateral 16 and 11 Gy [P = .004] and ipsilateral 26 and 16 Gy [P = .001] in the standard and SCS arm, respectively) and pretreatment patient-rated daytime xerostomia (35% and 13% [P = .01] in the standard and SCS arm, respectively) differed significantly between the arms. In the SCS arm, 1 patient (2.8%) experienced FLOW12M compared with 2 (4.9%) in the standard arm (P = 1.00). However, a trend toward better relative parotid gland salivary function in favor of SCS radiation therapy was shown. Moreover, multivariable analysis showed that mean contralateral SCR region dose was the strongest dosimetric predictor for moderate-to-severe patient-rated daytime xerostomia and grade ≥2 physician-rated xerostomia, the latter including reported alteration in diet. Conclusions No significantly better parotid function was observed in SCS radiation therapy. However, additional multivariable analysis showed that dose to the SCR region was more predictive of the development of parotid gland function–related xerostomia endpoints than dose to the entire parotid gland. |
| Databáze: | OpenAIRE |
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