Document Detail


Reduction of radiation-induced xerostomia in nasopharyngeal carcinoma using CT simulation with laser patient marking and three-field irradiation technique.
MedLine Citation:
PMID:  9240636     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Tumor control and reduction of postirradiation xerostomia in patients with nasopharyngeal carcinoma (NPC) using the three-field irradiation technique based on the CT-based simulation with laser patient marking was investigated. METHODS AND MATERIALS: Seventy-eight patients with NPC were consecutively treated between 1983 and 1993. In 33 patients treated before 1987, target volume was determined using a conventional x-ray simulator with a reference of CT images, and the primary site was treated by the conventional parallel-opposed two-field technique (Group I). In 45 patients treated from 1987, target volume was determined using a CT simulator slice by slice, the treatment field was projected onto the patient's skin by a laser beam projector mounted on a C-arm, and the primary site was irradiated by a three-fields (anterior and bilateral) technique (Group II). In Group II, the shape of each field was determined using a beam's eye view to reduce the dose to the bilateral parotid glands. The three-field technique reduced the dose to the superficial lobe of parotid gland to about two-thirds of the dose given by the two-field technique. Radiation-induced xerostomia was evaluated by clinical symptoms and radioisotope sialography. RESULTS: The 5-year survival rate and disease-free survival rate were 46.6 and 31.2% in Group I, and 46.8 and 46.5% in Group II. A large variation in the volume of parotid glands were demonstrated, ranging from 9 cm3 to 61 cm3 among patients treated with CT simulation. Forty percent of the patients in Group II showed no or mild xerostomia, whereas all of the patients in Group I showed moderate to severe xerostomia (p < 0.01). The radioisotope sialography study showed that the mean secretion ratio by acid stimulation was improved from 3.8% in the Group I to 15.2% in the Group II (p < 0.01). CONCLUSIONS: CT simulation was useful to determine the size and shape of each field to reduce the dose to the parotid gland, of which size varies largely among individual patients. The three-field technique based on CT simulation with laser patient markings is suggested to result in superior complication-free survival in terms of salivary dysfunction than did the conventional two-field technique with x-ray simulatior for NPC.
Authors:
T Nishioka; H Shirato; T Arimoto; M Kaneko; T Kitahara; K Oomori; M Yasuda; S Fukuda; Y Inuyama; K Miyasaka
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of radiation oncology, biology, physics     Volume:  38     ISSN:  0360-3016     ISO Abbreviation:  Int. J. Radiat. Oncol. Biol. Phys.     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-08-07     Completed Date:  1997-08-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7603616     Medline TA:  Int J Radiat Oncol Biol Phys     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  705-12     Citation Subset:  IM    
Affiliation:
Department of Radiology, Hokkaido University, Sapporo, Kita-ku, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Child
Female
Humans
Male
Middle Aged
Nasopharyngeal Neoplasms / pathology,  radiotherapy*
Neoplasm Recurrence, Local / pathology
Neoplasm Staging
Parotid Gland / pathology
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted / methods*
Survival Rate
Tomography, X-Ray Computed*
Xerostomia / etiology,  prevention & control*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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