دورية أكاديمية
Assessment of Risk of Xerostomia After Whole-Brain Radiation Therapy and Association With Parotid Dose.
| العنوان: | Assessment of Risk of Xerostomia After Whole-Brain Radiation Therapy and Association With Parotid Dose. |
|---|---|
| المؤلفون: | Wang K; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Pearlstein KA; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Moon DH; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Mahbooba ZM; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Deal AM; Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill., Wang Y; Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill., Sutton SR; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Motley BB; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Judy GD; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Holmes JA; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Sheets NC; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Kasibhatla MS; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Pacholke HD; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Shen CJ; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Zagar TM; Northeastern Radiation Oncology, Glens Falls, New York., Marks LB; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill., Chera BS; Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill. |
| المصدر: | JAMA oncology [JAMA Oncol] 2019 Feb 01; Vol. 5 (2), pp. 221-228. |
| نوع المنشور: | Journal Article; Multicenter Study; Observational Study; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101652861 Publication Model: Print Cited Medium: Internet ISSN: 2374-2445 (Electronic) Linking ISSN: 23742437 NLM ISO Abbreviation: JAMA Oncol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Chicago, Il : American Medical Association, [2015]- |
| مواضيع طبية MeSH: | Organs at Risk* , Radiation Dosage*, Brain Neoplasms/*radiotherapy , Cranial Irradiation/*adverse effects , Parotid Gland/*radiation effects , Radiation Injuries/*etiology , Radiotherapy, Conformal/*adverse effects , Salivation/*drug effects , Xerostomia/*etiology, Adult ; Aged ; Aged, 80 and over ; Brain Neoplasms/secondary ; Female ; Humans ; Male ; Middle Aged ; North Carolina ; Parotid Gland/physiopathology ; Prospective Studies ; Radiation Injuries/diagnosis ; Radiation Injuries/physiopathology ; Risk Assessment ; Risk Factors ; Time Factors ; Xerostomia/diagnosis ; Xerostomia/physiopathology ; Young Adult |
| مستخلص: | Importance: Whole-brain radiation therapy (WBRT) delivers a substantial radiation dose to the parotid glands, but the parotid glands are not delineated for avoidance and xerostomia has never been reported as an adverse effect. Minimizing the toxic effects in patients receiving palliative treatments, such as WBRT, is crucial. Objective: To assess whether xerostomia is a toxic effect of WBRT. Design, Setting, and Participants: This observational cohort study enrolled patients from November 2, 2015, to March 20, 2018, at 1 academic center (University of North Carolina Hospitals) and 2 affiliated community hospitals (High Point Regional Hospital and University of North Carolina Rex Hospital). Adult patients (n = 100) receiving WBRT for the treatment or prophylaxis of brain metastases were enrolled. Patients who had substantial baseline xerostomia or did not complete WBRT or at least 1 postbaseline questionnaire were prospectively excluded from analysis and follow-up. Patients received 3-dimensional WBRT using opposed lateral fields covering the skull and the C1 or C2 vertebra. Per standard practice, the parotid glands were not prospectively delineated. Main Outcomes and Measures: Patients completed the University of Michigan Xerostomia Questionnaire and a 4-point bother score at baseline, immediately after WBRT, at 1 month, at 3 months, and at 6 months. The primary end point was the 1-month xerostomia score, with a hypothesized worsening score of 10 points from baseline. Results: Of the 100 patients enrolled, 73 (73%) were eligible for analysis and 55 (55%) were evaluable at 1 month. The 73 patients included 43 women (59%) and 30 men (41%) with a median (range) age of 61 (23-88) years. The median volume of parotid receiving at least 20 Gy (V20Gy) was 47%. The mean xerostomia score was 7 points at baseline and was statistically significantly higher at each assessment period, including 21 points immediately after WBRT (95% CI, 16-26; P < .001), 23 points (95% CI, 16-30; P < .001) at 1 month, 21 points (95% CI, 13-28; P < .001) at 3 months, and 14 points (95% CI, 7-21; P = .03) at 6 months. At 1 month, the xerostomia score increased by 20 points or more in 19 patients (35%). The xerostomia score at 1 month was associated with parotid dose as a continuous variable and was 35 points in patients with parotid V20Gy of 47% or greater, compared with only 9 points in patients with parotid V20Gy less than 47% (P < .001). The proportion of patients who self-reported to be bothered quite a bit or bothered very much by xerostomia at 1 month was 50% in those with parotid V20Gy of 47% or greater, compared with only 4% in those with parotid V20Gy less than 47% (P < .001). At 3 months, this difference was 50% vs 0% (P = .001). Xerostomia was not associated with medication use. Conclusions and Relevance: Clinically significant xerostomia occurred by the end of WBRT, appeared to be persistent, and appeared to be associated with parotid dose. The findings from this study suggest that the parotid glands should be delineated for avoidance to minimize these toxic effects in patients who undergo WBRT and often do not survive long enough for salivary recovery. |
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| تواريخ الأحداث: | Date Created: 20181130 Date Completed: 20191206 Latest Revision: 20220408 |
| رمز التحديث: | 20240628 |
| مُعرف محوري في PubMed: | PMC6439567 |
| DOI: | 10.1001/jamaoncol.2018.4951 |
| PMID: | 30489607 |
| قاعدة البيانات: | MEDLINE |
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