BAŞ-BOYUN KANSERİ YOĞUNLUK AYARLI RADYOTERAPİSİNDE PAROTİS BEZİ HACMİ VE HEDEF HACİM İLİŞKİLERİNİN PAROTİS BEZİ DOZUNA ETKİSİ

Year 2021, , 655 - 661, 30.12.2021

Alper Özseven , Zümrüt Arda Kaymak , Emine Elif Özkan , İbrahim Çobanbaş

https://doi.org/10.17343/sdutfd.981789

Abstract

Amaç
Baş-boyun kanseri radyoterapisinde, parotis ve hedef
hacim ilişkilerinin, parotisin alacağı radyasyon dozu
üzerine etkisini araştırmaktır.
Gereç ve Yöntem
Baş-boyun bölgesi kanserleri tanısı ile küratif, definitif
veya postoperatif adjuvan radyoterapi uygulanmış
hastalardan rastgele 50 hasta seçildi. Konturlama
sonrası her hastanın sağ ve sol parotislerinin ayrı ayrı
kraniyo-kaudal uzunluğu (KKU), parotis hacmi (Vparotis),
parotis ile kesişen planlanan hedef hacim (PTV)
dozu, sağ ve sol parotisin ayrı ayrı PTV70 hedefi ile
örtüşen KKU, parotis seviyesinde olan fakat parotis ile
kesişmeyen maksimum PTV dozu ve parotisin PTV
ile kesişen hacminin toplam parotis hacmine oranı
kaydedildi. Ayrıca, parotis seviyesindeki kesitlerde
PTV70 hacminin olup-olmadığı; var ise yerleşiminin
tek taraflı mı veya bilateral olup-olmadığı kaydedildi.
Yoğunluk ayarlı radyoterapi planlaması sonrası,
doz-hacim histogramları kullanılarak ortalama parotis
dozu (Dmean), 20 Gy ve üstü doz alan parotis hacmi
oranı (V20) ve 30 Gy ve üstü doz alan parotis hacmi
oranı (V30) değerleri ölçüldü. Ortalama parotis dozunun
26 Gy üstünde olmasına etki edebilecek faktörler
lojistik regresyon analizi ile incelendi. Sınır değer
belirleme amacıyla Receiver operating characteristics
(ROC) eğrisi analizi kullanıldı.
Bulgular
Tüm parotislerin ortanca Dmean, V20 ve V30 değerleri
sırasıyla, 26,55 Gy (14,74-66,78), %50,91 (26,53-
100) ve %32,21 (7,12-100) idi. Dmean>26Gy olan
grupta, parotis hacmi istatistiksel olarak anlamlı yüksek
bulundu (p=0,027). Dmean>26Gy olan grupta,
parotisin PTV ile kesişen hacminin tüm parotise oranı
belirgin yüksekti (%1,25 karşın %7,06, p<0,001). Çok
değişkenli analiz sonucunda parotis hacmi ve PTV
ile kesişen parotis hacminin oranının, parotis Dmean
üzerinde istatistiksel olarak anlamlı etkili olduğu görüldü
(her ikisi için de p<0,001). Dmean>26Gy olma ihtimalini
en iyi gösterecek PTV ile kesişen parotis hacmi
oranının sınır değerini tespit etmek için yapılan ROC
analizi sonucunda, sınır değer %2,8 olarak bulundu.
Sonuç
Parotis ortalama dozunu 26 Gy altında tutmak adına,
radyasyon onkoloğu konturlama aşamasında, PTV ile
kesişen parotis hacmini %2,8 altında tutmaya çalışması
faydalı olabilir.

Keywords

Baş-boyun kanseri, parotis bezi, yoğunluk ayarlı radyoterapi

THE EFFECT OF PAROTID GLAND VOLUME AND TARGET VOLUME RELATIONSHIPS ON PAROTID GLAND DOSE IN INTENSITY MODULATED RADIOTHERAPY OF HEAD AND NECK CANCER

Abstract

Objective
To investigate the effect of parotid and target volume
relationships on the radiation dose to be received by
the parotid in head and neck cancer radiotherapy.
Material and Methods
Fifty patients were randomly selected from the patients
who underwent curative, definitive or postoperative
adjuvant radiotherapy with the diagnosis of head
and neck cancer. After contouring, the cranio-caudal
length (CCL) of the right and left parotids, the parotid
volume (Vparotis), the planning target volume (PTV)
dose overlapping with the parotids, the CCL of the
right and left parotid overlapping with the PTV 70
target, the maximum PTV dose at parotid level but not
overlapping with parotids and the ratio of the parotid
volume overlapping with PTV to the total parotid
volume were recorded. In addition, it was recorded
whether there was a PTV70 volume in the slices at
parotid level and whether it was located unilaterally
or bilaterally. After the intensity modulated radiation
therapy planning, by using dose-volume histograms,
mean parotid gland dose (Dmean), volume ratio of
parotid gland that received 20 Gy and more doses
(V20), and volume ratio of parotid gland that received
30 Gy and more doses (V30) were measured. The
factors that may affect the mean parotid dose above
26 Gy were analyzed by logistic regression analysis.
Receiver operating characteristics (ROC) curve
analysis was used to determine the cut-off value.
Results
The median Dmean, V20 and V30 value of all parotid
glands was 26.55 Gy (14.74-66.78), 50.91% (26.53-
100) and 32.21% (7.12-100), respectively. The parotid
gland volume was found to be statistically significant
higher in the group with Dmean>26Gy (p=0.027). In
the group with Dmean>26Gy, the ratio of the volume
of the parotid gland overlapping with the PTV to the
entire parotid gland was significantly higher (1.25% vs.
7.06%, p<0.001). As a result of multivariate analysis,
it was observed that the ratio of parotid gland volume
and the volume of the parotid gland overlapping with
the PTV had a statistically significant effect on the
parotid Dmean (p<0.001 for both). As a result of the
ROC analysis, the cut-off value for the parotid gland
volume ratio overlapping with PTV that show the
probability of Dmean>26Gy, was found to be 2.8%.
Conclusion
To keep the mean dose of the parotid gland below 26
Gy, radiation oncologist should pay attention to keep
the volume ratio of the parotid gland overlapping with
PTV below 2.8%.

Keywords

Head and neck cancer, parotid gland, intensity modulated radiation therapy

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