A retrospective observational study of high radiation dose distribution related to the tooth-bearing area in various subsites of Head and Neck cancer patients
Keywords:
pre-radiotherapy dental treatment, tooth-bearing area, dose distribution, radiotherapy, head and neck cancerAbstract
Background: Radiotherapy for the treatment of head and neck cancer (HNC) aim to precisely deliver radiation to the tumor while minimizing unnecessary doses to the surrounding organs. However, radiation-induced toxicities in the oral cavity such as radiation caries and osteoradionecrosis (ORN), remain serious adverse events that are affected by the radiation dose delivered to the jaw, especially when dental extraction is performed in a high-dose exposure area (>50-60Gy). Therefore, a guideline demonstrating high radiation dose-related location of the tooth-bearing area in HNC might be beneficial for consideration of pre-radiotherapy dental treatment plans to prevent undesirable complications.
Objectives: The purpose of this study was to present the high radiation dose distribution related to the tooth-bearing area in HNC patients and provide a dental-dose landscape for improving the consideration of the pre-radiotherapy dental treatment plan. Materials and Methods: This was a retrospective observational study of HNC patients treated with conformal radiotherapy at King Chulalongkorn Memorial Hospital. Case studies from 6 subsites, including nasopharynx, oropharynx, oral cavity, hypopharynx and larynx, nasal cavity, and salivary gland, were selected by radiation oncologists. Delineation of teeth was performed on computed tomography simulation images by oral and maxillofacial surgeon. Dose distributions were illustrated in tooth-bearing areas.
Results: The area of dose distribution (50 and 60 Gy) correlated to the tooth-bearing area in 13 patients were presented and summarized into 4 groups. Group 1 midline oral cavity cancer (oral tongue, floor of mouth) received a high radiation dose to all teeth, but the maxillary teeth can be spared by the application of an intraoral stent. Group 2 lateralized oropharyngeal and oral cavity cancer (tonsil, base of tongue, retromolar trigone, buccal mucosa) received a high radiation dose to ipsilateral molar teeth. Group 3 nasopharyngeal, hypopharyngeal and laryngeal cancer with elective neck irradiation (ENI) received a high radiation dose to the molar teeth in the same side of irradiated neck. And, in group 4 HNC without ENI (low-grade parotid gland cancer), none of the teeth received a high radiation dose.
Conclusion: The current study illustrated the dental-dose landscape of the tooth-bearing area receiving high radiation doses in subsites of HNC treated with conformal radiotherapy techniques. A further prospective study is necessary to demonstrate the benefit of this dental-dose landscape to pre-post radiotherapy dental treatment plan potentially implemented in routine practice with reduced complication.
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