Protecting the oral mucosa in patients with oral tongue squamous cell carcinoma treated postoperatively with intensity-modulated radiotherapy: A randomized study
Objectives/Hypothesis: Is the severity of acute oral mucositis in patients who receive postoperative intensity‐modulated radiotherapy (PO‐IMRT) for oral tongue squamous cell carcinoma (SCC) reduced by sparing the oral mucosa outside of the planning target volume (PTV)? Study Design: Prospective, ran...
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| Veröffentlicht in: | The Laryngoscope 2012-02, Vol.122 (2), p.291-298 |
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| creator | Wang, Zhong-He Zhang, Shi-Zhou Zhang, Zhi-Yuan Zhang, Chen-Ping Hu, Hai-Sheng Tu, Wen-Yong Kirwan, Jessica Mendenhall, William M. |
| description | Objectives/Hypothesis:
Is the severity of acute oral mucositis in patients who receive postoperative intensity‐modulated radiotherapy (PO‐IMRT) for oral tongue squamous cell carcinoma (SCC) reduced by sparing the oral mucosa outside of the planning target volume (PTV)?
Study Design:
Prospective, randomized trial.
Methods:
Forty‐eight patients with oral tongue SCC who received PO‐IMRT at our institution were randomized to two groups: the oral‐sparing (OR‐SP) group and oral‐unsparing (OR‐USP) group. For the OR‐SP group (n = 24), the oral mucosa outside of the PTV was spared. Furthermore, the mucosa including the bilateral cheeks, upper lip, and lower lip was defined as the united site and given |
| doi_str_mv | 10.1002/lary.22434 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_917854591</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>917854591</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3964-7c446f2c8c21ff4f0880183cd2b997e8c95f63ba64c497ad9bd5a5201cca3cc03</originalsourceid><addsrcrecordid>eNp9kctu1TAYhC0EoqWw4QGQN6gSUoqvSczuqKIF6YhrEZeN9R_HaQ1JnNoOJbwNb4pPc1p2rCxrvn9Go0HoMSVHlBD2vIMwHzEmuLiD9qnktBBKybtoP4u8qCX7socexPidEFpxSe6jPcaY5ISW--jPu-CTNckN5zhdWOwDdLifjI-A3YBHSM4OKeIrly4WMfnhfLI4Xk7Q-yliY7sOGwjGDb4HnIKFZBs8-pj8aEM2-Gm7eTFwQ7JDdGkuet9M3TUYoHE-RwcY5xd4lf9D43v3O0sxTc38EN1roYv20e49QJ9OXp4dvyrWb09fH6_WheGqFEVlhChbZmrDaNuKltQ1oTU3DdsoVdnaKNmWfAOlMEJV0KhNI0EyQo0BbgzhB-hw8R2Dv5xsTLp3cVsOBpt7akWrWgqpaCafLaQJPsZgWz0G1-cRNCV6u4jeLqKvF8nwk53ttOltc4veTJCBpzsAooGuzf2Ni_84WVJBiMocXbgr19n5P5F6vfrw9Sa8WG5cTPbX7Q2EH7qseCX15zen-tv7s5OPdcW15H8BCC63zg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>917854591</pqid></control><display><type>article</type><title>Protecting the oral mucosa in patients with oral tongue squamous cell carcinoma treated postoperatively with intensity-modulated radiotherapy: A randomized study</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Wang, Zhong-He ; Zhang, Shi-Zhou ; Zhang, Zhi-Yuan ; Zhang, Chen-Ping ; Hu, Hai-Sheng ; Tu, Wen-Yong ; Kirwan, Jessica ; Mendenhall, William M.</creator><creatorcontrib>Wang, Zhong-He ; Zhang, Shi-Zhou ; Zhang, Zhi-Yuan ; Zhang, Chen-Ping ; Hu, Hai-Sheng ; Tu, Wen-Yong ; Kirwan, Jessica ; Mendenhall, William M.</creatorcontrib><description>Objectives/Hypothesis:
Is the severity of acute oral mucositis in patients who receive postoperative intensity‐modulated radiotherapy (PO‐IMRT) for oral tongue squamous cell carcinoma (SCC) reduced by sparing the oral mucosa outside of the planning target volume (PTV)?
Study Design:
Prospective, randomized trial.
Methods:
Forty‐eight patients with oral tongue SCC who received PO‐IMRT at our institution were randomized to two groups: the oral‐sparing (OR‐SP) group and oral‐unsparing (OR‐USP) group. For the OR‐SP group (n = 24), the oral mucosa outside of the PTV was spared. Furthermore, the mucosa including the bilateral cheeks, upper lip, and lower lip was defined as the united site and given <32 Gy. For the OR‐USP group (n = 24), none of the oral mucosa was protected. The severity of clinical acute mucositis in each patient was assessed weekly during PO‐IMRT until completely healed. Oral mucositis was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Dosimetry and therapeutic measures related to acute mucositis between the two groups were compared.
Results:
During PO‐IMRT, no patient experienced grade 4+ acute mucositis in any oral site. Compared to the OR‐USP group, there was less grade 2 and 3 mucositis in the united site of the OR‐SP group (0% and 25% vs. 45.8% and 54.2%, respectively; P = .000). Also, the mean dose to the united site was significantly lower with OR‐SP compared to OR‐USP (41.8 ± 7.4 Gy vs. 58.8 ± 2.2 Gy; P = .000). The OR‐SP group was associated with significant reductions in the use of analgesics (P = .043) and intravenous antibiotics (P = .039). No recurrences were detected in the vicinity of the spared oral mucosa (the united site) during a median follow‐up time of 30 months.
Conclusions:
OR‐SP PO‐IMRT for patients with oral tongue SCC resulted in a significant decrease in the severity of acute mucositis and improved quality of life. The sparing of the oral mucosa outside of the PTV is safe and does not compromise oncologic outcomes.</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.22434</identifier><identifier>PMID: 22253016</identifier><identifier>CODEN: LARYA8</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Acute mucositis ; Adult ; Aged ; Biological and medical sciences ; Carcinoma, Squamous Cell - diagnosis ; Carcinoma, Squamous Cell - radiotherapy ; Carcinoma, Squamous Cell - surgery ; Dose-Response Relationship, Radiation ; Female ; Follow-Up Studies ; Humans ; Incidence ; Level of Evidence: 2c ; Male ; Medical sciences ; Middle Aged ; Mouth Mucosa - radiation effects ; oral sparing ; Oral Surgical Procedures - methods ; oral tongue cancer ; Otorhinolaryngology. Stomatology ; postoperative intensity-modulated radiotherapy ; Prospective Studies ; Radiation Injuries - epidemiology ; Radiation Injuries - prevention & control ; Radiation Protection - methods ; Radiotherapy, Adjuvant - methods ; Tongue Neoplasms - diagnosis ; Tongue Neoplasms - radiotherapy ; Tongue Neoplasms - surgery ; Treatment Outcome ; Tumors ; United States - epidemiology ; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology ; Xerostomia - epidemiology ; Xerostomia - etiology ; Xerostomia - prevention & control</subject><ispartof>The Laryngoscope, 2012-02, Vol.122 (2), p.291-298</ispartof><rights>Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3964-7c446f2c8c21ff4f0880183cd2b997e8c95f63ba64c497ad9bd5a5201cca3cc03</citedby><cites>FETCH-LOGICAL-c3964-7c446f2c8c21ff4f0880183cd2b997e8c95f63ba64c497ad9bd5a5201cca3cc03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flary.22434$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flary.22434$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25614009$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22253016$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wang, Zhong-He</creatorcontrib><creatorcontrib>Zhang, Shi-Zhou</creatorcontrib><creatorcontrib>Zhang, Zhi-Yuan</creatorcontrib><creatorcontrib>Zhang, Chen-Ping</creatorcontrib><creatorcontrib>Hu, Hai-Sheng</creatorcontrib><creatorcontrib>Tu, Wen-Yong</creatorcontrib><creatorcontrib>Kirwan, Jessica</creatorcontrib><creatorcontrib>Mendenhall, William M.</creatorcontrib><title>Protecting the oral mucosa in patients with oral tongue squamous cell carcinoma treated postoperatively with intensity-modulated radiotherapy: A randomized study</title><title>The Laryngoscope</title><addtitle>The Laryngoscope</addtitle><description>Objectives/Hypothesis:
Is the severity of acute oral mucositis in patients who receive postoperative intensity‐modulated radiotherapy (PO‐IMRT) for oral tongue squamous cell carcinoma (SCC) reduced by sparing the oral mucosa outside of the planning target volume (PTV)?
Study Design:
Prospective, randomized trial.
Methods:
Forty‐eight patients with oral tongue SCC who received PO‐IMRT at our institution were randomized to two groups: the oral‐sparing (OR‐SP) group and oral‐unsparing (OR‐USP) group. For the OR‐SP group (n = 24), the oral mucosa outside of the PTV was spared. Furthermore, the mucosa including the bilateral cheeks, upper lip, and lower lip was defined as the united site and given <32 Gy. For the OR‐USP group (n = 24), none of the oral mucosa was protected. The severity of clinical acute mucositis in each patient was assessed weekly during PO‐IMRT until completely healed. Oral mucositis was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Dosimetry and therapeutic measures related to acute mucositis between the two groups were compared.
Results:
During PO‐IMRT, no patient experienced grade 4+ acute mucositis in any oral site. Compared to the OR‐USP group, there was less grade 2 and 3 mucositis in the united site of the OR‐SP group (0% and 25% vs. 45.8% and 54.2%, respectively; P = .000). Also, the mean dose to the united site was significantly lower with OR‐SP compared to OR‐USP (41.8 ± 7.4 Gy vs. 58.8 ± 2.2 Gy; P = .000). The OR‐SP group was associated with significant reductions in the use of analgesics (P = .043) and intravenous antibiotics (P = .039). No recurrences were detected in the vicinity of the spared oral mucosa (the united site) during a median follow‐up time of 30 months.
Conclusions:
OR‐SP PO‐IMRT for patients with oral tongue SCC resulted in a significant decrease in the severity of acute mucositis and improved quality of life. The sparing of the oral mucosa outside of the PTV is safe and does not compromise oncologic outcomes.</description><subject>Acute mucositis</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Squamous Cell - diagnosis</subject><subject>Carcinoma, Squamous Cell - radiotherapy</subject><subject>Carcinoma, Squamous Cell - surgery</subject><subject>Dose-Response Relationship, Radiation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Incidence</subject><subject>Level of Evidence: 2c</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mouth Mucosa - radiation effects</subject><subject>oral sparing</subject><subject>Oral Surgical Procedures - methods</subject><subject>oral tongue cancer</subject><subject>Otorhinolaryngology. Stomatology</subject><subject>postoperative intensity-modulated radiotherapy</subject><subject>Prospective Studies</subject><subject>Radiation Injuries - epidemiology</subject><subject>Radiation Injuries - prevention & control</subject><subject>Radiation Protection - methods</subject><subject>Radiotherapy, Adjuvant - methods</subject><subject>Tongue Neoplasms - diagnosis</subject><subject>Tongue Neoplasms - radiotherapy</subject><subject>Tongue Neoplasms - surgery</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>United States - epidemiology</subject><subject>Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology</subject><subject>Xerostomia - epidemiology</subject><subject>Xerostomia - etiology</subject><subject>Xerostomia - prevention & control</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctu1TAYhC0EoqWw4QGQN6gSUoqvSczuqKIF6YhrEZeN9R_HaQ1JnNoOJbwNb4pPc1p2rCxrvn9Go0HoMSVHlBD2vIMwHzEmuLiD9qnktBBKybtoP4u8qCX7socexPidEFpxSe6jPcaY5ISW--jPu-CTNckN5zhdWOwDdLifjI-A3YBHSM4OKeIrly4WMfnhfLI4Xk7Q-yliY7sOGwjGDb4HnIKFZBs8-pj8aEM2-Gm7eTFwQ7JDdGkuet9M3TUYoHE-RwcY5xd4lf9D43v3O0sxTc38EN1roYv20e49QJ9OXp4dvyrWb09fH6_WheGqFEVlhChbZmrDaNuKltQ1oTU3DdsoVdnaKNmWfAOlMEJV0KhNI0EyQo0BbgzhB-hw8R2Dv5xsTLp3cVsOBpt7akWrWgqpaCafLaQJPsZgWz0G1-cRNCV6u4jeLqKvF8nwk53ttOltc4veTJCBpzsAooGuzf2Ni_84WVJBiMocXbgr19n5P5F6vfrw9Sa8WG5cTPbX7Q2EH7qseCX15zen-tv7s5OPdcW15H8BCC63zg</recordid><startdate>201202</startdate><enddate>201202</enddate><creator>Wang, Zhong-He</creator><creator>Zhang, Shi-Zhou</creator><creator>Zhang, Zhi-Yuan</creator><creator>Zhang, Chen-Ping</creator><creator>Hu, Hai-Sheng</creator><creator>Tu, Wen-Yong</creator><creator>Kirwan, Jessica</creator><creator>Mendenhall, William M.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Wiley-Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201202</creationdate><title>Protecting the oral mucosa in patients with oral tongue squamous cell carcinoma treated postoperatively with intensity-modulated radiotherapy: A randomized study</title><author>Wang, Zhong-He ; Zhang, Shi-Zhou ; Zhang, Zhi-Yuan ; Zhang, Chen-Ping ; Hu, Hai-Sheng ; Tu, Wen-Yong ; Kirwan, Jessica ; Mendenhall, William M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3964-7c446f2c8c21ff4f0880183cd2b997e8c95f63ba64c497ad9bd5a5201cca3cc03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Acute mucositis</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Carcinoma, Squamous Cell - diagnosis</topic><topic>Carcinoma, Squamous Cell - radiotherapy</topic><topic>Carcinoma, Squamous Cell - surgery</topic><topic>Dose-Response Relationship, Radiation</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Incidence</topic><topic>Level of Evidence: 2c</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mouth Mucosa - radiation effects</topic><topic>oral sparing</topic><topic>Oral Surgical Procedures - methods</topic><topic>oral tongue cancer</topic><topic>Otorhinolaryngology. Stomatology</topic><topic>postoperative intensity-modulated radiotherapy</topic><topic>Prospective Studies</topic><topic>Radiation Injuries - epidemiology</topic><topic>Radiation Injuries - prevention & control</topic><topic>Radiation Protection - methods</topic><topic>Radiotherapy, Adjuvant - methods</topic><topic>Tongue Neoplasms - diagnosis</topic><topic>Tongue Neoplasms - radiotherapy</topic><topic>Tongue Neoplasms - surgery</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>United States - epidemiology</topic><topic>Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology</topic><topic>Xerostomia - epidemiology</topic><topic>Xerostomia - etiology</topic><topic>Xerostomia - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wang, Zhong-He</creatorcontrib><creatorcontrib>Zhang, Shi-Zhou</creatorcontrib><creatorcontrib>Zhang, Zhi-Yuan</creatorcontrib><creatorcontrib>Zhang, Chen-Ping</creatorcontrib><creatorcontrib>Hu, Hai-Sheng</creatorcontrib><creatorcontrib>Tu, Wen-Yong</creatorcontrib><creatorcontrib>Kirwan, Jessica</creatorcontrib><creatorcontrib>Mendenhall, William M.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wang, Zhong-He</au><au>Zhang, Shi-Zhou</au><au>Zhang, Zhi-Yuan</au><au>Zhang, Chen-Ping</au><au>Hu, Hai-Sheng</au><au>Tu, Wen-Yong</au><au>Kirwan, Jessica</au><au>Mendenhall, William M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Protecting the oral mucosa in patients with oral tongue squamous cell carcinoma treated postoperatively with intensity-modulated radiotherapy: A randomized study</atitle><jtitle>The Laryngoscope</jtitle><addtitle>The Laryngoscope</addtitle><date>2012-02</date><risdate>2012</risdate><volume>122</volume><issue>2</issue><spage>291</spage><epage>298</epage><pages>291-298</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><coden>LARYA8</coden><abstract>Objectives/Hypothesis:
Is the severity of acute oral mucositis in patients who receive postoperative intensity‐modulated radiotherapy (PO‐IMRT) for oral tongue squamous cell carcinoma (SCC) reduced by sparing the oral mucosa outside of the planning target volume (PTV)?
Study Design:
Prospective, randomized trial.
Methods:
Forty‐eight patients with oral tongue SCC who received PO‐IMRT at our institution were randomized to two groups: the oral‐sparing (OR‐SP) group and oral‐unsparing (OR‐USP) group. For the OR‐SP group (n = 24), the oral mucosa outside of the PTV was spared. Furthermore, the mucosa including the bilateral cheeks, upper lip, and lower lip was defined as the united site and given <32 Gy. For the OR‐USP group (n = 24), none of the oral mucosa was protected. The severity of clinical acute mucositis in each patient was assessed weekly during PO‐IMRT until completely healed. Oral mucositis was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Dosimetry and therapeutic measures related to acute mucositis between the two groups were compared.
Results:
During PO‐IMRT, no patient experienced grade 4+ acute mucositis in any oral site. Compared to the OR‐USP group, there was less grade 2 and 3 mucositis in the united site of the OR‐SP group (0% and 25% vs. 45.8% and 54.2%, respectively; P = .000). Also, the mean dose to the united site was significantly lower with OR‐SP compared to OR‐USP (41.8 ± 7.4 Gy vs. 58.8 ± 2.2 Gy; P = .000). The OR‐SP group was associated with significant reductions in the use of analgesics (P = .043) and intravenous antibiotics (P = .039). No recurrences were detected in the vicinity of the spared oral mucosa (the united site) during a median follow‐up time of 30 months.
Conclusions:
OR‐SP PO‐IMRT for patients with oral tongue SCC resulted in a significant decrease in the severity of acute mucositis and improved quality of life. The sparing of the oral mucosa outside of the PTV is safe and does not compromise oncologic outcomes.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>22253016</pmid><doi>10.1002/lary.22434</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | The Laryngoscope, 2012-02, Vol.122 (2), p.291-298 |
| issn | 0023-852X 1531-4995 |
| language | eng |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Acute mucositis Adult Aged Biological and medical sciences Carcinoma, Squamous Cell - diagnosis Carcinoma, Squamous Cell - radiotherapy Carcinoma, Squamous Cell - surgery Dose-Response Relationship, Radiation Female Follow-Up Studies Humans Incidence Level of Evidence: 2c Male Medical sciences Middle Aged Mouth Mucosa - radiation effects oral sparing Oral Surgical Procedures - methods oral tongue cancer Otorhinolaryngology. Stomatology postoperative intensity-modulated radiotherapy Prospective Studies Radiation Injuries - epidemiology Radiation Injuries - prevention & control Radiation Protection - methods Radiotherapy, Adjuvant - methods Tongue Neoplasms - diagnosis Tongue Neoplasms - radiotherapy Tongue Neoplasms - surgery Treatment Outcome Tumors United States - epidemiology Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology Xerostomia - epidemiology Xerostomia - etiology Xerostomia - prevention & control |
| title | Protecting the oral mucosa in patients with oral tongue squamous cell carcinoma treated postoperatively with intensity-modulated radiotherapy: A randomized study |
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