Effect of Cisplatin on parotid gland function in concomitant radiochemotherapy.

PURPOSE: To determine the influence of concomitant radiochemotherapy with cisplatin on parotid gland tissue complication probability.

METHODS AND MATERIALS: Patients treated with either radiotherapy (n = 61) or concomitant radiochemotherapy with cisplatin (n = 36) for head-and-neck cancer were prospectively evaluated. The dose and volume distributions of the parotid glands were noted in dose-volume histograms. Stimulated salivary flow rates were measured before, during the 2(nd) and 6(th) weeks and at 4 weeks and 6 months after the treatment. The data were fit using the normal tissue complication probability model of Lyman. Complication was defined as a reduction of the salivary flow rate to less than 25% of the pretreatment flow rate.

RESULTS: The normal tissue complication probability model parameter TD(50) (the dose leading to a complication probability of 50%) was found to be 32.2 Gy at 4 weeks and 32.1 Gy at 6 months for concomitant radiochemotherapy and 41.1 Gy at 4 weeks and 39.6 Gy at 6 months for radiotherapy. The tolerated dose for concomitant radiochemotherapy was at least 7 to 8 Gy lower than for radiotherapy alone at TD(50).

CONCLUSIONS: In this study, the concomitant radiochemotherapy tended to cause a higher probability of parotid gland tissue damage. Advanced radiotherapy planning approaches such as intensity-modulated radiotherapy may be particularly important for parotid sparing in radiochemotherapy because of cisplatin-related increased radiosensitivity of glands.