Radiotherapy & Oncology
Volume 93, Issue 3 , Pages 545-552 , December 2009

Delineation guidelines for organs at risk involved in radiation-induced salivary dysfunction and xerostomia

  • Tara A. van de Water

      Affiliations

    • Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, The Netherlands
    • Corresponding Author InformationCorresponding author. Address: Department of Radiation Oncology, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
  • ,
  • Henk P. Bijl

      Affiliations

    • Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, The Netherlands
  • ,
  • Henriëtte E. Westerlaan

      Affiliations

    • Department of Radiology, University Medical Center Groningen/University of Groningen, The Netherlands
  • ,
  • Johannes A. Langendijk

      Affiliations

    • Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, The Netherlands

Received 14 November 2008 ,Revised 4 September 2009 ,Accepted 17 September 2009.

References 

  1. Black JB. The structure of the salivary glands of the human soft palate. J Morphol. 1977;153:107–117
  2. Braam PM, Roesink JM, Moerland MA, et al. Long-term parotid gland function after radiotherapy. Int J Radiat Oncol Biol Phys. 2005;62:659–664
  3. Braam PM, Roesink JM, Raaijmakers CP, et al. Quality of life and salivary output in patients with head-and-neck cancer five years after radiotherapy. Radiat Oncol. 2007;2:3
  4. Collier DC, Burnett SS, Amin M, et al. Assessment of consistency in contouring of normal-tissue anatomic structures. J Appl Clin Med Phys. 2003;4:17–24
  5. Cooper JS, Fu K, Marks J, et al. Late effects of radiation therapy in the head and neck region. Int J Radiat Oncol Biol Phys. 1995;31:1141–1164
  6. Dawes C. How much saliva is enough for avoidance of xerostomia?. Caries Res. 2004;38:236–240
  7. Dawes C. Salivary flow patterns and the health of hard and soft oral tissues. J Am Dent Assoc. 2008;139:18S–24S
  8. DiSabato-Mordarski T, Kleinberg I. Measurement and comparison of the residual saliva on various oral mucosal and dentition surfaces in humans. Arch Oral Biol. 1996;41:655–665
  9. Eisbruch A, Kim HM, Terrell JE, et al. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;50:695–704
  10. Eisbruch A, Ten Haken RK, Kim HM, et al. Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys. 1999;45:577–587
  11. Eliasson L, Almstahl A, Lingstrom P, et al. Minor gland saliva flow rate and proteins in subjects with hyposalivation due to Sjogren’s syndrome and radiation therapy. Arch Oral Biol. 2005;50:293–299
  12. Eliasson L, Birkhed D, Carlen A. Feeling of dry mouth in relation to whole and minor gland saliva secretion rate. Arch Oral Biol. 2009;54:263–267
  13. Eliasson L, Birkhed D, Heyden G, et al. Studies on human minor salivary gland secretions using the Periotron method. Arch Oral Biol. 1996;41:1179–1182
  14. Geets X, Daisne JF, Arcangeli S, et al. Inter-observer variability in the delineation of pharyngo-laryngeal tumor, parotid glands and cervical spinal cord: comparison between CT-scan and MRI. Radiother Oncol. 2005;77:25–31
  15. Gregoire V, Eisbruch A, Hamoir M, et al. Proposal for the delineation of the nodal CTV in the node-positive and the post-operative neck. Radiother Oncol. 2006;79:15–20
  16. Gregoire V, Levendag P, Ang KK, et al. CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC, RTOG consensus guidelines. Radiother Oncol. 2003;69:227–236
  17. Hand AR, Pathmanathan D, Field RB. Morphological features of the minor salivary glands. Arch Oral Biol. 1999;44:S3–S10
  18. Harnsberger HR, Osborn AG, Ross J, et al. Head and neck. In: Diagnostic and surgical imaging anatomy: brain, head and neck, spine. Salt Lake City, UT: Amirsys; 2006;
  19. Harrison LB, Zelefsky MJ, Pfister DG, et al. Detailed quality of life assessment in patients treated with primary radiotherapy for squamous cell cancer of the base of the tongue. Head Neck. 1997;19:169–175
  20. Hermans R, Van der GA, Baert AL. Image interpretation in CT of laryngeal carcinoma: a study on intra- and interobserver reproducibility. Eur Radiol. 1997;7:1086–1090
  21. Huguenin PU, Taussky D, Moe K, et al. Quality of life in patients cured from a carcinoma of the head and neck by radiotherapy: the importance of the target volume. Int J Radiat Oncol Biol Phys. 1999;45:47–52
  22. Humphrey SP, Williamson RT. A review of saliva: normal composition, flow, and function. J Prosthet Dent. 2001;85:162–169
  23. Jellema AP, Doornaert P, Slotman BJ, et al. Does radiation dose to the salivary glands and oral cavity predict patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with curative radiotherapy?. Radiother Oncol. 2005;77:164–171
  24. Jellema AP, Slotman BJ, Doornaert P, et al. Impact of radiation-induced xerostomia on quality of life after primary radiotherapy among patients with head and neck cancer. Int J Radiat Oncol Biol Phys. 2007;
  25. Kam MK, Leung SF, Zee B, et al. Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol. 2007;25:4873–4879
  26. Ketting CH, ustin-Seymour M, Kalet I, et al. Consistency of three-dimensional planning target volumes across physicians and institutions. Int J Radiat Oncol Biol Phys. 1997;37:445–453
  27. Langendijk JA, Doornaert P, Verdonck-de LI, et al. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008;26:3770–3776
  28. Murdoch-Kinch CA, Kim HM, Vineberg KA, et al. Dose–effect relationships for the submandibular salivary glands and implications for their sparing by intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;
  29. Niedermeier W, Huber M, Fischer D, et al. Significance of saliva for the denture-wearing population. Gerodontology. 2000;17:104–118
  30. Pacholke HD, Amdur RJ, Morris CG, et al. Late xerostomia after intensity-modulated radiation therapy versus conventional radiotherapy. Am J Clin Oncol. 2005;28:351–358
  31. Pow EH, Kwong DL, McMillan AS, et al. Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys. 2006;66:981–991
  32. Rasch C, Eisbruch A, Remeijer P, et al. Irradiation of paranasal sinus tumors, a delineation and dose comparison study. Int J Radiat Oncol Biol Phys. 2002;52:120–127
  33. Riva A, Loffredo F, Puxeddu R, et al. A scanning and transmission electron microscope study of the human minor salivary glands. Arch Oral Biol. 1999;44:S27–S31
  34. Roesink JM, Moerland MA, Battermann JJ, et al. Quantitative dose–volume response analysis of changes in parotid gland function after radiotherapy in the head-and-neck region. Int J Radiat Oncol Biol Phys. 2001;51:938–946
  35. Saarilahti K, Kouri M, Collan J, et al. Sparing of the submandibular glands by intensity modulated radiotherapy in the treatment of head and neck cancer. Radiother Oncol. 2006;78:270–275
  36. Saarnak AE, Boersma M, van Bunningen BN, et al. Inter-observer variation in delineation of bladder and rectum contours for brachytherapy of cervical cancer. Radiother Oncol. 2000;56:37–42
  37. Shankar L, Khan A, Cheung G. Head and neck imaging. United States of America: The McGraw-Hill companies; 1998;
  38. Sivarajasingam V, Drummond JR. Measurements of human minor salivary gland secretions from different oral sites. Arch Oral Biol. 1995;40:723–729
  39. Sumi M, Yamada T, Takagi Y, et al. MR imaging of labial glands. AJNR Am J Neuroradiol. 2007;28:1552–1556
  40. van Nieuw Amerongen A, Veerman ECI, Vissink A. Samenstelling en eigenschappen van speeksel: van dun-vloeibare tot viskeuze mondvloeistof. In: Speeksel, speekselklieren en mondgezondheid. 2nd ed. Houten: Bohn Stafleu Van Loghum bv; 2008. p. 37–51.
  41. Vissink A, Jansma J, Spijkervet FK, et al. Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14:199–212
  42. Weiss E, Hess CF. The impact of gross tumor volume (GTV) and clinical target volume (CTV) definition on the total accuracy in radiotherapy theoretical aspects and practical experiences. Strahlenther Onkol. 2003;179:21–30
  43. Wolff M, Kleinberg I. Oral mucosal wetness in hypo- and normosalivators. Arch Oral Biol. 1998;43:455–462
  44. Wong EK, Truong PT, Kader HA, et al. Consistency in seroma contouring for partial breast radiotherapy: impact of guidelines. Int J Radiat Oncol Biol Phys. 2006;66:372–376

PII: S0167-8140(09)00556-8

doi: 10.1016/j.radonc.2009.09.008

Radiotherapy & Oncology
Volume 93, Issue 3 , Pages 545-552 , December 2009