Sarah A Milgrom1, Peter van Luijk2, Ramiro Pino3, Cecile M Ronckers4, Leontien C Kremer5, Paul W Gidley6, David R Grosshans7, Siddhartha Laskar8, M Fatih Okcu9, Louis S Constine10, Arnold C Paulino11. 1. Department of Radiation Oncology, University of Colorado, Aurora, Colorado. 2. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. 3. Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas. 4. Princess Máxima Centrum for Pediatric Oncology, Utrecht, Netherlands; Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany. 5. Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany; UMC Amsterdam, Location AMC, Department of Pediatrics, Amsterdam, Netherlands. 6. Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas. 7. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. 8. Department of Radiation Oncgqtology, Tata Memorial Hospital, Mumbai, India. 9. Department of Pediatrics, Baylor College of Medicine, Houston, Texas. 10. Department of Radiation Oncology, University of Rochester, Rochester, New York. 11. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. Electronic address: APaulino@mdanderson.org.
Abstract
PURPOSE: Radiation therapy (RT) to the head and neck (H&N) region is critical in the management of various pediatric malignancies; however, it may result in late toxicity. This comprehensive review from the Pediatric Normal Tissue Effects in the Clinic (PENTEC) initiative focused on salivary dysfunction and dental abnormalities in survivors who received RT to the H&N region as children. MATERIALS & METHODS: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. RESULTS: Of the 2,164 articles identified through a literature search, 40 were included in a qualitative synthesis and 3 were included in a quantitative synthesis. The dose-toxicity data regarding salivary function demonstrate that a mean parotid dose of 35 to 40 Gy is associated with a risk of acute and chronic grade ≥2 xerostomia of approximately 32% and 13% to 32%, respectively, in patients treated with chemo-radiation therapy. This risk increases with parotid dose; however, rates of xerostomia after lower dose exposure have not been reported. Dental developmental abnormalities are common after RT to the oral cavity. Risk factors include higher radiation dose to the developing teeth and younger age at RT. CONCLUSIONS: This PENTEC task force considers adoption of salivary gland dose constraints from the adult experience to be a reasonable strategy until more data specific to children become available; thus, we recommend limiting the parotid mean dose to ≤26 Gy. The minimum toxic dose for dental developmental abnormalities is unknown, suggesting that the dose to the teeth should be kept as low as possible particularly in younger patients, with special effort to keep doses <20 Gy in patients <4 years old.
PURPOSE: Radiation therapy (RT) to the head and neck (H&N) region is critical in the management of various pediatric malignancies; however, it may result in late toxicity. This comprehensive review from the Pediatric Normal Tissue Effects in the Clinic (PENTEC) initiative focused on salivary dysfunction and dental abnormalities in survivors who received RT to the H&N region as children. MATERIALS & METHODS: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. RESULTS: Of the 2,164 articles identified through a literature search, 40 were included in a qualitative synthesis and 3 were included in a quantitative synthesis. The dose-toxicity data regarding salivary function demonstrate that a mean parotid dose of 35 to 40 Gy is associated with a risk of acute and chronic grade ≥2 xerostomia of approximately 32% and 13% to 32%, respectively, in patients treated with chemo-radiation therapy. This risk increases with parotid dose; however, rates of xerostomia after lower dose exposure have not been reported. Dental developmental abnormalities are common after RT to the oral cavity. Risk factors include higher radiation dose to the developing teeth and younger age at RT. CONCLUSIONS: This PENTEC task force considers adoption of salivary gland dose constraints from the adult experience to be a reasonable strategy until more data specific to children become available; thus, we recommend limiting the parotid mean dose to ≤26 Gy. The minimum toxic dose for dental developmental abnormalities is unknown, suggesting that the dose to the teeth should be kept as low as possible particularly in younger patients, with special effort to keep doses <20 Gy in patients <4 years old.
Authors: Juliette Stolze; Jop C Teepen; Judith E Raber-Durlacher; Jacqueline J Loonen; Judith L Kok; Wim J E Tissing; Andrica C H de Vries; Sebastian J C M M Neggers; Eline van Dulmen-den Broeder; Marry M van den Heuvel-Eibrink; Helena J H van der Pal; A Birgitta Versluys; Margriet van der Heiden-van der Loo; Marloes Louwerens; Leontien C M Kremer; Henk S Brand; Dorine Bresters Journal: Cancers (Basel) Date: 2022-07-11 Impact factor: 6.575