Systematic dosimetric evaluation of risk of osteoradionecrosis (DERO): First results of dose reporting for preventing teeth osteoradionecrosis after head and neck irradiation |
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| Institution: | 1. Medical physics department, institut de cancérologie de l’Ouest, Saint-Herblain, France;2. IMT atlantique, Nantes université, CNRS/IN2P3, Subatech, Nantes, France;3. Radiation oncology department, institut de cancérologie de l’Ouest, Saint-Herblain, France;4. Odontology department, centre hospitalo-universitaire, Nantes, France;5. Nantes université, Oniris, Inserm, regenerative medicine and skeleton, RMeS, UMR 1229, Nantes, France;6. Maxillofacial surgery department, centre hospitalo-universitaire, Nantes, France;7. Radiation oncology department, Centre François-Baclesse, Caen, France;8. Laboratoire de physique corpusculaire, IN2P3/ENISAEN-CNRS, Caen, France;9. Normandie université, Caen, France;1. Department of Hematology, Liaocheng People''s Hospital, Shan Dong, China;2. Department of Radiotherapy, Liaocheng People''s Hospital, 252000 Shan Dong, China;1. Radiation Oncology Department, institut Curie, 25, rue d’Ulm, 75005 Paris, France;2. Medical Oncology Department, institut Curie, 25, rue d’Ulm, 75005 Paris, France;3. Surgical Oncology Department, institut Curie, 25, rue d’Ulm, 75005 Paris, France;4. Nuclear Medicine Department, institut Curie, 25, rue d’Ulm, 75005 Paris, France;1. Service d’oncologie radiothérapie, hôpitaux universitaires Pitié-Salpêtrière – Charles-Foix, Assistance publique–Hôpitaux de Paris, 47-83, boulevard de l’Hôpital, 75651 Paris cedex 13, France;2. Service d’ophtalmologie, Hôtel-Dieu, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes France;3. Service de neurochirurgie, groupe Pitié-Salpêtrière, Assistance publique–Hôpitaux de Paris, 47-83, boulevard de l’Hôpital, 75651 Paris cedex 13, France;1. Service de radiothérapie, centre Henry-S-Kaplan, CHRU Bretonneau, Tours, France;2. Institut Inter-régional de cancérologie, centre Jean-Bernard, clinique Victor-Hugo, Le Mans, France;1. Laboratory of dosing, analysis and characterization in high resolution, Department of Physics, Faculty of Sciences, Ferhat Abbas Sétif 1 University, El Baz campus 19137, Sétif, Algeria;2. Department of Physics, Khalifa University, Abu Dhabi, United Arab Emirates;1. Département de radiothérapie, centre Eugène-Marquis, LTSI Inserm 1099, université de Rennes 1, Rennes, France;2. Département de radiothérapie, centre Eugène-Marquis, Rennes, France;3. Service d’oncologie radiothérapie, hôpital Tenon, AP–HP, Sorbonne université, Paris, France;4. Université Paris Est Créteil, Créteil, France;5. Service d’oncologie radiothérapie, hôpital Haut-Lévêque, 158435, centre hospitalier universitaire de Bordeaux, Pessac, France;6. EA 4574 « Sciences, Philosophie, Humanités » université de Bordeaux, université Bordeaux Montaigne, Pessac, France;7. Comité de protection des personnes Sud-Ouest et Outre-Mer III, service de pharmacologie clinique, hôpital Pellegrin, 158435, centre hospitalier universitaire de Bordeaux, Bordeaux, France;8. Centre Oscar-Lambret, université de Lille, Cristal UMR, 9181, Lille, France;9. Département, de radiothérapie oncologie, institut Curie, université PSL, Paris/Saint-Cloud/Orsay, France;10. Laboratoire d’imagerie translationnelle en oncologie (Lito), U1288 université Paris Saclay/Inserm/Institut Curie, Orsay, France;11. Centre de protonthérapie, institut Curie, université PSL, Orsay, France;12. Département de radiothérapie, Institut de cancérologie de l’Ouest, René-Gauducheau, Saint-Herblain, France;13. Service de radiothérapie, centre Léon-Bérard, Lyon, France;14. Service de radiothérapie oncologie, Gustave-Roussy, Paris Saclay University, Oncostat U1018, Inserm, Villejuif, France;15. Faculté de médecine et centre atlantique de philosophie, université Rennes 1, Rennes, France |
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| Abstract: | PurposeOsteoRadioNecrosis (ORN) is a late complication of radiation for head and neck cancer. Predicting ORN is a major challenge. We developed DERO (Dosimetric Evaluation of Risk of ORN), a semi-automatic tool which reports doses delivered to tooth-bearing sectors, to guide post-therapeutic dental care. We present the method and the first results of a 125-patient prospective cohort.Material and methodsDosimetric data of patients treated with IMRT for head and neck cancer were prospectively segmented to the DERO algorithm. Four arches corresponding to 8-tooth sectors were semi-automatically generated. Thirty-two cylindrical Regions Of Interest (ROI) corresponding to each tooth and surrounding periodontium were created by linear interpolation. Mean doses (Dmean) of ROI were extracted and included in a database, along with data about primary tumor site, laterality and dose values from organs at risk. Dmean to tooth sectors were computed for molar sectors, (teeth X5 to X8) and anterior sectors (teeth X1 to X4). An individual dose map was generated and delivered to patients and dentists.ResultsDosimetric data from 125 patients treated with Tomotherapy® were prospectively collected and analyzed: 9 parotid tumors (PA), 41 Sub-Hyoid tumors (larynx, hypopharynx) (SH), 43 Oropharynx tumors (OR), 32 Oral Cavity tumors (OC). Irradiation was unilateral for 100% of PA tumors (9), 12% of OR tumors (5) and 47% of OC tumors (15). For unilateral cervical irradiation, Dmean in ipsilateral molar sectors was 54 Gy for OC tumors, 45 Gy for OR tumors, 20 Gy for PA tumors. For Oral Cavity bilateral irradiation, Dmean was high in all tooth sectors, 49 to 55 Gy. For SH tumors, Dmean in molar sectors was 27 Gy. A dose gradient of 10 to 20 Gy was observed between molar and anterior sectors whether radiation was uni or bilateral.ConclusionMandibular molar sectors of Oropharynx and Oral Cavity tumors were exposed to high Dmean of 40 to 50 Gy. On the other hand, tooth sectors received lower doses for SH radiation. The DERO tool guide post-radiation dental care with a personalized dosimetric cartography to patient. With data update and patient follow-up, we will be able to determine ORN risk after head and neck radiation. |
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| Keywords: | Head and neck radiotherapy Osteoradionecrosis Radiothérapie Ostéoradionécrose |
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