Radiation-induced Xerostomia: Evaluation with 18F-FDG PET/CT Radyoterapi İlişkili Kserostominin 18F-FDG PET/BT ile Değerlendirilmesi

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MÜTEVELİZADE G., Bozdemir B. Ç., Aydın N., Süner A. F., KARAKOYUN ÇELİK Ö., PARLAK Y., ...Daha Fazla

Molecular Imaging and Radionuclide Therapy, cilt.34, sa.3, ss.213-220, 2025 (ESCI, Scopus, TRDizin)

Özet

Objectives: To investigate the relationship between radiation dose, metabolic changes in the salivary glands assessed by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), and xerostomia severity in patients with head and neck cancer following radiotherapy (RT). Methods: We retrospectively analyzed 107 patients treated with intensity-modulated RT or volumetric modulated arc therapy for head and neck malignancies. Clinical xerostomia severity was evaluated at the time of post-treatment PET/CT. Mean gland doses and dose–volume parameters (V10–V50) were extracted from treatment plans. Metabolic changes were evaluated by Δmaximum standardized uptake value and Δmean standardized uptake value between pre and post treatment PET/CT scans. The relationships between clinical, dosimetric, and metabolic variables were examined. Results: Moderate-to-severe xerostomia occurred in 63.6% of patients. Both higher T and N stage were significantly associated with greater xerostomia severity (p<0.05). Patients with nodal metastases on pretreatment PET/CT demonstrated a higher prevalence of xerostomia. Dose–volume parameters (V10–V30 for parotids, V50 for submandibular glands) were significantly correlated with symptom severity. ΔSUV values were significantly associated with both mean dose and dose–volume parameters, particularly in the left parotid gland, where patients receiving >30 Gy showed markedly greater metabolic decline. Parotid glands demonstrated stronger dose-dependent metabolic changes compared with submandibular glands, consistent with their higher radiosensitivity. Conclusion: Despite the use of advanced RT techniques, xerostomia remains a frequent toxicity. 18F-FDG PET/CT reliably captured dose-dependent salivary gland impairment and reflected the impact of tumor burden on toxicity risk. These findings underscore the complementary role of PET-derived biomarkers as integrative tools for predicting salivary dysfunction beyond conventional dosimetric parameters.