Taner ARPACI, Gamze UĞURLUER, Gülhan ÖREKİCİ, Tuğana AKBAŞ, Meltem SERİN

NAZOFARENKS KANSERLİ OLGULARDA RADYOTERAPİ SONRASI MASTİKATÖR KASLARDA VE PAROTİS BEZLERİNDE GELİŞEN DEĞİŞİKLİKLERİN MRG İLE DEĞERLENDİRİLMESİ

Amaç: Bu çalışmada, nazofarenks kanserli olgularda radyoterapi RT sonrası mastikatör kaslarda ve parotis bezlerinde ortaya çıkan değişikliklerin manyetik rezonans görüntüleme MRG ile değerlendirilmesi amaçlandı. Hastalar ve Yöntem: Kurumumuzda 2009-2016 yılları arasında nazofarenks kanseri tanısıyla RT verilen 31 olgunun RT öncesi ve sonrası çekilen MRG’leri retrospektif olarak değerlendirildi. T2 ağırlıklı aksiyel imajlarda mastikatör kasların ve parotis bezlerinin maksimum transvers çapları ve sinyal özellikleri kaydedildi. Normal hipointens sinyal 0, hafif sinyal artışı 1 ve belirgin sinyal artışı 2 olarak skorlandı. Bulgular: RT öncesi çekilen ve takipte en son çekilen MRG arasındaki ortalama süre 44 aydı 12-84 ay . Sağ masseter kası RM :2.32mm 15% , sol masseter LM :2.42mm 15.4% , sağ medial pterygoid RMP :1.26mm 8.7% , sol medial pterygoid LMP :1.71mm 12% , sağ lateral pterygoid RLP :1.35mm 9.6% , sol lateral pterygoid LLP :1.32mm 9.4% , sağ parotis bezi RP :8.22mm 26% ve sol parotis bezi LP :8.87mm 28% oranında incelme gösterdi. RM 8 olguda 26% hafif, LM 5 olguda 16% hafif, RMP 5 olguda 16% hafif ve 1 olguda 3,5% belirgin, LMP 4 olguda 13% hafif ve 2 olguda 6,5% belirgin, RLP ve LLP 8’er olguda 26% hafif ve 3’er olguda 9,7% belirgin, RP 10 olguda 32% hafif ve 18 olguda 58% belirgin, LP 10 olguda 32% hafif ve 17 olguda 55% belirgin sinyal artışı gösterdi. Sonuç: Hacim kaybı ve sinyal artışı en sık parotis bezlerinde gözlendi. Mastikatör kaslar arasında en sık hacim kaybı masseterde ve en sık sinyal artışı lateral pterygoid kasta saptandı. Radiotherapy induced changes of masticatory muscles and parotid glands on MRI in patients with nasopharyngeal carcinoma

Radiotherapy Induced Changes of Masticatory Muscles and Parotid Glands On Mri In Patients With Nasopharyngeal Carcinoma

Objective: The aim of this study was to identify radiotherapy RT induced changes of masticatory muscles and parotid glands on magnetic resonance imaging MRI in patients with nasopharyngeal carcinoma NPC .Patients and Methods: Thirty-one patients treated with RT for NPC between 2009-2016 in our instution were included in the study. MRI examinations performed before and after RT were reviewed retrospectively. Transverse diameters and signal intensities of masticatory muscles and parotid glands were evaluated on T2 weighted axial MR images. Normal hypointense signal was scored as 0, mild hyperintensity as 1 and severe hyperintensity as 2. Results:The mean interval between pre-RT MRI and last control MRI was 44 months 12-84 months . Reductions of transverse diameters were; right masseter RM :2.32mm 15% , left masseter LM :2.42mm 15.4% , right medial pterygoid RMP :1.26mm 8.7% , left medial pterygoid LMP :1.71mm 12% , right lateral pterygoid RLP :1.35mm 9.6% , left lateral pterygoid LLP :1.32mm 9.4% , right parotid gland RP :8.22mm 26% , left parotid gland LP :8.87mm 28% . T2 signal changes were; RM: mild 8 cases 26% , LM: mild 5 cases 16% , RMP: mild 5 cases 16% , severe 1 case 3.5% , LMP: mild 4 cases 13% , severe 2 cases 6.5% , RLP and LLP: mild 8 cases 26% , severe 3 cases 9.7% , RP: mild 10 cases 32% , severe 18 cases 58% , LP: mild 10 cases 32% , severe 17 cases 55% . Conclusion: Volume loss and hyperintensity were mostly seen in parotid glands. Masseter was the muscle with highest rate of volume loss and lateral pyterygoid showed the highest rate of hyperintensity in masticatory muscles

Keywords:

Magnetic resonance imaging, masticatory muscle, nasopharyngeal carcinoma, parotid gland, radiotherapy,

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Parliament M, Alidrisi M, Munroe M. Implications of radiation dosimetry of the mandible in patients with carcinomas of the oral cavity and nasopharynx treated with intensity modulated radiation therapy. Int J Oral Maxillofac Surg 2005; 34:114–21. [CrossRef]

Johnson J, van As-Brooks CJ, Fagerberg-Mohlin B, Finizia C. Trismus in head and neck cancer patients in Sweden: incidence and risk factors. Med Sci Monit 2010; 16: CR278–82.

Louise Kent M, Brennan MT, Noll JL. Radiation-induced trismus in head and neck cancer patients. Support Care Cancer 2008; 16:305–9. [CrossRef]

Jellema AP, Slotman BJ, Doomaert P, Leemans CR, Langendijk JA. 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; 69:751–60. [CrossRef]

Chambers MS, Garden AS, Kies MS, Martin JW. Radiation induced xerostomia in patients with head and neck cancer: pathogenesis, impact on quality of life, and management. Head Neck 2004;26:796– 807. [CrossRef]

Vissink A, Jansma J, Spijkervet FK, Burlage FR, Coppes RP. Oral Sequelae of Head and Neck Radiotherapy. Crit Rev Oral Biol Med 2003; 14:199–212.

Farrugia ME, Bydder GM, Francis JM, Robson MD. Magnetic resonance imaging of facial muscles. Clin Radiol 2007; 62:1078–86. [CrossRef]

D’Ippolito SM, Borri Wolosker AM, D’Ippolito G, Herbert De Souza B, Fenyo- Pereira M. Evaluation of the lateral pterygoid muscle using magnetic resonance imaging. Dentomaxillofac Radiol 2010;39:494– 500. [CrossRef]

Kato K, Tomura N, Takahashi S, Watarai J. Motor denervation of tumors of the head and neck: changes in MR appearance. Magn Reson Med Sci 2002; 1:157–64. [CrossRef]

Al-Saleh MA, Jaremko JL, Saltaji H, Wolfaardt J, Major PW. MRI findings of radiation-induced changes of masticatory muscles: a systematic review. J Otolaryngol Head Neck Surg. 2013; Mar 28:42:26. [CrossRef]

Yeh SA, Tang Y, Lui CC, Huang YJ, Huang EY. Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone. Int J Radiat Oncol Biol Phys 2005;62:672–9. [CrossRef]

Stone H, Coleman C, Anscher M, McBride W. Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 2003;4:529–36.

Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev 2012; 5:CD005005. [CrossRef]

Liu Y, Chen M, Zhao C, Lu LX, Han F, Bao Y et al. Radiation-induced temporomandibular joint damage in nasopharyngeal carcinoma patients after intensity-modulated radiotherapy. Chinese journal of cancer 2007; 26:64–7.

Fukui T, Tsuruta M, Murata K, Wakimoto Y, Tokiwa H, Kuwahara Y. Correlation between facial morphology, mouth opening ability, and condylar movement during opening-closing jaw movements in female adults with normal occlusion. Eur J Orthod 2002; 24:327–36. [CrossRef]

Bhatia KS, King AD, Paunipagar BK. MRI findings in patients with severe trismus following radiotherapy for nasopharyngeal carcinoma. Eur Radiol 2009; 19: 2586–93. [CrossRef]

Chong J, Hinckley L, Ginsberg L. Masticator space abnormalities associated with mandibular osteoradionecrosis: MR and CT findings in five patients. AJNR Am J Neuroradiol 2000; 21:175–8.

Ariji Y, Fuwa N, Tachibana H, Ariji E. Denervation atrophy of the masticatory muscles in a patient with nasopharyngeal cancer: MR examinations before and after radiotherapy. Dentomaxillofac Radiol 2002; 31:204–8. [CrossRef]

Hsieh LC, Chen JW, Wang LY. Predicting the severity and prognosis of trismus after intensity-modulated radiation therapy for oral cancer patients by magnetic resonance imaging. PLoS One. 2014;9:e92561. [CrossRef]

VWC Wu, MTC Ying, DLW Kwong. Evaluation of radiation-induced changes to parotid glands following conventional radiotherapy in patients with nasopharygneal carcinoma. Br J Radiol 2011; 84: 843– 9. [CrossRef]