Elsevier

Radiotherapy and Oncology

Volume 77, Issue 2, November 2005, Pages 164-171
Radiotherapy and Oncology

Head and neck radiotherapy
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?

https://doi.org/10.1016/j.radonc.2005.10.002Get rights and content

Abstract

Background and Purpose

To investigate the association between the mean salivary gland and oral cavity dose, with patient-rated moderate and severe xerostomia and sticky saliva.

Patients and methods

One hundred and fifty-seven patients treated with bilateral irradiation for head and neck cancer were included. The parotid and submandibular glands and the oral cavity were delineated on plannings-CT scans. At baseline and 6 and 12 months self-reported xerostomia and sticky saliva were assessed using the EORTC QLQ-H&N35 questionnaire.

Results

At 6 months a significant association between the mean parotid (MDpar) and mean submandibular dose (MDsubm) and xerostomia was observed (OR−MDpar: 1.17; P=0.002 and OR−MDsubm: 1.08; P=0.02). Between MDpar and MDsubm, a significant interaction term was present. No significant association was found with the oral cavity dose. Xerostomia was reversible depending on MDpar and MDsubm.

Considering Sticky saliva, a significant association was found at 6 and 12 months with MDsubm (OR: 1.03; P<0.001). The P50 for sticky saliva increased with elapsing time.

Conclusions

Both MDpar and MDsubm influence the risk of xerostomia in irradiated patients at 6 months. This probability as a function of the mean parotid dose significantly depended on the mean dose in the submandibular glands. Sticky saliva mainly depends on MDsubm.

Section snippets

Patients

Patients eligible for this study were those with stage I–IVB [16] squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, nasopharynx and/or larynx. All patients were treated with primary or postoperative radiotherapy with curative intent, with a minimal life expectancy of 12 months. A good understanding of Dutch language was required to be able to complete the questionnaire. Excluded were those with distant metastases (M1), previously irradiated patients, patients treated in

Compliance

Of the 125 patients available for analysis of patient-rated xerostomia, 111 out of 113 patients at risk (98%) returned the questionnaire at 6 months. The compliance at 12 months after radiotherapy was 94 out of 94 patients at risk (100%). Of the 129 patients available for analysis of patient-rated sticky saliva, 115 out of 119 patients at risk (97%) returned the questionnaire at 6 months. The compliance at 12 months after radiotherapy was 103 out of 109 patients at risk (94%).

Changes in patient-rated xerostomia

At baseline, the

Discussion

Xerostomia is an important symptom after radiotherapy in the head and neck area affecting daily life [2]. Many studies have been published discussing the role of the dose in the parotid glands in radiation-induced xerostomia [3], [4], [5], [6], [7], [8], [9], [21], [22], [23], [24].

The results of our study show that both the MDpar and MDsubm are the most important predictive factors for patient-rated xerostomia. Moreover, the probability of developing MS-XER as a function of MDpar 6 months

References (35)

Cited by (110)

View all citing articles on Scopus

Conflict of interest. The authors have no conflict of interest in connection with the paper.

View full text