Short-term and long-term unstimulated saliva flow following unilateral vs bilateral radiotherapy for oropharyngeal carcinoma.
IMRT
oropharyngeal cancer
radiotherapy
salivary function
unilateral
unstimulated saliva flow
xerostomia
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
22
06
2020
revised:
31
08
2020
accepted:
22
09
2020
pubmed:
16
10
2020
medline:
23
6
2021
entrez:
15
10
2020
Statut:
ppublish
Résumé
We aimed to compare unstimulated saliva flow using 3-minute modified Schirmer test (MST) following bilateral vs unilateral radiotherapy (RT) in oropharyngeal carcinoma (OPC). We reviewed OPC patients treated with definitive intensity-modulated radiation therapy (IMRT) between 2011 and 2017. MST was measured at baseline, 1-/6-/12-/24-month post-RT. MST values were compared between bilateral-RT vs unilateral-RT groups. Multivariable logistic regression analysis (MVA) identified predictors of hyposalivation (MST < 25 mm). Total 498 bilateral-RT and 36 unilateral-RT patients were eligible. The MST values at 1-/6-/12-/24-month post-RT were all significantly reduced from baseline for the entire cohort. Baseline unilateral-RT and bilateral-RT MST values (in mm) were similar (P = .2), but much higher for unilateral-RT 1-month (mean: 19.1 vs 13.0, P = .03), 6-month (20.5 vs 9.3, P < .001), 12-month (20.1 vs 11.9, P < .01), and 24-month post-RT (22.2 vs 13.9, P = .04). MVA confirmed that unilateral RT reduced the likelihood of hyposalivation vs bilateral RT (OR 2.36, P = .006). Unilateral RT reduces unstimulated salivary flow in OPC patients.
Sections du résumé
BACKGROUND
We aimed to compare unstimulated saliva flow using 3-minute modified Schirmer test (MST) following bilateral vs unilateral radiotherapy (RT) in oropharyngeal carcinoma (OPC).
METHODS
We reviewed OPC patients treated with definitive intensity-modulated radiation therapy (IMRT) between 2011 and 2017. MST was measured at baseline, 1-/6-/12-/24-month post-RT. MST values were compared between bilateral-RT vs unilateral-RT groups. Multivariable logistic regression analysis (MVA) identified predictors of hyposalivation (MST < 25 mm).
RESULTS
Total 498 bilateral-RT and 36 unilateral-RT patients were eligible. The MST values at 1-/6-/12-/24-month post-RT were all significantly reduced from baseline for the entire cohort. Baseline unilateral-RT and bilateral-RT MST values (in mm) were similar (P = .2), but much higher for unilateral-RT 1-month (mean: 19.1 vs 13.0, P = .03), 6-month (20.5 vs 9.3, P < .001), 12-month (20.1 vs 11.9, P < .01), and 24-month post-RT (22.2 vs 13.9, P = .04). MVA confirmed that unilateral RT reduced the likelihood of hyposalivation vs bilateral RT (OR 2.36, P = .006).
CONCLUSION
Unilateral RT reduces unstimulated salivary flow in OPC patients.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
456-466Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Jellema AP, Slotman BJ, Doornaert 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(3):751-760.
Jensen SB, Pedersen AM, Vissink A, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer. 2010;18(8):1061-1079.
Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008;26(22):3770-3776.
Lieshout HF, Bots CP. The effect of radiotherapy on dental hard tissue-a systematic review. Clin Oral Investig. 2014;18(1):17-24.
Huang SH, Waldron J, Bratman SV, et al. Re-evaluation of ipsilateral radiation for T1-T2N0-N2b tonsil carcinoma at the Princess Margaret Hospital in the human papillomavirus era, 25 years later. Int J Radiat Oncol Biol Phys. 2017;98(1):159-169.
O'Sullivan B, Warde P, Grice B, et al. The benefits and pitfalls of ipsilateral radiotherapy in carcinoma of the tonsillar region. Int J Radiat Oncol Biol Phys. 2001;51(2):332-343.
Parliament MB, Scrimger RA, Anderson SG, et al. Preservation of oral health-related quality of life and salivary flow rates after inverse-planned intensity-modulated radiotherapy (IMRT) for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2004;58(3):663-673.
Henson BS, Inglehart MR, Eisbruch A, Ship JA. Preserved salivary output and xerostomia-related quality of life in head and neck cancer patients receiving parotid-sparing radiotherapy. Oral Oncol. 2001;37(1):84-93.
Wong K, Huang SH, O'Sullivan B, et al. Point-of-care outcome assessment in the cancer clinic: audit of data quality. Radiother Oncol. 2010;95(3):339-343.
Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA. Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys. 1999;45(3):577-587.
Fontana M, Zunt S, Eckert GJ, Zero D. A screening test for unstimulated salivary flow measurement. Oper Dent. 2005;30(1):3-8.
Lopez-Jornet P, Camacho-Alonso F, Bermejo-Fenoll A. A simple test for salivary gland hypofunction using oral Schirmer's test. J Oral Pathol Med. 2006;35(4):244-248.
Spielman AI. Gustducin and its role in taste. J Dent Res. 1998;77(4):539-544.
Dawes C, Pedersen AM, Villa A, et al. The functions of human saliva: a review sponsored by the World Workshop on Oral Medicine VI. Arch Oral Biol. 2015;60(6):863-874.
Pedersen AM, Bardow A, Jensen SB, Nauntofte B. Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion. Oral Dis. 2002;8(3):117-129.
Ramirez-Amador V, Silverman S Jr, Mayer P, Tyler M, Quivey J. Candidal colonization and oral candidiasis in patients undergoing oral and pharyngeal radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(2):149-153.
Sciubba JJ, Goldenberg D. Oral complications of radiotherapy. Lancet Oncol. 2006;7(2):175-183.
Spijkervet FKL, Brennan MT, Peterson DE, Witjes MJH, Vissink A. Research frontiers in oral toxicities of cancer therapies: osteoradionecrosis of the jaws. J Natl Cancer Inst Monogr. 2019;2019(53):86-94.
Brizel DM, Wasserman TH, Henke M, et al. Phase III randomized trial of amifostine as a radioprotector in head and neck cancer. J Clin Oncol. 2000;18(19):3339-3345.
Lee MG, Freeman AR, Roos DE, Milner AD, Borg MF. Randomized double-blind trial of amifostine versus placebo for radiation-induced xerostomia in patients with head and neck cancer. J Med Imaging Radiat Oncol. 2019;63(1):142-150.
Burlage FR, Roesink JM, Kampinga HH, et al. Protection of salivary function by concomitant pilocarpine during radiotherapy: a double-blind, randomized, placebo-controlled study. Int J Radiat Oncol Biol Phys. 2008;70(1):14-22.
Warde P, O'Sullivan B, Aslanidis J, et al. A phase III placebo-controlled trial of oral pilocarpine in patients undergoing radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002;54(1):9-13.
Jha N, Seikaly H, Harris J, et al. Phase III randomized study: oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation-induced xerostomia. Head Neck. 2009;31(2):234-243.
Scrimger RA, Seikaly H, Vos LJ, et al. Combination of submandibular salivary gland transfer and intensity-modulated radiotherapy to reduce dryness of mouth (xerostomia) in patients with head and neck cancer. Head Neck. 2018;40(11):2353-2361.
Wong RK, Deshmukh S, Wyatt G, et al. Acupuncture-like transcutaneous electrical nerve stimulation versus pilocarpine in treating radiation-induced xerostomia: results of RTOG 0537 phase 3 study. Int J Radiat Oncol Biol Phys. 2015;92(2):220-227.
Duncan GG, Epstein JB, Tu D, et al. Quality of life, mucositis, and xerostomia from radiotherapy for head and neck cancers: a report from the NCIC CTG HN2 randomized trial of an antimicrobial lozenge to prevent mucositis. Head Neck. 2005;27(5):421-428.
Strietzel FP, Lafaurie GI, Mendoza GR, et al. Efficacy and safety of an intraoral electrostimulation device for xerostomia relief: a multicenter, randomized trial. Arthritis Rheum. 2011;63(1):180-190.
Vijayan A, Asha ML, Babu S, Chakraborty S. Prospective phase II study of the efficacy of transcutaneous electrical nerve stimulation in post-radiation patients. Clin Oncol (R Coll Radiol). 2014;26(12):743-747.
Forner L, Hyldegaard O, von Brockdorff AS, et al. Does hyperbaric oxygen treatment have the potential to increase salivary flow rate and reduce xerostomia in previously irradiated head and neck cancer patients? A pilot study. Oral Oncol. 2011;47(6):546-551.
Momm F, Volegova-Neher NJ, Schulte-Monting J, Guttenberger R. Different saliva substitutes for treatment of xerostomia following radiotherapy. A prospective crossover study. Strahlenther Onkol. 2005;181(4):231-236.
Jensen SB, Vissink A, Limesand KH, Reyland ME. Salivary gland hypofunction and xerostomia in head and neck radiation patients. J Natl Cancer Inst Monogr. 2019;2019(53):95-106.
Gupta T, Agarwal J, Jain S, et al. Three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: a randomized controlled trial. Radiother Oncol. 2012;104(3):343-348.
Nutting CM, Morden JP, Harrington KJ, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12(2):127-136.
Steneker M, Lomax A, Schneider U. Intensity modulated photon and proton therapy for the treatment of head and neck tumors. Radiother Oncol. 2006;80(2):263-267.
Morley L, Tsang SW, Breen SL, et al. Technical challenges of sparing infrahyoid swallowing organs at risk in oropharynx squamous cell cancer treated with IMRT. Med Dosim. 2014;39(2):146-151.
Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009;2(3):303-307.
Chajon E, Lafond C, Louvel G, et al. Salivary gland-sparing other than parotid-sparing in definitive head-and-neck intensity-modulated radiotherapy does not seem to jeopardize local control. Radiat Oncol. 2013;8:132.
Konings AW, Coppes RP, Vissink A. On the mechanism of salivary gland radiosensitivity. Int J Radiat Oncol Biol Phys. 2005;62(4):1187-1194.
Deasy JO, Moiseenko V, Marks L, Chao KS, Nam J, Eisbruch A. Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S58-S63.
Konings AW, Faber H, Cotteleer F, Vissink A, Coppes RP. Secondary radiation damage as the main cause for unexpected volume effects: a histopathologic study of the parotid gland. Int J Radiat Oncol Biol Phys. 2006;64(1):98-105.
O'Daniel JC, Garden AS, Schwartz DL, et al. Parotid gland dose in intensity-modulated radiotherapy for head and neck cancer: is what you plan what you get? Int J Radiat Oncol Biol Phys. 2007;69(4):1290-1296.
Anand AK, Jain J, Negi PS, et al. Can dose reduction to one parotid gland prevent xerostomia?-a feasibility study for locally advanced head and neck cancer patients treated with intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol). 2006;18(6):497-504.
Chin RI, Rao YJ, Hwang MY, et al. Comparison of unilateral versus bilateral intensity-modulated radiotherapy for surgically treated squamous cell carcinoma of the palatine tonsil. Cancer. 2017;123(23):4594-4607.
Kim Y, Cho KH, Moon SH, et al. Comparison of the clinical outcomes of patients with squamous cell carcinoma of the tonsil receiving postoperative ipsilateral versus bilateral neck radiotherapy: a propensity score matching analysis (KROG 11-07). Cancer Res Treat. 2017;49(4):1097-1105.
Seiwert TY, Foster CC, Blair EA, et al. OPTIMA: a phase II dose and volume de-escalation trial for human papillomavirus-positive oropharyngeal cancer. Ann Oncol. 2019;30(10):1673.
de Veij Mestdagh PD, Walraven I, Vogel WV, et al. SPECT/CT-guided elective nodal irradiation for head and neck cancer is oncologically safe and less toxic: a potentially practice-changing approach. Radiother Oncol. 2020;147:56-63.
Navazesh M, Kumar SK. University of Southern California School of D. measuring salivary flow: challenges and opportunities. J Am Dent Assoc. 2008;139:35S-40S.
Franzen L, Funegard U, Ericson T, Henriksson R. Parotid gland function during and following radiotherapy of malignancies in the head and neck. A consecutive study of salivary flow and patient discomfort. Eur J Cancer. 1992;28(2-3):457-462.
Eisbruch A, Harris J, Garden AS, et al. Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys. 2010;76(5):1333-1338.
Kam MK, Leung SF, Zee B, et al. Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol. 2007;25(31):4873-4879.
Toledano I, Graff P, Serre A, et al. Intensity-modulated radiotherapy in head and neck cancer: results of the prospective study GORTEC 2004-03. Radiother Oncol. 2012;103(1):57-62.
Peng G, Wang T, Yang KY, et al. A prospective, randomized study comparing outcomes and toxicities of intensity-modulated radiotherapy vs. conventional two-dimensional radiotherapy for the treatment of nasopharyngeal carcinoma. Radiother Oncol. 2012;104(3):286-293.
So JS, Chung SC, Kho HS, Kim YK, Chung JW. Dry mouth among the elderly in Korea: a survey of prevalence, severity, and associated factors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(4):475-483.
Kaplan I, Zuk-Paz L, Wolff A. Association between salivary flow rates, oral symptoms, and oral mucosal status. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(2):235-241.
Baum BJ, Alevizos I, Zheng C, et al. Early responses to adenoviral-mediated transfer of the aquaporin-1 cDNA for radiation-induced salivary hypofunction. Proc Natl Acad Sci U S A. 2012;109(47):19403-19407.
Gronhoj C, Jensen DH, Vester-Glowinski P, et al. Safety and efficacy of mesenchymal stem cells for radiation-induced xerostomia: a randomized, placebo-controlled phase 1/2 trial (MESRIX). Int J Radiat Oncol Biol Phys. 2018;101(3):581-592.
Hill G, Headon D, Harris ZI, Huttner K, Limesand KH. Pharmacological activation of the EDA/EDAR signaling pathway restores salivary gland function following radiation-induced damage. PLoS One. 2014;9(11):e112840.
Morgan-Bathke M, Harris ZI, Arnett DG, et al. The Rapalogue, CCI-779, improves salivary gland function following radiation. PLoS One. 2014;9(12):e113183.