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Radiation induced xerostomia is a persistent clinical presentation that affects the quality of life in head and neck cancer patients even with the best of the intensity modulated radiotherapy protocols. Comprehensive review of the anatomic, histologic, developmental and neuronal entities of salivary glands from a regenerative perspective, ensuing radiation is taken. It also evaluates the systemic and glandular radiation responses that form the early and late clinical changes. From these, the article submits probable strategies; based on the current knowledge and future challenges involved, in reversing radiation induced xerostomia. Further, it elaborates on the status of radioprotectors and mitigators including the recently reported biologic and chemical derivatives and proposes the rationale of using combination radioprotector therapy in radiation injuries. A brief of palliative regimes, alternate treatment modes and technologic advancements in radiotherapy are also explained. Salivary gland histologic components, which need to be protected in the emerging radiotherapy protocols and can be targeted in different salivary gland regeneration therapies is highlighted. The paper contributes to an improved understanding in radiation induced xerostomia and deliberates on novel mechanisms towards enhancing quality of life in head and neck cancer radiotherapy patients.

Introduction: Diffusion tensor imaging (DTI) has been used in cervical trauma and spondylotic myelopathy, and it has been found to correlate with neural deficit and prognosticate neural recovery. Such a correlation has not been studied in Pott’s spine with paraplegia. Hence, this prospective study has been used to find correlation of DTI parameters with neural deficit in these patients. Methods: Thirty-four patients of spinal TB were enrolled and DTI was performed before the start of treatment and after six months. Fractional anisotropy (FA), Mean diffusivity (MD), and Tractography were studied. Neurological deficit was graded by the Jain and Sinha scoring. Changes in FA and MD at and below the site of lesion (SOL) were compared to above the SOL (control) using the unpaired t-test. Pre-treatment and post-treatment values were also compared using the paired t-test. Correlation of DTI parameters with neurological score was done by Pearson’s correlation. Subjective assessment of Tractography images was done. Results: Mean average FA was not significantly decreased at the SOL in patients with paraplegia as compared to control. After six months of treatment, a significant decrease (p = 0.02) in mean average FA at the SOL compared to pre-treatment was seen. Moderate positive correlation (r = 0.49) between mean average FA and neural score after six months of treatment was found. Tractography images were not consistent with severity of paraplegia. Conclusion: Unlike spondylotic myelopathy and trauma, epidural collection and its organized inflammatory tissue in Pott’s spine precludes accurate assessment of diffusion characteristics of the compressed cord.