Analysis of factors influencing the development of xerostomia during intensity-modulated radiotherapy

Abstract

OBJECTIVES Factors influencing xerostomia during intensity-modulated radiation therapy (IMRT) were assessed. METHODS A 6-week study of 32 head and neck cancer (HNC) patients was performed. Subjects completed the Xerostomia Inventory (XI) and provided stimulated saliva (SS) at baseline, week two and at end of IMRT. Influence of SS flow rate (SSFR), calcium and mucin 5b (MUC5b) concentrations and radiation dose on xerostomia was determined. RESULTS HNC subjects experienced mean SSFR decline of 36% by visit two (N=27; p=0.012) and 57% by visit three (N=20; p=0.0004), Concentrations of calcium and MUC5b increased, but not significantly during IMRT (p>0.05). Xerostomia correlated most with decreasing salivary flow rate as determined by Spearman correlations (p<0.04) and linear mixed models (p<0.0001). CONCLUSIONS Although IMRT is sparing to the parotid glands, it has an early effect on SSFR and the constituents in saliva in a manner that is associated with the perception of xerostomia.

Impact of xerostomia on dysphagia after chemotherapy–intensity‐modulated radiotherapy for oropharyngeal cancer: Prospective longitudinal study

“…Mucins bind water molecules effectively, and their presence on the mucosal surfaces helps maintain these tissues in a hydrated state and, importantly, provide a sense of hydration to the patient . Reduced salivary mucins after CRT may greatly impact the sensation of dry mouth . The importance of the mucin‐containing secretions is highlighted in the relatively weak correlations between SSF rates, dominated by parotid gland secretions, and PRX in our study.…”

The effect of parotid gland‐sparing intensity‐modulated radiotherapy on salivary composition, flow rate and xerostomia measures

“…() were an early increased TP concentration, but no significant changes in any parameter >12 months. A third publication (Randall et al., ) was the only to assess IMRT‐treated patients. It differed from our study by collecting WMS only.…”

“…Reviewing all published studies, it is not possible to draw definitive conclusions regarding the changes in salivary composition after RT, due to heterogeneity in analytes selected for testing and short follow‐up in the more statistically robust prospective studies. The one area of consensus for all studies reporting salivary flow (Almstahl & Wikstrom, ; de Barros Pontes, Polizello, & Spadaro, ; Ben‐Aryeh, Gutman, Szargel, & Laufer, ; Brown, Dreizen, Rider, & Johnston, ; Funegard et al., ; Makkonen, Tenovuo, Vilja, & Heimdahl, ; Randall et al., ; Tiwana et al., ) was a significant reduction in either WMS or individual parotid saliva flow at <6 months. At >12 months, Valdez et al.…”

“…Xerostomia measures are reported in three studies (Dijkema et al., ; Randall et al., ; Tiwana et al., ). No studies have undertaken an analysis for a possible relationship between individual saliva components, and physician‐reported (Tiwana et al., ) or patient‐reported (Dijkema et al., ; Randall et al., ) xerostomia scores. We assessed for a possible relationship between PG saliva analytes and xerostomia severity after IMRT.…”

Avaliação Da Xerostomia Em Pacientes Com Câncer De Cabeça E Pescoço Submetidos Ao Tratamento Radioterápico

“…Assim, a Intensity Modulated Radiotherapy (IMRT) foi desenvolvida para o tratamento de câncer de cabeça e pescoço com o objetivo de fornecer dose mais precisa e poupar as glândulas salivares. Estudos comparativos entre as tecnologias anteriores e a IMRT têm mostrado que a proteção é significativa, porém incompleta (RANDALL et al, 2013).…”