Comparison of treatment techniques for reduction in the submandibular gland dose: A retrospective study

Abstract

IntroductionRecent studies have suggested reducing the dose submandibular glands receive when patients undergo head and neck radiotherapy can play a crucial role in preventing xerostomia. However, they are traditionally not spared due to concern that target coverage may be compromised. We investigated the possibility of sparing the contralateral submandibular gland (cSM) by utilising modern planning techniques.Methods10 head and neck patients previously treated with conformal therapy at our centre were retrospectively planned using intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). Each patient was prescribed 70 Gy in 35 fractions to the primary volume, with 56 Gy delivered to the elective nodal areas. The primary objective was to spare the cSM gland using appropriate dose constraints.ResultsMean dose to the cSM gland was reduced to an acceptable dose level (39 Gy) for all patients replanned using an IMRT or VMAT technique, without compromising planned target volume (PTV) coverage or other critical structures. VMAT was able to reduce the mean dose to 31.5 ± 5.5 Gy compared to 34.5 ± 4.8 Gy of IMRT and offered improved plan conformity.ConclusionSparing the cSM gland is possible using IMRT and VMAT planning, whilst preserving coverage on the elective PTV. This has produced a change in protocol in our department, more focus placed on sparing the SM glands. VMAT is a viable alternative method of delivering treatment and will be utilised when required.

Effectiveness of trancutaneous electrical nerve stimulationon improving hyposalivation in xerostomia patients with diabetes mellitus

“…Salivary replacements and pharmaceutical medicines have only provided brief comfort. Several researchers have considered using transcutaneous electrical nerve stimulation (TENS) to treat xerostomia (Hoyne et al 2017).…”

Trans-cutaneous electrical nerve stimulation to treat dry mouth (xerostomia) following radiotherapy for head and neck cancer. A systematic review

“…These include the total dose of radiation, whether radiation is unilateral, or bilateral, and the extent of the upper aerodigestive tract included in the fields [ 5 ]. Advanced techniques of tailored radiation, such as Intensity Modulated Radiotherapy (IMRT) or Volumetric Modulated Arc Radiotherapy (VMAT), may help spare key structures such as the major salivary glands [ 6 ]. The intrinsic patient response to radiotherapy is another important factor.…”

Efeito de uma formulação farmacêutica de pilocarpina em pacientes com xerostomia: estudo randomizado, controlado, duplo-cego e <i>crossover</i>

“…A hipossalivação constitui na redução do fluxo salivar e é um sinal clínico muitas vezes confundido com a xerostomia, que é caracterizada pela sensação subjetiva de boca seca, e decorre na maioria das vezes da hipossalivação (Han;Suarez-Durall;Mulligan, 2015;Saleh et al, 2015;Turner, 2016 (Randall et al, 2013;Schwarz et al, 2014;Hanchanale et al, 2015;Saleh et al, 2015). (Braam et al, 2006;Han;Suarez-Durall;Mulligan, 2015;Pinna et al, 2015;Hoyne et al, 2017;Wang e Eisbruch, 2016;Espenel et al, 2017). (Trivedi et al, 2008;Visacri et al, 2015); (List e Bilir, 2004;Melo Filho et al, 2013;Klein et al, 2014;Niska et al, 2017).…”