Evaluation, prevention and management of radiotherapy-induced xerostomia in head and neck cancer patients

Castro, Gilberto de; Federico, Miriam Hatsue Honda

doi:10.1097/01.cco.0000219256.37843.83

Cited by 32 publications

(14 citation statements)

References 41 publications

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“…Occurring within 24 h after irradiation, early radiation injuries of the parotid glands are known as acute radiation parotitis, manifesting fever, dry mouth, pain, swelling and tenderness clinically [1]. Late radiation injuries of the parotid glands usually present as transient or permanent xerostomia, which further increases the risk for developing dental caries, compromises the oral mucosal integrity, and results in oral pain, loss of taste, difficulty with swallowing and chewing, sleep disorders and worse quality of life [2]. Sialometric studies disclose reduction of salivary flow in the acute setting [3] as well as in the late stage [3,4] after head and neck radiation.…”

Section: Introductionmentioning

confidence: 99%

Perfusion characteristics of late radiation injury of parotid glands: quantitative evaluation with dynamic contrast-enhanced MRI

Juan¹,

Chen²,

Jen³

et al. 2008

Eur Radiol

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We aimed to quantitatively investigate the alteration of parotid perfusion after irradiation using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) based on a two-compartment tracer kinetic model. This study enrolled 19 patients (53.2 +/- 14.9 years) treated by head and neck radiotherapy and 19 age-relevant and sex-matched subjects as a control group. Perfusion parameters (K ( el ), k (21) and A) of parotid glands were analyzed based on the Brix model from T1-weighted DCE-MRI. Suitability of the Brix model was evaluated via Monte Carlo simulation for the goodness-of-fit. Analysis of nonlinear goodness-of-fit showed that the Brix model is appropriate in evaluating the parotid perfusion (R(2) = 0.938 +/- 0.050). The irradiated parotid glands showed significantly lower K ( el ) (P < 0.0005) and k (21) (P < 0.05) and consequently significantly higher value of peak enhancement (P < 0.0005) and time-to-peak (P < 0.0005) compared with non-irradiated ones, suggestive of gradual and prolonged accumulation and delayed wash-out of contrast agent due to increased extracellular extravascular space and decreased vascular permeability in the irradiated glands. Linear regression analysis showed dose-dependent perfusion changes of the irradiated parotid glands. We conclude that quantitative DCE-MRI is a potential tool in investigating parotid gland perfusion changes after radiotherapy.

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Section: Introductionmentioning

confidence: 99%

Perfusion characteristics of late radiation injury of parotid glands: quantitative evaluation with dynamic contrast-enhanced MRI

Juan¹,

Chen²,

Jen³

et al. 2008

Eur Radiol

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“…Current treatment that focuses on assuaging symptoms with artificial salivary substitutes and prosecretory drugs is ineffective for long-term relief 6 . Although improved radiation delivery techniques have helped diminish the severity of the condition, normal tissue toxicity and its complications remain a limiting factor in cancer treatment 6,7 . Pre-emptive measures to prevent radiotherapy-associated complications are, therefore, becoming the norm.…”

Section: Introductionmentioning

confidence: 99%

Retroductal Submandibular Gland Instillation and Localized Fractionated Irradiation in a Rat Model of Salivary Hypofunction

Nair

Zheng

Sunavala‐Dossabhoy

2016

JoVE

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Normal tissues that lie within the portals of radiation are inadvertently damaged. Salivary glands are often injured during head and neck radiotherapy. Irreparable cell damage results in a chronic loss of salivary function that impairs basic oral activities, and increases the risk of oral infections and dental caries. Salivary hypofunction and its complications gravely impact a patient's comfort. Current symptomatic management of the condition is ineffective, and newer therapies to assuage the condition are needed. Salivary glands are exocrine glands, which expel their secretions into the mouth via excretory ducts. Cannulation of these ducts provides direct access to the glands. Retroductal delivery of a contrast agent to major salivary glands is a routine out-patient procedure for diagnostic imaging. Using a similar procedure, localized treatment of the glands is feasible. However, performing this technique in preclinical studies with small animals poses unique challenges. In this study we describe the technique of retroductal administration in rat submandibular glands, a procedure that was refined in Dr. Bruce Baum's laboratory (NIH)1, and lay out a procedure for local gland irradiation.

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“…Targeted radiotherapy is standard for these patients, who are treated with 1-2 Gy of radiation daily for 5 weeks, and who almost always suffer a loss or altered sense of taste (ageusia and dysgeusia, respectively). Taste dysfunction reduces appetite and leads to weight loss, diminished quality of life and poorer outcomes (de Castro and Federico, 2006;Ruo Redda and Allis, 2006). In rodents, taste function and buds are lost following radiation (Conger and Wells, 1969;Mossman et al, 1979;Yamazaki et al, 2009).…”

Section: New Hypotheses Of Taste Dysfunctionmentioning

confidence: 99%

Progress and renewal in gustation: new insights into taste bud development

2015

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The sense of taste, or gustation, is mediated by taste buds, which are housed in specialized taste papillae found in a stereotyped pattern on the surface of the tongue. Each bud, regardless of its location, is a collection of ∼100 cells that belong to at least five different functional classes, which transduce sweet, bitter, salt, sour and umami (the taste of glutamate) signals. Taste receptor cells harbor functional similarities to neurons but, like epithelial cells, are rapidly and continuously renewed throughout adult life. Here, I review recent advances in our understanding of how the pattern of taste buds is established in embryos and discuss the cellular and molecular mechanisms governing taste cell turnover. I also highlight how these findings aid our understanding of how and why many cancer therapies result in taste dysfunction.

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Evaluation, prevention and management of radiotherapy-induced xerostomia in head and neck cancer patients

Abstract: Despite some advances in radiation therapy-induced xerostomia prevention, its treatment is an area in which advances are urgently needed.

Cited by 32 publications

References 41 publications

Perfusion characteristics of late radiation injury of parotid glands: quantitative evaluation with dynamic contrast-enhanced MRI

Perfusion characteristics of late radiation injury of parotid glands: quantitative evaluation with dynamic contrast-enhanced MRI

Retroductal Submandibular Gland Instillation and Localized Fractionated Irradiation in a Rat Model of Salivary Hypofunction

Progress and renewal in gustation: new insights into taste bud development

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