Some factors influencing salivary function when treating with radiotherapy

Mira, Joaquin G.; Wescott, William B.; Starcke, Edgar N.; Shannon, Ira L.

doi:10.1016/0360-3016(81)90140-1

Cited by 144 publications

(54 citation statements)

References 20 publications

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“…The largest difference in saliva properties was observed between baseline and 2 weeks into RT, suggesting that the serous cells of the salivary glands are affected by the relatively low doses of radiation received in the first two weeks of RT. This is in keeping with previous work demonstrating a sharp reduction in salivary flow rates during the first week of RT delivered with conventional fractionation [5,6,[20][21][22][23][24][25]. The mechanism behind this is thought to be due to early damage to the plasma membrane in acinar cells rather than cell death which occurs later in the course of RT damage [26].…”

Section: Discussionsupporting

confidence: 89%

Radiotherapy-induced xerostomia, pre-clinical promise of LMS-611

Paterson

Caldwell

Porteous

et al. 2015

Support Care Cancer

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2ABSTRACT PURPOSE Radiotherapy induced xerostomia (RIX) is the most common permanent side effect of radiotherapy (RT) to the head and neck (H&N). There is no effective topical treatment. LMS-611 is a mimetic of a natural lamellar body which prevents thick secretions like saliva from congesting organs. Primary objective -assess saliva properties before and during RT to the H&N. Secondary objectives -re-assess saliva properties with the addition of LMS-611, measure inter-patient variability, correlate patient reported symptoms with laboratory measurements and design subsequent first-in-human clinical trial of LMS-611. METHODS Patients with H&N cancer receiving RT as primary treatment were recruited. Patients completed the Groningen RIX (GRIX) questionnaire and provided saliva samples at baseline, weeks 2, 4 and 6 of RT. Saliva adhesiveness and viscosity was tested by measuring time taken to travel 5cm down an inclined plane. RESULTS 30 patients were enrolled. The inclined plane test (IPT) results (seconds) were as follows: baseline 31.3, week-2: 49.7, week-4: 51.1, week-6: 55.7. Wide inter-patient variability was seen at baseline. GRIX scores increased as RT progressed. Spearman rank correlation coefficient of inclined plane tests with GRIX scores was -0.06 at baseline, week-2 0.25, week-4 0.12 and week-6 0.08. LMS-611 concentrations of 10mg/ml and 20mg/ml significantly reduced IPT times on saliva samples. CONCLUSIONS Saliva becomes more visco-adhesive and RIX worsens as RT progresses. There is little correlation between objective and subjective measures of RIX. The addition of LMS611to thick, sticky saliva restores its fluidity ex-vivo. This warrants in-vivo analysis of the effect of LMS-611 upon RIX.

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Section: Discussionsupporting

confidence: 89%

Radiotherapy-induced xerostomia, pre-clinical promise of LMS-611

Paterson

Caldwell

Porteous

et al. 2015

Support Care Cancer

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“…Significant dose reduction to the parotid glands was obtained with either IMRT technique in comparison with 3DRT. Doses in excess of 30 Gy have been reported to cause permanent decrease in saliva output in patients with head and neck cancer [24]. With IMRT, the dose to half of the parotid volume was less than 30 Gy with the fixed-field IMRT plans.…”

Section: Discussionmentioning

confidence: 99%

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Cheng

Chao

Low

2001

Intl Journal of Cancer

125

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SUMMARY We studied target volume coverage and normal tissue sparing of serial tomotherapy intensity modulated radiation therapy (IMRT) and fixed-field IMRT for nasopharyngeal carcinoma (NPC), as compared with those of conventional beam arrangements. Twelve patients with NPC (T2-4N1-3M0) at Mallinckrodt Institute of Radiology underwent computed tomography simulation. Images were then transferred to a virtual simulation workstation computer for target contouring. Target gross tumor volumes (GTV) were primary nasopharyngeal tumor (GTV NP ) with a prescription of 70 Gy, grossly enlarged cervical nodes (GTV LN ) with a prescription of 70 Gy, and the uninvolved cervical lymphatics [designated as the clinical tumor volume (CTV)] with a prescription of 60 Gy. Critical organs, including the parotid gland, spinal cord, brain stem, mandible, and pituitary gland, were also delineated. Conventional beam arrangements were designed following the guidelines of Intergroup (SWOG, RTOG, ECOG) NPC Study 0099 in which the dose was prescribed to the central axis and the target volumes were aimed to receive the prescribed dose ± 10%. Similar dosimetric criteria were used to assess the target volume coverage capability of IMRT. Serial tomotherapy IMRT was planned using a 0.86-cm wide multivane collimator, while a dynamic multileaf collimator system with five equally spaced fixed gantry angles was designated for fixed-beam IMRT. The fractional volume of each critical organ that received a certain predefined threshold dose was obtained from dose-volume histograms of each organ in either the three-dimensional or IMRT treatment planning computer systems. Statistical analysis (paired t-test) was used to examine statistical significance. We found that serial tomotherapy achieved similar target volume coverage as conventional techniques (97.8 ± 2.3% vs. 98.9 ± 1.3%). The static-field IMRT technique (five equally spaced fields) was inferior, with 92.1 ± 8.6% fractional GTV NP receiving 70 Gy ± 10% dose (P < 0.05). However, GTV LN coverage of 70 Gy was significantly better with both IMRT techniques (96.1 ± 3.2%, 87.7 ± 10.6%, and 42.2 ± 21% for tomotherapy, fixed-field IMRT, and conventional therapy, respectively). CTV coverage of 60 Gy was also significantly better with the IMRT techniques. Parotid gland sparing was quantified by evaluating the fractional volume of parotid gland receiving more than 30 Gy; 66.6 ± 15%, 48.3 ± 4%, and 93 ± 10% of the parotid volume received more than 30 Gy using tomotherapy, fixed-field IMRT, and conventional therapy, respectively (P < 0.05). Fixed-field IMRT technique had the best parotid-sparing effect despite less desirable target coverage. The pituitary gland, mandible, spinal cord, and brain stem were also better spared by both IMRT techniques. These encouraging dosimetric results substantiate the theoretical advantage of inverse-planning IMRT in the management of Publication of the International Union Against Cancer NPC. We showed that target coverage of the primary tumor was maintained and nodal coverage ...

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“…It has been suggested that the final degree of radiation-induced hyposalivation depends on individual patient characteristics, such as pre-irradiation salivary gland activity, age, and sex (Eneroth et al, 1972a,b;Mira et al, 1981). It has been stated that salivary glands with high flow rates before the initiation of radiotherapy show less reduction in salivary flow rate (Eneroth et al, 1972a,b;Mira et al, 1981Mira et al, , 1982, but this observation could not be confirmed in recent dose-volume studies (Eisbruch et al, 1999(Eisbruch et al, , 2001Roesink et al, 2001). Clinically, of more importance is the observation that the irradiated volume of salivary gland tissue correlates directly with the severity of oral complications (Cheng et al, 1981;Mira et al, 1981;Tsujii, 1985;Liu et al, 1990;Hazuka et al, 1993;Jones et al, 1996;Nishioka et al, 1997;Eisbruch et al, 1999Eisbruch et al, , 2001Wu et al, 2000;Roesink et al, 2001).…”

Section: Salivary Glandsmentioning

confidence: 99%

“…It has been stated that salivary glands with high flow rates before the initiation of radiotherapy show less reduction in salivary flow rate (Eneroth et al, 1972a,b;Mira et al, 1981Mira et al, , 1982, but this observation could not be confirmed in recent dose-volume studies (Eisbruch et al, 1999(Eisbruch et al, , 2001Roesink et al, 2001). Clinically, of more importance is the observation that the irradiated volume of salivary gland tissue correlates directly with the severity of oral complications (Cheng et al, 1981;Mira et al, 1981;Tsujii, 1985;Liu et al, 1990;Hazuka et al, 1993;Jones et al, 1996;Nishioka et al, 1997;Eisbruch et al, 1999Eisbruch et al, , 2001Wu et al, 2000;Roesink et al, 2001). The implementation of alternative fractionation schedules, like hyperfractionation and accelerated fractionation, to reduce the side-effects of radiotherapy on normal tissues has also been proposed Dishe, 1991, 1994), but its effect on salivary gland function and morphology is negligible (Price et al, 1995;Coppes et al, 2002), which is advantageous for tumor control.…”

Section: Salivary Glandsmentioning

confidence: 99%

Oral Sequelae of Head and Neck Radiotherapy

Vissink

Jansma

Spijkervet

et al. 2003

Critical Reviews in Oral Biology & Medicine

774

512

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In addition to anti-tumor effects, ionizing radiation causes damage in normal tissues located in the radiation portals. Oral complications of radiotherapy in the head and neck region are the result of the deleterious effects of radiation on, e.g., salivary glands, oral mucosa, bone, dentition, masticatory musculature, and temporomandibular joints. The clinical consequences of radiotherapy include mucositis, hyposalivation, taste loss, osteoradionecrosis, radiation caries, and trismus. Mucositis and taste loss are reversible consequences that usually subside early post-irradiation, while hyposalivation is normally irreversible. Furthermore, the risk of developing radiation caries and osteoradionecrosis is a life-long threat. All these consequences form a heavy burden for the patients and have a tremendous impact on their quality of life during and after radiotherapy. In this review, the radiation-induced changes in healthy oral tissues and the resulting clinical consequences are discussed.

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Some factors influencing salivary function when treating with radiotherapy

Cited by 144 publications

References 20 publications

Radiotherapy-induced xerostomia, pre-clinical promise of LMS-611

Radiotherapy-induced xerostomia, pre-clinical promise of LMS-611

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Oral Sequelae of Head and Neck Radiotherapy

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