Reducing xerostomia after chemo-IMRT for head-and-neck cancer: beyond sparing the parotid glands. 2012

Michael Little, and Matthew Schipper, and Felix Y Feng, and Karen Vineberg, and Craig Cornwall, and Carol-Anne Murdoch-Kinch, and Avraham Eisbruch
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA. eisbruch@umich.edu

OBJECTIVE To assess whether, in addition to sparing the parotid glands (PGs), xerostomia after chemotherapy plus intensity-modulated radiotherapy (chemo-IMRT) for head-and-neck cancer is affected by reducing the dose to the other salivary glands. METHODS In a prospective study, 78 patients with Stage III-IV oropharynx/nasopharynx cancer underwent chemo-IMRT, with the aim of sparing the parts of the bilateral PGs, oral cavity (OC) containing the minor salivary glands, and contralateral submandibular gland (SMG) outside the target (when contralateral level I was not a target). Before therapy and periodically for 24 months, validated patient-reported xerostomia questionnaire (XQ) scores and observer-graded xerostomia scores were recorded. Also, the stimulated and unstimulated saliva was measured selectively from each of the PGs and SMGs. The mean OC doses served as surrogates of minor salivary gland dysfunction. Regression models assessed the XQ and observer-graded xerostomia predictors. RESULTS Statistically significant predictors of the XQ score on univariate analysis included the OC, PG, and SMG mean doses and the baseline XQ score, time since RT, and both stimulated and unstimulated PG saliva flow rates. Similar factors were statistically significant predictors of observer-graded xerostomia. The OC, PG, and SMG mean doses were moderately intercorrelated (r = 0.47-0.55). On multivariate analyses, after adjusting for the PG and SMG doses, the OC mean dose (p < .0001), interval from RT (p < .0001), and stimulated PG saliva (p < .0025) were significant predictors of the XQ scores and the OC mean dose and time for observer-graded xerostomia. Although scatter plots showed no thresholds, an OC mean dose of <40 Gy and contralateral SMG mean dose of <50 Gy were each associated with low patient-reported and observer-rated xerostomia at almost all post-therapy points. CONCLUSIONS The PG, SMG, and OC mean doses were significant predictors of both patient-reported and observer-rated xerostomia after chemo-IMRT, with OC doses remaining significant after adjusting for the PG and SMG doses. These results support efforts to spare all the salivary glands by IMRT, beyond the PGs alone.

UI MeSH Term Description Entries
D009303 Nasopharyngeal Neoplasms Tumors or cancer of the NASOPHARYNX. Cancer of Nasopharynx,Nasopharyngeal Cancer,Cancer of the Nasopharynx,Nasopharynx Cancer,Nasopharynx Neoplasms,Neoplasms, Nasopharyngeal,Cancer, Nasopharyngeal,Cancer, Nasopharynx,Cancers, Nasopharyngeal,Cancers, Nasopharynx,Nasopharyngeal Cancers,Nasopharyngeal Neoplasm,Nasopharynx Cancers,Nasopharynx Neoplasm,Neoplasm, Nasopharyngeal,Neoplasm, Nasopharynx,Neoplasms, Nasopharynx
D009959 Oropharyngeal Neoplasms Tumors or cancer of the OROPHARYNX. Cancer of Oropharnyx,Oropharyngeal Cancer,Cancer of the Oropharynx,Neoplasms, Oropharyngeal,Oropharynx Cancer,Oropharynx Neoplasms,Cancer, Oropharyngeal,Cancer, Oropharynx,Cancers, Oropharyngeal,Cancers, Oropharynx,Neoplasm, Oropharyngeal,Neoplasm, Oropharynx,Neoplasms, Oropharynx,Oropharnyx Cancer,Oropharnyx Cancers,Oropharyngeal Cancers,Oropharyngeal Neoplasm,Oropharynx Cancers,Oropharynx Neoplasm
D010306 Parotid Gland The largest of the three pairs of SALIVARY GLANDS. They lie on the sides of the FACE immediately below and in front of the EAR. Gland, Parotid,Glands, Parotid,Parotid Glands
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D011795 Surveys and Questionnaires Collections of data obtained from voluntary subjects. The information usually takes the form of answers to questions, or suggestions. Community Survey,Nonrespondent,Questionnaire,Questionnaires,Respondent,Survey,Survey Method,Survey Methods,Surveys,Baseline Survey,Community Surveys,Methodology, Survey,Nonrespondents,Questionnaire Design,Randomized Response Technique,Repeated Rounds of Survey,Respondents,Survey Methodology,Baseline Surveys,Design, Questionnaire,Designs, Questionnaire,Methods, Survey,Questionnaire Designs,Questionnaires and Surveys,Randomized Response Techniques,Response Technique, Randomized,Response Techniques, Randomized,Survey, Baseline,Survey, Community,Surveys, Baseline,Surveys, Community,Techniques, Randomized Response
D011879 Radiotherapy Dosage The total amount of radiation absorbed by tissues as a result of radiotherapy. Dosage, Radiotherapy,Dosages, Radiotherapy,Radiotherapy Dosages
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000704 Analysis of Variance A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable. ANOVA,Analysis, Variance,Variance Analysis,Analyses, Variance,Variance Analyses
D012463 Saliva The clear, viscous fluid secreted by the SALIVARY GLANDS and mucous glands of the mouth. It contains MUCINS, water, organic salts, and ptylin. Salivas
D012469 Salivary Glands Glands that secrete SALIVA in the MOUTH. There are three pairs of salivary glands (PAROTID GLAND; SUBLINGUAL GLAND; SUBMANDIBULAR GLAND). Gland, Salivary,Glands, Salivary,Salivary Gland

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