Abstract
Purpose: Xerostomia is a well known complication of radiation for head and neck cancer. It causes significant impairment of Quality Of Life (QOL).Comprehensive assessment is possible with the help of scintigraphy, Dose-volume histogram (DVH) parameters as well as QOL questionnaire. Methods: Thirty patients of head and neck cancer undergoing radiation were assessed for xerostomia. Scintigraphic assessment of parotid gland function was done before and at six weeks after radiation. QOL questionnaire was administered before, during, and at six weeks after radiation as well as at two years of follow up. Dose received by parotids were correlated with scintigraphic and QOL outcomes. Results: Mean parotid gland volume and dose received were 24.9 cc and 45.3 Gy respectively. Mean Salivary Excretion Factor (SEF) decreased from 54.1 to 12 at six weeks after radiation. QOL scores worsened from first week (mean value: 2.37) of radiotherapy (RT) to fourth week (mean value: 15.50, p < 0.0000) , remained same till completion of RT (mean value: 17.57, p = 0.1063) and at six weeks after radiation (mean value:16.10, p = 0.2519 ). There was a significant decrease in QOL scores between post RT six weeks versus two years follow up (p < 0.0000). Mean parotid dose and QOL scores correlated at six weeks (p < 0.0000), whereas no correlation was found between SEF and QOL. Conclusion: Comprehensive assessment of parotid gland function with Scintigraphy, QOL questionnaire and its correlation with dose volume parameters is helpful in quantifying xerostomia. Even though radiation induced xerostomia persisted for a long time after radiation, it did not translate to decreased QOL.
Highlights
Over 200,000 cases of head and neck cancers occur each year in India accounting for 30% of all cancers in males and 11 to 16% of all cancers among females
In scintigraphy the mean maximal uptake of the tracer prior to RT ranged from 789 ct/s to 7980 ct/s with a mean of 2921 ct/s with no significant differences between the two sides
The mean parotid dose in those treated with intensity modulated radiation therapy (IMRT) was 30.8 Gy, which is similar to the 30.02 Gy by Chao et al.[11] though marginally higher compared to 28 Gy by Van Rij et al.[10] who studied the xerostomia related Quality Of Life (QOL) in patients treated with parotid sparing IMRT
Summary
Over 200,000 cases of head and neck cancers occur each year in India accounting for 30% of all cancers in males and 11 to 16% of all cancers among females. Xerostomia is one of the most important sequelae of radiation, which interferes with the Quality Of Life (QOL) of the patient. It lasts for up to several months to years and may or may not recover, depending on the volume of salivary glands irradiated, the total radiation dose and individual patient variation.[3] With the advent of computed tomography (CT) based planning, quantification of dose received by parotid is possible. The different ways of assessing parotid gland function are scintigraphy[4], QOL questionnaire[5, 6, 7] among many others.
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