Evaluation of Xerostomia in Patients with Head and Neck Squamous Cell Carcinoma Treated with Radiotherapy

Abstract

Background: The sixth most prevalent cancer in the world is head and neck squamous cell carcinoma (HNSCC). In multiple combinations, surgery, radiation and chemotherapy are used in HNC control. As radiation-induced salivary gland damage and xerostomia is one of the most usual and distressing impacts, diffusion-weighted magnetic resonance imaging (DW-MRI) is a promising technique for the assessment of alterations due to radiation therapy. The aim of the study is to evaluate the effect of Chemoradiotherapy either concurrent or sequential/RTH on salivary glands using DW-MRI performed before and after chemoradiotherapy/RTH, correlation between DW-MRI changes and delivered radiation dose to salivary glands, study the acute toxicity of chemoradiotherapy/RTH on salivary glands and assess quality of life for patients with radiation-induced xerostomia. Patients and Methods: This prospective study included 43 patients with Head and Neck squamous cell carcinoma treated with definitive radiotherapy, sequential therapy or concurrent chemoradiotherapy at Clinical Oncology and Nuclear Medicine Department, MRI diffusion scans were done at Diagnostic Radiology Department Tanta University Hospitals throughout the period from May 2016 to May 2019. DW-MRI performed before and after RTH. For patients receiving CCRTH, DW sequence will be performed before starting RTH and 2 - 3 months post-RTH once at rest and then repeated continuously during salivary stimulation by ascorbic acid. In case of induction chemotherapy, DW-MRI was done before and after induction and 2 - 3 months post-RTH. Results: In all time periods, ADC values were lower for the PG than the SMG. ADC change of PGs was higher in hypopharyngeal carcinoma, while ADC change of SMGs were higher in oropharyngeal carcinoma. ADC change in PGs & SMGs was higher in advanced stage. Conclusion: To assess the radiation-induced xerostomia, DW-MRI can be used as non-invasive tool. Xerostomia questionnaire is helpful instrument for evaluating of quality of life for patients with radiation-induced xerostomia. There was a significant correlation between xerostomia and quality of life.