Abstract
Hyposalivation and sensation of dry mouth (xerostomia) are one of the most common adverse effects in the treatment of patients with head and neck cancer.Objective:This study evaluates the prevalence of late hyposalivation and associated factors in survivors of squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx treated with radiotherapy with or without concomitant chemotherapy.Methodology:A cross-sectional study was conducted with 88 patients who had concluded radiotherapy at least three months before the study, at a referral center for the treatment of head and neck cancer in the Southern region of Brazil. Hyposalivation was evaluated based on the stimulated salivary flow rate using the spitting method. Multivariate analysis using binary logistic regression was performed to determine the associations between hyposalivation and clinical and demographic variables.Results:Hyposalivation was found in 78.41% of the sample and the mean radiation dose was 63.01 Gy (±9.58). In the crude model of the multivariate analysis, hyposalivation was associated with higher doses of radiation (p=0.038), treatment with concomitant radiotherapy and chemotherapy (p=0.005), and time elapsed since the end of radiotherapy (p=0.025). In the adjusted model of the multivariate analysis, hyposalivation was only associated with dose and time elapsed. Patient who received higher doses of radiation had a 4.25-fold greater chance of presenting hyposalivation, whereas a longer time elapsed since the end of radiotherapy exerted a 75% protective effect against the occurrence of hyposalivation.Conclusion:Hyposalivation is a highly prevalence late-onset side effect of radiotherapy in patients treated for head and neck cancer, with a greater chance of occurrence among those who received higher doses of radiation and those who ended therapy less than 22 months before our study. Concomitant chemotherapy and radiotherapy does not seem to increase the chances of hyposalivation compared to radiotherapy alone.
Highlights
Cancer of the oral cavity, pharynx, and larynx corresponds to approximately 4.6% of all cases of cancer worldwide.1 In 2018, 834,860 new cases of cancer in these anatomic sites were diagnosed.1 When anatomic sub-sites are analyzed, the incidence of cancer of the mouth and oropharnyx is higher, followed by cancer of the larynx and hypopharynx.2 Due to demographic changes, the number of cases of lip, mouth, and pharyngeal cancer is expected to increase by 62%, reaching 856,000 cases annually by 2035.Radiotherapy (RT) is widely employed in the treatment of head and neck cancer used as primary therapy, adjunct therapy to surgery, with concomitant chemotherapy (CT) or as palliative treatment
This study evaluates the prevalence of late hyposalivation and associated factors in survivors of squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx treated with radiotherapy with or without concomitant chemotherapy
In the crude model of the multivariate analysis, hyposalivation was associated with higher doses of radiation (p=0.038), treatment with concomitant radiotherapy and chemotherapy (p=0.005), and time elapsed since the end of radiotherapy (p=0.025)
Summary
Cancer of the oral cavity, pharynx, and larynx corresponds to approximately 4.6% of all cases of cancer worldwide. In 2018, 834,860 new cases of cancer in these anatomic sites were diagnosed. When anatomic sub-sites are analyzed, the incidence of cancer of the mouth and oropharnyx is higher, followed by cancer of the larynx and hypopharynx. Due to demographic changes, the number of cases of lip, mouth, and pharyngeal cancer is expected to increase by 62%, reaching 856,000 cases annually by 2035.Radiotherapy (RT) is widely employed in the treatment of head and neck cancer used as primary therapy, adjunct therapy to surgery, with concomitant chemotherapy (CT) or as palliative treatment. Cancer of the oral cavity, pharynx, and larynx corresponds to approximately 4.6% of all cases of cancer worldwide.. In 2018, 834,860 new cases of cancer in these anatomic sites were diagnosed.. When anatomic sub-sites are analyzed, the incidence of cancer of the mouth and oropharnyx is higher, followed by cancer of the larynx and hypopharynx.. Radiotherapy (RT) is widely employed in the treatment of head and neck cancer used as primary therapy, adjunct therapy to surgery, with concomitant chemotherapy (CT) or as palliative treatment. High doses of RT can negatively affect the soft and hard tissues of the oral cavity.. Patients with head and neck cancer are generally irradiated with high doses (50 to 70 Gy), which side-effects include hyposalivation, trismus, and dysphagia; in hard tissues, the effects may be osteoradionecrosis and radiation caries – all of which have a late-onset. High doses of RT can negatively affect the soft and hard tissues of the oral cavity. Patients with head and neck cancer are generally irradiated with high doses (50 to 70 Gy), which side-effects include hyposalivation, trismus, and dysphagia; in hard tissues, the effects may be osteoradionecrosis and radiation caries – all of which have a late-onset.
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