Degree Of Xerostomia Research Articles

Predictive value of delta radiomics in xerostomia after chemoradiotherapy in patients with stage III-IV nasopharyngeal carcinoma

BackgroundXerostomia is one of the most common side effects in nasopharyngeal carcinoma (NPC) patients after chemoradiotherapy. To establish a Delta radiomics model for predicting xerostomia secondary to chemoradiotherapy for NPC based on magnetic resonance T1-weighted imaging (T1WI) sequence and evaluate its diagnostic efficacy.MethodsClinical data and Magnetic resonance imaging (MRI) data before treatment and after induction chemotherapy (IC) of 255 NPC patients with stage III-IV were collected retrospectively. Within one week after CCRT, the patients were divided into mild (92 cases) and severe (163 cases) according to the grade of xerostomia. Parotid glands in T1WI sequence images before and after IC were delineated as regions of interest for radiomics feature extraction, and Delta radiomics feature values were calculated. Univariate logistic analysis, correlation, and Gradient Boosting Decision Tree (GBDT) methods were applied to reduce the dimension, select the best radiomics features, and establish pretreatment, post-IC, and Delta radiomics xerostomia grading predictive models. The receiver operating characteristic (ROC) curve and decision curve were drawn to evaluate the predictive efficacy of different models.ResultsFinally, 15, 10, and 12 optimal features were selected from pretreatment, post-IC, and Delta radiomics features, respectively, and a xerostomia prediction model was constructed with AUC values of 0.738, 0.751, and 0.843 in the training set, respectively. Only age was statistically significant in the clinical data of both groups (P < 0.05).ConclusionDelta radiomics can predict the degree of xerostomia after chemoradiotherapy for NPC patients and it has certain guiding significance for clinical early intervention measures.

Comparison of Free Colon Flap versus Free Jejunum Flap in the Treatment of Xerostomia

After radiation or multiple surgeries for oral cancers the patients may develop various degree of xerostomia. They have difficulty in swallowing and speech, also tend to develop inflammation of mucosa, dental caries and even trismus. When the xerostomia is mild, it can be treated with medication or just by frequent hydration with water. When the xerostomia is more severe surgical correction may be an option, namely using free jejunum or colon flap to provide lubrication. However, in the literature there was no comparison between free colon and free jejunum flap for surgical treatment of xerostomia. Our hospital receives a large number of oral cancers due to consumption of betel nuts which causes 3000 new cases of oral cancers per year in our country. Among our patients 34 had xerostomia treated with surgery. For patients who had no family history of colon cancer and colonoscopy showed no abnormal findings, a free colon flap was selected for reconstruction of xerostomia. When the family history was not clear and the patients were old with polyps during previous colonoscopy, free jejunum flap was used. Technically the free jejunum flap was harvested from the second portion of jejunum. For colon flap a segment was harvested from right colon. The postoperative results were compared regarding easiness of surgery, bacteria count of the flap, amount and quality of lubrication, comfort of the mouth (including flavor of secretion), requirement of secondary debulking procedures, complications of surgery, infection of lung during follow-ups, etc. The patients reported different responses to the spontaneous movement of jejunum flap inside the mouth. The bad smell of colon flap disappeared after 3 months. The results regarding subjective issue were obtained in the outpatient clinic with questionnaire using 5-point likert scale. The objective data such as requirement of secondary debulking procedures, complications of surgery, and infection of lung during follow-ups were analyzed. Conclusion: In terms of quality of lubrication, both groups showed similar results. So far there are no patients who develop cancer from the flaps in either group, but jejunum flap seems to be a safer consideration for patients with long life expectancy.

Potential Predictive Value of Intravoxel Incoherent Motion Magnetic Resonance for Xerostomia of Nasopharyngeal Carcinoma

Xerostomia, caused by radiation-induced parotid damage, is the most commonly reported complications of radiotherapy (RT) to nasopharyngeal carcinoma (NPC). This study aimed to evaluate the value of IVIM MR in monitoring radiation parotid gland damage and predicting the risk of xerostomia. A total of 54 patients were enrolled and underwent IVIM MR scans at before RT, after the fifth fraction, halfway through the course of RT, and at the end of radiotherapy. The parameters of IVIM MR include pseudo-diffusion coefficient (D*), perfusion fraction (f), and pure diffusion coefficient (D). The degree of xerostomia in NPC patients was assessed before each MR examination using the acute radiation morbidity scoring criteria proposed by the Radiation Therapy Oncology Group (RTOG). Concurrently, the time when the patient first reported suffering from xerostomia was recorded. The IVIM parameters trend throughout the RT, and the relationships between IVIM parameters and xerostomia, were analyzed. All of the IVIM parameters increased from pre-RT to post-RT significantly (all p < 0.001). The increase rate of D from pre-RT to halfway through the RT was 32.61%, which was significantly higher than 15.64% from halfway to post-RT (p<0.001), indicating that cell necrosis in the first half of treatment is significantly higher than that in the second half. Both D* and F had significantly increased from pre-RT to halfway through the radiotherapy (p<0.001), with an increase rate of 19.58% and 29.38%, respectively. However, no significant increase was observed from Halfway to post-RT (p>0.05), with an increase rate of 4.10% and 8.30%, respectively. This may be due to radiation-induced vasculitic dilation that is significant in the first half of the radiotherapy but plateaus in the second half. Pre-D (OR = 23.85; 95% CI = 2.39, 237.82; p = .007) and pre-D* (OR = 0.75; 95% CI = 0.63, 0.91; p = 0.003) are independent influencing factors for xerostomia at 3 months after the completion of RT. D and F were significantly higher after the fifth fraction compared with Pre-RT (both p<0.05), respectively increased 31.25% and 25.16%. D* increase by 15% (p = 0.081). IVIM scans can assess parotid gland damage early. And the average time of parotid damage underwent IVIM scan was 5.99 ± 0.84 (day), much earlier than 11.84 ± 2.74 (day) according to RTOG. Our study indicates that IVIM MR can dynamically monitor radiotherapy-induced parotid gland damage, and much earlier and objectively than RTOG.

A CASE-CONTROL STUDY SHOWING THAT ANXIETY PLAYS A ROLE IN PREDICTING BURNING MOUTH SYNDROME

<h3>Objectives</h3> To evaluate the influence of anxiety, depression, and stress in patients with burning mouth syndrome (BMS). <h3>Study Design</h3> A case-control study was carried out with 60 individuals allocated in 3 groups: with BMS, with nonneoplastic oral lesions, and healthy controls. We used the visual analog scale, Beck's Anxiety and Depression inventories, Lipp's Stress Inventory, the Xerostomia Inventory–Dutch version, and a BMS questionnaire. Kruskal-Wallis/Dunn's tests, chi-square tests, and multinomial logistic regression (SPSS 20.0; <i>P</i> < .05) were used. <h3>Results</h3> The BMS group had high visual analog scale scores (<i>P</i> < .001) and higher frequencies of moderate/severe anxiety (<i>P</i> < .001) and depression (<i>P</i> < .001) and showed higher rates of stress in the alert (<i>P</i> = .003), resistance (<i>P</i> < .001), and exhaustion phases (<i>P</i> < .001). When evaluating the Xerostomia Inventory, we observed that 100% of patients with BMS had some degree of xerostomia, 40% reported moderate xerostomia, and 60% reported severe xerostomia (<i>P</i> < .001). All patients with BMS reported burning and dry mouth, 90% dry mouth, 80% dysgeusia, all values significantly higher than in the control group (<i>P</i> < .001). Anxiety increased the risk of SBA independently by 123.8 times (<i>P</i> = .004). <h3>Conclusions</h3> Psychosomatic involvement is associated with SBA, and anxiety is the most important factor.

EVALUATION OF SALIVARY FUNCTION IN PATIENTS SUBMITTED RADIOTHERAPY FOR HEAD AND NECK CANCER AND PHOTOBIOMODULATION

<h3>Objectives</h3> Evaluate the salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation. <h3>Study Design</h3> Cross-sectional study with a quantitative approach carried out in the dentistry service of a reference cancer hospital in Pernambuco between February and September 2019. <h3>Results</h3> The study sample consisted of 23 patients, of both sexes, treated with radiotherapy for cancer in the head and neck region. The patients were submitted to photobiomodulation with an infrared laser, as intraoral applications to prevent mucositis and extraoral applications to stimulate salivary glands. Subjective and objective symptoms were assessed by measuring unstimulated salivary flow (USF) using the spitting technique before, during, and after radiotherapy. At the beginning of treatment, 22 patients had USF >0.2 mL/min (grade 1), at the end of which 15 patients remained unchanged and only 3 patients progressed to grade 3. Regarding subjective classification, the majority remained in grade 1 (absence of disability) throughout treatment (52%). <h3>Conclusions</h3> The use of photobiomodulation did not significantly interfere in the patients' complaint of xerostomia; however, it seems to prevent patients from reaching higher degrees of xerostomia taking into account the measured salivary levels of flow.

Systematic evaluation of laryngeal impairment in Sj\xf6gren\u2019s syndrome

IntroductionSjögren’s syndrome (SjS) causes malfunction of the salivary and lacrimal glands. Consequently, patients suffer from xerostomia and keratoconjunctivitis sicca. This can further affect the voice and swallowing function resulting in an impaired quality of life. Aim of this study is the systematic evaluation of the impact on voice and swallowing-related quality of life in patients with SjS.Material and methodsSjS patients were classified according to the American–European Consensus Group (AECG) criteria; antibodies to Ro (SS-A) or La (SS-B) antigens were detected, ESSPRI was completed. We used the following quality of life questionnaires: EORTC QLQ H&N 35, Anderson Dysphagia Inventory (ADI) and Voice Handicap Index (VHI). Patients additionally received a detailed phoniatric examination (auditory perception, videostroboscopy, acoustic analysis, Dysphonia Severity Index (DSI), aerodynamics measurements).ResultsAlmost all the 54 patients (96.3%) had a limited quality of life due to their swallowing problems and 48% due to their voice problems. Both values correlated significantly with the degree of xerostomia. In the phoniatric examination, 77.8% had an increased DSI and two-thirds had abnormalities in videostroboscopy.ConclusionsA reasonable impairment of quality of life in patients with SjS due to the limitations in voice and swallowing function was observed. As SjS does not limitate life expectancy, preservation of quality of life is important. Detection of voice and swallowing problems as potential reasons for quality of life impairment should be detected and, if diagnosed, treated accordingly.

Evaluation of the salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation.

Background Head and neck radiotherapy is typically associated with toxicities that can have profound effects on the patient's quality of life. Xerostomia, which may or may not be related to hypofunction of the salivary gland, leading to negative consequences, mainly in quality of life, leaving patients more susceptible to the development of oral mucositis, dental caries, oral infection and difficulties in speech is one of the most common side effects of such treatment. The aim of the present study was to evaluate salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation. Material and Methods A cross-sectional study with a quantitative approach was carried out in the Dentistry Department of the Hospital de Câncer de Pernambuco between February and September 2019. Results The study sample comprised 23 patients of both genders, treated with radiotherapy for cancer in the head and neck region. The patients were submitted to photobiomodulation with infrared laser, as intraoral applications in order to prevent mucositis and extraoral applications to stimulate salivary glands. The applications were undertaken three times a week on alternate days throughout the radiotherapy period. The following parameters were used: Intraoral 15mW, 12J / cm2, 10s / point, 2.4 J / point, and extraoral 30mW, 7.5J / cm2, 10s / point, 0.3J / point, both with a wavelength of 830nm and area of 0.028cm². Subjective and objective symptoms were evaluated by measuring the unstimulated salivary flow (USF) using the spitting technique before, during and after radiotherapy treatment. For statistical analysis, a significance level of 5% was adopted. Most patients were male (70%) with 60 years of age on average. At the beginning of treatment, 22 patients had USF> 0.2 ml / min (grade 1), at the end of which 15 patients remained unchanged and only 3 patients progressed to grade 3. As for the subjective classification, most (52%) remained in grade 1 (absence of disability) throughout the treatment. Conclusions Based upon the results of this study it was possible to conclude that the use of photobiomodulation did not significantly interfere with the xerostomia complaint of patients in treatment with radiotherapy, however, it does seem to prevent patients from reaching higher degrees of xerostomia taking into account salivary flow measures. Key words:Photobiomodulation, head and neck neoplasms, radiotherapy, xerostomia, saliva.

Clinical observation on prevention and treatment of radiation-induced parotid-gland injury in patients with nasopharyngeal carcinoma by Compound Sarcandra Glabra

ObjectiveTo investigate the protective effect of the Compound Sarcandra Glabra on radiation injury of parotid glands in patients with nasopharyngeal carcinoma. MethodsSixty patients with primary nasopharyngeal carcinoma in the First Affiliated Hospital of Guangxi Medical University from June 2018 to January 2019 were collected, which were divided into treatment group and control group using a random number table. All patients were treated by a combination of 9-field intense-modulated radiotherapy and chemotherapy. The treatment group was given the Compound Sarcandra Glabra orally every day from 3 days before radiotherapy to the end. The degree of xerostomia (dry mouth) of patients was compared between the two groups at the end of radiotherapy and 3 months after radiotherapy by the chi-square test. The maximal adsorption and secretion rates of the parotid glands were compared between groups before radiotherapy, at the end of radiotherapy and 3 months after radiotherapy by the independent sample t-test. ResultsThe symptoms of dry mouth were alleviated in the treatment group, and the degree of dry mouth significantly differed between groups at the end of radiotherapy and 3 months after radiotherapy (χ2 ​= ​6.696 and 10.977, P ​< ​0.05). There were no significant differences in the maximal adsorption and secretion rates of the parotid glands between groups before radiotherapy (t ​= ​0.974 and −4.646, P ​> ​0.05); however, both variables were significantly higher in the treatment group at the end of radiotherapy and 3 months after radiotherapy (t ​= ​2.920 and 5.037; t ​= ​2.820 and 2.213, P ​< 0.05). Patients presented no liver and kidney injury after radiotherapy. ConclusionsOral administration of the Compound Sarcandra Glabra can effectively prevent radiation injury of the parotid glands in patients with nasopharyngeal carcinoma, thereby alleviating the degree of dry mouth after radiotherapy.

Prospective assessment of gustatory function after radiotherapy for head and neck cancers.

Taste disorders are major causes of morbidity in patients undergoing head and neck irradiation. We quantitatively assessed the gustatory function of patients with head and neck cancers who underwent radiotherapy using recently developed standardised tools for measuring taste. Twenty patients undergoing head and neck irradiation responded to a specific questionnaire and were assessed by olfactory and gustatory function tests. To assess changes over time, testing was performed before, immediately after, and at 2- and 4-week intervals following the start of radiotherapy. Concurrently, patients were evaluated for xerostomia from radiotherapy. A decrease in the taste recognition threshold was observed in the second week after the beginning of radiotherapy. The taste detection threshold improved within the 14th-18th week. Most affected patients demonstrated that their gustatory function primarily decreased independent of the olfactory function. Disturbances in taste were exponentially worsened beyond an accumulated dose of 30Gy and involved all tastants. According to a multivariate analysis, radiation-induced taste impairment was not influenced by the degree of xerostomia. However, there was an association between the dose of irradiation and the severity of taste disturbance. In this preliminary study, we found that the taste function was worse 2weeks after the start of radiotherapy and returned to pretreatment levels within 4.5months. Taste disturbances were exponentially worse beyond an accumulated dose of 20Gy. Taste dysfunction after radiotherapy was not influenced by the degree of xerostomia, whereas only the dose of irradiation was associated with the severity of taste dysfunction.

Potential Applications of 68Ga-PSMA-11 PET/CT in the Evaluation of Salivary Gland Uptake Function: Preliminary Observations and Comparison with 99mTcO4− Salivary Gland Scintigraphy

Purpose To preliminarily evaluate the feasibility and potential of using 68Ga-PSMA-11 PET/CT in evaluating the function of salivary glands and lacrimal glands in comparison with 99mTc-pertechnetate (99mTcO4−) salivary gland scintigraphy (SGS). Methods A retrospective study was performed in 15 patients with different degrees of xerostomia and suspected salivary gland dysfunction. Each patient underwent 68Ga-PSMA-11 PET/CT first and SGS the next day, and the findings of both scans were compared. Results The results of 68Ga-PSMA-11 PET/CT and SGS were consistent in 12/15 patients (80%) and were inconsistent in the remaining patients (20%). For 5 (33.3%) of 15 patients, 68Ga-PSMA-11 PET/CT provided more information than did SGS. Additionally, 68Ga-PSMA-11 PET/CT corrected the misdiagnosis by SGS for 1 patient. Conclusions 68Ga-PSMA-11 PET/CT is a potentially useful imaging tool for evaluating the function of salivary glands and lacrimal glands. 68Ga-PSMA-11 PET/CT can be a promising supplement to SGS, and its clinical value deserves further study.

Disruption of tight junction structure contributes to secretory dysfunction in IgG4-related sialadenitis.

IgG4-related sialadenitis (IgG4-RS) is a chronic fibro-inflammatory disease characterized by swelling of salivary glands and varying degrees of xerostomia. Tight junctions (TJs) play an essential role in maintaining secretory function by regulating the paracellular flow of ions and water. However, whether TJs are altered and contribute to the hyposecretion in IgG4-RS is not fully understood. Here, a total of 399 differentially expressed proteins were identified in IgG4-RS submandibular glands (SMGs) and enriched in the regulation of actin cytoskeleton and the salivary secretion. Real-time PCR results showed that the mRNA levels of claudin-3, -4, -6, -7, -8, -10, -12, occludin, and ZO-1 were significantly lower, whereas claudin-1 and -5 were higher in IgG4-RS SMGs. Immunohistochemical and immunofluorescence staining revealed that claudin-1, -3, -4, occludin, and ZO-1 were mainly distributed at apicolateral membranes in acini and ducts of SMGs from controls, whereas claudin-1 protein intensity at apicolateral membrane was elevated, while the staining of claudin-3, -4, and ZO-1 were reduced in IgG4-RS SMGs. Occludin was dispersed into cytoplasm of acini and ducts in SMGs of patients. Among them, claudin-3 and ZO-1 protein levels were positively correlated with saliva flow rate. Furthermore, the decreased fluorescence intensity of F-actin at peri-apicolateral membranes and the loss of ZO-1 staining at the same location were observed in acinar and ductal cells of IgG4-RS SMGs, which might be responsible for disorganization of TJ complex. Taken together, these findings indicate that the integrity of TJ complex of SMGs is impaired and might contribute to hyposalivation of IgG4-RS patients.

Unusual Conditions Impairing Saliva Secretion: Developmental Anomalies of Salivary Glands.

Salivary glands (SG) arise from ectodermal tissue between 6 and 12th weeks of intrauterine life through finely regulated epithelial-mesenchymal interactions. For this reason, different types of structural congenital anomalies, ranging from asymptomatic anatomical variants to alterations associated with syndromic conditions, have been described. Notable glandular parenchyma anomalies are the SG aplasia and the ectopic SG tissue. Major SG aplasia is a developmental anomaly, leading to variable degrees of xerostomia, and oral dryness. Ectopic SG tissue can occur as accessory gland tissue, salivary tissue associated with branchial cleft anomalies, or true heterotopic SG tissue. Among salivary ducts anomalies, congenital atresia is a rare developmental anomaly due to duct canalization failure in oral cavity, lead to salivary retention posterior to the imperforate orifice. Accessory ducts originate from the invagination of the developing duct in two places or from the premature ventral branching of the main duct. Heterotopic ducts may arise from glandular bud positioned in an anomalous site lateral to the stomodeum or from the failure of the intraoral groove development, hindering their proximal canalization. These anomalies require multidisciplinary approach to diagnosis and treatment. While ectopic or accessory SG tissue/ducts often do not require any treatment, patients with SG aplasia could benefit from strategies for restoring SG function. This article attempts to review the literature on SG parenchyma and ducts anomalies in head and neck region providing clinicians with a comprehensive range of clinical phenotypes and possible future applications of bioengineered therapies for next-generation of regenerative medicine.

Relationship between patient and physician-rated xerostomia and dose distribution to the oral cavity and salivary glands for head and neck cancer patients after radiotherapy

Introduction: Xerostomia is a frequent complication after curative intended radiotherapy (RT) for head and neck squamous cell carcinoma (HNSCC). Assessment of xerostomia is commonly done by the physician. The aim of this study is to investigate the relation between patient and physician-rated xerostomia and to predict the degree of xerostomia from patients with self-reported xerostomia based on delivered doses to the oral cavity, parotid, and submandibular glands.Material and methods: During a 2-year period, consecutive HNSCC patients attending the follow-up clinic were included. All included patients had self-reported xerostomia, and completed the disease-specific EORTC QLQ-H&N35 questionnaire. The physician assessed the degree of xerostomia with the DAHANCA toxicity scale and was blinded for the EORTC score. Oral cavity, parotid, and submandibular glands (OAR) were delineated on the planning CT according to international guidelines. DVH were extracted from treatment plans. Logistic regression tested the relation between mean doses, patient characteristics, and xerostomia scores. Differences between DVH values and scoring of xerostomia were analyzed with a Kruskal–Wallis test. The relation between xerostomia and dose distributions was further investigated using principal component analysis (PCA).Results: In total, 109 patients were included in the study. A weak correlation was seen between patient and physician-rated toxicity (p = .001), however, in general patients reported more toxicity than physicians. For EORTC score ≥2, the multi-variable analysis was significant for doses to the oral cavity, tobacco status and use of xerogenic medication. Neither the DVH analysis nor the PCA found any clear distinction between xerostomia scores for EORTC or DAHANCA and investigated OARs.Conclusion: Patients tended to report higher scores of xerostomia than the physician. PCA indicated a complex relation between doses to the OAR and xerostomia scores, showing e.g., that reducing doses in one organ was on the expense of increased dose to another organ.

Impact of xerostomia on the quality of life of patients submitted to head and neck radiotherapy

Background The aim of the present work was to evaluate the impact of xerostomia on the quality of life of patients who underwent radiotherapy in the head and neck region. Material and Methods This was a cross-sectional, quantitative study. The sample comprised 40 patients whose xerostomia was classified through the xerostomia inventory and the quality of life evaluated through the oral health impact profile questionnaire (OHIP). Results The majority of participants were male (75%), mean age 58.7 years. According to the degree of severity of the xerostomia, the average score among the participants was 36 points, this being considered moderate xerostomia. A significant impact was observed, with the median score 11 points, with the highest scores in the domains related to functional limitation, physical pain and physical disability. The majority of the participants (97.5%) had reduced salivary flow after the end of radiotherapy. There was a significant positive correlation between the degree of xerostomia and reduced quality of life, Pearson correlation 0.5421, (p< 0.05). Conclusions Based upon the results it is concluded that xerostomia has a negative impact on the quality of life of patients who undergo radiotherapy in the head and neck region. Key words:Head and neck neoplasms, radiotherapy, xerostomia, quality of life.

Diagnostic value of acustic radiation force impulse imaging in the assessment of salivary gland involvement in primary Sjögren's sydrome.

The aim of this study is to investigate the diagnostic value of Acoustic Radiation Force Impulse (ARFI) imagingin the assessment of salivary gland involvement in primary Sjögren's syndrome (pSS). Twenty fivepatients with pSS and 25 healthy volunteers were included. First, echostructures and the thickness of the submandibular andparotid glands were evaluated by B-mode ultrasonography. Then, ARFI imaging with Virtual Touch Quantification® wasperformed. Ten independent shear wave velocity measurements were taken from each gland. Finally, the mean shear wavevelocity (SWV) values were calculated, and used for further analysis. The mean SWV values of parotid and submandibularglands were significantly higher in the pSS patients than in the healthy control group (p<0.001). The cut-off of SWVvalues were calculated to be 1.98 m/s for submandibular glands, and 1.93 m/s for parotid glands. In pSS patients, the meanSWV values of parotid glands were higher than those of the submandibular glands (p<0.001) and no statistically significantrelationships between symptom duration or the degree of xerostomia and mean SWV values of parotid and submandibularglands were found (all p>0.005). Our findings indicate that ARFI imaging may provide a non-invasive, simpleand fast means of assessment of glandular impairment as an alternative test when other salivary gland tests are inconclusive orcannot be performed. ARFI may be a valuable adjunct for the clinical diagnosis of pSS.

The protective effect of optimized target delineation in intensity modulated radiation therapy on swallowing function in patients with different TNM staging of nasopharyngeal carcinoma

Objective:To investigate the protective effect of optimized target delineation in intensity modulated radiation therapy(IMRT) on swallowing function in patients with different TNM staging of nasopharyngeal carcinoma.Method:Fifty patients with nasopharyngeal carcinoma were enrolled in this study. They were randomly divided into 25 cases of experimental group and 25 cases of control group by random number table and received IMRT treatment. Patients in control group only received routine delineation of target areas, the patients in experimental group were given the delineation of the relevant parts of the swallowing on the basis of the control group.And then, the degree of dysphagia, xerostomia, weight loss, and quality of life were assessed in the two groups of patients during and after IMRT.Result:There was no significant change in the degree of dysphagia in stage Ⅱ patients during radiotherapy, but the degree of dysphagia in stage Ⅲ and Ⅳ patients increased with the increase of radiotherapy time. After the end of radiotherapy, there was no significant change in the degree of dysphagia in the control group of patients. Compared with the 0th week after the end of radiotherapy, the stage Ⅱ patients in experimental group showed significant improvement in week 12(P<0.05), while the stage Ⅲ and Ⅳ patients showed significant improvement in week 24 after radiotherapy(P<0.05). The degree of xerostomia of two groups of patients continued to increase with varying degrees during and after IMRT(P<0.05 or P<0.01). The weight of the two groups of patients during radiotherapy continued to decrease with the increase of radiotherapy time,and gradually recovered after the end of radiotherapy.And in the experimental group, the weight loss was significantly lower in week 12 and week 24 than in the control group (P<0.05). During radiotherapy, the quality of life scores of the two groups became lower and lower with the increase of radiotherapy time compared with the 0th week of radiotherapy. After the end of radiotherapy, the quality of life began to gradually improve, and in week 24 after the end of radiotherapy, the quality of life of the experimental group of patients was significantly higher than that of the control group (P<0.05).Conclusion:During radiotherapy of patients with nasopharyngeal carcinoma, the structural organs associated with swallowing function are given individualized target delineation can reduce the occurring of dysphagia due to radiotherapy and improve the quality of life of patients after radiotherapy.

Early Changes in Apparent Diffusion Coefficient for Salivary Glands during Radiotherapy for Nasopharyngeal Carcinoma Associated with Xerostomia.

ObjectiveTo evaluate the early changes in the apparent diffusion coefficient (ADC) of the salivary glands during radiotherapy (RT) and their association with the degree of xerostomia at 6 months after RT in patients with nasopharyngeal carcinoma (NPC).Materials and MethodsWe enrolled 26 patients with NPC who underwent RT. Each patient underwent diffusion-weighted MRI of the salivary glands at rest and with gustatory stimulation within 1 week before RT and 2 weeks after the beginning of RT. The ADC at rest (ADCR) and increase and increase rate with stimulation (ADCI, ADCIR) of the submandibular and parotid glands were calculated. The differences in the variables' values between 2 weeks after the beginning of RT and baseline (ΔADCR, ΔADCI, and ΔADCIR) were compared to the degree of xerostomia at 6 months after RT.ResultsThe ADCR of the submandibular and parotid glands were both significantly higher at 2 weeks after the beginning of RT than found at baseline (both p < 0.01). The ADCI and ADCIR for the parotid glands were both significantly lower at 2 weeks after the beginning of RT than found at baseline (both p < 0.01). ΔADCI and ΔADCIR of the parotid glands were associated with the degree of xerostomia at 6 months after RT (r = −0.61 and −0.72, both p < 0.01).ConclusionThe ADCs of the salivary glands change early during RT. The differences in the ADC increase and increase rate of the parotid glands between 2 weeks after the beginning of RT and baseline were associated with the degree of xerostomia at 6 months after RT.

Oral shedding of human herpesviruses in patients undergoing radiotherapy/chemotherapy for head and neck squamous cell carcinoma is not affected by xerostomia

ABSTRACT Background: Xerostomia is a very relevant and frequent complication of radiotherapy, causing the irradiated oral mucosa to be affected by bacterial, fungal and viral infections. Objective: The objective of this study was to evaluate a possible relationship between oral shedding of human herpesviruses and xerostomia in patients with squamous cell carcinoma of head and neck submitted to radio/chemotherapy. Methods: In this study, oral rinse samples were collected weekly from 20 patients during radiotherapy. The samples were submitted to PCR and enzymatic digestion for detection of human herpesviruses. Xerostomia was evaluated according to the Seminars in Radiation Oncology criteria. Results: There was a higher frequency of grade 1 xerostomia (51.4%), observed first in the 1st week of radiotherapy. In the 4th week of radiotherapy, all patients presented some degree of xerostomia. Analysis of herpesviruses showed oral shedding of EBV, HHV-6 and HHV-7 in all weeks. Considering all the periods, the highest frequency was in patients with EBV excretion (55.0%), which was significantly higher than that of other viruses. Conclusion: We observed that oral shedding of herpesviruses was not affected by xerostomia as there was a progression in their excretion, even with the evolution of xerostomia. This suggested that there is a local replication in the oral cavity that is not completely dependent of salivary excretion.

The effect of submandibular gland preservation during level 1B neck dissection on postoperative xerostomia

ObjectiveCompare the presence and degree of postoperative xerostomia following preservation or excision of the submandibular gland (SMG) during level IB neck dissection (ND) without adjuvant radiation. MethodsRetrospective review with patient questionnaire administered to patients with pT1-2N0 oral squamous cell carcinoma (SCC) who underwent resection and ND with SMG preservation or SMG excision without postoperative radiation from 2011 to 2015. We analyzed an additional control group that was age and gender-matched and had not undergone oral resection or SMG excision. We compared the scores reported by the three groups from three questionnaires: University of Michigan Xerostomia Quality of Life (XeQoL), Short Form-8 (SF-8), and a xerostomia severity scale (XSS). Dry mouth severity (DMS) was calculated based on XSS scores among those complaining of any xerostomia. ResultsEleven SMG preservation group, 14 SMG excision group and 15 control group patients completed the survey. Complication and recurrence rates were comparable among experimental groups. No differences were identified between the two experimental groups for the XeQoL, SF-8, and XSS questionnaires (p=0.96, 0.87, 0.7). Control patients reported less xerostomia on XeQoL (p=0.046) and XSS (p=0.01) compared to the experimental groups combined with no statistical difference in SF-8 scores (p=0.25). No patients in either group developed regional recurrence in level IB. ConclusionSMG preservation, though technically and oncologically sound, does not appear in this study to reduce xerostomia. Oral resection with ND may result in some degree of xerostomia perception.

Application of ultrasound in evaluating degree of xerostomia in patients with nasopharyngeal carcinoma receiving radiotherapy

Objective To investigate the effectiveness of ultrasound in evaluating the degree of xerostomia in the patients with nasopharyngeal carcinoma (NPC) receiving intensity-modulated radiotherapy (IMRT). Methods A total of 30 NPC patients who were admitted to our hospital from May 2013 to December 2014 were enrolled in this study. The degree of xerostomia in these NPC patients was scored according to the Radiation Therapy Oncology Group scoring criteria. Color Doppler ultrasound was used to measure the peak systolic blood flow velocity of the parotid gland and submandibular gland and the changes in vascular diameter of the parotid gland in the NPC patients before, during, and after IMRT. The correlation between each parameter and the degree of xerostomia was determined by analysis of variance. Results In the 28 NPC patients included in the statistical analysis, the degree of xerostomia during IMRT was significantly higher than that before IMRT (P=0.024), and the degree of xerostomia at 3 months after IMRT was significantly lower than that during IMRT (P=0.035). The peak systolic blood flow velocity of the parotid gland and submandibular gland and the proportion of patients with decreases in vascular diameter of the parotid gland during IMRT were significantly higher than those before IMRT (P=0.001 and 0.003; P=0.001); the above parameters at 3 months after IMRT were significantly lower than those during IMRT (P=0.008 and 0.012; P=0.001). During IMRT and after IMRT, the degree of xerostomia was significantly correlated with the peak systolic blood flow velocity of the parotid gland (r=0.563, P=0.026; r=0.409, P=0.031). Conclusions Ultrasound can be used as a noninvasive detection for the hemodynamic changes in the parotid gland, and it has a certain clinical reference value for evaluating the degree of xerostomia in NPC patients during and after IMRT. Key words: Blood flow of parotid gland; Xerostomia; B ultrasound detection; Nasopharyngeal neoplasms/radiotherapy