Xerostomia Scores Research Articles

Assessment of Risk of Xerostomia After Whole-Brain Radiation Therapy and Association With Parotid Dose

Whole-brain radiation therapy (WBRT) delivers a substantial radiation dose to the parotid glands, but the parotid glands are not delineated for avoidance and xerostomia has never been reported as an adverse effect. Minimizing the toxic effects in patients receiving palliative treatments, such as WBRT, is crucial. To assess whether xerostomia is a toxic effect of WBRT. This observational cohort study enrolled patients from November 2, 2015, to March 20, 2018, at 1 academic center (University of North Carolina Hospitals) and 2 affiliated community hospitals (High Point Regional Hospital and University of North Carolina Rex Hospital). Adult patients (n = 100) receiving WBRT for the treatment or prophylaxis of brain metastases were enrolled. Patients who had substantial baseline xerostomia or did not complete WBRT or at least 1 postbaseline questionnaire were prospectively excluded from analysis and follow-up. Patients received 3-dimensional WBRT using opposed lateral fields covering the skull and the C1 or C2 vertebra. Per standard practice, the parotid glands were not prospectively delineated. Patients completed the University of Michigan Xerostomia Questionnaire and a 4-point bother score at baseline, immediately after WBRT, at 1 month, at 3 months, and at 6 months. The primary end point was the 1-month xerostomia score, with a hypothesized worsening score of 10 points from baseline. Of the 100 patients enrolled, 73 (73%) were eligible for analysis and 55 (55%) were evaluable at 1 month. The 73 patients included 43 women (59%) and 30 men (41%) with a median (range) age of 61 (23-88) years. The median volume of parotid receiving at least 20 Gy (V20Gy) was 47%. The mean xerostomia score was 7 points at baseline and was statistically significantly higher at each assessment period, including 21 points immediately after WBRT (95% CI, 16-26; P < .001), 23 points (95% CI, 16-30; P < .001) at 1 month, 21 points (95% CI, 13-28; P < .001) at 3 months, and 14 points (95% CI, 7-21; P = .03) at 6 months. At 1 month, the xerostomia score increased by 20 points or more in 19 patients (35%). The xerostomia score at 1 month was associated with parotid dose as a continuous variable and was 35 points in patients with parotid V20Gy of 47% or greater, compared with only 9 points in patients with parotid V20Gy less than 47% (P < .001). The proportion of patients who self-reported to be bothered quite a bit or bothered very much by xerostomia at 1 month was 50% in those with parotid V20Gy of 47% or greater, compared with only 4% in those with parotid V20Gy less than 47% (P < .001). At 3 months, this difference was 50% vs 0% (P = .001). Xerostomia was not associated with medication use. Clinically significant xerostomia occurred by the end of WBRT, appeared to be persistent, and appeared to be associated with parotid dose. The findings from this study suggest that the parotid glands should be delineated for avoidance to minimize these toxic effects in patients who undergo WBRT and often do not survive long enough for salivary recovery.

A Phase II Study of Two-Step Intensity Modulated Radiation Therapy (IMRT) with Chemotherapy for Loco-Regionally Advanced Nasopharyngeal Cancer (NPC) (JCOG1015)

A phase II study of adaptive two-step IMRT with chemotherapy (Cx) for NPC (JCOG1015, UMIN-CTR: UMIN000005448) was conducted to evaluate the efficacy and safety. Acute toxicities and treatment compliance had been reported, and this is the final report on efficacy. Patients (pts) aged 20-75 years with stages II-IVB NPC with performance status of 0-1 were enrolled. As adaptive two-step IMRT, computed tomography planning was done twice before the start of IMRT for initial plan of 46 Gy/23 fractions (fr) and at the third or fourth week of treatment for boost plan of 24 Gy/12 fr with a total radiation dose of 70 Gy/ 35 fr. Individual case review was performed. Cx (cisplatin 80 mg/ m2 /3-weeks × 3 cycles) was given concurrently with IMRT, followed by adjuvant Cx (cisplatin 70 mg/ m2 with 5-FU 700 mg/m2 for 5 days/4-weeks × 3 cycles). The primary endpoint was 3-year overall survival (OS). The sample size was set as 75 pts by precision-base so that the 95% confidence interval (CI) for the estimated 3-year OS would be ±10% around the expected value of 74% based on the predicted proportion of stage (UICC 7th) II:III:IV = 20%:40%:40%. If upper limit of the 95% CI of estimated 3-year OS based on the actual proportion of stage was not lower than the expected value of target population by the conventional treatment, we conclude that adaptive two-step IMRT method was to be considered as a standard treatment. As a secondary endpoint, xerostomia score was evaluated. The expected incidences of Grade 2 or more xerostomia at 1, 2, and 3 years after IMRT were 30%, 25%, and 20%. From April 2011 to October 2014, 75 pts were enrolled from 12 institutions. The pts consisted of 60 men and 15 women with the median age of 55 years (range, 28-75). At least 2 cycles of concurrent Cx with a total dose of 70 Gy was completed in 74 pts (99%). However, the full protocol treatment including 3 cycles of adjuvant Cx was completed for 39 pts (52%). The 3-year OS for the 75 pts was 88% [95% CI; 78%-94%]. The upper and lower limit of the 95% CI of the 3-year OS (94%) was higher than the target population’s expected 3-year OS of 75% adjusted by the stage with actual proportion of stage II:III:IV = 21%:44%:35%; thus the primary endpoint was met. The 3-year progression-free survival (PFS) and loco-regional PFS were 71% [59%-80%] and 77% [66%-85%]. Loco-regional recurrences were noted in 13 pts (17%). In terms of late toxicities, 15 pts (20%) showed grade 3 toxicities including hearing impaired, aspiration, and dysphagia. No grade 4-5 toxicities were noted. Grade 2 or more xerostomia was noted in 26% (18/70), 12% (8/69), and 9% (6/65) at 1, 2, and 3 years after start of IMRT. Adaptive two-step IMRT for NPC showed an excellent 3-year OS with acceptable toxicities, and the incidence of xerostomia was satisfactorily low. This method would be a new standard treatment for locally advanced NPC.

Early Prediction of Acute Xerostomia During Radiation Therapy for Head and Neck Cancer Based on Texture Analysis of Daily CT

To investigate radiation-induced changes of computed tomography (CT)textures in parotid glands (PG) to predict acute xerostomia during radiotherapy (RT) for head and neck cancer (HNC). Daily or fraction kilovoltage CTs acquired using diagnostic CT scanners (eg, in-room CTs) during intensity-modulated RT for 59 HNC patients at 3 institutions were analyzed. The PG contours were generated on selected daily/fraction CTs. A series of histogram-based texture features, including the mean CT number (MCTN) in Hounsfield units, volume, standard deviation, skewness, kurtosis, and entropy for PGs were calculated for each fraction. Correlations between the changes of the texture features, radiation dose, and observed acute xerostomia were analyzed. A classifier model and the incurred CT-based xerostomia score (CTXS) were introduced to predict xerostomia based on combined changes of MCTN and volume of PGs. The t test and Spearman and Pearson correlation tests were used in the analyses. Substantial changes in various CT texture features of PGs were observed during RT delivery. The changes of PG MCTN or volume are not strongly correlated with the observed xerostomia grades if they are considered separately. The CTXS showed a significant correlation to the observed xerostomia grades (r=0.71, P<.00001). The CTXS-based classifier can predict the xerostomia severity with a success rate ranging from 79% to 98%. The xerostomia severity at the end of treatment can be predicted based on the CTXS determined at the fifth week with a precision and sensitivity of 100%. Significant changes in the CT histogram features of the parotid glands were observed during RT of HNC. A practical method of using the changes of MCTN and volume of PGs is proposed to predict radiation-induced acute xerostomia, which may be used to help design adaptive treatment.

Xerostomia, salivary characteristics and gland volumes following intensity‐modulated radiotherapy for nasopharyngeal carcinoma: a two‐year follow up

To evaluate changes in xerostomia status, salivary characteristics and gland volumes 2 years following radiotherapy in nasopharyngeal carcinoma patients. Xerostomia scores, salivary flow rates, pH and buffering capacity were measured at pre-radiotherapy, mid-radiotherapy, 2 weeks, 3 months and 2 years post-radiotherapy. Salivary gland volumes and their correlation with radiation dose were also assessed. Mean radiation dose to oral cavity, parotid and submandibular glands (SMG) was 44.5, 65.0 and 38.6 Gy respectively. Parotid and SMG volumes decreased 33% at 3 months post-radiotherapy; volumes at 2 years post-radiotherapy were 84% and 51% of pre-radiotherapy levels, respectively. Correlations were observed between parotid gland volume per cent reduction and its radiation dose and between resting salivary flow rate reduction and post-radiotherapy/pre-radiotherapy SMG volume ratio. Salivary flow rates and resting saliva pH remained significantly low at 2 years post-radiotherapy (both flow rates, P = 0.001; resting saliva pH, P = 0.005). Similarly, xerostomia scores remained significantly higher compared with pre-radiotherapy levels. Submandibular gland volumetric shrinkage persisted 2 years after radiotherapy. Xerostomia scores remained significantly higher, and salivary flow rates and resting saliva pH remained significantly lower, suggesting that study participants were still at risk for hyposalivation-related oral diseases.

Preliminary Comparative Study of Oral7® Versus Salt-Soda Mouthwash on Oral Health Related Problems and Quality of Life among Head and Neck Cancer Patients Undergoing Radiotherapy.

BackgroundThis quasi-clinical trial compared the effects of Oral7® and salt-soda mouthwash on the development of dental caries, salivary gland function, radiation mucositis, xerostomia and EORTC QLQ H&N C35 scores in head and neck cancer patients who underwent radiotherapy.MethodsWe included patients with histopathologically diagnosed head and neck cancers who had received radiation, with an Eastern Cooperative Oncology Group (ECOG) performance status 0–1 and age range of 15–60 years. Patients with prior radiotherapy and chemotherapy, edentulous status, total parotidectomy, sicca syndrome or on xerosis-induced medications were excluded. We assigned 15 patients each to the Oral7® and salt-soda groups.ResultsThere was no significant difference in the mean Decayed, Missing and Filling Teeth (DMFT) score between groups. Head and neck cancer patients who were on Oral7® had a significantly better quality of life than those on salt-soda in relation to the swallowing problems, social eating, mouth opening, xerostomia and illness scales. Patients who were on Oral7® had a significantly lower xerostomia score than patients on salt-soda mouthwash. Patients on Oral7® had a significantly lower mucositis score in week 5–7 compared to patients in the salt-soda group.ConclusionOral7® showed advantages over salt-soda solution in relation to reducing xerostomia, easing radiation-induced mucositis, and improving quality of life, despite the non-significant difference in the dental caries assessment.

Should short-term use of alcohol-containing mouthrinse be avoided for fear of worsening xerostomia?

This study aimed to assess the short-term effect of alcohol-containing mouthrinse versus mouthrinse without alcohol on xerostomia scores reported by Xerostomia Inventory (XI) scores and short version of the Xerostomia Inventory (SXI). This study was a two-group parallel-arm randomised controlled trial where participants were randomly allocated to twice a day for 7days use of either alcohol-containing or alcohol-free mouthrinse. Allocation was concealed. The participants, the outcome assessors and the statistician were blinded to the allocation status. A total of 163 participants completed the pre-and post-intervention data collection. There were no statistically significant differences between the study groups with respect to demographics or other measured independent variables. After adjusting for age and gender, regression coefficient (95% CI) for XI was 0.02 (-1.72-2.29) and that for SXI was 0.03 (-0.54-0.83). Both adjusted and unadjusted models showed no significant differences in change in XI or SXI. The mean difference in scores between the groups for XI was -0.45 (-2.45-1.55) and for SXI was 0.05 (-0.65-0.75). There was no significant difference in the change in xerostomia levels as a result of short-term exposure to alcohol-containing mouthrinse, when compared to those exposed to alcohol-free mouthrinse. Short-term use of alcohol-containing mouthrinse does not result in worsening xerostomia.

Can sparing of the superficial contralateral parotid lobe reduce xerostomia following radiotherapy for head and neck cancer?

The purpose of this study is to see whether sparing the superficial contralateral parotid lobe can help limiting xerostomia following radiotherapy for head and neck cancer. 88 patients that were included in two prospective randomized studies were analysed in the current study. Using the dosimetry of both the parotid glands, we divided our patients in four groups. Group 1 includes patients where we were able to reduce the radiation dose below the threshold in order to spare both the ipsilateral and contralateral parotid glands, Group 2 consists of patients where only the contralateral parotid gland could be spared. Group 3 consists of patients where only the contralateral superficial parotid lobe could be spared, while in Group 4 not even the contralateral superficial lobe could be spared. When we compared Group 1 and Group 2, we did not observe a significant difference between both groups in terms of xerostomia scores at 6 or 12 months. When we compared these groups with Group 3, we observed significant differences with more xerostomia in Group 3 where only the contralateral superficial lobe was spared. A significant difference was also observed between Group 3 and Group 4 with more xerostomia in Group 4. Sparing of just one superficial parotid lobe results in less xerostomia when compared to not sparing any lobe of both parotid glands. Advances in knowledge: When sparing of the whole contralateral parotid gland is not possible, delineating both the superficial parotid glands and trying to spare at least one of them can mean a way forward in limiting xerostomia in head and neck cancer patients treated with radiotherapy.

Early Prediction of Xerostomia During Radiation Therapy for Head and Neck Cancer Based on Radiomic Analysis of Daily CT

To investigate changes of CT radiomicss of parotid glands (PG) to predict acute Xerostomia during radiotherapy (RT) for head and neck cancer (HNC). Daily diagnostic-quality CTs were acquired for 23 HNC patients. PG contours were generated and changes of histogram-based radiomics were calculated. Correlations between metrics, radiation dose, and observed acute Xerostomia were analyzed. A CT-Based Xerostomia Score (CTXS) is introduced to evaluate/predict xerostomia by combining changes of mean CT number (MCTN) and volume of parotid glands. Substantial changes in various radiomic metrics of PGs were observed. The average MCTN and volume for all patients were reduced by 9.4 HU and 49.6 cm3, respectively. Individually, the changes of PG MCTN or volume are not strongly correlated with the observed xerostomia grades while the CTXS did. The xerostomia grade at the end of treatment can be predicted based on the CTXS determined at the 5th week with a precision of 80% and a sensitivity of 100%. Significant changes in the CT histogram radiomic metrics of the parotid glands were observed during RT of HNC. A practical method of using the changes of MCTN and volume is proposed to predict radiation-induced acute xerostomia, allowing adaptive treatment.

18F-FDG PET image biomarkers improve prediction of late radiation-induced xerostomia

Background and purposeCurrent prediction of radiation-induced xerostomia 12months after radiotherapy (Xer12m) is based on mean parotid gland dose and baseline xerostomia (Xerbaseline) scores. The hypothesis of this study was that prediction of Xer12m is improved with patient-specific characteristics extracted from 18F-FDG PET images, quantified in PET image biomarkers (PET-IBMs). Patients and methodsIntensity and textural PET-IBMs of the parotid gland were collected from pre-treatment 18F-FDG PET images of 161 head and neck cancer patients. Patient-rated toxicity was prospectively collected. Multivariable logistic regression models resulting from step-wise forward selection and Lasso regularisation were internally validated by bootstrapping. The reference model with parotid gland dose and Xerbaseline was compared with the resulting PET-IBM models. ResultsHigh values of the intensity PET-IBM (90th percentile (P90)) and textural PET-IBM (Long Run High Grey-level Emphasis 3 (LRHG3E)) were significantly associated with lower risk of Xer12m. Both PET-IBMs significantly added in the prediction of Xer12m to the reference model. The AUC increased from 0.73 (0.65–0.81) (reference model) to 0.77 (0.70–0.84) (P90) and 0.77 (0.69–0.84) (LRHG3E). ConclusionPrediction of Xer12m was significantly improved with pre-treatment PET-IBMs, indicating that high metabolic parotid gland activity is associated with lower risk of developing late xerostomia. This study highlights the potential of incorporating patient-specific PET-derived functional characteristics into NTCP model development.

Geometric Image Biomarker Changes of the Parotid Gland Are Associated With Late Xerostomia

To identify a surrogate marker for late xerostomia 12months after radiation therapy (Xer12m), according to information obtained shortly after treatment. Differences in parotid gland (PG) were quantified in image biomarkers (ΔIBMs) before and 6weeks after radiation therapy in 107 patients. By performing stepwise forward selection, ΔIBMs that were associated with Xer12m were selected. Subsequently other variables, such as PG dose and acute xerostomia scores, were added to improve the prediction performance. All models were internally validated. Prediction of Xer12m based on PG surface reduction (ΔPG-surface) was good (area under the receiver operating characteristic curve, 0.82). Parotid gland dose was related to ΔPG-surface (P<.001, R2=0.27). The addition of acute xerostomia scores to the ΔPG-surface improved the prediction of Xer12m significantly, and vice versa. The final model including ΔPG-surface and acute xerostomia had outstanding performance in predicting Xer12m early after radiation therapy (area under the receiver operating characteristic curve, 0.90). Parotid gland surface reduction was associated with late xerostomia. The early posttreatment model with ΔPG-surface and acute xerostomia scores can be considered as a surrogate marker for late xerostomia.

The effect of parotid gland-sparing intensity-modulated radiotherapy on salivary composition, flow rate and xerostomia measures.

To describe parotid gland (PG) saliva organic and inorganic composition and flow rate changes, after curative intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), and analyse the relationship between PG saliva analytes and xerostomia measures. Twenty-six patients recruited to five prospective phase 2 or 3 trials which assessed toxicity and efficacy of IMRT by HNC subsite, provided longitudinal PG saliva. Salivary flow rate, and subjective and objective xerostomia measures were prospectively collected and saliva tested for inorganic and organic analytes. Statistical comparisons of longitudinal analyte changes and analysis for a relationship between dichotomized xerostomia score and saliva analytes were performed. One hundred and forty-two PG saliva samples from 26 patients were analysed. At 3-6months after IMRT, stimulated and unstimulated saliva showed significantly decreased flow rate, total protein (TP) secretion rate, phosphate concentration and increased lactoferrin (LF) concentration. Stimulated saliva alone had elevated LF secretion rate and beta-2-microglobulin (B2 M) concentration with decreased calcium (Ca2+ ) and magnesium (Mg2+ ) concentrations and Ca2+ secretion rate. At >12months, under stimulated and unstimulated conditions, increased LF concentration and decreased Mg2+ and phosphate concentration persisted and, in stimulated saliva, there was decreased potassium (K+ ) and Mg2+ concentration. Unstimulated TP secretion rate was lower in the presence of high-grade xerostomia. Otherwise, no relationship between xerostomia grade and PG salivary flow rate, TP and Ca2+ secretion rate was found. Fewer significant differences in PG saliva analytes >12months after IMRT indicate good functional recovery. Residual xerostomia after IMRT will only be further reduced by addressing the sparing of subsites of the PG or other salivary gland tissues, in addition to the PG.

Minimally invasive surgery versus radiotherapy/chemoradiotherapy for small-volume primary oropharyngeal carcinoma.

More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human papillomavirus. Human papillomavirus-associated OPSCC affects younger patients and often presents at a higher stage; however, it is associated with a better prognosis.Until recently, first-line management of OPSCC involved chemoradiotherapy, as research had demonstrated comparable survival outcomes when compared with open surgery, with significantly decreased morbidity. However, interventions have now evolved with computerised planning and intensity-modulated radiotherapy, and the advent of endoscopic head and neck surgery, which provide the potential for decreased treatment-associated morbidity.The oropharynx plays an essential role in swallowing, speech and protecting the airway as it is situated at the bifurcation of the respiratory and digestive tracts. Treatment modality recommendations are based on survival outcomes. Given the younger patient demographic, establishing the safety of modalities that potentially have better functional outcome is becoming increasingly important. To assess the efficacy of endoscopic head and neck surgery (transoral robotic surgery or transoral laser microsurgery) for small-volume, primary (T1-2, N0-2) oropharyngeal squamous cell carcinoma (OPSCC) in comparison to radiotherapy/chemoradiotherapy. The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 8 November 2016. Randomised controlled trials in patients with carcinoma in the oropharynx subsite (as defined by the World Health Organization classification C09, C10). Cancers included were primary squamous cell carcinomas arising from the oropharyngeal mucosa. The tumours were classified as T1-T2 with or without nodal disease and with no evidence of distant metastatic spread. The intervention was transoral, minimally invasive surgery with or without adjuvant radiotherapy or adjuvant chemoradiotherapy. The comparator was primary radiotherapy with or without induction or concurrent chemotherapy for the tumour. The treatments received and compared were of curative intent and patients had not undergone prior intervention, other than diagnostic biopsy. We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related mortality was to be studied where possible), locoregional control, disease-free survival and progression-free survival or time to recurrence. All outcomes were to be measured at two, three and five years after diagnosis. Our secondary outcomes included quality of life, harms associated with treatment, patient satisfaction and xerostomia score. No completed studies met the inclusion criteria for the review. Two ongoing trials fulfilled the selection criteria, however neither are complete.'Early-stage squamous cell carcinoma of the oropharynx: radiotherapy versus trans-oral robotic surgery (ORATOR)' is a phase II randomised controlled trial comparing primary radiation therapy with primary transoral robotic surgery for small-volume primary (T1-2, N0-2) OPSCC. It is currently in progress with an estimated completion date of June 2021.'European Organisation for Research and Treatment of Cancer 1420 (EORTC 1420-HNCG-ROG)' is a phase III, randomised study assessing the "best of" radiotherapy compared to transoral robotic surgery/transoral laser microsurgery in patients with T1-T2, N0 squamous cell carcinoma of the oropharynx and base of tongue. It was due to start accrual mid-2016. The role of endoscopic head and neck surgery in the management of OPSCC is clearly expanding as evidenced by its more overt incorporation into the current National Comprehensive Cancer Network guidelines. Data are mounting regarding its outcomes both in terms of survival and lower morbidity. As confidence increases, it is being used in the management of more advanced OPSCC.Based on this review, there is currently no high-quality evidence from randomised controlled trials regarding clinical outcomes for patients with oropharyngeal cancer receiving endoscopic head and neck surgery compared with primary chemoradiotherapy.

Randomized Trial of Vitamin C/E Complex for Prevention of Radiation-Induced Xerostomia in Patients with Head and Neck Cancer.

The present study was conducted to determine the preventive efficacy of vitamin C/E complex supplementation for radiotherapy (RT)-induced xerostomia in patients with head and neck cancer. Prospective, double-blinded, randomized, placebo-controlled study. A single tertiary referral institution. The trial group (n = 25) received antioxidant supplements (100 IU of vitamin E + 500 mg of vitamin C) twice per day during RT, while the control group (n = 20) received an identical placebo. Pre-RT and 1 and 6 months post-RT, patient-reported xerostomia questionnaires, observer-rated xerostomia score, and salivary scintigraphy were serially obtained to compare xerostomia severity between the 2 groups. The trial group showed greater improvements in xerostomia questionnaire and score at 6 months post-RT when compared with those at 1 month post-RT (P = .007 and .008, respectively). In contrast, the control group showed no changes between 1 and 6 months post-RT. By salivary scintigraphy, there was no difference in maximal accumulation or ejection fraction between the 2 groups. However, the trial group maintained significantly better oral indices at the prestimulatory (P = .01) and poststimulatory (P = .009) stages at 1 month post-RT, compared with the control group. At the final follow-up, there was no difference in overall survival and disease-free survival between the 2 groups. Our data suggest that short-term supplementation with an antioxidant vitamin E/C complex exerts a protective effect against RT-induced xerostomia.

Determinants of thirst distress in patients on hemodialysis.

Thirst sensation can induce nonadherence with fluid restriction in patients on hemodialysis (HD) and may lead to large interdialytic weight gain (IWG). This study aimed to evaluate thirst distress and its determinants and to explore fluid management strategies used by patients on HD. A cross-sectional study was conducted in a sample of 203 patients who were followed in three HD centers in Turkey, from January 2015 to June 2015. Data were collected by a personal information form, the Thirst Distress Scale (TDS) and the Visual Analogue Scale (VAS) for thirst and xerostomia. Data analysis was performed using descriptive statistics, Student's t test, the one-way analysis of variance, Pearson's correlation coefficients, and linear regression analysis. The mean TDS score was 20.71±8.34, which is a higher than moderate level of thirst distress. The significant determinants of thirst distress of the patients were the VAS thirst score (unstandardized β=1.73, p<0.001), the VAS xerostomia score (unstandardized β=0.42, p<0.001), and the IWG values (unstandardized β=1.20, p=0.003), after controlling for specific variables. The most common strategies used to reduce fluid intake or relieve thirst were avoiding salty foods (70.9%), limiting salt on food (70.9%), and spacing liquids over the entire day (57.6%). Patients with higher levels of thirst and xerostomia and those with a high IWG were more likely to have higher thirst distress. A greater understanding of thirst distress and its related factors could contribute to more effective interventions that improve health and well-being in patients on HD.

PV-0477: Early CT image biomarkers change and xerostomia score are strong predictors for late xerostomia

PV-0477: Early CT image biomarkers change and xerostomia score are strong predictors for late xerostomia

Recovery of Salivary Function: Contralateral Parotid-sparing Intensity-modulated Radiotherapy versus Bilateral Superficial Lobe Parotid-sparing Intensity-modulated Radiotherapy

AimsTo establish whether there is a difference in recovery of salivary function with bilateral superficial lobe parotid-sparing intensity-modulated radiotherapy (BSLPS-IMRT) versus contralateral parotid-sparing IMRT (CLPS-IMRT) in patients with locally advanced head and neck squamous cell cancers. Materials and methodsA dosimetric analysis was carried out on data from two studies in which patients received BSLPS-IMRT (PARSPORT II) or CLPS-IMRT (PARSPORT). Acute (National Cancer Institute, Common Terminology Criteria for adverse events – NCI CTCAEv3.0) and late (Late Effects of Normal Tissue- subjective, objective, management analytical – LENTSOMA and Radiation Therapy Oncology Group) xerostomia scores were dichotomised: recovery (grade 0–1) versus no recovery (≥grade 2). Incidence of recovery of salivary function was compared between the two techniques and dose-response relationships were determined by fitting dose-response curves to the data using non-linear logistic regression analysis. ResultsSeventy-one patients received BSLPS-IMRT and 35 received CLPS-IMRT. Patients received 65 Gy in 30 fractions to the primary site and involved nodal levels and 54 Gy in 30 fractions to elective nodal levels. There were significant differences in mean doses to contralateral parotid gland (29.4 Gy versus 24.9 Gy, P < 0.005) and superficial lobes (26.8 Gy versus 30.5 Gy, P = 0.02) for BSLPS and CLPS-IMRT, respectively. Lower risk of long-term ≥grade 2 subjective xerostomia (LENTSOMA) was reported with BSLPS-IMRT (odds ratio 0.50; 95% confidence interval 0.29–0.86; P = 0.012). The percentage of patients who reported recovery of parotid saliva flow at 1 year was higher with BSLPS-IMRT compared with CLPS-IMRT techniques (67.1% versus 52.8%), but the difference was not statistically significant (P = 0.12). For the whole parotid gland, the tolerance doses, D50, were 25.6 Gy (95% confidence interval 20.6–30.5), k = 2.7 (0.9–4.5) (CLPS-IMRT) and 28.9 Gy (26.1–31.9), k = 2.4 (1.4–3.4) (BSLPS-IMRT). For the superficial lobe, D50 were similar: BSLPS-IMRT 23.5 Gy (19.3–27.6), k = 1.9 (0.5–3.8); CLPS-IMRT 24.0 Gy (17.7–30.1), k = 2.1 (0.1–4.1). ConclusionBSLPS-IMRT reduces the risk of developing high-grade subjective xerostomia compared with CLPS-IMRT. The D50 of the superficial lobe may be a more reliable predictor of recovery of parotid function than the whole gland mean dose.

Sparing bilateral neck level IB in oropharyngeal carcinoma and xerostomia outcomes.

To assess whether sparing neck-level IB in target delineation of node-positive (N+) oropharyngeal carcinoma (OPC) can improve xerostomia outcomes without compromising locoregional control (LRC). A total of 125 N+ OPC patients with a median age of 57 years underwent chemoradiation between May 2010 and December 2011. A total of 74% of patients had T1-T2 disease, 26% T3-T4, 16% N1, 8% N2A, 48% N2B, 28% N2C; 53% base of tongue, 41% tonsil, and 6% other. Patients were divided into those who had target delineation sparing of bilateral level IB (the spared cohort) versus no sparing (the treated cohort). Sparing of contralateral high-level II nodes was also performed more consistently in the spared cohort. A prospective xerostomia questionnaire (patient reported) was given at each patient follow-up visit to this cohort of patients to assess late xerostomia. Clinical assessment (observer rated) at each patient follow-up visit was also recorded. The 2-year LRC for the spared and treated cohorts was 97.5% and 93.8%, respectively (median follow-up, 23.2 mo). No locoregional failures occurred outside of treatment fields. The spared cohort experienced significant benefits in patient-reported xerostomia summary scores (P=0.021) and observer-rated xerostomia scores (P=0.006). In addition, there were significant reductions in mean doses to the ipsilateral submandibular gland (63.9 vs. 70.5 Gy; P<0.001), contralateral submandibular gland (45.0 vs. 56.2 Gy; P<0.001), oral cavity (35.9 vs. 45.2 Gy; P<0.001), and contralateral parotid gland (20.0 vs. 24.4 Gy; P<0.001). Target delineation sparing of bilateral level IB nodes in N+ OPC reduced mean doses to salivary organs without compromising LRC. Patients with reduced target volumes had better patient-reported xerostomia outcomes.

MO‐G‐304‐01: FEATURED PRESENTATION: Expanding the Knowledge Base for Data‐Driven Treatment Planning: Incorporating Patient Outcome Models

Purpose:To extend the capabilities of knowledge‐based treatment planning beyond simple dose queries by incorporating validated patient outcome models.Methods:From an analytic, relational database of 684 head and neck cancer patients, 372 patients were identified having dose data for both left and right parotid glands as well as baseline and follow‐up xerostomia assessments. For each existing patient, knowledge‐based treatment planning was simulated for by querying the dose‐volume histograms and geometric shape relationships (overlap volume histograms) for all other patients. Dose predictions were captured at normalized volume thresholds (NVT) of 0%, 10%, 20, 30%, 40%, 50%, and 85% and were compared with the actual achieved doses using the Wilcoxon signed‐rank test. Next, a logistic regression model was used to predict the maximum severity of xerostomia up to three months following radiotherapy. Baseline xerostomia scores were subtracted from follow‐up assessments and were also included in the model. The relative risks from predicted doses and actual doses were computed and compared.Results:The predicted doses for both parotid glands were significantly less than the achieved doses (p &lt; 0.0001), with differences ranging from 830 cGy ± 1270 cGy (0% NVT) to 1673 cGy ± 1197 cGy (30% NVT). The modelled risk of xerostomia ranged from 54% to 64% for achieved doses and from 33% to 51% for the dose predictions. Relative risks varied from 1.24 to 1.87, with maximum relative risk occurring at 85% NVT.Conclusions:Data‐driven generation of treatment planning objectives without consideration of the underlying normal tissue complication probability may Result in inferior plans, even if quality metrics indicate otherwise. Inclusion of complication models in knowledge‐based treatment planning is necessary in order to close the feedback loop between radiotherapy treatments and patient outcomes. Future work includes advancing and validating complication models in the context of knowledge‐based treatment planning.This work is supported by Philips Radiation Oncology Systems.

Pilocarpine and Prevention of Radiation Induced Xerostomia in HNSCC

Stated Purpose: To evaluate the efficacy and safety of concomitant pilocarpine with radiation therapy for the prevention of radiation induced xerostomia in Head & Neck cancer. Material & methods: A prospective, randomized, study was carried out on sixty treatment naive histopathologically proven patients of squamous cell carcinoma of head and neck. All the patients received 64Gy/32Fraction/6.2wks with and without pilocarpine. The study group received concomitant Pilocarpine hydrochloride 5.0 mg four times a day, starting three days prior to start of radiotherapy, continued for 3-months. Patients were evaluated at four points for xerostomia using subjective and objective scale. The Zimmermans Xerostomia Questionnaire and Visual Analogue Scale were used for evaluation of results. The statistical analysis was done by Paired sample T test and Mann-Whiteny U-Test. Results: The average Zimmerman Xerostomia scores of the pilocarpine group as compared to the control group were: First assessment - 100mm Vs 100mm; Second assessment - 48mm Vs 37mm; Third assessment - 57mm Vs 41mm; Fourth assessment - 62 Vs 44mm. The average LENT SOMA grades for the study group and the control group along with SEM respectively were: First assessment 1 Vs 1; Second assessment 2.7 (SEM-8.510X10-2) Vs 3 (SEM -0.000); Third assessment 2.3 (SEM -0.1150) Vs 2.5 (SEM -9.285X10-2); Fourth assessment 2.3 (SEM - 0.1150) Vs 2.5 (SEM -9.285X102). The RTOG Salivary Gland Morbidity Scores for the study group and the control group respectively were: First assessment – 0 Vs 0; Second assessment - 1.8 Vs 2 (p Value-0.595); Third assessment - 1.6 Vs 1.8 (p Value -0.094); Fourth assessment - 1.6 Vs 1.8 (p Value-0.054). Conclusion: The objective assessment of xerostomia done by these scales were favorable in the study group as compared to the control group signifying that concomitant pilocarpine preserved better salivary gland function.

Correlation of Anemia, Xerostomia and its Association with Candidial Colonization among Postmenopausal Women of Different Socioeconomic Status in Patients Attending Dental School in South India

ABSTRACTBackground and objectivesMenopause is a physiological state that gives rise to adaptive changes at both oral and systemic level. One of the major problems in these patients is burning mouth syndrome though no appreciable organic lesions are present. Xerostomia is another frequent symptom seen in menopause. The present study was undertaken to correlate between possible oral complications – xerostomia, anemia, and candidal colonization among postmenopausal women of different socioeconomic statuses. With this background the present study was undertaken to correlate between possible oral complications – xerostomia, anemia, and candidal colonization among postmenopausal women of different socioeconomic statuses.Materials and methodsAfter obtaining explained and informed consent, 40 females subjects with age range from 40 to 80 years attending outpatient department of our dental school were included in the study. A specially designed proforma was used to record demographic details and annual percapita income. A structured questionnaire was used for assessing clinical subjective symptoms of xerostomia. Hemoglobin estimation was done by cyanomethemoglobin method. Saliva sampling for estimation of colony forming units was performed using oral rinse technique.ResultsTotal sample of 40 subjects anemia was prevalent in 57.5%. Xerostomia was prevalent in 75% of total sample. Association between anemia and xerostomia status showed a significant positive correlation (p = 0.04) between anemia and xerostomia. Correlation between socioeconomic status with the variables (xerostomia score and candidal counts) showed no significant positive correlation.ConclusionDental practitioners need to be aware about menopause and its oral manifestations as a possible risk factor for various oral health problems. Oral physicians should be vigilant and encourage postmenopausal women to seek appropriate oral healthcare which in turn improves systemic health.How to cite this articleKotha R, Sudhakarareddy R, Alapati S. Correlation of Anemia, Xerostomia and its Association with Candidial Colonization among Postmenopausal Women of Different Socioeconomic Status in Patients Attending Dental School in South India. Int J Experiment Dent Sci 2014;3(1):33-36.