Prevalence of hyposalivation and associated factors in survivors of head and neck cancer treated with radiotherapy

Abstract

Prevalence of hyposalivation and associated factors in survivors of head and neck cancer treated with radiotherapy 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.

Trismus, health-related quality of life, and trismus-related symptoms up to 5 years post-radiotherapy for head and neck cancer treated between 2007 and 2012

“…The endpoint deterioration seen in the EORTC QLQ HN35 domains, senses, sticky saliva, and dry mouth, could, however, be attributed to the development of late radiation-induced effects [22]. Epstein et al [23] concluded that both fraction size, treatment time, and radiated tissue volume impacted the development of mucositis, and Schultz et al [24] found a 78% incidence of hyposalivation in their 88 patients, where higher radiation doses increased the risk of xerostomia four-fold. Hence, other factors influenced by tumor site, treatment type, and dosage of RT also impact HRQL.…”

It's not only swallowing: a clinician primer to adult food refusal beyond dysphagia

“…The literature supports an association between xerostomia and numerous medical conditions, including but not limited to: Sjogren's syndrome, diabetes types I and II [11], systemic scleroderma [12], early and late effects of high dose radiation [13], chronic hemodialysis treatment [14], and as an adverse effect of numerous common medications, especially in the setting of polypharmacy [15]. Further, xerostomia is associated with stress, anxiety, depression, and older age [16,17].…”

Manejo odontológico de las manifestaciones orales inducidas por radioterapia de cabeza y cuello

“…La xerostomía es definida como la sensación subjetiva de boca seca y es una de las complicaciones más frecuentes, reportándose en un 81-100% de los pacientes durante y después del curso de radioterapia 35 . Si bien esta se correlaciona con la tasa de secreción salival reducida conocida como hiposalivación, ambos fenómenos son independientes 36,37 . El daño de las glándulas salivales es generalmente irreversible a dosis superiores a 50 Gy, por ende, puede ser considerado un efecto determinístico 38 .…”