Evaluation of irradiated salivary gland function in patients with head and neck tumours treated with radiotherapy

Abdullah, Baharudin; Khairuddin, Anm; Nizam, A; Samsuddin, A R

doi:10.1017/s0022215108002466

Cited by 8 publications

(6 citation statements)

References 20 publications

(25 reference statements)

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“…Promising survival times also increase the challenges of confronting delayed and long-term RT or CCRTrelated complications such as trismus (limited mouth opening) and xerostomia (dry mouth) which may occur during the initial 3 months of treatment up to a period of several years (Cooper et al 1995;Baharudin et al 2009;Kamstra et al 2011;Deboni et al 2012). Trismus occurs in 5-38% of head and neck cancer patients and may reduce the mouth's opening by 18% after RT (Dijkstra et al 2004(Dijkstra et al , 2006.…”

Section: Introductionmentioning

confidence: 99%

Trismus, xerostomia and nutrition status in nasopharyngeal carcinoma survivors treated with radiation

Chen

Wang

et al. 2014

Eur J Cancer Care (Engl)

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The aims of the study were to: (1) examine levels of trismus, xerostomia and nutritional status; (2) compare levels of trismus, xerostomia and nutritional status in patients with nasopharyngeal carcinoma (NPC) receiving different types of radiation modalities; and (3) identify factors related to NPC survivors' risk status for malnutrition and existing malnutrition. A cross-sectional study with consecutive sampling was conducted. NPC survivors were recruited from otolaryngology/oncology outpatient clinics in a medical centre in Northern Taiwan. Study measures included (1) Mandibular Function Impairment Questionnaire, (2) Xerostomia Questionnaire, (3) Mini Nutrition Assessment, (4) Hospital Anxiety and Depression Scale - Depression subscale, and (5) Symptom Severity Scale. A total of 110 subjects were recruited. Those receiving intensity-modulated radiation therapy had less trismus and xerostomia than patients receiving two-dimensional radiation therapy. Patients with female gender, advanced stage, completion of treatments within 1 year, higher levels of depression, more severe trismus and higher symptom severity tended to have malnutrition or were at risk of malnutrition. Trismus and xerostomia are long-term problems in some NPC survivors and may contribute to malnutrition. To better manage a patient's trismus and xerostomia and to enhance nutritional status, clinicians should develop a patient-specific care programme based on careful assessment and targeted measures to improve oral function and insure adequate nutritional intake.

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Section: Introductionmentioning

confidence: 99%

Trismus, xerostomia and nutrition status in nasopharyngeal carcinoma survivors treated with radiation

Chen

Wang

et al. 2014

Eur J Cancer Care (Engl)

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“…Despite clinical interventions to spare or shield the salivary glands from radiation, the occurrence of salivary hypofunction has remained a persistent clinical problem. [4][5][6]8,11 With no effective treatment to avert or treat the condition, palliative relief of symptoms remains the mainstay in the management of this condition. 1,4,5,9,10 Previous studies from our laboratories and that of others have indicated that TLK1B is instrumental for cell survival after genotoxic damage in 'normal' cells, 19,20 and its expression in cancers correlates with resistance to chemotherapeutics.…”

Section: Discussionmentioning

confidence: 99%

“…Half of each salivary gland was fixed in 4% cold paraformaldehyde and processed for paraffin embedding and sectioning, whereas the other half was fixed in 2% formaldehyde, 0.2% glutaraldehyde in PBS (pH 7.4) and embedded in OCT compound (Tissue-Tek). Frozen sections were fixed in formaldehyde/glutaraldehyde fixative and reacted with X-gal (0.5 mg ml À1 ) in PBS (pH 7.4) containing 5 mM K 4 Fe(CN) 6 , 5 mM K 3 Fe(CN) 6 , 2 mM MgCl 2 at 4 1C for 16 h. Tissue sections were washed and counterstained with eosin. Cells that stained blue were counted in five random fields per gland at Â400 high-power magnification.…”

Section: In Vivo Infusion Of Adenovirus Ivis Imaging and Exposure Ofmentioning

confidence: 99%

“…Owing to the inevitable destruction of major salivary glands that lie within the portals of radiation, the most common and distressing side effect of radiotherapy is xerostomia or dry mouth. [4][5][6] The reduction in salivary flow makes it difficult to perform basic oral activities, and it perpetuates the risk of oral mucositis, infections and rampant dental decay. Radiation-induced xerostomia is irreversible, and its associated morbidity compromises a patient's comfort and well-being.…”

Section: Introductionmentioning

confidence: 99%

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Adenoviral delivery of Tousled kinase for the protection of salivary glands against ionizing radiation damage

Palaniyandi

Odaka

et al. 2010

Gene Ther

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Oral complications of salivary hypofunction often afflict cancer patients undergoing radiotherapy for head and neck cancers. Dry mouth or xerostomia is an undesirable consequence of radiotherapy that compromises normal oral functions in addition to causing odynophagia and increasing the patient's risk of oral infections and dental caries. Radiation-induced xerostomia is irreversible, and palliative measures to provide symptomatic relief remain the mainstay of treatment. Previously, we identified a splice variant of a cellular kinase, Tousled-like kinase 1B (TLK1B), which when overexpressed protects normal epithelial cells against ionizing radiation (IR)-induced cell death. To address the need to protect salivary glands in patients undergoing regional radiotherapy, we investigated whether preemptive expression of TLK1B in salivary glands protects against IR. In stably-derived salivary cell lines in vitro, TLK1B expression increased cell survival after IR. Cells expressing exogenous TLK1B were less radiosensitive (A5-TLK1B, a/b¼0.67 Gy; ParC5-TLK1B, a/b¼4.3 Gy) compared to control cells (A5-BK, a/b¼1.7 Gy; ParC5-BK, a/b¼32.7 Gy). Using a recombinant adenovirus serotype 5 viral vector for TLK1B gene transfer into rat submandibular salivary glands in vivo, we demonstrated that TLK1B protects the saliva-secreting acinar cells and better preserves salivary gland function against IR relative to control glands. After a single fraction of 16 Gy, the decline in salivary function at 8 weeks was less pronounced in TLK1B-treated animals (40%) as compared to saline-treated controls (67%). Histopathological analysis demonstrated increase in acinar atrophy, decrease in acinar cell number, and increase in inflammatory infiltrate and fibrosis in irradiated control tissues relative to TLK1B-treated glands. These results show the radioprotective benefits of TLK1B and implicate its usefulness in the management of regional radiotherapy-induced xerostomia.

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“…Mira et al showed a decrease in saliva 24 hours after receiving doses up to 2.25Gy. (12) Bornstein et al also proved mouth dryness as the most common complication of radiotherapy (13) ; Baharudin et al as well stated that salivary gland dysfunction is among the principal difficulties brought about by radiotherapy (14) ; also Mc Milan et al reached the same conclusion and found the relation between mouth dryness and the radiation dose significant. (15) Radiotherapy complications such as mucositis can sometimes stop the treatment for 4 to 5 weeks, and are so painful that make eating, drinking and brushing impossible for the patient.…”

Section: Introductionmentioning

confidence: 88%

Effect of Radiation on Saliva Flow Rate in Patients under Head and Neck Radiotherapy

Mardani

Ghafari

Farhad

et al. 2013

3dj

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Introduction: The aim of this study was to evaluate the salivation flow rate objectively using Schirmer test; and mouth dryness and other consequences subjectively by distributing questionnaires to patients receiving head and neck radiotherapy. Materials and Methods: In this descriptive study that was carried out at Imam Khomeini hospital, Tehran, Iran, the saliva flow rate of 33 patients receiving radiotherapy was evaluated in millimeter in 5 minutes using Schirmer test (with a filtered paper calibrated from 1 to 35mm) before treatment, two weeks and four weeks after and at the end of treatment thus having four groups of measurements. Mouth dryness and other consequences were recorded by questionnaire at final stage. Friedman test, chisquare, dependent and independent t-tests were applied to analyze the data. Results: In all four groups, the mean of the saliva flow rate decrease during treatment was significant and followed a descending pattern. At the end of the treatment, the total received dosage and saliva flow rate had an inverse relationship, (P value=0.000). The mean salivation decrease in bilateral radiation was estimated more than unilateral one; though their relation was not statistically significant (P value=0.251). The mean salivation decrease in bilateral radiation of nasopharyngeal cancer was meaningfully greater than unilateral (P value 0.05). Conclusion: During radiation, saliva flow rate depends on the total dosage and the radiation site. Increasing the total dosage of radiation and the field diameter would result in the decrease of salivation of the major salivary glands, particularly parotid ones.

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Evaluation of irradiated salivary gland function in patients with head and neck tumours treated with radiotherapy

Abstract: Salivary function in post-irradiated head and neck tumour patients (assessed as salivary flow rates) was significantly reduced compared with normal controls, suggesting marked salivary gland hypofunction.

Cited by 8 publications

References 20 publications

Trismus, xerostomia and nutrition status in nasopharyngeal carcinoma survivors treated with radiation

Trismus, xerostomia and nutrition status in nasopharyngeal carcinoma survivors treated with radiation

Adenoviral delivery of Tousled kinase for the protection of salivary glands against ionizing radiation damage

Effect of Radiation on Saliva Flow Rate in Patients under Head and Neck Radiotherapy

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