Functional outcomes of the modified submandibular gland transfer procedure

Abstract

Objectives Treatment for advanced head and neck cancers typically includes surgery followed by radiation therapy (RT). Radiation‐induced xerostomia is a common sequela of these treatments. The modified submandibular gland transfer (M‐SGT) procedure was developed to decrease xerostomia in the treatment of oral cavity cancer by sparing one submandibular gland (SMG) from radiation. This study's objectives were to: 1) elucidate the radiation‐sparing capacity of the M‐SGT, and 2) study the xerostomia‐reducing potential of the M‐SGT based on the University of Washington Quality‐of‐Life Questionnaire (UW‐QOL). Methods Radiation therapy treatment plans were reviewed for all patients treated with surgery and RT who had a M‐SGT at the University of Alberta Hospital during the study period. Outcomes included: 1) radiation dose received by the transferred SMG within the periparotid area compared to the submandibular triangle (ST), and 2) patient‐reported saliva scores on the UW‐QOL compared to historical controls without a gland transfer. Results Twenty‐two patients were included. The mean radiation dose received by the transferred SMG was 29.00 grays (Gy) (standard deviation 14.59 Gy), thus reducing the mean radiation dose to the SMG by a statistically significant 18.34 Gy (confidence interval 95% (13.37, 23.32), P < 0.01) compared to the ST and below the D50 of the SMG (34 Gy). Sixty‐five percent of patients rated their saliva as normal or mildly reduced on the UW‐QOL as compared to 16% of controls (P = 0.01). Conclusion The M‐SGT technique is successful at reducing the radiation dose sustained by the SMG during adjuvant treatment and provides a significant improvement in xerostomia‐related functional outcomes as compared to historical controls not receiving a gland transfer. Level of Evidence 4 Laryngoscope, 130:925–929, 2020

Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes

“…Despite the use of conformal techniques, xerostomia and dysphagia remain common morbidities with significant impacts on quality of life (11,27). Our patients treated primary TORS received radiotherapy doses of 60-66 Gy but also underwent a submandibular gland transfer, which likely decreased RT-related xerostomia (14,15). As with other primary surgical approaches, TORS can also offer the opportunity for de-escalation of treatment by reducing or avoiding post-operative RT/CRT (21).…”

“…Free flap reconstruction of the oropharynx was performed in cases where the resection caused a significant surgical oro-cervical fistula, carotid artery was exposure or a >50% of BOT defect. Patients with tonsillar or lateral posterior pharyngeal wall tumors received an ipsilateral selective neck dissection +/-contralateral submandibular gland transfer (14,15). Bilateral selective neck dissection was performed in patients with BOT tumors or bilateral nodal disease based on pre-operative PET-CT imaging.…”

NIR‐II Responsive Inorganic 2D Nanomaterials for Cancer Photothermal Therapy: Recent Advances and Future Challenges

“…[ 311,401 ] Conventional polymerization initiator (AIPH) as classical thermo‐labile molecule can break down into free radicals under light or heat stimulation to destroy cancer cells in the absence of oxygen, which provides a more easy way for ROS induced cancer cell death compared with highly oxygen‐dependent. [ 402–404 ] Based on it, a photonic/thermosresponsive hybrid nanosystem AIPH@Nb 2 C@mSiO 2 NPs with biocompatibility and biosafety was employed by Chen et al. [ 107 ] for oxygen independent tumors treatment ( Figure A).…”