Long-term Outcomes of Submandibular Gland Transfer for Prevention of Postradiation Xerostomia

Seikaly, Hadi; Jha, Naresh; Harris, Jeffrey R.; Barnaby, Pam; Liu, Richard; Williams, David C.; McGaw, Tim; Rieger, Jana; Wolfaardt, Johan; Hanson, John

doi:10.1001/archotol.130.8.956

Cited by 86 publications

(96 citation statements)

References 28 publications

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“…Selective collection of submandibular/sublingual saliva from Wharton's duct orifices. Plots of SMG saliva flow rates vs. mean SMG doses at various post-RT time points (1,3,6,12,18, and 24 months). A.…”

Section: Discussionmentioning

confidence: 99%

“…Mucin-secreting glands include the SMGs and the minor salivary glands (15). The important role of the mucin-producing glands has been demonstrated in studies which correlated RT doses to these glands and patient-reported xerostomia (3,(16)(17), and in studies which transferred surgically the contralateral SMG to the non-irradiated sub-mental space, resulting in a significant improvement of both SMG salivary flow rates and patient-reported dry mouth symptoms (18).…”

Section: Introductionmentioning

confidence: 99%

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Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy

Murdoch‐Kinch

Kim

Vineberg

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

211

142

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Purpose-Submandibular salivary glands (SMGs) dysfunction contributes to xerostomia after radiotherapy (RT) of head and neck (HN) cancer. We assessed SMG dose-response relationships and their implications for sparing these glands by intensity modulated radiotherapy (IMRT).Patients and Methods-148 HN cancer patients underwent unstimulated and stimulated SMG salivary flow rate measurements selectively from Wharton's duct orifices, before RT and periodically through 24 months after RT. Correlations of flow rates and mean SMG doses were modeled throughout all time points. IMRT re-planning in eight patients whose contralateral level I was not a target incorporated the results in a new cost function aiming to spare contralateral SMGs.Results-Stimulated SMG flow rates decreased exponentially by (1.2%) Gy as mean doses increased up to 39 Gy threshold, and then plateaued near zero. At mean doses ≤39 Gy, but not higher, flow rates recovered over time at 2.2%/month. Similarly, the unstimulated salivary flow rates decreased exponentially by (3%) Gy as mean dose increased and recovered over time if mean dose was <39 Gy. IMRT re-planning reduced mean contralateral SMG dose by average 12 Gy, achieving ≤39 Gy in 5/8 patients, without target under-dosing, increasing the mean doses to the parotid glands and swallowing structures by average 2-3 Gy.Conclusions-SMG salivary flow rates depended on mean dose with recovery over time up to a threshold of 39 Gy. Substantial SMG dose reduction to below this threshold and without target under-dosing is feasible in some patients, at the expense of modestly higher doses to some other organs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy

Murdoch‐Kinch

Kim

Vineberg

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

211

142

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“…Subsequently, the authors described long‐term preservation of salivary flow in 83% of patients compared to 0% in the nontransfer group after a mean of 70 Gy neck treatment and a minimum of 2 years of follow‐up 10. Further studies involving submandibular gland transplantation for treatment of keratoconjunctivitis sicca with microvascular anastomoses to the superficial temporal artery and vein were completed by Yu et al11 in 2004.…”

Section: Discussionmentioning

confidence: 99%

Free thyroid transfer: Short‐term results of a novel procedure to prevent post‐radiation hypothyroidism

et al. 2016

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BackgroundThe incidence of radiation‐induced hypothyroidism (RIH) in patients with head and neck cancer is >50%. The purpose of this study was to assess the long‐term efficacy of free thyroid transfer (FTT) for prevention of RIH in patients with head and neck cancer.MethodsHemithyroid dissection was completed in 10 patients with advanced head and neck cancer undergoing ablation, radial forearm free flap (RFFF) reconstruction, and postoperative radiotherapy (RT). The hemithyroid was anastomosed to the donor site vessels in the forearm. Thyroid laboratory testing and technetium (Tc) scans were performed 6 weeks and 12 months postoperatively to establish functional integrity.ResultsFTT was successfully performed in 9 of 10 recruited patients. Postoperative Tc scans demonstrated strong Tc uptake in the forearm donor site at 6 weeks and 12 months in all patients who underwent transplantations.ConclusionFTT is feasible with maintenance of function, and may represent a novel strategy for prevention of RIH. © 2016 Elsevier Head & Neck Published by Wiley Periodicals, Inc. Head Neck 39: 1234–1238, 2017

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“…De nouvelles techniques permettent d'épargner partiellement les glandes salivaires pendant l'irradiation évitant peut être la xé-rostomie et l'hyposialie [18,19]. L'Intensity Modulated Irradiation Therapy (IMRT), a été progressivement mise en oeuvre depuis plus d'une dizaine d'années et constitue un grand progrès technologique par rapport à la radiothérapie classique pour le traitement des cancers des VADS [20].…”

Section: Sécrétion Salivaire Et Pouvoir Tamponunclassified

Évaluation quantitative de la secrétion et du pouvoir tampon de la salive au cours de la radiothérapie des cancers des voies aéro-digestives supérieures au Sénégal

Lecor

Dia-Tine

Gaye

et al. 2013

Med Buccale Chir Buccale

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Résumé -Introduction. La radiothérapie, ou utilisation des rayonnements ionisants pour détruire le tissu cancé-reux, représente un des traitements de base pour les cancers des voies aéro-digestives (VADS). Elle doit détruire les cellules cancéreuses, tout en épargnant au mieux les organes ou tissus sains avoisinants. L'objectif de cette étude était d'évaluer les effets de la radiothérapie sur la fonction des glandes salivaires chez des patients traités pour un cancer des VADS. Matériel et méthodes. Une étude transversale descriptive a été réalisée sur 33 patients atteints d'un cancer des VADS et traités dans le service de radiothérapie de l'Hôpital Aristide Le Dantec de Dakar (Sénégal). La xérostomie, les débits salivaires non stimulé et stimulé ainsi que le pH salivaire ont été évalués, avant (T0), pendant (T), et un mois après la fin de la radiothérapie (T1). Les données ont été statistiquement analysées et exploitées en utilisant le logiciel SPSS. Résultats. L'âge des patients variait de 18 à 69 ans. Les patients ayant plus de 60 ans représentaient 45,5 % de la population étudiée. Les hommes constituaient la majorité de l'échantillon (54,5 %). Avant la radiothérapie, aucun signe de xérostomie n'a été observé chez les patients : tous avaient un débit salivaire normal. Pendant les séances de radiothérapie, tous les patients se sont plaints de sécheresse buccale : 19 avaient une hyposialie modérée et 13 avaient une hyposialie sévère. La xérostomie et l'hyposialie sévère ou modérée étaient statistiquement associées à la dose de radiothérapie (p < 0,005). À T0, tous les patients avaient un pH neutre. À T1, 28/33 patients avaient un pH salivaire inférieur à 5,5, évoquant une hyposialie. Conclusion. L'orientation vers de nouvelles techniques d'irradiation de la tête et du cou pour épargner partiellement les glandes salivaires ouvre des voies potentielles de recherche et d'innovation pour les années à venir.Abstract -Quantitative evaluation of the secretion and buffer capacity of saliva during radiotherapy for cancers of the upper aerodigestive tract in Senegal. Introduction. Radiation therapy is a common treatment for head and neck cancers, which uses ionizing radiation, to destroy cancerous tissue. Its purpose is the sterilization of cancer cells while sparing the best surrounding healthy tissue or organs. The objective of this study was to evaluate the effects of radiotherapy on salivary gland function in patients treated for head and neck cancer. Material and methods. A descriptive cross-sectional study was performed repeatedly in 33 patients with head and neck cancer and treated with radiotherapy department of the Aristide Le Dantec Hospital in Dakar (Senegal). Xerostomia, salivary flow unstimulated and stimulated saliva and pH were measured before (T0), during (T), and one month after radiotherapy (T1). The data were statistically analyzed and evaluated using the SPSS software. Results. The extreme age of patients was 18 and 69 years. People over 60 years old accounted for 45.5% of the population. Men constitut...

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Long-term Outcomes of Submandibular Gland Transfer for Prevention of Postradiation Xerostomia

Cited by 86 publications

References 28 publications

Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy

Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy

Free thyroid transfer: Short‐term results of a novel procedure to prevent post‐radiation hypothyroidism

Évaluation quantitative de la secrétion et du pouvoir tampon de la salive au cours de la radiothérapie des cancers des voies aéro-digestives supérieures au Sénégal

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