Radiation‐induced Xerostomia in patients with head and neck cancer: Pathogenesis, impact on quality of life, and management

Chambers, Mark S.; Garden, Adam S.; Kies, Merrill S.; Martin, Jack W.

doi:10.1002/hed.20045

Cited by 231 publications

(193 citation statements)

References 65 publications

(107 reference statements)

Supporting

Mentioning

169

Contrasting

Unclassified

Order By: Relevance

“…Patients with SCC are generally treated with surgery in combination with radiotherapy [20,21] . However, permanent xerostomia is a common complication of radiation therapy for head and neck [22] . Therefore, it is essential to develop more effective radiotherapy regimens for oral SCC.…”

Section: Discussionmentioning

confidence: 99%

Over-expression of Gadd45a enhances radiotherapy efficacy in human Tca8113 cell line

Zhang

Wang

et al. 2011

Acta Pharmacol Sin

View full text Add to dashboard Cite

Aim:To investigate the effect of the growth arrest-and DNA damage-inducible Gadd45a gene on the radiosensitivity of human tongue squamous cell carcinoma cell line to ionizing radiation (IR). Methods: Short interfering ribonucleic acid (si-RNA) targeting Gadd45a or an irrelevant mRNA (nonsense si-RNA) was chemically synthesized. The constructed si-RNAs were transfected into Tca8113 cells and Gadd45a expression was determined using quantitative real-time PCR and Western-blot. After 24-h exposure to IR at a dose rate of 4 Gy/min, apoptosis of Tca8113 cells was detected using flow cytometry, and radiosensitivity was measured using MTT assays. Results: IR apparently increased the expression of Gadd45a at mRNA and protein levels in Tca8113 cells. The effect was efficiently inhibited by transfection with Gadd45a si-RNA (P<0.01). Furthermore, silencing Gadd45a gene significantly increased cell viability and decreased the percentage of apoptotic cells during irradiation, which indicated that IR-induced Gadd45a over-expression could increase the radiosensitivity of Tca8113 cells. Conclusion: These results indicated that targeting Gadd45a may have important therapeutic implications in sensitizing Tca8113 cells to IR.

show abstract

Section: Discussionmentioning

confidence: 99%

Over-expression of Gadd45a enhances radiotherapy efficacy in human Tca8113 cell line

Zhang

Wang

et al. 2011

Acta Pharmacol Sin

View full text Add to dashboard Cite

show abstract

“…Xerostomia is one of the commonest radiation-induced complications in nasopharyngeal carcinoma (NPC) patients after a radical course of radiotherapy [1,2]. Persistent xerostomia, which is due to the damage of the parotid glands, causes difficulties in mastication and swallowing and enhances the risks of dental problems; these subsequently degrade the quality of life in long-term survivors [3,4].With the recent advancements in radiotherapy techniques such as intensity-modulated radiotherapy (IMRT), highly conformal dose distributions are possible and the sparing of parotid gland can be made more effective. However, conventional radiotherapy protocol for NPC is still used in some centres, and the treatment protocol is to employ lateral opposing beams to the face and upper neck plus an anterior beam to cover the lower neck.…”

mentioning

confidence: 99%

Evaluation of radiation-induced changes to parotid glands following conventional radiotherapy in patients with nasopharygneal carcinoma

Wu¹,

Ying²,

Kwong³

2011

BJR

View full text Add to dashboard Cite

Objectives: Xerostomia is a common post-radiotherapy (post-RT) complication in nasopharyngeal carcinoma (NPC) patients. This study evaluated the relation of post-RT parotid gland changes with the dose received. Methods: Data from 18 NPC patients treated by radiotherapy between 1997 and 2001 were collected. Parotid gland volumes were measured and compared between their pre-RT and post-RT CT images; both sets of CT were conducted with the same scanning protocol. Doppler ultrasound was used to assess the haemodynamic condition of the glands after radiotherapy. Doppler ultrasound results were compared against 18 agematched normal participants. A questionnaire was used to evaluate the patients' comments of xerostomia condition. Radiotherapy treatment plans of the participants were retrieved from the Eclipse treatment planning system from which the radiation doses delivered to the parotid glands were estimated. The correlations of parotid gland doses and the post-RT changes were evaluated. Results: The post-RT parotid glands were significantly smaller (p,0.001) than the pre-RT ones. They also demonstrated lower vascular velocity, resistive and pulsatility indices (p,0.05) than normal participants. The degree of volume shrinkage and subjective severity of xerostomia demonstrated dose dependence, but such dependence was not definite in the haemodynamic changes. Conclusion: It was possible to predict the gland volume change and subjective severity of xerostomia based on the dose to the parotid glands for NPC patients. However, such prediction was not effective for the vascular changes. The damage to the gland was long lasting and had significant effects on the patients' quality of life. Xerostomia is one of the commonest radiation-induced complications in nasopharyngeal carcinoma (NPC) patients after a radical course of radiotherapy [1,2]. Persistent xerostomia, which is due to the damage of the parotid glands, causes difficulties in mastication and swallowing and enhances the risks of dental problems; these subsequently degrade the quality of life in long-term survivors [3,4].With the recent advancements in radiotherapy techniques such as intensity-modulated radiotherapy (IMRT), highly conformal dose distributions are possible and the sparing of parotid gland can be made more effective. However, conventional radiotherapy protocol for NPC is still used in some centres, and the treatment protocol is to employ lateral opposing beams to the face and upper neck plus an anterior beam to cover the lower neck. This inevitably irradiates the parotid glands to a mean dose of over 45 Gy, with the medial portion receiving as high as 60 Gy [5,6].Up to now, the mechanism of parotid gland damage and saliva reduction due to radiation is largely unknown. It is postulated that the saliva secretion of the parotid glands is related to the changes in morphology and vascular condition as a result of radiation therapy [7]. CT is a useful imaging tool for monitoring the response of radiation therapy by providing morphological information of th...

show abstract

“…Many changes in salivary glands at 60 Gy are reversible, but beyond this, permanent damage occurs [4]. RT decreases salivary volume and pH, and changes its composition [5]. When the submandibular glands are excised, these processes occur more rapidly and patients may cease RT.…”

Section: Discussionmentioning

confidence: 99%

Practicability of Submandibular Gland in Squamous Cell Carcinomas of Oral Cavity

Malgonde

Kumar

2014

Indian J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

Current surgical treatment for oral cancers includes wide surgical excision of the primary lesion with appropriate neck dissection. Although tumor metastasis to the gland is uncommon, submandibular glands are frequently excised as a part of neck dissection because of their proximity to the primary lesion and afferent lymph nodes. Herein, we have retrospectively investigated the rate of involvement of submandibular glands in oral cavity tumors, and discussed the feasibility about resection of the submandibular glands. 94 patients undergoing 98 supraomohyoid neck dissections for oral cavity squamous cell carcinoma from 1st May 2010 till 31st May 2014 were retrospectively evaluated. Inclusion criteria were histopathologically confirmed squamous cell carcinoma of the oral cavity and surgery as the primary treatment modality, consisting of resection of the primary lesion with additional neck dissection, including at least one submandibular gland. Among the 98 specimens involvement of submandibular gland was seen only in 3 patients (3.06 %). Submandibular gland involvement was due to direct invasion of primary tumors and via the metastatic periglandular lymph nodes. Decision regarding excision of the gland should be done during the operation with the help of visual examination and frozen sections instead of preoperative planned resection. Preserving submandibular gland is both technically as well as oncologically feasible and can achieve potential benefit in preserving the submandibular salivary flow.

show abstract

Radiation‐induced Xerostomia in patients with head and neck cancer: Pathogenesis, impact on quality of life, and management

Abstract: New treatment approaches to xerostomia from RT for head and neck cancer may result in significant improvement in patient QOL.

Cited by 231 publications

References 65 publications

Over-expression of Gadd45a enhances radiotherapy efficacy in human Tca8113 cell line

Over-expression of Gadd45a enhances radiotherapy efficacy in human Tca8113 cell line

Evaluation of radiation-induced changes to parotid glands following conventional radiotherapy in patients with nasopharygneal carcinoma

Practicability of Submandibular Gland in Squamous Cell Carcinomas of Oral Cavity

Contact Info

Product

Resources

About