The impact of tongue-deviating and tongue-depressing oral stents on long-term radiation-associated symptoms in oropharyngeal cancer survivors

Abstract

Objectives: To evaluate whether the use of oral stents during intensity modulated radiation therapy (IMRT) for oropharyngeal cancer (OPC) is associated with long-term patient reported symptoms. Materials and methods: Data was obtained from a prospective observational study of disease-free head and neck cancer survivors. Radiation-associated patient reported symptoms were assessed using the MD Anderson Symptom Inventory Head and Neck module (MDASI-HN). Scores of 5 (11-point Likert scale, 0-10) were considered moderate/severe. Stratification was performed regarding IMRT volume (uni-versus bilateral neck) and stent utilization, with non-parametric analyses between groups. Results: 462 OPC survivors formed the cohort (54% tonsil, 46% base of tongue primaries). A tonguedeviating stent was used in 17%, tongue-depressing stent in 46%, and no stent in 37%. Median prescribed dose to the high dose clinical target volume was 66.0 Gy. Median follow-up from RT to MDASI-HN assessment was 68 months. Twenty percent had received unilateral neck RT (all had tonsil primaries), in whom a significant improvement in the proportion of patients with moderate/severe taste impairment (2% vs. 15%, p = 0.047) and lack of appetite (0% vs. 9%, p = 0.019) was associated with the use of tonguedeviating stents compared to no oral stent. In those who had received bilateral neck RT, a significant improvement in the proportion of patients with moderate/severe difficulty swallowing/chewing was associated with use of a tongue-depressing stent (21% vs. 31% without oral stent, p = 0.013). Conclusion: Disease-site specific select use of oral stents during IMRT was associated with reduced longterm patient reported symptoms in OPC survivors.

Radiation-Induced Salivary Gland Dysfunction: Mechanisms, Therapeutics and Future Directions

“…Intraoral stents are personalized medical devices designed to position and stabilize the oral cavity to prevent unnecessary irradiation of adjacent tissues. These devices are easy to manufacture [ 193 ] and have been demonstrated to efficiently reduce irradiation of off-target tissues [ 194 , 195 , 196 ]. Salivary glands can be protected from irradiation by temporarily relocating them further away from the field of irradiation in a procedure known as temporary SMG transplantation.…”

Factors associated with complex oral treatment device usage in patients with head and neck cancer

“…Recently published studies have also shown the dosimetric advantages of oral stents, including decreased mean and/or maximum dose to non-target areas of the oral mucosa [12]. It was also shown that participants with COTDs had lower toxicityrelated side-effects such as mucositis and xerostomia [12]. It was also shown that participants with stents had lower toxicity-related side-effects such as mucositis and xerostomia.…”

“…There is a current, albeit scarce, body of literature that addresses the relationship between COTDs and reduction of radiotherapy toxicities, namely RIOM [11]. Recently published studies have also shown the dosimetric advantages of oral stents, including decreased mean and/or maximum dose to non-target areas of the oral mucosa [12]. It was also shown that participants with COTDs had lower toxicityrelated side-effects such as mucositis and xerostomia [12].…”

Evaluation of radiodensity and dimensional stability of polymeric materials used for oral stents during external beam radiotherapy of head and neck carcinomas

“…The advantage of intraoral stents during radiotherapy of head and neck cancers to avoid unnecessary dose exposure to healthy tissue structures is widely accepted and reported in several case reports and case series [13] , [14] , [16] , [19] , [20] , [25] . While the principles of optimal positioning are well studied, the choice of material has not been investigated systematically.…”