Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
Radiother Oncol. 2013 Nov;109(2):311-6. doi: 10.1016/j.radonc.2013.06.040. Epub 2013 Aug 15.
The purpose of this prospective study was to investigate the relationship between xerostomia during the day (XERday) and night (XERnight) and sticky saliva during the day (STICday) and night (STICnight) and dose distributions in different major and minor salivary glands among head and neck cancer (HNC) patients treated with primary radiotherapy (RT) or chemoradiation (CHRT).
The study population was composed of 201 consecutive HNC patients treated with intensity modulated radiotherapy (IMRT) or 3-dimensional conformal radiotherapy (3D-CRT). All patients were included in a standard follow up programme in which acute and late side effects and quality of life (QoL) were prospectively assessed, prior to, during and after treatment. The primary endpoints were XERday, XERnight, STICday, STICnight as assessed by the Groningen Radiotherapy Induced Xerostomia questionnaire (GRIX) six months after completion of treatment. Organs at risk (OARs) potentially involved in salivary function were delineated on planning-CT, including the parotid, submandibular and sublingual glands and the minor glands in the soft palate, buccal mucosa and lips. Patients with moderate-to-severe xerostomia or moderate-to-severe sticky saliva, respectively, at baseline were excluded. In order to determine which salivary glands were most important, a multivariate logistic regression analysis with an extended bootstrapping technique was used.
In total, 29% and 19% of the cases suffered from XERday and XERnight, respectively. The multivariate analysis showed that baseline xerostomia and the mean parotid gland dose were the most important predictors for XERday and XERnight. At 6months after (CH)RT, 10% and 12% of the cases reported STICday and STICnight respectively. We were not able to identify prognostic factors related to dose distributions with regard to STICday. The mean submandibular gland dose was associated with STICnight. Baseline xerostomia and sticky saliva scores on the GRIX were associated with XERday, XERnight, STICday. Increasing age was correlated with both XERnight and STICnight.
Organs at risk for XERday and STICday are similar to organs at risk for XERnight and STICnight.
本前瞻性研究旨在探讨头颈部癌症（HNC）患者在接受调强放疗（IMRT）或三维适形放疗（3D-CRT）后，白天（XERday）和夜间（XERnight）口干以及白天（STICday）和夜间（STICnight）粘性唾液与不同大小唾液腺剂量分布之间的关系。
该研究人群由 201 例连续接受调强放疗（IMRT）或 3 维适形放疗（3D-CRT）的 HNC 患者组成。所有患者均纳入标准随访计划，在治疗前、治疗期间和治疗后前瞻性评估急性和晚期副作用以及生活质量（QoL）。主要终点是治疗结束后 6 个月通过格罗宁根放疗诱导性口干症问卷（GRIX）评估的 XERday、XERnight、STICday、STICnight。有潜在唾液功能受累的危险器官（OARs）包括腮腺、颌下腺和舌下腺，以及软腭、颊黏膜和唇的小唾液腺。排除基线时存在中重度口干或中重度粘性唾液的患者。为了确定哪些唾液腺最重要，我们使用了具有扩展引导技术的多变量逻辑回归分析。
总共有 29%和 19%的患者分别患有白天和夜间口干症。多变量分析显示，基线口干症和腮腺平均剂量是白天和夜间口干症最重要的预测因素。在（CH）RT 后 6 个月，分别有 10%和 12%的患者报告有白天和夜间粘性唾液。我们无法确定与 STICday 相关的剂量分布的预后因素。颌下腺平均剂量与 STICnight 相关。GRIX 上的基线口干症和粘性唾液评分与 XERday、XERnight、STICday 相关。年龄增加与 XERnight 和 STICnight 均相关。
与 XERnight 和 STICnight 相关的危险器官与 XERday 和 STICday 相似。
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