Schulz Riéli Elis, Bonzanini Laura Izabel Lampert, Ortigara Gabriela Barbieri, Soldera Eloisa Barbieri, Danesi Cristiane Cademartori, Antoniazzi Raquel Pippi, Ferrazzo Kívia Linhares
Universidade Federal de Santa Maria, Santa Maria, RS, Brasil.
Universidade Federal de Santa Maria, Faculdade de Odontologia, Departamento de Patologia, Santa Maria, RS, Brasil.
J Appl Oral Sci. 2021 Apr 19;29:e20200854. doi: 10.1590/1678-7757-2020-0854. eCollection 2021.
Hyposalivation and sensation of dry mouth (xerostomia) are one of the most common adverse effects in the treatment of patients with head and neck cancer.
This study evaluates the prevalence of late hyposalivation and associated factors in survivors of squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx treated with radiotherapy with or without concomitant chemotherapy.
A cross-sectional study was conducted with 88 patients who had concluded radiotherapy at least three months before the study, at a referral center for the treatment of head and neck cancer in the Southern region of Brazil. Hyposalivation was evaluated based on the stimulated salivary flow rate using the spitting method. Multivariate analysis using binary logistic regression was performed to determine the associations between hyposalivation and clinical and demographic variables.
Hyposalivation was found in 78.41% of the sample and the mean radiation dose was 63.01 Gy (±9.58). In the crude model of the multivariate analysis, hyposalivation was associated with higher doses of radiation (p=0.038), treatment with concomitant radiotherapy and chemotherapy (p=0.005), and time elapsed since the end of radiotherapy (p=0.025). In the adjusted model of the multivariate analysis, hyposalivation was only associated with dose and time elapsed. Patient who received higher doses of radiation had a 4.25-fold greater chance of presenting hyposalivation, whereas a longer time elapsed since the end of radiotherapy exerted a 75% protective effect against the occurrence of hyposalivation.
Hyposalivation is a highly prevalence late-onset side effect of radiotherapy in patients treated for head and neck cancer, with a greater chance of occurrence among those who received higher doses of radiation and those who ended therapy less than 22 months before our study. Concomitant chemotherapy and radiotherapy does not seem to increase the chances of hyposalivation compared to radiotherapy alone.
唾液分泌减少和口干感觉（口腔干燥症）是头颈癌患者治疗中最常见的不良反应之一。
本研究评估接受放疗联合或不联合化疗的口腔、口咽、下咽或喉鳞状细胞癌幸存者中晚期唾液分泌减少的患病率及相关因素。
在巴西南部地区一家头颈癌治疗转诊中心，对88例在研究前至少三个月结束放疗的患者进行了一项横断面研究。采用吐唾法根据刺激唾液流速评估唾液分泌减少情况。使用二元逻辑回归进行多变量分析，以确定唾液分泌减少与临床和人口统计学变量之间的关联。
样本中78.41%存在唾液分泌减少，平均辐射剂量为63.01 Gy（±9.58）。在多变量分析的粗模型中，唾液分泌减少与更高的辐射剂量（p = 0.038）、放疗联合化疗（p = 0.005）以及放疗结束后的时间（p = 0.025）相关。在多变量分析的调整模型中，唾液分泌减少仅与剂量和时间相关。接受更高辐射剂量的患者出现唾液分泌减少的可能性高4.25倍，而放疗结束后时间越长，对唾液分泌减少的发生有75%的保护作用。
唾液分泌减少是头颈癌放疗患者中一种高发的迟发性副作用，在接受更高辐射剂量以及在我们研究前不到22个月结束治疗的患者中发生几率更高。与单纯放疗相比，联合化疗和放疗似乎不会增加唾液分泌减少的几率。
