Steenbakkers R J H M, van Doornik S P, Vissink A, Kerdijk W, van Laar T
Department of Radiotherapy, University of Groningen, University Medical Center Groningen, the Netherlands.
Department of Dental Medicine, University of Groningen, Groningen, the Netherlands.
Clin Park Relat Disord. 2022 Feb 14;6:100138. doi: 10.1016/j.prdoa.2022.100138. eCollection 2022.
Drooling is a common symptom in patients with parkinsonism, causing physical and emotional distress. It is unknown which major salivary glands are the best candidates for irradiation to reduce drooling with minimal adverse events. Therefore, this study assessed the efficacy and safety of submandibular and parotid salivary gland irradiation to reduce drooling.
A prospective, randomised, double-blind, placebo-controlled trial was conducted at the University Medical Center Groningen, the Netherlands. After informed consent, 31 patients with parkinsonism and severe drooling according to the Unified Parkinson Disease Rating Scale (UPDRS) were included in this study. Exclusion criteria consisted of the use of anticholinergic drugs, the existence of salivary gland diseases, and/or an history of (pre)malignancies of the salivary glands. Patients were randomized for parotid-, submandibular- or sham irradiation (2x6 Gy with one week interval). Patients were evaluated at 1, 3, 6 and 12 months after radiation. Primary outcome measure was drooling severity according to the UPDRS. Secondary outcomes measures consisted of stimulated glandular salivary secretion rates and adverse effects.
Overall 31 parkinsonian patients were included. Initially 11 patients were radiated on the parotid glands, 10 patients on the submandibular glands and 10 patients were sham-radiated. After 6 months, the sham-radiated patients were actively treated after a second randomisation. One patient in the parotid radiation group discontinued his participation after three months due to physical deterioration. Radiation of parotid or submandibular glands significantly improved the existing drooling, as compared to placebo radiation. Parotid- and submandibular radiation was equally effective, but more patients in the submandibular radiated group reported sticky saliva vs. patients treated by parotid radiation (33∙33% vs. 13∙33%).
Major salivary gland radiation significantly improves drooling in parkinsonian patients with few adverse effects. However, parotid gland radiation is accompanied by fewer side effects and therefore is the preferred mode of radiation in this patient population.
流涎是帕金森病患者的常见症状，会导致身体和情绪困扰。目前尚不清楚哪个主要唾液腺是进行照射以减少流涎且不良事件最少的最佳选择。因此，本研究评估了下颌下腺和腮腺照射减少流涎的疗效和安全性。
在荷兰格罗宁根大学医学中心进行了一项前瞻性、随机、双盲、安慰剂对照试验。在获得知情同意后，根据统一帕金森病评定量表（UPDRS），31例患有帕金森病且流涎严重的患者被纳入本研究。排除标准包括使用抗胆碱能药物、存在唾液腺疾病和/或有唾液腺（前）恶性肿瘤病史。患者被随机分为接受腮腺、下颌下腺照射或假照射（2×6 Gy，间隔一周）。在放疗后1、3、6和12个月对患者进行评估。主要结局指标是根据UPDRS评估的流涎严重程度。次要结局指标包括刺激后的腺体唾液分泌率和不良反应。
共纳入31例帕金森病患者。最初，11例患者接受腮腺照射，10例患者接受下颌下腺照射，10例患者接受假照射。6个月后，假照射患者在第二次随机分组后接受积极治疗。腮腺照射组有1例患者在3个月后因身体状况恶化而退出研究。与安慰剂照射相比，腮腺或下颌下腺照射显著改善了现有的流涎症状。腮腺照射和下颌下腺照射同样有效，但下颌下腺照射组报告唾液黏稠的患者比腮腺照射组更多（33.33%对13.33%）。
主要唾液腺照射可显著改善帕金森病患者的流涎症状，且不良反应较少。然而，腮腺照射的副作用较少，因此是该患者群体首选的照射方式。
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