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01-11-2012 | Original Article

Long-term oral effects in patients treated with radiochemotherapy for head and neck cancer

Authors: Aline Lima da Silva Deboni, Adelmo José Giordani, Nilza Nelly Fontana Lopes, Rodrigo Souza Dias, Roberto Araujo Segreto, Siri Beier Jensen, Helena Regina Comodo Segreto

Published in: Supportive Care in Cancer | Issue 11/2012

Abstract

Purpose

The purpose of this study is to assess the late oral complications and the role of salivary gland hypofunction in the severity of mucosal reaction in nonsurgical head and neck cancer patients, submitted to radiotherapy with or without chemotherapy.

Methods and materials

Five hundred fifteen charts from patients treated between 2005 and 2009 were reviewed, and 41 patients met the inclusion criteria. Salivary gland function was assessed using a simplified grading system (GSX) and sialometry. Late effects were assessed using the Common Toxicity Criteria (CTC Version 2.0).

Results

The average follow-up was 17.1 (4–51) months. A statistical correlation was found for whole salivary flow rates and the average CTC grades for the mucous membrane. Both unstimulated/stimulated whole salivary flow rates (<0.09 mL/min) were identified as potential risk factors (p < 0.05) and an independent predictor for late mucous membrane toxicity (≥grade 2). A significant correlation was also found between unstimulated salivary flow rates—GSX scores (p = 0.001) and CTC grades for salivary glands. Eighty-five percent of the patients were classified as suffering from salivary gland hypofunction, as well as 58.2 % considered dryness of the mouth the most debilitating complication.

Conclusions

Considering the late effects assessed, the salivary gland hypofunction was the most significant and received the highest morbidity graduation (grade 2/grade 3); xerostomia was also considered the most debilitating complication after treatment. Data show the role of salivary gland hypofunction in the severity of late mucous membrane complication.

Shah JP, Gil Z (2009) Current concepts in management of oral cancer—surgery. Oral Oncol 45:394–401PubMedCrossRef

Gallegos-Hernández JF (2006) Head and neck cancer. Risk factors and prevention. Cir Cir 74(4):287–93PubMed

McMahon S, Chen AY (2003) Head and neck cancer. Cancer Metastasis Rev 22:21–24PubMedCrossRef

Döbrõssy L (2005) Epidemiology of head and neck cancer: magnitude of the problem. Cancer Metastasis Rev 24:9–17PubMedCrossRef

Chua DTT, Tian Y, Wei WI (2007) Late oral complications following radiotherapy for head and neck cancers. Expert Rev Anticancer Ther 7(9):1215–1224PubMedCrossRef

Zackrisson B, Mercke C, Strander H et al (2003) A systematic overview of radiation therapy effects in head and neck cancer. Acta Oncol 42(5):443–461PubMedCrossRef

Al-Sarraf M, Pajak TF, Byhardt RW et al (1997) Postoperative radiotherapy with concurrent cisplatin appears to improve locoregional control of advanced, resectable head and neck cancers: RTOG 88-24. Int J Radiat Oncol Biol Phys 37(4):777–782PubMedCrossRef

Newlin HE, Amdur RJ, Riggs CE et al (2010) Concomitant weekly cisplatin and altered fractionation radiotherapy in locally advanced head and neck cancer. Cancer 116:4533–4540PubMedCrossRef

Bentzen SM, Rosenthal DI, Weymuller EA, Trotti A (2007) Increasing toxicity in nonoperative head and neck cancer treatment: investigations and interventions. Int J Radiat Oncol Biol Phys 69(2 Suppl):S79–S82PubMedCrossRef

10.

Pignon JP, Maître AL, Bourhis J et al (2007) Meta-analyses of chemotherapy in head and neck cancer (MACH-NC): an update. Int J Radiat Oncol Biol Phys 69(2 Suppl):S112–S114PubMedCrossRef

11.

Langendijk JA (2007) New developments in radiotherapy of head and neck cancer: higher precision with less patient discomfort? Radiother Oncol 85:1–6PubMedCrossRef

12.

Trotti A (2000) Toxicity in head and neck cancer: a review of trends and issues. Int J Radiat Oncol Biol Phys 47(1):1–12PubMedCrossRef

13.

Kawashima M (2004) Chemoradiotherapy for head and neck cancer: current status and perspectives. Int J Clin Oncol 9:421–434PubMedCrossRef

14.

Dirix P, Abbeel S, Vanstraelen B et al (2009) Dysphagia after chemoradiotherapy for head-and-neck squamous cell carcinoma: dose–effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 75(2):385–392PubMedCrossRef

15.

Perlmutter MA, Johnson JT, Snyderman CH et al (2002) Functional outcomes after treatment of squamous cell carcinoma of the base of the tongue. Arch Otolaryngol Head Neck Surg 128:887–891PubMed

16.

Eisbruch A, Rhodus RD et al (2003) The prevention and treatment of radiotherapy-induced xerostomia. Semin Radiat Oncol 13(3):302–308PubMedCrossRef

17.

Jensen SB, Pedersen AM, Reibel J, Nauntofte B (2003) Xerostomia and hypofunction of the salivary glands in cancer therapy. Support Care Cancer 11:207–225PubMed

18.

Saad ED, Hoff PM, Carnelós RP et al (2002) Critérios Comuns de Toxicidade do Instituto Nacional de Câncer dos Estados Unidos (Common toxicity criteria of the National Cancer Institute). Rev Bras Cancerol 48(1):63–96

19.

Cancer Therapy Evaluation Program (1999) Common Toxicity Criteria, Version 2.0. http://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcv20_4-30-992.pdf. Accessed 20 Jan 2010

20.

Eisbrush A, Rhodus N, Rosenthal D et al (2003) How should we measure and report radiotherapy-induced xerostomia? Semin Radiat Oncol 13(3):226–234CrossRef

21.

Radiation Therapy Oncology Group (1999) A phase III study to test the efficacy of the prophylatic use of oral pilocarpine to reduce hyposalivation and mucositis associated with curative radiation therapy in head and neck cancer patients. RTOG97-09. Philadelphia, PA: Radiation Therapy Oncology Group. www.rtog.org/members/protocols/97-09/97-09.pdf. Accessed 20 Jan 2010

22.

Navazesh M, Christensen CM (1982) A comparison of whole mouth resting and stimulated salivary measurement procedures. J Dent Res 61(10):1158–62PubMedCrossRef

23.

Adelstein DJ (2007) Concurrent chemoradiotherapy in the management of squamous cell cancer of the oropharynx: current standards and future directions. Int J Radiat Oncol Biol Phys 69(2 Suppl):S37–S39PubMedCrossRef

24.

Furness S, Glenny AM, Worthington HV et al (2010) Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. Cochrane Database of Systematic Reviews, 9: CD006386

25.

Stone HB, Coleman CN, Anscher MS, McBride WH (2003) Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 4:529–536PubMedCrossRef

26.

Givens DJ, Karnell LH, Gupta AK et al (2009) Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 135(12):1209–1217PubMedCrossRef

27.

Withers HR, Peters LJ, Taylor JMG (1995) Late normal tissue sequelae from radiation therapy for carcinoma of the tonsil: patterns of fractionation study of radiobiology. Int J Radiat Oncol Biol Phys 33(3):563–568PubMedCrossRef

28.

Citrin D, Mansueti J, Likhacheva A (2009) Long-term outcomes and toxicity of concurrent paclitaxel and radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 74(4):1040–1046PubMedCrossRef

29.

Chen AM, Li BQ, Jennelle RLS et al (2010) Late esophageal toxicity after radiation therapy for head and neck cancer. Head Neck 32:178–183PubMedCrossRef

30.

Power DA (2005) Late effects of radiotherapy: how to assess and improve outcomes. Br J Radiol 78:150–152PubMedCrossRef

31.

Cooper JS, Fu K, Marks J, Silverman S (1995) Late effects of radiation therapy in the head and neck region. Int J Radiation Oncology Biol Phys 31(5):1141–1164CrossRef

32.

Vissink A, Jansma J, Spijkervet FKL (2003) Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 14(3):199–212PubMedCrossRef

33.

Olmi P, Crispino S, Fallai C et al (2006) Locoregionally advanced carcinoma of the oropharynx: conventional radiotherapy vs. accelerated hyperfractionated radiotherapy vs. concomitant radiotherapy and chemotherapy—a multicenter randomized trial. Int J Radiat Oncol Biol Phys 55(1):78–92CrossRef

34.

Machtay M, Moughan J, Trotti A et al (2008) Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26:3582–3589PubMedCrossRef

35.

Fischer DJ, Epstein JB (2008) Management of patients who have undergone head and neck cancer therapy. Dent Clin N Am 52:39–60PubMedCrossRef

36.

Epstein JB, Stevensen-Moore P (2001) Periodontal disease and periodontal management in patients with cancer. Oral Oncol 37:613–619PubMedCrossRef

37.

Eisbruch A, Kim HM, Terrel JE et al (2001) Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 50(3):695–704PubMedCrossRef

38.

Sonis ST, Fey EG (2002) Oral complications of cancer therapy. Oncology 16(5):680–686PubMed

39.

Yeh SA, Tang Y, Lui CC et al (2005) Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone. Int J Radiat Oncol Biol Phys 62(3):672–679PubMedCrossRef

40.

Fu KK, Pajak TF, Marcial VA et al (1995) Late effects of hyperfractionated radiotherapy for advanced head and neck cancer: long-term follow-up results of RTOG 83-13. Int J Radiat Oncol Biol Phys 32(3):577–588PubMedCrossRef

41.

Sreebny LM, Valdini A (2006) Xerostomia. Part I: relationship to other oral symptoms and salivary gland hypofunction. Oral Surg Oral Med Oral Pathol 66(4):451–458CrossRef

42.

Guchelaar HJ, Vermes A, Meerwaldt JH (1997) Radiation-induced xerostomia: pathophysiology, clinical course and supportive treatment. Support Care Cancer 5:281–288PubMedCrossRef

43.

Kaplan I, Zuk-Paz L, Wolff A (2008) Association between salivary flow rates, oral symptoms, and oral mucosal status. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:235–41PubMedCrossRef

44.

Jensen SB et al (2010) A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer 18(8):1061–79PubMedCrossRef

45.

Rose-Ped AM, Bellm LA, Epstein JB et al (2002) Complications of radiation therapy for head and neck cancers. Cancer Nurs 25(6):461–465PubMedCrossRef

Title: Long-term oral effects in patients treated with radiochemotherapy for head and neck cancer
Authors: Aline Lima da Silva Deboni
Adelmo José Giordani
Nilza Nelly Fontana Lopes
Rodrigo Souza Dias
Roberto Araujo Segreto
Siri Beier Jensen
Helena Regina Comodo Segreto
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 11/2012
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-012-1418-7

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