IMPACT OF INTENSITY MODULATED RADIATION THERAPY ON THE SALIVARY GLANDS FUNCTION AND SALIVA FLOW RATE

  • Sonja Rogoleva Gjurovski Faculty of Medical Sciences, Dental medicine, University Goce Delcev, Stip, R. North Macedonia
  • Vladimir Popovski University Clinic for Maxillofacial surgery, Faculty of Dentistry, Ss. Cyril and Methodius, University in Skopje, R. North Macedonia
  • Lenche Kostadinova University Clinic of Radiotherapy and Oncology, Skopje, R. North Macedonia
  • Bruno Nikolovski Faculty of Medical Sciences, University Goce Delcev, Stip, R. North Macedonia

Abstract

In patients with head and neck cancer, the most common issue after radiation treatment is xerostomia and the consequences of that, which are affecting the quality of everyday life of the patient. Subjectively xerostomia is manifested as dryness in the oral cavity, followed with obstructed chewing and swallowing of the food. Mostly it happens because of the death of the cells in the gland that are supposed to be dividing, caused by the radiation. To improve patients’ life after treatment, IMRT approach has been considered to be a better solution for the gland tissue sparing during the radiation treatment, therefore, to decrease the severity and the intensity of the following  xerostomia. The IMRT technique allows the chosen dose of radiation to be applied specifically on the tissue where it is supposed to be, sparing the surrounding healthy parts from the unnecessary radiation. The aim of this study was to evaluate the influence of the Intensity Modulated Radiation therapy (IMRT), with different intensity and dosage, on the function of salivary glands. For this study were analyzed total number of 87 surveys, 41 of them were used for detail analysis. This study is based on narrative review on published articles written in English language, reporting results related to the use of Intensity modulated radiation therapy treatment in patients with head and neck cancer. The gathered results have shown that the function of the salivary glands after radiation treatment can be in many cases protected during the treatment, or even restored to some level, therefore the resulting xerostomia can be reduced and its’ following negative effects affecting the patients’ life could be minimized by using the improved technique IMRT. In many studies the evaluated levels of xerostomia have been found to be significantly lower in the groups of patients treated with IMRT technique, compared with the other group of patients treated with conventional radiation therapy. Also, a big influence has the dosage of the radiation beams, on what depends on the outcome of the salivation function in patients treated with radiation therapy.


Key words: Intensity modulated radiation therapy, xerostomia, salivary glands hypo-function, saliva reduction, saliva flow rate, salivary gland sparing.


https://doi.org/10.55302/JMS2251172rgj

References

1. Wang X, Eisbruch A. IMRT for head and neck cancer: reducing xerostomia and dysphagia. J Radiat Res. 2016;57 Suppl 1(Suppl 1):i69-i75.
2. Acauan MD, Figueiredo MA, Cherubini K, Gomes AP, Salum FG. Radiotherapy-induced salivary dysfunction: Structural changes, pathogenetic mechanisms and therapies. Arch Oral Biol. 2015;60:1802–10.
3. Vissink A, Mitchell JB, Baum BJ, et al. Clinical management of salivary gland hypofunction and xerostomia in head-and-neck cancer patients: successes and barriers. Int J Radiat Oncol Biol Phys. 2010;78(4):983-991.
4. Kaae JK, Stenfeldt L, Eriksen JG. Xerostomia after Radiotherapy for Oral and Oropharyngeal Cancer: Increasing Salivary Flow with Tasteless Sugar-free Chewing Gum. Front Oncol. 2016;6:111. Published 2016 May 3.
5. Strigari L, Benassi M, Arcangeli G, Bruzzaniti V, Giovinazzo G, Marucci L. A novel dose constraint to reduce xerostomia in head-and-neck cancer patients treated with intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2010; 77: 269– 76.
6. Hoyne C, BaAppSci (Medical Radiations),Marcus Dreosti, MBBS(Hons), FRANZCR,John Shakeshaft, MA, PhD& Siddartha Baxi,Comparison of treatment techniques for reduction in thesubmandibular gland dose: A retrospective study, J Med Radiat Sci64,2017;125–130
7. Collan J, Kapanen M, Makitie A. Submandibular gland-sparing intensity modulated radiotherapy in the treatment of head and neck cancer: Sites of locoregional relapse and survival. Acta Oncol 2012; 51: 735– 42.
8. Doornaert P, Verbakel W, Rietveld D, Slotman BJ, Senan S. Sparing the contralateral submandibular without compromising PTV coverage by using volumetric modulated arc therapy. Radiat Oncol 2011; 6: 74.
9. Murdoch-Kinch A, Kim HM, Vineberg KA, Ship JA, Eisbruch A. Dose-effect relationships for the submandibular salivary glands and implications for their sparing by intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72: 373– 82.
10. Webster GJ, Rowbottom CG, Mackay RI. Accuracy and precision of an IGRT solution. Med Dosim 2009; 34: 99– 106.
11. Bertelsen A, Hansen CR, Johansen J, Brink C. Single arc volumetric modulated arc therapy of head and neck cancer. Radiother Oncol 2010; 95: 142– 8.
12. Vanetti E, Clivio A, Nicolini G, et al. Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: A treatment planning comparison with fixed field IMRT. Radiother Oncol 2009; 92: 111– 7.
13. Byungchul Ch.Intensity-modulated radiation therapy: a review with a physics perspectiveRadiat Oncol J. 2018 Mar.
14. Rim CH, Lee J, Kim WC, et al. A survey of radiation therapy utilization in Korea from 2010 to 2016: focusing on use of intensity-modulated radiation therapy. J Korean Med Sci. 2018;33:e67.
15. Das IJ, Cheng CW, Chopra KL, Mitra RK, Srivastava SP, Glatstein E. Intensity-modulated radiation therapy dose prescription, recording, and delivery: patterns of variability among institutions and treatment planning systems. J Natl Cancer Inst. 2008;100:300–7.
16. Bhide SA, Ahmed M, Newbold K, Harrington KJ, Nutting CM. The role of intensity modulated radiotherapy in advanced oral cavity carcinoma. J Cancer Res Ther. 2012;8:67–71.
17. Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer(PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12:127–36.
18. Dirix P, Vanstraelen B, Jorissen M, Vander Poorten V, Nuyts S. Intensity-modulated radiotherapy for sinonasal cancer: improved outcome compared to conventional radiotherapy. Int J Radiat Oncol Biol Phys. 2010;15:998–1004.
19. Schmitt, C. IMRT reduces incidence of xerostomia in patients with head and neck cancer. Nat Rev Clin Oncol 8, 194, 2011. https://doi.org/10.1038/nrclinonc. 2011.23
20. Eisbruch A, Kim HM, Terrell JE, Marsh LH, Dawson LA, et al. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;3:695–704.
21. Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, et al. A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys. 2001;4:907–16.
22. Manikantan K, Khode S, Sayed SI et al. . Dysphagia in head and neck cancer. Cancer Treat Rev 2009;35:724–32.
23. Deasy JO, Moiseenko V, Marks L, Chao KS, Nam J, et al. Radiotherapy dose–volume effects on salivary gland function. Int J Radiat Oncol Biol Phys. 2010;76:58–63.
24. Van Luijk P, Pringle S, Deasy JO, Moiseenko VV, Faber H, et al. Sparing the region of the salivary gland containing stem cells preserves saliva production after radiotherapy for head and neck cancer. Sci Transl Med. 2015;16:305.
25. Zhong-He W. et al. Impact of salivary gland dosimetry on post-IMRT recovery of saliva output and xerostomia grade for head-and-neck cancer patients treated with or without contralateral submandibular gland sparing: a longitudinal study, Int J Radiat Oncol Biol Phys. 2011.
26. Pow EH, Kwong DL, McMillan AS, et al. Xerostomia andquality of life after intensity-modulated radiotherapy vsconventional radiotherapy for early-stage nasopharyngealcarcinoma: Initial report on a randomized controlled clinicaltrial.Int J Radiat Oncol Biol Phys 2006;66:981-91.
27. Kam MK, Leung SF, Zee B, et al. Prospective randomized studyof intensity-modulated radiotherapy on salivary gland functionin early-stage nasopharyngeal carcinoma patients. J Clin Oncol2007;25:4873-79
28. Pètra M.BraamM.D.Chris H.J.Terhaard, Intensity Modulated therapy significantly reduces xerostomia compared with conventional radiotherapy, International Journal of Radiation Oncology, Biology, Physics, vol. 66. Issue 4, November 2006, 975-980.
29. Rij, C., Oughlane-Heemsbergen, W., Ackerstaff, A. et al. Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life. Radiat Oncol 3, 41, 2008.
30. Kałużny J, Wierzbicka M, Nogala H, Milecki P, Kopeć T. Radiotherapy induced xerostomia: mechanisms, diagnostics, prevention and treatment--evidence based up to 2013. Otolaryngol Pol. 2014;68:1–14.
31. Teng F. et al. “Reducing Xerostomia by Comprehensive Protection of Salivary Glands in Intensity-Modulated Radiation Therapy with Helical Tomotherapy Technique for Head-and-Neck Cancer Patients: A Prospective Observational Study.” BioMed Research International 2019.
32. A. Villa, A. Wolff, D. Aframian et al., “World Workshop on Oral Medicine VI: a systematic review of medication-induced salivary gland dysfunction: prevalence, diagnosis, and treatment,” Clinical Oral Investigations, vol. 19, no. 7, pp. 1563–1580, 2015.
33. J. Castelli, A. Simon, G. Louvel et al., “Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia,” Journal of Radiation Oncology, vol. 10, no. 1, article no. 6, 2015.
34. Jaguar, G.C., Prado, J.D., Campanhã, D. et al. Clinical features and preventive therapies of radiation-induced xerostomia in head and neck cancer patient: a literature review. Appl Cancer Res 37, 31, 2017.
35. Verrone JR, Alves FA, Prado JD, Marcicano AD, de Assis Pellizzon AC, Damascena AS, Jaguar GC. Benefits of an 649 intraoral stent in decreasing the irradiation dose to oral healthy tissue: dosimetric and clinical features. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118:573–8.
36. Sood AJ, Fox NF, O'Connell BP, Lovelace TL, Nguyen SA, et al. Salivary gland transfer to prevent radiation-induced xerostomia: a systematic review and meta-analysis. Oral Oncol. 2014;50:77–83.
37. Yang WF, Liao GQ, Hakim SG, Ouyang DQ, Ringash J, et al. Is Pilocarpine Effective in Preventing Radiation-Induced Xerostomia? A Systematic Review and Meta-analysis. Int J Radiat Oncol Biol Phys. 2016;94:503–11.
38. Vigneswaran N., Williams M.D. Epidemiological Trends in Head and Neck Cancer and Aids in Diagnosis Changing Epidemiology of Head and Neck Cancer. Oral Maxillofac. Surg. Clin. N. Am. 2014;26:123–141.
39. Osailan S, Pramanik R, Shirodaria S, Challacombe SJ, Proctor GB. Investigating the relationship between hyposalivation and mucosal wetness. Oral Dis. 2010.
40. Jensen SB, Pedersen AML, Vissink A, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer. 2010 Mar 25;
41.Palma LF, Gonnelli FA, Marcucci M, Giordani AJ, Dias RS, Segreto RA, et al. A novel method to evaluate salivary flow rates of head and neck cancer patients after radiotherapy: a pilot study. Braz J Otorhinolaryngol. 2018;84:227-31.
Published
2022-05-05
How to Cite
GJUROVSKI, Sonja Rogoleva et al. IMPACT OF INTENSITY MODULATED RADIATION THERAPY ON THE SALIVARY GLANDS FUNCTION AND SALIVA FLOW RATE. Journal of Morphological Sciences, [S.l.], v. 5, n. 1, p. 172-178, may 2022. ISSN 2545-4706. Available at: <http://www.jms.mk/jms/article/view/vol5no1-23>. Date accessed: 28 mar. 2024.
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Articles