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Supportive Care in Cancer

, Volume 20, Issue 11, pp 2903–2911 | Cite as

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

  • 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
Original Article

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.

Keywords

Radiotherapy Chemotherapy Late effect Head and neck cancer Oral complication 

Notes

Acknowledgments

We are especially grateful for the patients for their participation in this study.

Conflict of interest

The authors report no actual or potential conflict of interest.

References

  1. 1.
    Shah JP, Gil Z (2009) Current concepts in management of oral cancer—surgery. Oral Oncol 45:394–401PubMedCrossRefGoogle Scholar
  2. 2.
    Gallegos-Hernández JF (2006) Head and neck cancer. Risk factors and prevention. Cir Cir 74(4):287–93PubMedGoogle Scholar
  3. 3.
    McMahon S, Chen AY (2003) Head and neck cancer. Cancer Metastasis Rev 22:21–24PubMedCrossRefGoogle Scholar
  4. 4.
    Döbrõssy L (2005) Epidemiology of head and neck cancer: magnitude of the problem. Cancer Metastasis Rev 24:9–17PubMedCrossRefGoogle Scholar
  5. 5.
    Chua DTT, Tian Y, Wei WI (2007) Late oral complications following radiotherapy for head and neck cancers. Expert Rev Anticancer Ther 7(9):1215–1224PubMedCrossRefGoogle Scholar
  6. 6.
    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):443–461PubMedCrossRefGoogle Scholar
  7. 7.
    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):777–782PubMedCrossRefGoogle Scholar
  8. 8.
    Newlin HE, Amdur RJ, Riggs CE et al (2010) Concomitant weekly cisplatin and altered fractionation radiotherapy in locally advanced head and neck cancer. Cancer 116:4533–4540PubMedCrossRefGoogle Scholar
  9. 9.
    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–S82PubMedCrossRefGoogle Scholar
  10. 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–S114PubMedCrossRefGoogle Scholar
  11. 11.
    Langendijk JA (2007) New developments in radiotherapy of head and neck cancer: higher precision with less patient discomfort? Radiother Oncol 85:1–6PubMedCrossRefGoogle Scholar
  12. 12.
    Trotti A (2000) Toxicity in head and neck cancer: a review of trends and issues. Int J Radiat Oncol Biol Phys 47(1):1–12PubMedCrossRefGoogle Scholar
  13. 13.
    Kawashima M (2004) Chemoradiotherapy for head and neck cancer: current status and perspectives. Int J Clin Oncol 9:421–434PubMedCrossRefGoogle Scholar
  14. 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):385–392PubMedCrossRefGoogle Scholar
  15. 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 128:887–891PubMedGoogle Scholar
  16. 16.
    Eisbruch A, Rhodus RD et al (2003) The prevention and treatment of radiotherapy-induced xerostomia. Semin Radiat Oncol 13(3):302–308PubMedCrossRefGoogle Scholar
  17. 17.
    Jensen SB, Pedersen AM, Reibel J, Nauntofte B (2003) Xerostomia and hypofunction of the salivary glands in cancer therapy. Support Care Cancer 11:207–225PubMedGoogle Scholar
  18. 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):63–96Google Scholar
  19. 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. 20.
    Eisbrush A, Rhodus N, Rosenthal D et al (2003) How should we measure and report radiotherapy-induced xerostomia? Semin Radiat Oncol 13(3):226–234CrossRefGoogle Scholar
  21. 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. 22.
    Navazesh M, Christensen CM (1982) A comparison of whole mouth resting and stimulated salivary measurement procedures. J Dent Res 61(10):1158–62PubMedCrossRefGoogle Scholar
  23. 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–S39PubMedCrossRefGoogle Scholar
  24. 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: CD006386Google Scholar
  25. 25.
    Stone HB, Coleman CN, Anscher MS, McBride WH (2003) Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 4:529–536PubMedCrossRefGoogle Scholar
  26. 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):1209–1217PubMedCrossRefGoogle Scholar
  27. 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):563–568PubMedCrossRefGoogle Scholar
  28. 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):1040–1046PubMedCrossRefGoogle Scholar
  29. 29.
    Chen AM, Li BQ, Jennelle RLS et al (2010) Late esophageal toxicity after radiation therapy for head and neck cancer. Head Neck 32:178–183PubMedCrossRefGoogle Scholar
  30. 30.
    Power DA (2005) Late effects of radiotherapy: how to assess and improve outcomes. Br J Radiol 78:150–152PubMedCrossRefGoogle Scholar
  31. 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):1141–1164CrossRefGoogle Scholar
  32. 32.
    Vissink A, Jansma J, Spijkervet FKL (2003) Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 14(3):199–212PubMedCrossRefGoogle Scholar
  33. 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):78–92CrossRefGoogle Scholar
  34. 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 26:3582–3589PubMedCrossRefGoogle Scholar
  35. 35.
    Fischer DJ, Epstein JB (2008) Management of patients who have undergone head and neck cancer therapy. Dent Clin N Am 52:39–60PubMedCrossRefGoogle Scholar
  36. 36.
    Epstein JB, Stevensen-Moore P (2001) Periodontal disease and periodontal management in patients with cancer. Oral Oncol 37:613–619PubMedCrossRefGoogle Scholar
  37. 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):695–704PubMedCrossRefGoogle Scholar
  38. 38.
    Sonis ST, Fey EG (2002) Oral complications of cancer therapy. Oncology 16(5):680–686PubMedGoogle Scholar
  39. 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):672–679PubMedCrossRefGoogle Scholar
  40. 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):577–588PubMedCrossRefGoogle Scholar
  41. 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):451–458CrossRefGoogle Scholar
  42. 42.
    Guchelaar HJ, Vermes A, Meerwaldt JH (1997) Radiation-induced xerostomia: pathophysiology, clinical course and supportive treatment. Support Care Cancer 5:281–288PubMedCrossRefGoogle Scholar
  43. 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 106:235–41PubMedCrossRefGoogle Scholar
  44. 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):1061–79PubMedCrossRefGoogle Scholar
  45. 45.
    Rose-Ped AM, Bellm LA, Epstein JB et al (2002) Complications of radiation therapy for head and neck cancers. Cancer Nurs 25(6):461–465PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Aline Lima da Silva Deboni
    • 2
  • Adelmo José Giordani
    • 2
  • Nilza Nelly Fontana Lopes
    • 3
  • Rodrigo Souza Dias
    • 2
  • Roberto Araujo Segreto
    • 2
  • Siri Beier Jensen
    • 4
  • Helena Regina Comodo Segreto
    • 1
    • 2
  1. 1.Division of Radiotherapy, Department of Imaging DiagnosisFederal University of São Paulo—UNIFESP/EPMSão PauloBrazil
  2. 2.Division of Radiotherapy, Department of Imaging DiagnosisFederal University of São Paulo—UNIFESP/EPMSão PauloBrazil
  3. 3.Institute of Pediatric OncologyFederal University of São Paulo—IOP/GRAACC/UNIFESPSão PauloBrazil
  4. 4.Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark

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