Does radiation dose to the salivary glands and oral cavity predict patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with curative radiotherapy?

Abstract

Background and purpose: To investigate the association between the mean salivary gland and oral cavity dose, with patient-rated moderate and severe xerostomia and sticky saliva.

Patients and methods: One hundred and fifty-seven patients treated with bilateral irradiation for head and neck cancer were included. The parotid and submandibular glands and the oral cavity were delineated on plannings-CT scans. At baseline and 6 and 12 months self-reported xerostomia and sticky saliva were assessed using the EORTC QLQ-H&N35 questionnaire.

Results: At 6 months a significant association between the mean parotid (MD(par)) and mean submandibular dose (MD(subm)) and xerostomia was observed (OR - MD(par): 1.17; P=0.002 and OR - MD(subm): 1.08; P = 0.02). Between MD(par) and MD(subm), a significant interaction term was present. No significant association was found with the oral cavity dose. Xerostomia was reversible depending on MD(par) and MD(subm). Considering Sticky saliva, a significant association was found at 6 and 12 months with MD(subm) (OR: 1.03; P < 0.001). The P50 for sticky saliva increased with elapsing time.

Conclusions: Both MD(par) and MD(subm) influence the risk of xerostomia in irradiated patients at 6 months. This probability as a function of the mean parotid dose significantly depended on the mean dose in the submandibular glands. Sticky saliva mainly depends on MD(subm).