Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Apr:127:105783.
doi: 10.1016/j.oraloncology.2022.105783. Epub 2022 Feb 26.

The impact of head and neck radiotherapy on salivary flow and quality of life: Results of the ORARAD study

Alexander Lin  1 , Erika S Helgeson  2 , Nathaniel S Treister  3 , Brian L Schmidt  4 , Lauren L Patton  5 , Linda S Elting  6 , Rajesh V Lalla  7 , Michael T Brennan  8 , Thomas P Sollecito  9
Affiliations
Multicenter Study

The impact of head and neck radiotherapy on salivary flow and quality of life: Results of the ORARAD study

Alexander Lin et al. Oral Oncol. 2022 Apr.

Abstract

Objectives: Salivary hypofunction and xerostomia, are common side effects of radiotherapy, negatively impacting quality of life. The OraRad study presents results on the longitudinal impact of radiotherapy on salivary flow and patient-reported outcomes.

Patients and methods: Prospective, multicenter cohort study of 572 patients receiving curative-intent head and neck radiotherapy (RT). Stimulated salivary flow (SSF) rate and patient-reported outcomes were measured prior to RT and at 6- and 18-months post-RT. Linear mixed effects models examined the relationship between RT dose and change in salivary flow, and change in patient-reported outcomes.

Results: 544 patients had baseline salivary flow measurement, with median (IQR) stimulated flow rate of 0.975 (0.648, 1.417) g/min. Average RT dose to parotid glands was associated with change in salivary flow post-RT (p < 0.001). Diminished flow to 37% of pre-RT level was observed at 6 months (median: 0.358, IQR: 0.188 to 0.640 g/min, n = 481) with partial recovery to 59% of pre-RT at 18 months (median: 0.575, IQR: 0.338 to 0.884 g/min, n = 422). Significant improvement in patient-reported swallowing, senses (taste and smell), mouth opening, dry mouth, and sticky saliva (p-values < 0.03) were observed between 6 and 18 months post-RT. Changes in swallowing, mouth opening, dry mouth, and sticky saliva were significantly associated with changes in salivary flow from baseline (p-values < 0.04).

Conclusion: Salivary flow and patient-reported outcomes decreased as a result of RT, but demonstrated partial recovery during follow-up. Continued efforts are needed to improve post-RT salivary function to support quality of life.

Keywords: Head and Neck Neoplasms; Quality of Life; Radiotherapy; Xerostomia.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared

Figures

Figure 1:
Figure 1:
Distribution of salivary flow at baseline (n=544), 6 months post-RT (n=481), and 18 months post-RT (n=422). The dot and line represent mean ± SD at each visit.
Figure 2:
Figure 2:
Loess curve for salivary flow rate (g/min) by primary site of RT (N=564)
Figure 3:
Figure 3:
Loess curve for salivary flow rate (g/min) by quartiles of average RT dose to the parotid glands (N=563). Dose to the parotids is categorized based on quartiles: quartile 1≤;2018 (cGy), quartile 2>2018 and ≤2586 (cGy), quartile 3 >2586 and ≤ 3358 (cGy), and quartile 4 > 3358(cGy). Visit month has been jittered for visualization purposes. Statistical comparisons between quartiles are provided in Supplementary Table S4.
Figure 4
Figure 4
(a-e): Selected EORTC QLQ-H&N35 scales at baseline, 6 months post-RT, and 18 months post-RT for a) swallowing b) senses problems c) opening mouth and d) dry mouth, and e) sticky saliva. A score ≥ 50 corresponds to responses of “quite a bit” or “very much” for the opening mouth, dry mouth, and sticky saliva scale.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Fuchs HE Jemal A. Cancer statistics, 2021. CA: a cancer journal for clinicians 2021;71:7–33. - PubMed
    1. Wijers OB, Levendag PC, Braaksma MM, Boonzaaijer M, Visch LL Schmitz PI. Patients with head and neck cancer cured by radiation therapy: A survey of the dry mouth syndrome in long-term survivors. Head & neck 2002;24:737–47. - PubMed
    1. Jensen AB, Hansen O, Jørgensen K Bastholt L. Influence of late side-effects upon daily life after radiotherapy for laryngeal and pharyngeal cancer. Acta oncologica (Stockholm, Sweden) 1994;33:487–91. - PubMed
    1. Lin A, Kim HM, Terrell JE, Dawson LA, Ship JA Eisbruch A. Quality of life after parotid-sparing imrt for head-and-neck cancer: A prospective longitudinal study. International journal of radiation oncology, biology, physics 2003;57:61–70. - PubMed
    1. Jabbari S, Kim HM, Feng M, Lin A, Tsien C, Elshaikh M, et al. Matched case-control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer: Initial report. International journal of radiation oncology, biology, physics 2005;63:725–31. - PubMed

Publication types