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Submandibular Gland Sparing Radiotherapy for Locally Advanced Head and Neck Squamous Cell Cancers: Xerostomia Outcomes

Aneequa Hussain, Post Graduate, Department of Radiotherapy, MNJIO and RCC, Osmania Medical College, Hyderabad, Telangana 500095, India. , Madisetty Adilakshmi1 , C. Sanjeeva Kumari2 , Aneequa Hussain3

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Indian Journal of Cancer Education and Research 6(2):p 143-151, July-Dec 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijcer.2321.9815.6218.4

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Abstract

  Aim: To spare the contralateral submandibular gland in head and neck cancers using IMRT and to compare them with the contralateral unspared group of head and neck cancers also on IMRT but in whom sparing of cSMG is not possible because of various factors and to access xerostomia outcomes in these two groups. Materials and methods: It is a prospective and comparative intent to reduce toxicity levels in 30 patients presented to our hospital of locally advanced head and neck cancers and treated with IMRT and concurrent chemotherapy and their follow-up. All patients with stage I, II / IV Head and Neck cancers to be treated with bilateral head and neck IMRT. Appropriately selected patients with favourable primary tumor characteristics and no definite contralateral neck disease treated with cSMG- sparing. 

Results: Post treatment after 2 months where a score of 2 was seen in 13.3% of patients in the cSMG sparing was done against 30% of the control group. At the end of 4 and 6 months from commencement of treatment were 3.3% and 3.3% respectively in the study group and,16%  and 6.6% in the control group. The difference at 2 and 4 months was clinically significant but statistically could not be proved. This significant difference was observed due to the lower dryness felt by the patients at rest in the cSMG spared arm. Pre irradiation MR sialography with secretion stimulation could not help predict severity of radiation induced xerostomia. Whereas post irradiated MR imaging revealed submandibular gland secretion response in submandibular gland spared arm and revealed that submandibular gland secretion response is most influential to radiation induced xerostomia grading clinically whereas statistical significance could not beproved. This difference was seen when grade 2 and 3 response was seen in base liner SG vs post RT rSG in  both IMRT (36% and 30%) and conventional arms (43% and 40%respectively).

Conclusions: The useof IMRT with daily imaging and time required for careful selection of patients and properexecution of the treatment may lead to questions regarding the time and the costrequired for execution of this type of planning. 

Keywords: Cancer; Submandibular; Xerostomia; Radiotherapy.    

 

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DOI: DOI: http://dx.doi.org/10.21088/ijcer.2321.9815.6218.4

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