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Objective To investigate the relationship between parotid image texture and acute radiation xerostomia (grade) during radiotherapy in patients with head and neck cancer.The mathematical model was established to predict the severity of radiation dry mouth in the early stage.Methods 23 patients with head and neck cancer treated with radiotherapy were observed.The degree of xerostomia was evaluated according to RTOG criteria.The weekly validated CT images of these patients during radiotherapy were collected and transmitted to the MIM system to outline the parotid gland,and an internal analysis program was developed in MATLAB (R2013a).The changes of texture features of weekly parotid CT images during radiotherapy were analyzed,including mean CT value (MCTN),standard deviation (STD),skewness,kurtosis,entropy and volume.The mathematical model was established,and the KNN method was used to optimize the model and predict the level of xerostomia.Results There was no significant correlation among the changes of MCTN,volume and the degree of xerostomia (P ＞ 0.05).However,according to the weekly changes of MCTN and volume,the model was established to predict the grade of xerostomia with an accuracy of 99％.Conclusions The changes of parotid gland MCTN and volume were significantly correlated with acute radiation xerostomia during radiotherapy for head and neck cancer,and the MCTN changes can be used to predict the severity of xerostomia in the early stage.
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Objective To compare the therapeutic effect of dark plum mixture on rats with radiation-induced xerostomia, given by gastric gavage and oral spray. Methods Rat model of radiation-induced xerostomia were developed by electron linear accelerator. Wistar rats were randomly divided into spray group and gastric gavage group, and normal group, positive control group and normal control group were set up within these two groups. The dark plum mixture was administered for 14 days. After treated for 7 days and 14 days, saliva was collected and submandibular gland samples were collected. The salivary secretion, Sorgan index, component analysis and pathological changes of submaxillary glands between the groups were assessed. Results On the 7thday after irradiation, the saliva secretion and gland coefficient of the dark plum spray group were significantly higher than the positive control group and normal control group (P＜ 0. 05). The saliva secretion, gland coefficient and saliva amylase activity of the dark plum mixture spray group were significantly higher than the dark plum mixture gastric gavage group (P＜ 0. 05). On the 14th day after irradiation, the saliva secretion and gland coefficient of the oral spray group were significantly higher than the gastric gavage group (P ＜ 0. 05 ). The pathological examination of submandibular gland tissues showed that 7 days after irradiation, there were less interglandular space and inflammatory cell infiltration in the oral spray group than the gastric gavage group. On the 14th day after irradiation, the ductal damage and cell nuclear pyknosis in the oral spray group were milder than the gastric gavage group. Vacuolated necrosis and nuclear pyknosis of some glandular cells were visible in the gastric gavage group 7 and 14 days after irradiation. Conclusions Compared with gastric gavage, the oral spray of dark plum mixture increases more saliva and salivary α-amylase secretion, effectively promote the repair of submandibular glandular cells after salivary gland irradiation, and indicates a better therapeutic effect on radiation-induced xerostomia.
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La xerostomía es la sensación de boca seca producto de una alteración del funcionamiento de las glándulas salivales. No es una enfermedad propiamente tal, pero sí una manifestación común a una serie de patologías alterando considerablemente la calidad de vida de los pacientes. Es una complicación frecuente de los pacientes oncológicos de cabeza y cuello que han sido irradiados, por lo que el otorrinolaringólogo juega un rol importante en su manejo. El objetivo de esta revisión es actualizar el manejo de la xerostomía, haciendo énfasis en la prevención de ésta en el paciente oncológico.
Xerostomia is the sensation of dry mouth and is usully caused by an altered functioning of the salivary glands. It is not a disease itself, but it is a common manifestation of a number of pathologies altering the quality of life of patients. It is a common complication of head and neck cancer patients that have been irradiated, so the otolaryngologist plays an important role in its management. The objective ofthis review is to update the management of xerostomia, with emphasis on preventing this in cancer patients.
Subject(s)
Humans , Radiotherapy/adverse effects , Xerostomia/diagnosis , Xerostomia/etiology , Xerostomia/therapy , Radiation Injuries/diagnosis , Radiation Injuries/therapy , Head and Neck Neoplasms/radiotherapyABSTRACT
<p><b>OBJECTIVE</b>To assess the relative standardization of acupuncture protocols for radiation-induced xerostomia.</p><p><b>METHODS</b>A literature search was carried out up to November 10, 2012 in the databases PubMed/MEDLINE, EMBASE and China National Knowledge Infrastruction with the terms: radiation-induced xerostomia, acupuncture, acupuncture treatment, and acupuncture therapy. Five ancient Chinese classic acupuncture works were also reviewed with the keywords "dry mouth, thirst, dry tongue, dry eyes and dry lips" to search the effective acupuncture points for dry mouth-associated symptoms in ancient China.</p><p><b>RESULTS</b>Twenty-two full-text articles relevant to acupuncture treatment for radiation-induced xerostomia were included and a total of 48 acupuncture points were searched in the 5 ancient Chinese classic acupuncture works, in which the most commonly used points were Chengjiang (CV24), Shuigou (GV 26), Duiduan (GV 27), Jinjin (EX-HN 12), and Yuye (EX-HN 13) on head and neck, Sanjian (LI 3), Shangyang (LI 1), Shaoshang (LU 11), Shaoze (SI 1), Xialian (LI 8) on hand, Fuliu (KI 7), Dazhong (KI 4), Zuqiaoyin (GB 44), Taichong (LR 3), Zhaohai (KI 6) on foot, Burong (ST 19), Zhangmen (LR 13), Tiantu (CV 22), Qimen (LR 14) on abdomen, Feishu (BL 13), Danshu (BL 19), Xiaochaogshu (BL 27), Ganshu (BL 18) on back, Shenmen (TF 4), Shen (CO10, Kidney), Yidan (CO11, Pancreas) and Pi (CO13, Spleen) on ear.</p><p><b>CONCLUSION</b>There were considerable heterogeneities in the current acupuncture treatment protocols for radiation-induced xerostomia. Based on the results of the review and the personal perspectives, the authors provide a recommendation for manual acupuncture protocols in treating radiationinduced xerostomia patients with head and neck cancer.</p>
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Reference Standards , Radiation Injuries , Reference Standards , Xerostomia , TherapeuticsABSTRACT
Radiation-induced xerostomia is the common radiotherapy-related complication of nasopharyngeal cancer and other head and neck cancers.The cause is that the radioactive rays damage salivary gland acini,ducts,blood vessels and nerves at different levels,resulting in dry mouth,mucositis,sialadenitis,and even dysphagia,trismus and other symptoms.In addition,radiation-induced xerostomia has a close relation to the radiation effect on the genes.Reasonable application of cytoprotective agents and sialagogues is the main treatment means.Chinese medicine also plays a crucial role in the prevention and treatment of radiation-induced xerostomia in recent years.
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Objective To investigate the value of magnetic resonance sialography (MRS) as a noninvasive tool in evaluating major salivary gland function before and after radiotherapy (RT) for nasopharyngeal carcinoma patients.Methods From August 2009 to June 2010,patients with stage Ⅰ and Ⅱa (AJCC/UICC 2002) nasopharyngeal carcinoma were enrolled.All the patients were treated with intensity modulated radiation therapy alone.MRS with salivary stimulation was performed in patients before and after RT on a 3.0T MR scanner.An MRS categorical scoring system was used to compare the visibility of ducts pre-RT and post-RT.The relationship between MRS score and EORTC Core QOL and EORTC Head and Neck QOL was analyzed.Spearman rank correlation test was performed to analyze the non-stimulated and stimulated MRS findings and the clinical severity of xerostomia.Results All 10 enrolled patients completed planned treatment.The mean dose of the parotid glands and submandibular glands were (37.99 + 3.70) Gy and (55.65 + 2.99) Gy,respectively.Good-quality MRS images were obtained.The visibility scores of both the parotid and submandibular ducts were increased after secretion stimulation.Irradiation decreased the visualization of the salivary ducts and attenuated the response to secretion stimulation.There were specific correlations between post-RT secretion response of the parotid gland and EORTC QLQ scales ( global QOL scale in QLQ-C30 ( rs =0.636,P =0.048 ) and xerostomia scale in QLQ H&N35 ( rs =- 0.694,P =0.026) ).Conclusions MRS can be used as a non-invasive way to evaluated of the functional changes of major salivary glands before and after RT and as a promising approach for investigating radiation-induced xerostomia.