39 Submandibular Salivary Gland Transfer Procedure for the Prevention of XRT Induced Xerostomia in Patients with Carcinoma of the Nasopharynx

Submandibular salivary gland transfer for the prevention of radiation-induced xerostomia in patients with nasopharyngeal carcinoma: 5-Year outcomes

BACKGROUND

Our aim in this study was to investigate the value of the submandibular salivary gland transfer procedure in prevention of radiation-induced xerostomia in patients with nasopharyngeal carcinoma (NPC).

METHODS

In all, there were 70 patients, consisting of a test group (36 patients) and a control group (34 patients) in a nonrandomized fashion. In the test group, the submandibular salivary gland was transferred to submental space before radiotherapy (XRT) and shielded. Salivary gland functions were evaluated by the amount of saliva and a quality of life questionnaire before and after XRT and 3 and 60 months after XRT.

RESULTS

At 5 years, the trapping and excretion functions of salivary gland were significantly better in the test group (p = .000 and p = .000). The mean weight of saliva after XRT was heavier (1.65 g vs 0.73 g, p = .000), and the incidence of xerostomia was lower in the test group, with no difference in 5-year survival and neck nodal recurrence between the 2 groups.

CONCLUSIONS

Salivary gland transfer procedure prevents XRT-induced xerostomia and improves quality of life of patients with NPC.

Sparing the parotid glands and surgically transferred submandibular gland with helical tomotherapy in post-operative radiation of head and neck cancer: a planning study

BACKGROUND AND PURPOSE

To evaluate the feasibility of sparing the parotid glands and surgically transferred submandibular gland (SMG) by intensity modulated radiotherapy (IMRT) in post-operative cases of head and neck cancer (HNC).

MATERIALS AND METHODS

Ten patients (larynx-2, base of tongue-4, tonsil-3, and unknown primary-1; pathologic stages III-IV) who underwent SMG transfers on the side of N0 neck along with definitive surgery were selected for this study. IMRT planning was done retrospectively using helical tomotherapy approach. Planning objective was to deliver 60 Gy to PTV1 and 54 Gy to PTV2 while maintaining the mean dose to the total parotid volume (TPV) and SMG less than 26 Gy.

RESULTS

The mean dose (+/-SD) to the TPV and SMG were 25+/-0.6 Gy and 23+/-1.9 Gy, respectively. The D(95) for PTV1 and PTV2 were 59.9+/-0.1 Gy and 54.9+/-0.3 Gy, respectively, satisfying our planning goal for PTV coverage. The D(99) for PTV1 and PTV2 were 58.2+/-0.7 Gy and 49.5+/-2.2 Gy, respectively, showing that sparing the salivary glands did not result in underdosing of the PTVs.

CONCLUSIONS

By combining the gland transfer and IMRT, the mean dose to TPV and transferred SMG could be reduced to less than 26 Gy in post-operative patients of HNC.