The impact of xerostomy on the quality of life in irradiated patients with head and neck cancer; Wplyw kserostomi na jakosc zycia chorych napromienionych z powodow narzadow glowy i szyi

Introduction. The common side effect of radiation therapy for head and neck cancer is dryness of mucous membranes of the oral cavity and pharynx, known as xerostomy. Xerostomy is a consequence of salivary gland dysfunction. Saliva plays an important role in maintaining the correct condition of the oral cavity mucosa due to antibacterial, antifungal, moistening and digestive functions. There are quantitative and qualitative methods of assessing the radiotherapy induced dysfunction of salivary glands. Sialometry and dynamic salivary gland scintigraphy are among the quantitative methods of assessment. Subjective evaluation of xerostomy is a valuable part of quality of life assessment. Aim of the Study. To evaluate the impact of xerostomy on the quality of life in patients with head and neck cancer treated with radiation therapy. Patients with pathologically confirmed head and neck cancer, treated with radical radiotherapy or chemoradiotherapy were eligible for this study. Patients with incomplete 12-month follow up were excluded from the analysis. All patients were treated with 3D conformal radiotherapy. Parallel opposing fields were used in every case. Patients were divided into two groups for research purposes, depending upon the volume of salivary glands included in irradiated volume. Patients with a high risk of xerostomy (treatment volume contained 60-100% of parotid gland volume) were assigned to group I and the remaining patients (treatment volume contained 20-30% of parotid gland volume) were assigned to group II. The irradiated volume of the parotid gland depended on the primary tumor site and was based on computer tomography definition of clinical target volume. The intensity of salivary gland dysfunction was tested by objective (dynamic scintigraphy) and subjective (quality of life questionnaire) methods. Patients were asked to complete the quality of life questionnaire. Tests were carried out before treatment and then after 30-36 Gy and 3, 6 and 12 months after the completion of radiation therapy. Patients characteristics. Seventy patients (8 women and 62 men) who meet the inclusion and exclusion criteria were enrolled in the study between April 2001 and February 2003. Patients ranged in age from 35 to 80 years (median: 58 years). Seventy patients were included in the study group. Only 52 patients completed all the designed tests during the 12-month follow up. The minimal scores defining the quality of life were seen at week III of radiotherapy and then they gradually reached some 80-85% of the baseline score at the end of the 12-month follow up. Analysis revealed a relationship between the quality of life score and selected clinical data (intensity of early post-radiation mucositis and high risk of xerostomy). Conclusions. Xerostomy affects the quality of life. Worse quality of life is linked with the intensity of early post-radiation reaction. Improvement of the quality of life is observed after the healing of the early reaction of mucous membranes. The quality of life depends on the irradiated volume of the salivary glands. Improvement of post treatment quality of life is evident in patients with a lesser volume of salivary glands included in treatment volume. (authors)