Salivary function can be spared and xerostomia reduced when intensity-modulated radiotherapy (IMRT) is used instead of conventional therapy to treat squamous cell carcinoma of the head and neck (HNSCC).
A recent trial focused on 94 people with HNSCC who were randomized to IMRT or conventional radiotherapy at six radiotherapy centers across the United Kingdom between January 2003 and December 2007. Their saliva flow was measured and treatment side effects were assessed before and during therapy. The patients also reported on their quality of life for up to 2 years after treatment ended.
At the 12-month assessment, the rate of grade-2-or-worse xerostomia was markedly lower in the IMRT patients than in those who underwent conventional radiotherapy (38% vs. 74%, respectively). The IMRT group did report more fatigue—the only recorded acute adverse event of grade 2 or worse that differed significantly between the two treatment arms (74% vs. 41%).
At 24 months, grade-2-or-worse xerostomia was still much greater in the conventionally radiotherapy patients than in the IMRT subjects (83% vs. 29%).
“At 12 and 24 months, significant benefits were seen in recovery of saliva secretion with IMRT compared with conventional radiotherapy, as were clinically significant improvements in dry-mouth-specific and global quality-of-life scores,” summarized Dr. Christopher M. Nutting, FRCR, and coauthors (Lancet Oncol. 2011;12:127-136).
The team concluded that sparing the parotid glands with IMRT significantly reduces the incidence of xerostomia and leads to recovery of saliva secretion and improvements in associated quality of life, “and thus strongly supports a role for IMRT in squamous cell carcinoma of the head and neck.”