Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T22:39:31.329Z Has data issue: false hasContentIssue false
  • English
  • Français

Survival and quality of life in oropharyngeal cancer patients treated with primary chemoradiation after salivary gland transfer

Published online by Cambridge University Press:  24 June 2016

G B Morand ,
J Madana ,
S D Da Silva ,
M Roskies ,
K Sultanem ,
M J Black ,
A M Mlynarek  and
M P Hier
G B Morand
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Québec, Canada
J Madana
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Québec, Canada
S D Da Silva
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Québec, Canada
M Roskies
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Québec, Canada
K Sultanem
Affiliation:
Department of Radiation Oncology, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Québec, Canada
M J Black
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Québec, Canada
A M Mlynarek
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Québec, Canada
M P Hier*
Affiliation:
Department of Otolaryngology – Head & Neck Surgery, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Québec, Canada
*
Address for correspondence: Dr M P Hier, Department of Otolaryngology – Head & Neck Surgery, Sir Mortimer B Davis Jewish General Hospital, 3755 Côte-Ste-Catherine, Montreal, Québec, Canada H3T1E2 Fax: +1 514 843 1403 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Salivary gland transfer surgery can reduce xerostomia in oropharyngeal squamous cell carcinoma patients undergoing primary chemoradiation. A potential drawback of salivary gland transfer is the treatment delay associated with the surgery, and its complications. This study aimed to determine whether the treatment delay affects patient survival and to evaluate patient quality of life after salivary gland transfer.

Methods:

A retrospective analysis of 138 patients (salivary gland transfer group, n = 58; non-salivary gland transfer group, n = 80) was performed. Patient survival was compared between these groups using multivariate analysis. Salivary gland transfer patients were further evaluated for surgical complications and for quality of life using the head and neck module of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.

Results:

Salivary gland transfer and non-salivary gland transfer patients had comparable baseline clinical characteristics. Salivary gland transfer patients experienced a median treatment delay of 16.5 days before chemoradiation (p = 0.035). Multivariate analysis showed that this did not, however, correspond to a survival disadvantage (p = 0.24 and p = 0.97 for disease-free and disease-specific survival, respectively). A very low complication rate was reported for the salivary gland transfer group (1.7 per cent). Questionnaire scores for the item ‘xerostomia’ were very low in salivary gland transfer patients.

Conclusion:

The treatment delay associated with salivary gland transfer surgery does not negatively affect patient survival. Oropharyngeal squamous cell patients have an excellent quality of life after salivary gland transfer.

Keywords

Salivary GlandsOropharyngeal CancerXerostomiaQuality of LifeRadiotherapy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 8 , August 2016 , pp. 755 - 762
Copyright
Copyright © JLO (1984) Limited 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented as an oral presentation at the International Federation of Head & Neck Oncologic Societies 5th World Congress/American Head & Neck Society 2014 Meeting, 26–30 July 2014, New York City, USA.

References

1 Calais, G, Alfonsi, M, Bardet, E, Sire, C, Germain, T, Bergerot, P et al. Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst 1999;91:2081–6Google Scholar
2 Soo, KC, Tan, EH, Wee, J, Lim, D, Tai, BC, Khoo, ML et al. Surgery and adjuvant radiotherapy vs concurrent chemoradiotherapy in stage III/IV nonmetastatic squamous cell head and neck cancer: a randomised comparison. Br J Cancer 2005;93:279–86Google Scholar
3 Marur, S, D'Souza, G, Westra, WH, Forastiere, AA. HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncol 2010;11:781–9CrossRefGoogle ScholarPubMed
4 Ang, KK, Harris, J, Wheeler, R, Weber, R, Rosenthal, DI, Nguyen-Tan, PF et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 2010;363:24–35 CrossRefGoogle ScholarPubMed
5 Fakhry, C, Westra, WH, Li, S, Cmelak, A, Ridge, JA, Pinto, H et al. Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 2008;100:261–9Google Scholar
6 Jensen, SB, Pedersen, AM, Vissink, A, Andersen, E, Brown, CG, Davies, AN et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 2010;18:1039–60Google Scholar
7 Dirix, P, Nuyts, S. Evidence-based organ-sparing radiotherapy in head and neck cancer. Lancet Oncol 2010;11:85–91 Google Scholar
8 Hey, J, Setz, J, Gerlach, R, Vordermark, D, Gernhardt, CR, Kuhnt, T. Effect of cisplatin on parotid gland function in concomitant radiochemotherapy. Int J Radiat Oncol Biol Phys 2009;75:1475–80Google Scholar
9 Nutting, CM, Morden, JP, Harrington, KJ, Urbano, TG, Bhide, SA, Clark, C et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 2011;12:127–36CrossRefGoogle ScholarPubMed
10 Milne, RW, Dawes, C. The relative contributions of different salivary glands to the blood group activity of whole saliva in humans. Vox Sang 1973;25:298–307 Google Scholar
11 Jha, N, Seikaly, H, Harris, J, Williams, D, Sultanem, K, Hier, M et al. Phase III randomized study: oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation-induced xerostomia. Head Neck 2009;31:234–43Google Scholar
12 More, YI, Tsue, TT, Girod, DA, Harbison, J, Sykes, KJ, Williams, C et al. Functional swallowing outcomes following transoral robotic surgery vs primary chemoradiotherapy in patients with advanced-stage oropharynx and supraglottis cancers. JAMA Otolaryngol Head Neck Surg 2013;139:43–8Google Scholar
13 Seikaly, H, Jha, N, McGaw, T, Coulter, L, Liu, R, Oldring, D. Submandibular gland transfer: a new method of preventing radiation-induced xerostomia. Laryngoscope 2001;111:347–52Google Scholar
14 Jha, N, Harris, J, Seikaly, H, Jacobs, JR, McEwan, AJ, Robbins, KT et al. A phase II study of submandibular gland transfer prior to radiation for prevention of radiation-induced xerostomia in head-and-neck cancer (RTOG 0244). Int J Radiat Oncol Biol Phys 2012;84:437–42CrossRefGoogle ScholarPubMed
15 Zhang, Y, Guo, CB, Zhang, L, Wang, Y, Peng, X, Mao, C et al. Prevention of radiation-induced xerostomia by submandibular gland transfer. Head Neck 2012;34:937–42Google Scholar
16 Wan Leung, S, Lee, TF, Chien, CY, Chao, PJ, Tsai, WL, Fang, FM. Health-related quality of life in 640 head and neck cancer survivors after radiotherapy using EORTC QLQ-C30 and QLQ-H&N35 questionnaires. BMC Cancer 2011;11:128 Google Scholar
17 Braam, PM, Roesink, JM, Raaijmakers, CP, Busschers, WB, Terhaard, CH. Quality of life and salivary output in patients with head-and-neck cancer five years after radiotherapy. Radiat Oncol 2007;2:3 Google Scholar
18 Bjordal, K, de Graeff, A, Fayers, PM, Hammerlid, E, van Pottelsberghe, C, Curran, D et al. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group. Eur J Cancer 2000;36:1796–807CrossRefGoogle ScholarPubMed
19 Al-Mamgani, A, van Rooij, P, Tans, L, Verduijn, GM, Sewnaik, A, Baatenburg de Jong RJ. A prospective evaluation of patient-reported quality-of-life after (chemo)radiation for oropharyngeal cancer: which patients are at risk of significant quality-of-life deterioration? Radiother Oncol 2013;106:359–63Google Scholar
20 Edge, SB, Byrd, DR, Compton, CC, Fritz, AG, Greene, FL, Trotti, A, eds. AJCC Cancer Staging Manual, 7th edn. New York: Springer, 2010 Google ScholarPubMed
21 Eisbruch, A, Gregoire, V. Balancing risk and reward in target delineation for highly conformal radiotherapy in head and neck cancer. Semin Radiat Oncol 2009;19:43–52 Google Scholar
22 Hartford, AC, Galvin, JM, Beyer, DC, Eichler, TJ, Ibbott, GS, Kavanagh, B et al. American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) Practice Guideline for Intensity-modulated Radiation Therapy (IMRT). Am J Clin Oncol 2012;35:612–17CrossRefGoogle ScholarPubMed
23 Cull, A, Sprangers, MAG, Bjordal, K, Aaronson, N, on behalf of the EORTC Quality of Life Study Group. Translation Procedure. Brussels: EORTC, 1998 Google Scholar
24 Middletion, D. “Statistics at square one”. Br Med J 1976;2:1008–9Google Scholar
25 Sood, AJ, Fox, NF, O'Connell, BP, Lovelace, TL, Nguyen, SA, Sharma, AK et al. Salivary gland transfer to prevent radiation-induced xerostomia: a systematic review and meta-analysis. Oral Oncol 2014;50:77–83 Google Scholar
26 van Harten, MC, de Ridder, M, Hamming-Vrieze, O, Smeele, LE, Balm, AJ, van den Brekel, MW. The association of treatment delay and prognosis in head and neck squamous cell carcinoma (HNSCC) patients in a Dutch comprehensive cancer center. Oral Oncol 2014;50:282–90CrossRefGoogle Scholar
27 Leon, X, de Vega, M, Orus, C, Moran, J, Verges, J, Quer, M. The effect of waiting time on local control and survival in head and neck carcinoma patients treated with radiotherapy. Radiother Oncol 2003;66:277–81Google Scholar
28 Huang, L, Zhang, W, Zhuang, T, Wu, F, Li, D, Zheng, M et al. Submandibular gland sparing in intensity-modulated radiotherapy for N0-stage nasopharyngeal carcinoma. Br J Radiol 2014;87:20130651 Google Scholar
29 Al-Qahtani, K, Hier, MP, Sultanum, K, Black, MJ. The role of submandibular salivary gland transfer in preventing xerostomia in the chemoradiotherapy patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:753–6Google Scholar
30 Saarilahti, K, Kouri, M, Collan, J, Kangasmaki, A, Atula, T, Joensuu, H et al. Sparing of the submandibular glands by intensity modulated radiotherapy in the treatment of head and neck cancer. Radiother Oncol 2006;78:270–5CrossRefGoogle ScholarPubMed
31 Little, M, Schipper, M, Feng, FY, Vineberg, K, Cornwall, C, Murdoch-Kinch, CA et al. Reducing xerostomia after chemo-IMRT for head-and-neck cancer: beyond sparing the parotid glands. Int J Radiat Oncol Biol Phys 2012;83:1007–14Google Scholar