• Kauko Saarilahti, Mauri Kouri, Juhani Collan, Aki Kangasmäki, Timo Atula, Heikki Joensuu, and Mikko Tenhunen.
• Department of Oncology, Helsinki University Central Hospital, Finland. kauko.saarilahti@hus.fi
• Radiother Oncol. 2006 Mar 1; 78 (3): 270-5.

Background And PurposeThe submandibular glands produce most of the unstimulated saliva output and are the key in prevention of radiation-related xerostomia. We investigated whether sparing of the submandibular function is feasible with intensity modulated radiotherapy (IMRT).Patients And MethodsThirty-six patients diagnosed with head and neck cancer were treated with IMRT and had at least one parotid gland excluded from the planning target volume. In a subset, of these patients (n=18) where the risk of cancer recurrence in the contralateral submandibular region was judged low, the contralateral submandibular gland was spared from full-dose irradiation. The total unstimulated and stimulated salivary flow rates and adverse effects were monitored.ResultsTwelve months following IMRT mean unstimulated saliva flow was 60% of the baseline value among patients who had one submandibular gland spared and 25% among those who did not (P=0.006). Patients whose contralateral submandibular was spared reported less grade two or three xerostomia (4 vs. 11; P=0.018), and used less saliva substitutes. No cancer recurrences were detected at the vicinity of the spared glands during a median follow-up time of 31 months.ConclusionsSubmandibular gland sparing with IMRT is safe in selected patients treated for head and neck cancer. It is effective in prevention of radiation-associated xerostomia.

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