Submandibular Salivary Gland Transfer Prevents XRT Xerostomia
Presenter: N Jha
Affiliation: Cross Cancer Institute Edmonton, AB Canada, Universsity of Alberta
Xerostomia is a significant problem for many patients after XRT to the head and neck. This study looks at a novel surgical procedure to prevent radiation induced xerostomia. The submandibular salivary gland is transferred to the submental space and salivary function is evaluated.Materials and Methods:
- The study is a non-randomized prospective study performed on patients with SCC of the Head and Neck. Patients with tumors of the Larynx, Hypopharynx, Oropharynx and Unknown primaries were eligible for the study. Tumor of Oral cavity and the Nasopharynx or bilateral neck lesions were ineligible.
- All patients had surgery for their primary lesions with ipsilateral neck dissection and selective contralateral neck dissection of level I-III nodes.
- If no disease was found in the contralateral neck dissection, the contralateral submandibular gland salivary gland was transferred to the submental space
- he posterior and the inferior borders of the transferred gland were marked with a 25-gauge wire to help identify the gland during XRT planning
- Standard post operative 3 fieldÊ XRT was delivered and the transferred gland was shielded from the XRT.
- Dose range was 5000 to 7000 cGy
- Salivary gland functions were evaluated using:
- Salivary flow studies pre and post simulation
- Salivary Scans
- The University of Washington Quality of Life Questionnaire
- These salivary gland function evaluations were obtained prior to surgery, 2 weeks after surgery, half way through XRT and 2, 6 and 10 months after the completion of XRT
- 34 patients eligible for study.
- 33 patients had surgical transfer of the submandibular gland and 27 patients finished XRT, 3 patients had no indication for post operative XRT and 3 patients refused XRT.
- The eligible patients were compared to the patients who refused post op XRT and the patients where post-op XRT was not indicated.
- Pts did not complain of xerostomia and did not differ significantly from the control group
- 50% of the patients maintained a normal consistency of saliva and salivary glands have remained functional as confirmed by salivary scans
- The surgical procedure added 45 minutes to the surgical time and there were no surgical complications associated with the procedure
- Three patients died of of MI , one of PE
- One patient recurred within the radiation field during treatment
- Surgical transfer of a submandibular salivary gland to the submental space prior to starting XRT appears to prevent XRT induced xerostomia.
- The procedure appears to add little time or complication to the surgical procedure.
- The is an interesting study that attempts to address a difficult quality of life issue of H+N patients. The study indicates that a short uncomplicated procedure could potentially spare patients from xerostomia. However, the study did not look at the DVH’s of the contralateral parotid gland in the treatment planning. This makes it difficult to determine if the beneficial clinical effects are due to parotid sparing and not the transferred gland. Also the study did not address the issue of comesis.