Xerostomía y radioterapia de cabeza y cuello: actualización

Autores/as

  • Anna Vives-Soler Universidad de Barcelona
  • José López-López Universidad de Barcelona
  • Enric Jané-Salas Universidad de Barcelona

DOI:

https://doi.org/10.35509/01239015.212

Palabras clave:

Xerostomía, Radioterapia, Radioterapia de intensidad modulada (IMRT)

Resumen

En la radioterapia de cabeza y cuello las glándulas salivales suelen recibir una dosis elevada de radiación, lo que provoca una disminución progresiva y, a partir de determinada dosis, irreversible de la secreción salival, entre otros efectos. La xerostomía o sensación de boca seca es el efecto secundario más frecuente tras la radioterapia de cabeza y cuello, el cual disminuye la calidad de vida de los pacientes al dificultar funciones como la fonación y la deglución. Dada la complejidad y la temprana aparición de este síntoma, su prevención es la solución más eficaz. Los avances de las últimas décadas tienen un papel imprescindible: la radioterapia de intensidad modulada, la administración de sustancias citoprotectoras y el autotransplante de glándula submandibular parecen limitar en cierta medida el efecto de la radiación y disminuir así la sensación de sequedad bucal.

Biografía del autor/a

Anna Vives-Soler, Universidad de Barcelona

Facultad de Odontología, Universidad de Barcelona, Barcelona, España

José López-López, Universidad de Barcelona

Facultad de Odontología, Universidad de Barcelona - Grupo de salud Oral y sistema masticatorio IDIBELL, Barcelona, España

Enric Jané-Salas, Universidad de Barcelona

Facultad de Odontología, Universidad de Barcelona - Grupo de salud Oral y sistema masticatorio IDIBELL, Barcelona, España

Referencias bibliográficas

Gomez-Millan J, Fernández JR, Medina Carmona JA. Current status of IMRT in head and neck cáncer. Rep Pract Oncol Radiother. 2013;18:371-5.

https://doi.org/10.1016/j.rpor.2013.09.008

Coppes RP, Zeilstra LJ, Kampinga HH, Konings AW. Early to late sparing of radiation damage to the parotid gland by adrenergic and muscarinic receptor agonists. Br J Cancer. 2001;85:1055-63.

https://doi.org/10.1054/bjoc.2001.2038

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: management strategies and economic impact. Support Care Cancer. 2010;18:1061-79.

https://doi.org/10.1007/s00520-010-0837-6

Jellema AP, Slotman BJ, Doornaert P, Leemans CR, Langendijk JA. Impact of radiation-induced xerostomia on quality of life after primary radiotherapy among patients with head and neck cancer. Int J Radiat Oncol Biol Phys. 2007;69:751-60.

https://doi.org/10.1016/j.ijrobp.2007.04.021

Bernier J, Hall EJ, Giaccia A. Radiation oncology: a century of achievements. Nat Rev Cancer. 2004;4:737-47.

https://doi.org/10.1038/nrc1451

Wu F, Weng S, Li C, Sun J, Li L, Gao Q. Submandibular gland transfer for the prevention of postradiation xerostomia in patients with head and neck cancer: a systematic review and meta-analysis. ORL J Otorhinolaryngol Relat Spec. 2015;77:70-86.

https://doi.org/10.1159/000371854

Grégoire V, Jeraj R, Lee JA, O'Sullivan B. Radiotherapy for head and neck tumours in 2012 and beyond: conformal, tailored, and adaptive? Lancet Oncol. 2012;13:292-300.

https://doi.org/10.1016/S1470-2045(12)70237-1

Deasy JO, Moiseenko V, Marks L, Chao KS, Nam J, Eisbruch A. Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys. 2010;76 3 Suppl: S58-63.

https://doi.org/10.1016/j.ijrobp.2009.06.090

Konings AW, Coppes RP, Vissink A. On the mechanism of salivary gland radiosensitivity. Int J Radiat Oncol Biol Phys. 2005;62:1187-94.

https://doi.org/10.1016/j.ijrobp.2004.12.051

Takagi K, Yamaguchi K, Sakurai T, Asari T, Hashimoto K, Terakawa S. Secretion of saliva in X-irradiated rat submandibular glands. Radiat Res. 2003;159:351-60.

https://doi.org/10.1667/0033-7587(2003)159[0351:SOSIXI]2.0.CO;2

Asari T, Maruyama K, Kusama H. Salivation triggered by pilocarpine involves aquaporin-5 in normal rats but not in irradiated rats. Clin Exp Pharmacol Physiol. 2009;36:531-8.

https://doi.org/10.1111/j.1440-1681.2008.05104.x

Li Z, Zhao D, Gong B, Xu Y, Sun H, Yang B, et al. Decreased saliva secretion and down-regulation of AQP5 in submandibular gland in irradiated rats. Radiat Res. 2006;165:678-87.

https://doi.org/10.1667/RR3569.1

Coppes RP, Meter A, Latumalea SP, Roffel AF, Kampinga HH. Defects in muscarinic receptor-coupled signal transduction in isolated parotid gland cells after in vivo irradiation: evidence for a non-DNA target of radiation. Br J Cancer. 2005;92:539-46.

https://doi.org/10.1038/sj.bjc.6602365

Villa A, Wolff A, Narayana N, Dawes C, Aframian DJ, Lynge Pedersen AM, et al.WorldWorkshop on Oral Medicine VI: A systematic review of medication-induced salivary gland dysfunction. Oral Dis. 2015, http://dx.doi.org/10.1111/odi.12402. Nov 25.

https://doi.org/10.1111/odi.12402

Zou Y, Song T, Yu W, Zhao R, Wang Y, Xie R, et al. XRCC3 polymorphisms are associated with the risk of developing radiation-induced late xerostomia in nasopharyngeal carcinoma patients treated with intensity modulation radiated therapy. Jpn J Clin Oncol. 2014;44:241-8.

https://doi.org/10.1093/jjco/hyt202

Jabbari S, Kim HM, Feng M, Lin A, Tsien C, Elshaikh M, et al. Matched case-control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer: initial report. Int J Radiat Oncol Biol Phys. 2005;63:725-31.

https://doi.org/10.1016/j.ijrobp.2005.02.045

McMillan AS, Pow EH, Kwong DL, Wong MC, Sham JS, Leung LH, et al. Preservation of quality of life after intensity-modulated radiotherapy for early-stage nasopharyngeal carcinoma: results of a prospective longitudinal study. Head Neck. 2006;28:712-22.

https://doi.org/10.1002/hed.20378

Late Radiation Morbidity Schema [consulta el 18 de octubre de 2015]. Disponible en: https://www.rtog.org/ResearchAssociates/AdverseEventReporting/RTOGEORTCLateRadiationMorbidityScoringSchema.aspx

Common Terminology Criteria for Adverse Events v3.0 (CTCAE) [consulta el 18 de octubre de 2015]. Disponible en:. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf

Dijkema T, Raaijmakers CP, Ten Haken RK, Roesink JM, Braam PM, Houweling AC, et al. Parotid gland function after radiotherapy: the combined Michigan and Utrecht experience. Int J Radiat Oncol Biol Phys. 2010;78:449-53.

https://doi.org/10.1016/j.ijrobp.2009.07.1708

Stock M, Dörr W, Stromberger C, Mock U, Koizar S, Pötter R, et al. Investigations on parotid gland recovery after IMRT in head and neck tumor patients. Strahlenther Onkol. 2010;186:665-71.

https://doi.org/10.1007/s00066-010-2157-7

Münter MW, Karger CP, Hoffner SG, Hof H, Thilmann C, Rudat V, et al. Evaluation of salivary gland function after treatment of head-and-neck tumors with intensity-modulated radiotherapy by quantitative pertechnetate scintigraphy. Int J Radiat Oncol Biol Phys. 2004;58:175-84.

https://doi.org/10.1016/S0360-3016(03)01437-8

López-López J, Jané Salas E, Chimenos Küstner E. Prognosis and treatment of dry mouth. Systematic review. Med Clin (Barc). 2014;142:119-24.

https://doi.org/10.1016/j.medcli.2013.02.036

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;12:127-36.

https://doi.org/10.1016/S1470-2045(10)70290-4

Kam MK, Leung SF, Zee B, Chau RM, Suen JJ, Mo F, et al. Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol. 2007;25:4873-9.

https://doi.org/10.1200/JCO.2007.11.5501

Meirovitz A, Murdoch-Kinch CA, Schipper M, Pan C, Eisbruch A. Grading xerostomia by physicians or by patients after intensitymodulated radiotherapy of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2006;66:445-53.

https://doi.org/10.1016/j.ijrobp.2006.05.002

Pow EH, Kwong DL, McMillan AS, Wong MC, Sham JS, Leung LH, et al. Xerostomia and quality of life after intensitymodulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys. 2006;66:981-91.

https://doi.org/10.1016/j.ijrobp.2006.06.013

Gupta T, Hotwani C, Kannan S, Master Z, Rangarajan V, Murthy V, et al. Prospective longitudinal assessment of parotid gland function using dynamic quantitative pertechnate scintigraphy and estimation of dose-response relationship of parotidsparing radiotherapy in head-neck cancers. Radiat Oncol. 2015;10:67.

https://doi.org/10.1186/s13014-015-0371-2

Li Y, Taylor JM, Ten Haken RK, Eisbruch A. The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2007;67:660-9.

https://doi.org/10.1016/j.ijrobp.2006.09.021

Beetz I, Steenbakkers RJ, Chouvalova O, Leemans CR, Doornaert P, van der Laan BF, et al. The QUANTEC criteria for parotid gland dose and their efficacy to prevent moderate to severe patientrated xerostomia. Acta Oncol. 2014;53:597-604.

https://doi.org/10.3109/0284186X.2013.831186

Dijkema T, Raaijmakers CP, Braam PM, Roesink JM, Monninkhof EM, Terhaard CH. Xerostomia: a day and night difference. Radiother Oncol. 2012;104:219-23.

https://doi.org/10.1016/j.radonc.2012.06.004

Daly ME, Lieskovsky Y, Pawlicki T, Yau J, Pinto H, Kaplan M, et al. Evaluation of patterns of failure and subjective salivary function in patients treated with intensity modulated radiotherapy for head and neck squamous cell carcinoma. Head Neck. 2007;29:211-20.

https://doi.org/10.1002/hed.20505

Van Rij CM, Oughlane-Heemsbergen WD, Ackerstaff AH, Lamers EA, Balm AJ, Rasch CR. Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life. Radiat Oncol. 2008;3:41.

https://doi.org/10.1186/1748-717X-3-41

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;83:1007-14.

https://doi.org/10.1016/j.ijrobp.2011.09.004

Law A, Kennedy T, Pellitteri P, Wood C, Christie D, Yumen O. Efficacy and safety of subcutaneous amifostine in minimizing radiation-induced toxicities in patients receiving combinedmodality treatment for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2007;69: 1361-8.

https://doi.org/10.1016/j.ijrobp.2007.05.052

Kouvaris JR, Kouloulias VE, Vlahos LJ. Amifostine: the first selective-target and broad-spectrum radioprotector. Oncologist. 2007;12:738-47.

https://doi.org/10.1634/theoncologist.12-6-738

Rudat V, Münter M, Rades D, Grötz KA, Bajrovic A, Haberkorn U, et al. The effect of amifostine or IMRT to preserve the parotid function after radiotherapy of the head and neck region measured by quantitative salivary gland scintigraphy. Radiother Oncol. 2008;89:71-80.

https://doi.org/10.1016/j.radonc.2008.07.016

Gu J, Zhu S, Li X, Wu H, Li Y, Hua F. Effect of amifostine in head and neck cancer patients treated with radiotherapy: a systematic review and meta-analysis based on randomized controlled trials. PLoS One. 2014;9:e95968.

https://doi.org/10.1371/journal.pone.0095968

Rades D, Fehlauer F, Bajrovic A, Mahlmann B, Richter E, Alberti W. Serious adverse effects of amifostine during radiotherapy in head and neck cancer patients. Radiother Oncol. 2004;70:261-4.

https://doi.org/10.1016/j.radonc.2003.10.005

Pimentel MJ, Filho MM, Araújo M, Gomes DQ, Costa DALJ. Evaluation of radioprotective effect of pilocarpine ingestion on salivary glands. Anticancer Res. 2014;34:1993-9.

Burlage FR, Roesink JM, Kampinga HH, Coppes RP, Terhaard C, Langendijk JA, et al. Protection of salivary function by concomitant pilocarpine during radiotherapy: a double-blind, randomized, placebo-controlled study. Int J Radiat Oncol Biol Phys. 2008;70:14-22.

https://doi.org/10.1016/j.ijrobp.2007.06.016

Nakamura N, Sasano N, Yamashita H, Igaki H, Shiraishi K, Terahara A. Oral pilocarpine (5 mg t.i.d.) used for xerostomia causes adverse effects in Japanese. Auris Nasus Larynx. 2009;36:310-3.

https://doi.org/10.1016/j.anl.2008.04.008

Nyárády Z, Németh A, Bán A, Mukics A, Nyárády J, Ember I, et al. A randomized study to assess the effectiveness of orally administered pilocarpine during and after radiotherapy of head and neck cancer. Anticancer Res. 2006;26(2B):1557-62.

Seikaly H, Jha N, McGaw T, Coulter L, Liu R, Oldring D. Submandibular gland transfer: a new method of preventing radiationinduced xerostomia. Laryngoscope. 2001;111:347-52.

https://doi.org/10.1097/00005537-200102000-00028

Rieger JM, Jha N, Lam Tang JA, Harris J, Seikaly H. Functional outcomes related to the prevention of radiation-induced xerostomia: oral pilocarpine versus submandibular salivary gland transfer. Head Neck. 2012;34:168-74.

https://doi.org/10.1002/hed.21682

Cómo citar

[1]
Vives-Soler, A. et al. 2017. Xerostomía y radioterapia de cabeza y cuello: actualización. Revista Colombiana de Cancerología. 21, 1 (mar. 2017), 26–32. DOI:https://doi.org/10.35509/01239015.212.

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01-03-2017

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