title: Quantifying radioxerostomia: salivary flow rate, examiner's score, and quality of life questionnaire.
abstract: OBJECTIVE
  Salivary flow rates alone are not sufficient to quantify all aspects of radioxerostomia. This is a problem in studies aiming to reduce radioxerostomia. The aim of this study was to evaluate the association between objectively measured salivary flow rate and subjective xerostomia ratings by the physician (RTOG scale) or the patients (quality of life [QoL] questionnaire).
  
  
  METHODS
  In a case-control study patients who underwent recall for oral cancer were screened. Inclusion criteria for this diagnostic, noninterventional study were: history of oral carcinoma, surgical and radiation therapy, time interval from start of radiation therapy > 90 days, salivary glands within the radiation field. The control group consisted of patients, who had not received radiotherapy. RTOG salivary gland score, quality of life (EORTC QLQ-C30 and H&N35), and sialometry were recorded.
  
  
  RESULTS
  Patients with RTOG score 0 had mean salivary flow rates of 0.3 ml/min, those with RTOG 1 0.12 ml/min, RTOG 2 0.02 ml/min, and RTOG 3 < 0.01 ml/min. RTOG score 4 (total fibrosis) did not occur. Based on salivary flow rates, all patients were grouped into xerostomia < 0.2 ml/min (30 patients) and nonxerostomia (twelve patients). QoL results revealed significant differences between patients with xerostomia and nonxerostomia for physical function, dyspnea, swallowing, social eating, dry mouth, nutritional support, and a tendency to higher values for appetite loss.
  
  
  CONCLUSIONS
  The correlation between "subjective" QoL parameters and salivary flow was confirmed. The different subjective aspects of radioxerostomia seem to be better differentiated by the EORTC QoL questionnaire.
authors.affiliation: Klinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum der Johannes Gutenberg-Universität, Augustusplatz 2, 55131, Mainz, Germany. al-nawas@mkg.klinik.uni-mainz.de
authors.forename: Bilal
authors.initials: B
authors.lastname: Al-Nawas
authors.forename: Katy
authors.initials: K
authors.lastname: Al-Nawas
authors.forename: Martin
authors.initials: M
authors.lastname: Kunkel
authors.forename: Knut A
authors.initials: KA
authors.lastname: Grötz
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy; D010808:Physical Examination; D011788:Quality of Life; D011832:Radiation Injuries / Q000175:diagnosis* / Q000209:etiology; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012472:Salivation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014987:Xerostomia / Q000175:diagnosis* / Q000209:etiology*