title: Grading xerostomia by physicians or by patients after intensity-modulated radiotherapy of head-and-neck cancer.
abstract: OBJECTIVE
  To assess observer-based vs. patient self-reported scoring of xerostomia after intensity-modulated radiotherapy (IMRT) of head-and-neck (HN) cancer.
  
  
  METHODS
  A total of 38 patients who had received IMRT for HN cancer underwent xerostomia evaluations 6 to 24 months after completion of therapy using three methods each time: (1) Grading by 3 observers according to the Radiotherapy Oncology Group/European Organization for Research and Therapy of Cancer (RTOG/EORTC) system; (2) patient self-reported validated xerostomia questionnaire (XQ); and (3) major salivary gland flow measurements.
  
  
  RESULTS
  The interobserver agreement regarding the RTOG/EORTC grades was moderate: kappa-coefficient 0.54 (95% CI=0.31-0.76). The correlations between the average RTOG/EORTC grades and the salivary flow rates were not statistically significant. A trend for significant correlation was observed between these grades and the percent (relative to the pretherapy) nonstimulated salivary flow rates (p=0.07), but not with the percent stimulated flow rates. Better correlations were found between grading made more than the median time (15 min) after the last liquid sipping and the nonstimulated (but not the stimulated) flows compared with grading made shortly after sipping. In contrast, significant correlations were found between the XQ scores and the nonstimulated (p<0.005) and the stimulated (p<0.005) salivary flow rates, as well as with the percentages of the corresponding pretherapy values (p=0.002 and 0.038, respectively). No significant correlation was found between the RTOG/EORTC grades and the XQ scores. The observer-based grades underestimated the severity of xerostomia compared with the patient self-reported scores.
  
  
  CONCLUSIONS
  Patient self-reported, rather than physician-assessed scores, should be the main end points in evaluating xerostomia.
authors.affiliation: Department of Radiation Oncology, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-0010, USA.
authors.forename: Amichay
authors.initials: A
authors.lastname: Meirovitz
authors.forename: Carol Anne
authors.initials: CA
authors.lastname: Murdoch-Kinch
authors.forename: Mathew
authors.initials: M
authors.lastname: Schipper
authors.forename: Charlie
authors.initials: C
authors.lastname: Pan
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D011829:Radiation Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D015203:Reproducibility of Results; D012472:Salivation / Q000502:physiology / Q000528:radiation effects; D014987:Xerostomia / Q000175:diagnosis* / Q000209:etiology