title: Long-term oral effects in patients treated with radiochemotherapy for head and neck cancer.
abstract: OBJECTIVE
  The purpose of this study is to assess the late oral complications and the role of salivary gland hypofunction in the severity of mucosal reaction in nonsurgical head and neck cancer patients, submitted to radiotherapy with or without chemotherapy.
  
  
  METHODS
  Five hundred fifteen charts from patients treated between 2005 and 2009 were reviewed, and 41 patients met the inclusion criteria. Salivary gland function was assessed using a simplified grading system (GSX) and sialometry. Late effects were assessed using the Common Toxicity Criteria (CTC Version 2.0).
  
  
  RESULTS
  The average follow-up was 17.1 (4-51) months. A statistical correlation was found for whole salivary flow rates and the average CTC grades for the mucous membrane. Both unstimulated/stimulated whole salivary flow rates (<0.09 mL/min) were identified as potential risk factors (p < 0.05) and an independent predictor for late mucous membrane toxicity (≥ grade 2). A significant correlation was also found between unstimulated salivary flow rates-GSX scores (p = 0.001) and CTC grades for salivary glands. Eighty-five percent of the patients were classified as suffering from salivary gland hypofunction, as well as 58.2 % considered dryness of the mouth the most debilitating complication.
  
  
  CONCLUSIONS
  Considering the late effects assessed, the salivary gland hypofunction was the most significant and received the highest morbidity graduation (grade 2/grade 3); xerostomia was also considered the most debilitating complication after treatment. Data show the role of salivary gland hypofunction in the severity of late mucous membrane complication.
authors.affiliation: Division of Radiotherapy, Department of Imaging Diagnosis, Federal University of São Paulo-UNIFESP/EPM, Botucatu Street, 740, Vila Clementino, CEP 04023-900, São Paulo, Brazil.
authors.forename: Aline Lima da Silva
authors.initials: AL
authors.lastname: Deboni
authors.forename: Adelmo José
authors.initials: AJ
authors.lastname: Giordani
authors.forename: Nilza Nelly Fontana
authors.initials: NN
authors.lastname: Lopes
authors.forename: Rodrigo Souza
authors.initials: RS
authors.lastname: Dias
authors.forename: Roberto Araujo
authors.initials: RA
authors.lastname: Segreto
authors.forename: Siri Beier
authors.initials: SB
authors.lastname: Jensen
authors.forename: Helena Regina Comodo
authors.initials: HR
authors.lastname: Segreto
mesh_terms: D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D012307:Risk Factors; D012463:Saliva / Q000378:metabolism; D012469:Salivary Glands / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D012720:Severity of Illness Index; D013997:Time Factors; D014987:Xerostomia / Q000209:etiology*