Xerostomia: a day and night difference.
OBJECTIVE
To compare patient-reported xerostomia during daytime and during nighttime with objectively measured parotid and submandibular gland function in a cohort of head-and-neck cancer (HNC) patients treated with RT.


METHODS
A cohort of 138 HNC patients underwent objective measurements of parotid (PF) and submandibular (SMF) gland function and completed a xerostomia questionnaire (XQ) before RT, at 6 weeks, 6 months and 1 year after RT. No attempt was made to spare the submandibular gland(s). The XQ contained specific questions concerning the sensation of dry mouth during day- (XD) and nighttime (XN), scored on a 5-point Likert scale. Patients with no or mild (grade 1-3) xerostomia and patients with more severe (grade 4-5) complaints were grouped together.


RESULTS
Before RT, no association existed between dry mouth complaints and PF or SMF. At 6 weeks, 6 months and 1 year after RT; 37%, 51% and 36% had grade 4-5 XD and 65%, 64% and 56% had grade 4-5 XN, respectively. Patients with grade 4-5 XD and XN had significantly worse SMF at all time points after RT compared to patients with grade 1-3 XD and XN, while PF was significantly worse only at 6 weeks after RT. In multivariate analyses, SMF was consistently the most important factor related to XN after treatment. PF significantly influenced XD at 6 weeks and 1 year after RT.


CONCLUSIONS
Differentiating between complaints during day- and nighttime in xerostomia research is necessary. Dry mouth at night is a frequent problem after (parotid-sparing) RT for HNC and is explained by submandibular gland dysfunction. Sparing of the contralateral submandibular gland, in addition to parotid gland sparing, may result in improved patient-reported xerostomia.
Department of Radiotherapy, University Medical Center Utrecht, The Netherlands. T.Dijkema@umcutrecht.nl
Tim
T
Dijkema
Cornelis P J
CP
Raaijmakers
Pètra M
PM
Braam
Judith M
JM
Roesink
Evelyn M
EM
Monninkhof
Chris H J
CH
Terhaard
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002940:Circadian Rhythm; D004307:Dose-Response Relationship, Radiation; D004311:Double-Blind Method; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010306:Parotid Gland / Q000528:radiation effects; D010862:Pilocarpine / Q000627:therapeutic use; D011788:Quality of Life; D011829:Radiation Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012472:Salivation / Q000528:radiation effects*; D018709:Statistics, Nonparametric; D014987:Xerostomia / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*
D010862:Pilocarpine