title: Safety of contralateral submandibular gland sparing in locally advanced oropharyngeal cancers: A multicenter review.
abstract: BACKGROUND
  Previous groups have shown contralateral submandibular gland sparing to improve xerostomia with safe outcomes, but primarily in early-stage disease. In this study, we present a large cohort of patients with locally advanced head and neck cancer that underwent contralateral submandibular gland-sparing radiotherapy, to demonstrate feasibility and safety specifically in patients with locally advanced disease.
  
  
  METHODS
  We retrospectively analyzed patients who were treated prospectively with contralateral submandibular gland sparing. Only patients who underwent bilateral neck radiotherapy with contralateral submandibular gland doses <39 Gy were included.
  
  
  RESULTS
  We identified 71 patients. Approximately 80% of patients had ≥N2b disease. The contralateral submandibular gland mean dose was 33 Gy and, at a median follow-up of 27.3 months, no patients experienced treatment failure in the contralateral level IB lymph nodes.
  
  
  CONCLUSIONS
  Xerostomia remains a significant morbidity despite parotid sparing and can be minimized further by contralateral submandibular gland sparing. These data provide important preliminary evidence that contralateral submandibular gland sparing is feasible and may be safe even in locally advanced cancers.
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Tyler P
authors.initials: TP
authors.lastname: Robin
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Gan
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Moses
authors.initials: M
authors.lastname: Tam
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: David
authors.initials: D
authors.lastname: Westerly
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Riaz
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: Sana D
authors.initials: SD
authors.lastname: Karam
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Nancy
authors.initials: N
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.
authors.forename: David
authors.initials: D
authors.lastname: Raben
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D058958:Organs at Risk; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D011446:Prospective Studies; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013363:Submandibular Gland / Q000528:radiation effects*
keywords: head and neck cancer; intensity-modulated radiation therapy (IMRT); salivary glands; submandibular gland; xerostomia