Radiation Therapy for Hypersalivation: A Prospective Study in 50 Amyotrophic Lateral Sclerosis Patients
| Autor: | Gaëlle Bruneteau, Nadine Le Forestier, Maya Abdelnour-Mallet, Jésus Gonzalez-Bermejo, Timothée Lenglet, Pierre-François Pradat, François Salachas, A. Levy, Vincent Meininger, Avi Assouline, Sylvie Delanian |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Hypersalivation Cancer Research medicine.medical_specialty medicine.medical_treatment Submandibular Gland Gastroenterology Statistics Nonparametric Internal medicine medicine Humans Parotid Gland Radiology Nuclear Medicine and imaging Prospective Studies Prospective cohort study Aged Aged 80 and over Photons Radiation Sialorrhea Salivary gland business.industry Amyotrophic Lateral Sclerosis Remission Induction Radiotherapy Dosage Middle Aged Submandibular gland Parotid gland SSS Radiation therapy medicine.anatomical_structure Oncology Female medicine.symptom Nuclear medicine business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 88:589-595 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2013.11.230 |
| Popis: | Purpose This study aimed to evaluate the efficiency and the tolerance of radiation therapy (RT) on salivary glands in a large series of amyotrophic lateral sclerosis (ALS) patients with hypersalivation. Methods and Materials Fifty ALS patients that had medically failure pretreatment were included in this prospective study. RT was delivered through a conventional linear accelerator with 6-MV photons and 2 opposed beams fields including both submandibular glands and two-thirds of both parotid glands. Total RT dose was 10 Gy in 2 fractions (n=30) or 20 Gy in 4 fractions (n=20). RT efficacy was assessed with the 9-grade Sialorrhea Scoring Scale (SSS), recently prospectively validated as the most effective and sensitive tool to measure sialorrhea in ALS patients. Results At the end of RT, all patients had improved: 46 had a complete response (92% CR, SSS 1-3) and 4 had a partial response (8% PR, SSS 4-5). A significant lasting salivary reduction was observed 6 months after RT completion: there was 71% CR and 26% PR, and there was a significant SSS reduction versus baseline ( P −6 ). There was no grade 3 to 4 toxicity, and most side effects (34%) occurred during RT. Nine patients (18%) underwent a second salivary gland RT course, with a 3-months mean delay from the first RT, resulting in a SSS decrease (−77%). Both RT dose regimens induced a significant SSS decrease with no significant toxicity. There were, however, more patients with CR/PR in the 20-Gy protocol ( P =.02), and 8 of 9 patients (89%) receiving a second RT course had previously been treated within the 10-Gy protocol. Conclusion Radiation therapy of 20 Gy in 4 fractions is an efficient and safe treatment for ALS patients with sialorrhea. A shorter RT course (10 Gy in 2 fractions) may be proposed in patients in poor medical condition. |
| Databáze: | OpenAIRE |
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