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Japanese Journal of Clinical Oncology Advance Access published online on October 6, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyp113
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© The Author (2009). Published by Oxford University Press. All rights reserved

Radiation-induced Parotid Gland Changes in Oral Cancer Patients: Correlation Between Parotid Volume and Saliva Production

Keiko Teshima1, Ryuji Murakami2, Etsuji Tomitaka3, Tomoko Nomura1, Ryo Toya2, Akimitsu Hiraki1, Hideki Nakayama1, Toshinori Hirai4, Masanori Shinohara1, Natsuo Oya2 and Yasuyuki Yamashita3

1 Department of Oral and Maxillofacial Surgery, Kumamoto University Hospital
2 Department of Radiation Oncology, Kumamoto University Hospital
3 Department of Radiology, National Hospital Organization Kumamoto Medical Center
4 Department of Diagnostic Radiology, Kumamoto University Hospital, Kumamoto, Japan

For reprints and all correspondence: Ryuji Murakami, Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto 860-8556, Japan. E-mail: murakami{at}kumamoto-u.ac.jp

Received May 6, 2009; accepted August 10, 2009

Objective: To evaluate whether saliva production reflects the parotid volume during the course of radiation therapy (RT) in patients with head-and-neck cancer.

Methods: Twenty patients with advanced oral squamous cell carcinomas, who were treated with preoperative chemo-RT, underwent morphological assessment with CT or MRI and functional assessment with the Saxon test. For the Saxon test, saliva production was measured by weighing a gauze pad before and 2 min after chewing without swallowing; the low-normal value is 2 g. Saliva production and parotid volumes before and 2 weeks after RT were compared with the paired t-test, the Spearman rank correlation test and the Fisher exact test.

Results: After 30 Gy irradiation, mean saliva production was decreased from 4.2 to 1.0 g (P < 0.01); the reduction in saliva production ranged from 1.7 to 5.4 g (mean 3.2 g). The mean parotid volume was decreased from 68.2 to 47.9 cm3 (P < 0.01); the post-RT:pre-RT parotid volume ratio ranged from 54% to 85% (mean 71%). Although the initial parotid volume was correlated with initial saliva production (r = 0.47, P = 0.04), no significant correlation was noted after RT (r = 0.08, P = 0.71), and there were considerable individual variations. The parotid volume ratio was inversely correlated with the saliva-reduction amount (r = – 0.79, P < 0.01).

Conclusions: There was a correlation between decreased parotid gland volume and decreased saliva production in patients with head-and-neck cancer undergoing RT. Parotid volume reduction may predict parotid gland function.

Key Words: oral cancer • parotid gland • radiation therapy • xerostomia • saliva production


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