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Chen YC, Viet-Nhi NK, Dang LH, Su CH, Hung SH. Efficacy of Office-Based Salivary Ductal Steroid Irrigation for Managing Post-Irradiation Xerostomia in Head and Neck Cancer Patients: A Retrospective Study. Biomedicines 2024; 12:1033. [PMID: 38790995 PMCID: PMC11117565 DOI: 10.3390/biomedicines12051033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Post-irradiation xerostomia remains a significant quality of life concern for patients with head and neck cancers. Conventional therapies offer limited effectiveness. This study aims to investigate the therapeutic potential of office-based salivary ductal steroid irrigation in patients with post-irradiation xerostomia. This single-center observational study recruited 147 head and neck cancer patients suffering from post-irradiation xerostomia between November 2020 and October 2022. All included subjects received at least one round of successful salivary ductal cannulation and irrigation. The primary measure of efficacy was improvement in subjective xerostomia and objective salivary amylase levels. A logistic regression was employed to evaluate factors affecting treatment responsiveness. The response rate among nasopharyngeal cancer (NPC) patients was 74.8%, and that among non-NPC cancer was 65.6%, without significant intergroup differences. The statistical analysis revealed no significant influence of age, gender, or disease stage on treatment responsiveness. Post-treatment salivary amylase levels were significantly higher in responsive non-NPC patients. In conclusion, salivary ductal steroid irrigation emerged as a promising therapeutic modality for the management of post-irradiation xerostomia in head and neck cancer patients. While no explicit factors were predictive of responsiveness, the high rate of symptom improvement suggests that this therapy may be a viable alternative for patients that are refractory to standard treatments.
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Affiliation(s)
- Yen-Chun Chen
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Nguyen-Kieu Viet-Nhi
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Luong Huu Dang
- Department of Otolaryngology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam;
| | - Chin-Hui Su
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Otolaryngology, Mackay Memorial Hospital, Taipei 104217, Taiwan
| | - Shih-Han Hung
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei 116079, Taiwan
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Henricsson S, Wallin Bengtsson V, Renvert S, Sanmartin Berglund J, Lundegren N, Andersson P. Self-perceived oral health and orofacial appearance in older adults - an 18-year follow-up study in Karlskrona, Sweden. Acta Odontol Scand 2024; 83:255-263. [PMID: 38700368 PMCID: PMC11302640 DOI: 10.2340/aos.v83.40574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 03/31/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES To analyze whether self-perceived oral health and orofacial appearance change with increasing age. METHODS This longitudinal study is based on data from a questionnaire used in the Swedish National Study of Aging and Care. The sample comprises 160 participants 60 years of age at baseline 2001-2003. The same participants were re-examined at 66-, 72-, and 78 years of age. To analyze whether perceptions of oral health and orofacial appearance changed with increasing age, Cochran's Q test was conducted. Statistical significance was considered at p ≤ 0.05, and the calculated value Q must be equal to or greater than the critical chi-square value (Q ≥ 7.82). Significance values have been adjusted for the Bonferroni correction for multiple tests. RESULTS Self-perceived mouth dryness, both day (Q = 7.94) and night (Q = 23.41), increased over the 18-year follow-up. When divided by gender, significant differences were only seen for mouth dryness at nighttime. A decrease in sensitive teeth was perceived with increasing age, and an increase in self-perceived satisfaction with dental appearance, and a decrease in self-perceived problems with dental gaps between the ages of 60 and 78. These changes were, however, not statistically significant. Men experienced a higher proportion of discomfort with discolored teeth at age 78 than at 60 (Q = 9.09). CONCLUSIONS Self-perceived oral health and orofacial appearance were relatively stable, with few changes over an 18-year follow-up.
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Affiliation(s)
- Sara Henricsson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden; Faculty of Odontology, Malmö University, Malmö, Sweden.
| | | | - Stefan Renvert
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden; Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | | | | | - Pia Andersson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
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Ekkert S, Deeiam K, Klongnoi B, Sresumatchai V, Pimolbutr K, Khovidhunkit SOP. Prevalence of Xerostomia and Hyposalivation Among Individuals Attending Oral Cancer Screening in Thailand: A Cross-Sectional Study. J Int Soc Prev Community Dent 2024; 14:233-242. [PMID: 39055299 PMCID: PMC11268528 DOI: 10.4103/jispcd.jispcd_156_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 07/27/2024] Open
Abstract
Aim It has been speculated that the prevalence of xerostomia and hyposalivation might be higher among individuals attending oral cancer screening than among members of the general population. Therefore, this study investigated the prevalence of these conditions and their associated factors among individuals taking part in oral cancer screening and residing in the northeastern provinces of Thailand. Materials and Methods This cross-sectional study recruited convenient individuals aged ≥40 years with at least one oral cancer risk factor. In total, 561 participants were included. Demographic characteristics and relevant oral cancer risk factors were recorded. A questionnaire comprising five items was used to assess xerostomia. Participants were then categorized into two groups based on the absence or presence of xerostomia. Subsequently, the stimulated salivary flow rate was assessed using the spitting technique to identify hyposalivation. Participants were then separated into two groups depending on the absence or presence of hyposalivation. Univariate and multivariate logistic regression analyses were then performed to identify factors associated with xerostomia or hyposalivation. Results The mean age of participants was 65.62 ± 9.70 years, and approximately 60% of participants were post-menopausal women. The prevalence of xerostomia was 43.85%, and the prevalence of hyposalivation was 61.50%. It was revealed that age ≥65 years (odds ratio [OR] = 1.57, P = 0.02) and burning sensation in the mouth (OR = 5.36, P < 0.001) were strongly associated with xerostomia. Female participants were more likely to exhibit hyposalivation (OR = 2.38, P = 0.001). Oral cancer risk factors were not associated with xerostomia or hyposalivation. Conclusions In this study, age ≥65 years and burning sensation were identified as risk factors for xerostomia, whereas female sex was a risk factor for hyposalivation. Dentists should be aware of both conditions. Various interventions to alleviate dry mouth symptoms might be useful for individuals with these risk factors.
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Affiliation(s)
- Sutthipoach Ekkert
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Krongkan Deeiam
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Boworn Klongnoi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Vanvisa Sresumatchai
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Kununya Pimolbutr
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Bitz HC, Sachpazidis I, Zou J, Schnell D, Baltas D, Grosu AL, Nicolay NH, Rühle A. The role of the soft palate dose regarding normal tissue toxicities in older adults with head and neck cancer undergoing definitive radiotherapy. Radiat Oncol 2024; 19:53. [PMID: 38689338 PMCID: PMC11061999 DOI: 10.1186/s13014-024-02426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/29/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE The number of older adults with head and neck squamous cell carcinoma (HNSCC) is continuously increasing. Older HNSCC patients may be more vulnerable to radiotherapy-related toxicities, so that extrapolation of available normal tissue complication probability (NTCP) models to this population may not be appropriate. Hence, we aimed to investigate the correlation between organ at risk (OAR) doses and chronic toxicities in older patients with HNSCC undergoing definitive radiotherapy. METHODS Patients treated with definitive radiotherapy, either alone or with concomitant systemic treatment, between 2009 and 2019 in a large tertiary cancer center were eligible for this analysis. OARs were contoured based on international consensus guidelines, and EQD2 doses using α/ß values of 3 Gy for late effects were calculated based on the radiation treatment plans. Treatment-related toxicities were graded according to Common Terminology Criteria for Adverse Events version 5.0. Logistic regression analyses were carried out, and NTCP models were developed and internally validated using the bootstrapping method. RESULTS A total of 180 patients with a median age of 73 years fulfilled the inclusion criteria and were analyzed. Seventy-three patients developed chronic moderate xerostomia (grade 2), 34 moderate dysgeusia (grade 2), and 59 moderate-to-severe (grade 2-3) dysphagia after definitive radiotherapy. The soft palate dose was significantly associated with all analyzed toxicities (xerostomia: OR = 1.028, dysgeusia: OR = 1.022, dysphagia: OR = 1.027) in the multivariable regression. The superior pharyngeal constrictor muscle was also significantly related to chronic dysphagia (OR = 1.030). Consecutively developed and internally validated NTCP models were predictive for the analyzed toxicities (optimism-corrected AUCs after bootstrapping: AUCxerostomia=0.64, AUCdysgeusia=0.60, AUCdysphagia=0.64). CONCLUSIONS Our data suggest that the dose to the soft palate is associated with chronic moderate xerostomia, moderate dysgeusia and moderate-to-severe dysphagia in older HNSCC patients undergoing definitive radiotherapy. If validated in external studies, efforts should be undertaken to reduce the soft palate dose in these patients.
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Affiliation(s)
- Helena C Bitz
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
| | - Ilias Sachpazidis
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jiadai Zou
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Leipzig, Germany
| | - Daniel Schnell
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dimos Baltas
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Leipzig, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany.
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Leipzig, Germany.
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Johansson AK, Omar R, Lehmann S, Sannevik J, Mastrovito B, Johansson A. General and orofacial symptoms associated with acute and long COVID in 80- and 90-year-old Swedish COVID-19 survivors. J Dent 2024; 141:104824. [PMID: 38145803 DOI: 10.1016/j.jdent.2023.104824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVES To describe acute and long COVID-19 symptoms among older elderly Swedes and to find predictive factors for the development symptoms associated with acute and long COVID. MATERIAL AND METHODS A questionnaire about general and oral health was mailed to all 80-year-olds (born 1942, n = 6299) and 90-year-olds (born 1932, n = 1904) in two Swedish counties. Participants reporting COVID-19 were asked to complete an additional questionnaire. RESULTS Overall response rate was 66 % (n = 5375). Affirmative responses to having been sick/tested positive for COVID-19 were reported by 577 persons. Response rate to the COVID-19 questionnaire was 49 %. The majority (88 %) reported some general symptoms during the acute stage while 44 % reported orofacial symptom/s. Reporting of any form of long-COVID general symptoms was 37 and 35 % for orofacial symptoms. Predictive factors for contracting COVID-19 (based on self-report from 2017) were living in elderly housing/senior care facility (OR 1.6, CI 1.0-2.3), large number (>10) of weekly social contacts (OR 1.5, CI 1.3-1.9), being married (OR 1.4, CI 1.1-1.7) and high school/university education (OR 1.3 CI 1.1-1-6). The highest odds ratio for general symptoms of long-COVID were a single complete denture (OR 5.0, CI 2.0-12.3), reporting bad breath (OR 3.7, CI 1.9-7.2) and daytime dry mouth (OR 2.2, CI 1.1-4.2). Regarding long-COVID orofacial symptoms, the highest risk factors were bad breath (OR 3.8, CI 1.9-7.5) and a single complete denture in one jaw (OR 3.4, CI 1.2-9.8). CONCLUSION Long-COVID general and orofacial symptoms are common among older elderly COVID-19 survivors CLINICAL SIGNIFICANCE: Oral microorganisms may be responsible for development of long-COVID symptoms. Health personnel managing COVID-19 patients should carefully examine dental status, especially in those having acrylic-based removable dentures, for oral signs and symptoms. If found, rigorous oral hygiene procedures should be carried out including cleaning/disinfection of the denture.
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Affiliation(s)
- Ann-Katrin Johansson
- Department of Clinical Dentistry - Cariology, Faculty of Medicine, University of Bergen, Årstadveien 19, Bergen 5009, Norway.
| | - Ridwaan Omar
- Faculty of Dentistry, Kuwait University, Safat, Kuwait
| | - Sverre Lehmann
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Berit Mastrovito
- Dental Commissioning Unit, Östergötland County Council, Linköping, Sweden
| | - Anders Johansson
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine, University of Bergen, Bergen, Norway
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Fisic A, Aras HC, Almhöjd U, Almståhl A. Dental care professionals' awareness of oral dryness and its clinical management: a questionnaire-based study. BMC Oral Health 2024; 24:45. [PMID: 38191344 PMCID: PMC10775498 DOI: 10.1186/s12903-023-03813-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Despite the high prevalence of oral dryness and awareness of its complications, there is limited research on the clinical management of patients with oral dryness in general dental care. PURPOSE To (1) describe and compare awareness among dental care professionals regarding saliva functions, potential causes and complications of oral dryness, and patient management (2) Investigate if the length of professional experience influences these aspects. METHODS A digital self-administrated survey was sent to 2668 dental care professionals working in the general dental care, Public Dental Service, in Sweden. Twelve dental care professionals reviewed the questionnaire prior to its distribution. The questionnaire comprised 32 questions about patient management, awareness of saliva functions, causes and complications of oral dryness, and self-assessment queries. RESULTS The response rate was 18.6% (241 dentists and 257 dental hygienists). Older adults (65+) were asked more often about dry mouth (93.0%) compared to those aged 18-23 years (50.0%) and those under 18 years (24.9%). Dental hygienists encountered individuals with oral dryness more frequently (61.1%) than dentists (48.5%) (p < 0.01), and more often asked individuals in the age groups 18-23 years (p = 0.003), 24-40 years (p = 0.045), and 41-65 years (p = 0.031) about dry mouth. A higher proportion of dental hygienists (88.3%) than dentists (51.0%) had measured salivary secretion rate, (p < 0.001) and more often suggested preventive dental care 3-4 times a year, (42.5% vs. 30.5%) (p < 0.007). Dentists had a higher awareness of saliva functions, while dental hygienists had a higher awareness about causes and complications of oral dryness. Higher proportions of dentists and dental hygienists with over 10 years of professional experience had measured salivary secretion rate (69.1% vs. 95.7%) compared to their counterparts with less than 10 years of professional experience (35.9% vs. 79.5%) (p < 0.001 for both). CONCLUSION Compared to dentists, dental hygienists were more attentive to patients with oral dryness as they encountered these individuals more often, asked more age-groups, suggested frequent preventive measures, and had higher awareness of the causes and complications of oral dryness. Length of professional experience could improve both the management of patients with oral dryness and awareness of its causes, particularly for dental hygienists.
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Affiliation(s)
- Amela Fisic
- Dept of Oral Health, Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - Hulya Cevik Aras
- Dept of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Specialist Clinic of Oral Medicine, Public Dental Care, Region Västra Götaland, Västra Götaland, Sweden
| | - Ulrica Almhöjd
- Dept of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annica Almståhl
- Dept of Oral Health, Faculty of Odontology, Malmö University, Malmö, Sweden
- Dept of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Zhao DW, Teng F, Meng LL, Fan WJ, Luo YR, Jiang HY, Chen NX, Zhang XX, Yu W, Cai BN, Zhao LJ, Wang PG, Ma L. Development and validation of a nomogram for prediction of recovery from moderate-severe xerostomia post-radiotherapy in nasopharyngeal carcinoma patients. Radiother Oncol 2023; 184:109683. [PMID: 37120102 DOI: 10.1016/j.radonc.2023.109683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/28/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE Aim to create and validate a comprehensive nomogram capable of accurately predicting the transition from moderate-severe to normal-mild xerostomia post-radiotherapy (postRT) in patients with nasopharyngeal carcinoma (NPC). Materials and methods We constructed and internally verified a prediction model using a primary cohort comprising 223 patients who were pathologically diagnosed with NPC from February 2016 to December 2019. LASSO regression model was used to identify the clinical factors and relevant variables (the pre-radiotherapy (XQ-preRT) and immediate post-radiotherapy (XQ-postRT) xerostomia questionnaire scores, as well as the mean dose (Dmean) delivered to the parotid gland (PG), submandibular gland (SMG), sublingual gland (SLG), tubarial gland (TG), and oral cavity). Cox proportional hazards regression analysis was performed to develop the prediction model, which was presented as a nomogram. The models' performance with regard to calibration, discrimination, and clinical usefulness was evaluated. The external validation cohort comprised 78 patients. Results Due to better discrimination and calibration in the training cohort, age, gender, XQ-postRT, and Dmean of PG, SMG, and TG were included in the individualized prediction model (C-index of 0.741 (95% CI:0.717 to 0.765). Verification of the nomogram's performance in internal and external validation cohorts revealed good discrimination (C-index of 0.729 (0.692 to 0.766) and 0.736 (0.702 to 0.770), respectively) and calibration. Decision curve analysis revealed that the nomogram was clinically useful. The 12-month and 24-month moderate-severe xerostomia rate was statistically lower in the SMG-spared arm (28.4% (0.230 to 35.2) and 5.2% (0.029 to 0.093), respectively) than that in SMG-unspared arm (56.8% (0.474 to 0.672) and 12.5% (0.070 to 0.223), respectively), with an HR of 1.84 (95%CI: 1.412 to 2.397, p= 0.000). The difference in restricted mean survival time for remaining moderate-severe xerostomia between the two arms at 24 months was 5.757 months (95% CI, 3.863 to 7.651; p=0.000). Conclusion The developed nomogram, incorporating age, gender, XQ-postRT, and Dmean to PG, SMG, and TG, can be used for predicting recovery from moderate-severe xerostomia post-radiotherapy in NPC patients. Sparing SMG is highly important for the patient's recovery.
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Affiliation(s)
- Da-Wei Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing, China; Department of Radiology, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Feng Teng
- Department of Radiation Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Ling-Ling Meng
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Radiation Oncology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wen-Jun Fan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Radiation Oncology, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China; Department of Radiation Oncology, Armed Police Forces Corps Hospital of Henan Province, Zhengzhou, 450052, China
| | - Yan-Rong Luo
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hua-Yong Jiang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Radiation Oncology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Nan-Xiang Chen
- Department of Otolaryngology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin-Xin Zhang
- Department of Otolaryngology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wei Yu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Radiation Oncology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bo-Ning Cai
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Radiation Oncology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lu-Jun Zhao
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Pei-Guo Wang
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Lin Ma
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Radiation Oncology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
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