A Clinical Investigation into the Effectiveness of Three-Dimensional Treatment Planning and Conformational Dose-Delivery in Parotid Sparingin Head and Neck Cancer Patients Receiving Bilateral Radiation
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Cancers of the head and neck are associated with high levels of morbidity and are thus, once diagnosed, treated very aggressively. Unfortunately, the standard radiation protocol used to treat oral cancer has serious detrimental side effects to the oral health and well being of the patient due to the death of salivary glands as a result of radiation. In the past, physicians and dentists have outweighed the consequences of the treatment with the ultimate death of the cancer. Both the patient and the caregiver have tried, with little success, to treat these harsh side effects. In recent years, a new radiation protocol known as three-dimensional treatment planning and conformational dose-delivery has been developed. The new protocol provides tumorcidial doses to cancers while sparing the contralateral parotid salivary gland in patients receiving bilateral radiation. This study had two main objectives: first, clinical measurements of saliva were taken from patients receiving radiation for head and neck cancers in order to determine the effectiveness of the newly developed protocol, and second, quality of life questionnaires were filled out by patients in order to assess the social and mental ramifications patients experienced due to the loss of salivary gland function. Patients were placed on the appropriate radiation protocol (standard, ipsilateral, or bilateral) according to the stage of their tumor and its degree of metastases. Prior to the onset of radiation, saliva was collected from each patient in order to establish his or her baseline flow rate. Saliva (stimulated and unstimulated) was collected from the parotid and submandibular glands of the patient at pre-determined time intervals during the course of radiation therapy. The values obtained from these saliva collections were compared to the baseline flow rate in 111 order to detennine the percentage of baseline flow rate for that particular stage of radiation. The patient prior to saliva collection filled out the quality of life questionnaire. Results from this study found that saliva function in the treated gland diminished throughout radiation until it reached 0% of baseline. The spared gland also had a diminished saliva flow rate, however, to a much smaller degree due to the lower dose of radiation received.