Early Salivary Gland Shrinkage Is Associated With an Increased Risk of Acute Xerostomia in Head and Neck Cancer Radiation Therapy.

Authors

Teeradon Treechairusame, Peng Zhang, Yu-Chi Hu, Eric Aliotta, Anyi Li, Michalis Aristophanous, Laura Cervino, Joseph O Deasy, Nancy Y Lee, Jung Hun Oh, Pengpeng Zhang

Published in

Advances in radiation oncology. Volume 11. Issue 8. Pages 102090. Epub May 18, 2026.

Abstract

To investigate the relationship between geometric and dosimetric characteristics of salivary glands and acute xerostomia during or shortly after radiation therapy in patients with head and neck cancer (HNC).
We used an Automated Watchdog in Adaptive Radiotherapy Environment (AWARE) program to monitor changes in tumor and organ-at-risk using weekly cone beam computed tomography (CT) images for patients with HNC. Gross tumor volume and organ-at-risk contours were propagated from the planning CT to the weekly cone beam CT using deformable registration and reviewed by clinical users. This study analyzed 165 evaluable patients with AWARE-HNC treated between 2021 and 2024. The National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 was employed to grade toxicities. Acute xerostomia was defined as grade ≥2, occurring during or within 3 months after radiation therapy completion. We compared weekly salivary (parotid and submandibular) gland shrinkage and radiation doses between patients with and without acute xerostomia.
Of the 165 patients with HNC, 66 (40.0%) developed acute xerostomia. Patients with acute xerostomia exhibited significantly larger parotid gland shrinkage in the second and third weeks and submandibular gland shrinkage in the second week (15.4%, 21.0%, and 13.1%, respectively; t test P = .047, .032, and .007) during radiation therapy, compared with those without acute xerostomia (11.4%, 17.2%, and 7.7%). Compared with the nonxerostomia group, patients who developed acute xerostomia received significantly higher mean doses to the ipsilateral parotid (24.7 Gy vs 19.8 Gy; P = .003) and ipsilateral submandibular glands (60.7 Gy vs 57.4 Gy; P = .045). Lower parotid dose in the cone-down boost and subsequent adaptation mitigated the risk of acute xerostomia (P = .015).
Increased mean doses to the ipsilateral parotid and submandibular glands were associated with larger salivary gland shrinkage during radiation therapy and a significantly higher risk of acute xerostomia. This early signal could trigger adaptive replanning promptly. Cone-down and adaptive techniques can reduce the salivary gland dose, helping mitigate the risk of acute xerostomia.

PMID:
42382855
Bibliographic data and abstract were imported from PubMed on 01 Jul 2026.

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