Avi Assouline1, Antonin Levy2, Maya Abdelnour-Mallet3, Jesus Gonzalez-Bermejo4, Timothée Lenglet5, Nadine Le Forestier6, François Salachas5, Gaelle Bruneteau5, Vincent Meininger5, Sylvie Delanian7, Pierre-François Pradat8. 1. Department of Radiation Oncology, Centre Clinique de la Porte de Saint Cloud, Boulogne-Billancourt, France; Department of Radiation Oncology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France. Electronic address: avi.assouline@ccpsc.fr. 2. Department of Radiation Oncology, Gustave Roussy, Université Paris-Sud XI, Villejuif, France. 3. Service Evaluation Pharmaceutique et Bon Usage (SEPBU), Unité Evaluation Scientifique, Bon Usage et Information (ESBUI), APHP AGEPS/pôle Pharmacie Hospitalière, Hôpitaux de Paris (PHHP), Paris, France. 4. Departement of Pneumology and Intensive Care, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France. 5. Departement of Nervous System Diseases, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France. 6. Departement of Nervous System Diseases, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France; Département de Recherche ES3, Emmanuel Hirsch, EA 1610 Études sur les Sciences et les Techniques, Université Paris-Sud XI, Paris, France. 7. Department of Radiation Oncology, Centre Clinique de la Porte de Saint Cloud, Boulogne-Billancourt, France; Department of Radiation Oncology, Hôpital Saint Louis, APHP, Paris, France. 8. Departement of Nervous System Diseases, Paris ALS center, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France; UMR-678, INSERM-UPMC, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Abstract
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<10(-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.
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 ALSpatients 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 ALSpatients. 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<10(-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 ALSpatients with sialorrhea. A shorter RT course (10 Gy in 2 fractions) may be proposed in patients in poor medical condition.
Authors: Stephanie R McKeown; Paul Hatfield; Robin J D Prestwich; Richard E Shaffer; Roger E Taylor Journal: Br J Radiol Date: 2015-10-14 Impact factor: 3.039
Authors: Chafic Y Karam; Sabrina Paganoni; Nanette Joyce; Gregory T Carter; Richard Bedlack Journal: Am J Hosp Palliat Care Date: 2014-09-08 Impact factor: 2.500