Longitudinal scintigraphic study of parotid and submandibular gland function after total body irradiation at bone marrow transplantation Mats Bågesund 1,2 Sven Richter 3 Göran Dahllöf 2 1 Center for Orthodontics and Pedodontics, Linköping 2 Department of Pediatric Dentistry, Karolinska Institutet, Stockholm 3 Department of Nuclear Medicine, Huddinge University Hospital, Karolinska Institutet,
Longitudinal scintigraphic study of parotid and submandibular
Jan 14, 2015
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Longitudinal scintigraphic study ofparotid and submandibular
gland functionafter total body irradiation at bone marrow transplantation
Longitudinal scintigraphic study ofparotid and submandibular
gland functionafter total body irradiation at bone marrow transplantation
Mats Bågesund 1,2
Sven Richter 3
Göran Dahllöf 2 1 Center for Orthodontics and Pedodontics, Linköping
2 Department of Pediatric Dentistry, Karolinska Institutet, Stockholm3 Department of Nuclear Medicine,
Huddinge University Hospital, Karolinska Institutet, Sweden
Mats Bågesund 1,2
Sven Richter 3
Göran Dahllöf 2 1 Center for Orthodontics and Pedodontics, Linköping
2 Department of Pediatric Dentistry, Karolinska Institutet, Stockholm3 Department of Nuclear Medicine,
Huddinge University Hospital, Karolinska Institutet, Sweden
© Copyright: Mats Bågesund, DDS, PhD.
No material published in this file may be reproduced in any way without written permission from the author !
Address:Mats Bågesund DDS PhDCenter for Orthodontics and PedodonticsSE-581 85 LinköpingSWEDEN
Phone: +46 13 22 88 30Fax: +46 13 22 88 36E-mail: [email protected]
Regions of interestRegions of interest
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Time-activity curve showing scintigraphic variables
Time-activity curve showing scintigraphic variables
1515 3030 4545 6060Time from injection (minutes)Time from injection (minutes)
% of dose injected % of dose injected
00
FuFu
USUS
TMaTMa
RSRSDSDS
MaMa
MiMi
S%S%
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Percentage secretionS%=100% x (Ma-Mi) / Ma
Percentage secretionS%=100% x (Ma-Mi) / Ma
Time from injectionTime from injection
% of dose injected % of dose injected
MaMa
MiMi
S%S%
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ObjectiveObjective
To study
the scintigraphic functional changes over time
of the parotid and submandibular glands
in children and young adults during one year
after total body irradiation (TBI)
at bone marrow transplantation (BMT)
To study
the scintigraphic functional changes over time
of the parotid and submandibular glands
in children and young adults during one year
after total body irradiation (TBI)
at bone marrow transplantation (BMT)
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Patients examinedPatients examined
Before After After TBI/BMT 3 months 12
months n=9 n=5 n=3
Sex 1F, 8M 1F, 4M 3M
Mean age (years) 13.9 15.4 17.3 Range 8-28 8-28 9-29
Before After After TBI/BMT 3 months 12
months n=9 n=5 n=3
Sex 1F, 8M 1F, 4M 3M
Mean age (years) 13.9 15.4 17.3 Range 8-28 8-28 9-29
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Patients examinedPatients examined
Before After After TBI/BMT 3
months 12 months Diagnose n=9n=5 n=3
Lymphoma 2 2 2 AML 1 1 1 CML 1 1 ALL 4 1 SAA 1
Before After After TBI/BMT 3
months 12 months Diagnose n=9n=5 n=3
Lymphoma 2 2 2 AML 1 1 1 CML 1 1 ALL 4 1 SAA 1
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Conditioning Cyclophosphamide 10 Gy TBI
GVH-prophylaxis Methotrexate Cyclosporine A
Conditioning Cyclophosphamide 10 Gy TBI
GVH-prophylaxis Methotrexate Cyclosporine A
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MethodMethod
Whole salivary secretion rate Unstimulated (USSR) 15 minutes Chewing stimulated (SSSR) 5 minutes
Salivary gland scintigraphy 60 minutes
Whole salivary secretion rate Unstimulated (USSR) 15 minutes Chewing stimulated (SSSR) 5 minutes
Salivary gland scintigraphy 60 minutes
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Subtraction of background radiation
Bågesund et al. Dentomaxillofac Radiol 2000; 29: 264-71.Bågesund et al. Dentomaxillofac Radiol 2000; 29: 264-71. © M
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Statistical methodStatistical method
Wilcoxon Signed Rank TestWilcoxon Signed Rank Test
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Unstimulated (USSR) and stimulated (SSSR)salivary secretion rate (n=5)
00
11
22
ml/minml/min
months after TBI / BMT
months after TBI / BMT00 33 1212
USSRUSSR
SSSRSSSR
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Changes in salivary secretion rateafter TBI/BMT
Changes in salivary secretion rateafter TBI/BMT
0 vs. 3 months after USSR (n=7) P=0.018 SSSR (n=7) P=0.018
0 vs. 12 months after USSR (n=5) P=0.043 SSSR (n=5) P=0.043
3 vs. 12 months after SSSR (n=5) P=0.043
0 vs. 3 months after USSR (n=7) P=0.018 SSSR (n=7) P=0.018
0 vs. 12 months after USSR (n=5) P=0.043 SSSR (n=5) P=0.043
3 vs. 12 months after SSSR (n=5) P=0.043
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Scintigraphic differences inparotid glands
before vs. 3 months after TBI/BMT
Scintigraphic differences inparotid glands
before vs. 3 months after TBI/BMT
1515 3030 4545 6060Time from injection (minutes)Time from injection (minutes)
% of dose injected % of dose injected
00
TMaTMa
S%S%
P=0.043P=0.043
n=5
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00
100100
Before TBI/BMTBefore TBI/BMT 3 months after3 months after
Parotid secretion (S%Par)Parotid secretion (S%Par)%
of m
axim
al u
ptak
e%
of m
axim
al u
ptak
e
79%79%
51%51%
P=0.043P=0.043
n=5n=5
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Parotid secretion (S%Par)Parotid secretion (S%Par)%
of m
axim
al u
ptak
e
Months after TBI/BMTMonths after TBI/BMTn=3n=3
00
100100
00 33 1212
0%0%
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Scintigraphic differences insubmandibular glands
before vs. 3 months after TBI/BMT
Scintigraphic differences insubmandibular glands
before vs. 3 months after TBI/BMT
1515 3030 4545 6060Time from injection (minutes)Time from injection (minutes)
% of dose injected % of dose injected
00
FuFu
MaMa
MiMi
S%S%
P=0.043P=0.043
n=5
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00
100100
Before TBI/BMTBefore TBI/BMT 3 months after3 months after
Submandibular secretion (S%Sub)Submandibular secretion (S%Sub)%
of m
axim
al u
ptak
e%
of m
axim
al u
ptak
e
95%95%
44%44%
P=0.043P=0.043
n=5n=5
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Submandibular secretion (S%Sub)Submandibular secretion (S%Sub)%
of m
axim
al u
ptak
e
Months after TBI/BMTMonths after TBI/BMTn=3n=3
00
100100
00 33 1212
93%93%
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ConclusionConclusionThe excretion capacity (S%) is reduced three months after TBI/BMT in both parotid and submandibular glands.
The capacity to recover function is obvious in the submandibular glands, but is hardly present in the parotid glands one year after TBI/BMT.
A reduced recovering capacity of the parotid glands is a contributing factor to the reduced whole salivary secretion rate seen one year after TBI/BMT.
The excretion capacity (S%) is reduced three months after TBI/BMT in both parotid and submandibular glands.
The capacity to recover function is obvious in the submandibular glands, but is hardly present in the parotid glands one year after TBI/BMT.
A reduced recovering capacity of the parotid glands is a contributing factor to the reduced whole salivary secretion rate seen one year after TBI/BMT.
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Swedish Children’s Cancer Foundation
Swedish Society of Pediatric Dentistry
ACTA research and travel foundationMölnlycke Toiletries AB / Cederroth
Public Dental Health Service Östergötland
Swedish Children’s Cancer Foundation
Swedish Society of Pediatric Dentistry
ACTA research and travel foundationMölnlycke Toiletries AB / Cederroth
Public Dental Health Service Östergötland
SponsorsSponsors
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References:
Bågesund M, Richter S, Ågren B, Dahllöf G. Correlation between quantitative salivary gland scintigraphy and salivary secretion rates in children and young adults treated for hematological, malignant and metabolic diseases. Dentomaxillofac Radiol 2000; 29: 264-271.
Bågesund M, Richter S, Ågren B, Ringdén O, Dahllöf G. Scintigraphic study of the major salivary glands in pediatric bone marrow transplant recipients. Bone Marrow Transplant 2000; 26: 775-779.
Bågesund M, Winiarski J, Dahllöf G. Subjective xerostomia in long-term surviving children and adolescents after pediatric bone marrow transplantation. Transplantation 2000; 69: 822-826.
Dahllöf G, Bågesund M, Ringdén O. Impact of conditioning regimens on salivary function, caries associated microorganisms and dental caries in children treated with bone marrow transplantation. A four-year longitudinal study. Bone Marrow Transplant 1997; 20: 479-483.
Dahllöf G, Bågesund M, Remberger M, Ringdén O. Risk factors for salivary gland dysfunction in children 1 year after bone marrow transplantation. Eur J Cancer Oral Oncol 1997; 33: 327-331.
References:
Bågesund M, Richter S, Ågren B, Dahllöf G. Correlation between quantitative salivary gland scintigraphy and salivary secretion rates in children and young adults treated for hematological, malignant and metabolic diseases. Dentomaxillofac Radiol 2000; 29: 264-271.
Bågesund M, Richter S, Ågren B, Ringdén O, Dahllöf G. Scintigraphic study of the major salivary glands in pediatric bone marrow transplant recipients. Bone Marrow Transplant 2000; 26: 775-779.
Bågesund M, Winiarski J, Dahllöf G. Subjective xerostomia in long-term surviving children and adolescents after pediatric bone marrow transplantation. Transplantation 2000; 69: 822-826.
Dahllöf G, Bågesund M, Ringdén O. Impact of conditioning regimens on salivary function, caries associated microorganisms and dental caries in children treated with bone marrow transplantation. A four-year longitudinal study. Bone Marrow Transplant 1997; 20: 479-483.
Dahllöf G, Bågesund M, Remberger M, Ringdén O. Risk factors for salivary gland dysfunction in children 1 year after bone marrow transplantation. Eur J Cancer Oral Oncol 1997; 33: 327-331.
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