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, 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 PhD Center for Orthodontics and Pedodontics SE-581 85 Linköping SWEDEN Phone: +46 13 22 88 30 Fax: +46 13 22 88 36 E-mail: firstname.lastname@example.org Regions of interest © Mats Bågesund Time-activity curve showing scintigraphic variables Ma % of dose injected Fu S% US DS RS © Mats Bågesund TMa Mi 0 15 30 45 60 Time from injection (minutes) Percentage secretion S%=100% x (Ma-Mi) / Ma Ma % of dose injected S% © Mats Bågesund Mi Time from injection Objective To study the scintigraphic functional changes over time of the parotid and submandibular glands in children and young adults during one year © Mats Bågesund after total body irradiation (TBI) at bone marrow transplantation (BMT) Patients examined Before After After TBI/BMT 3 months 12 months n=9 n=5 n=3 Sex 1F, 8M 1F, 4M 3M © Mats Bågesund Mean age (years) 13.9 15.4 17.3 Range 8-28 8-28 9-29 Patients examined Before After After TBI/BMT 3 months 12 months Diagnose n=9 n=5 n=3 Lymphoma 2 2 2 AML 1 1 1 © Mats Bågesund CML 1 1 ALL 4 1 SAA 1 Conditioning Cyclophosphamide 10 Gy TBI GVH-prophylaxis Methotrexate © Mats Bågesund Cyclosporine A Method Whole salivary secretion rate Unstimulated (USSR) 15 minutes Chewing stimulated (SSSR) 5 minutes Salivary gland scintigraphy 60 minutes © Mats Bågesund Subtraction of background radiation © Mats Bågesund Bågesund et al. Dentomaxillofac Radiol 2000; 29: 264-71. Statistical method Wilcoxon Signed Rank Test © Mats Bågesund Unstimulated (USSR) and stimulated (SSSR) salivary secretion rate (n=5) ml/min USSR 2 SSSR 1 © Mats Bågesund 0 months after 0 3 12 TBI / BMT Changes in salivary secretion rate after 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 © Mats Bågesund SSSR (n=5) P=0.043 3 vs. 12 months after SSSR (n=5) P=0.043 Scintigraphic differences in parotid glands before vs. 3 months after TBI/BMT P=0.043 % of dose injected S% © Mats Bågesund TMa 0 15 30 45 60 n=5 Time from injection (minutes) Parotid secretion (S%Par) P=0.043 % of maximal uptake 100 79% © Mats Bågesund 51% 0 Before TBI/BMT 3 months after n=5 % of maximal uptake Parotid secretion (S%Par) 100 0% © Mats Bågesund 0 0 3 12 n=3 Months after TBI/BMT Scintigraphic differences in submandibular glands before vs. 3 months after TBI/BMT Ma P=0.043 % of dose injected Fu S% © Mats Bågesund Mi 0 15 30 45 60 n=5 Time from injection (minutes) Submandibular secretion (S%Sub) P=0.043 100 % of maximal uptake 95% 44% © Mats Bågesund 0 Before TBI/BMT 3 months after n=5 Submandibular secretion (S%Sub) 100 % of maximal uptake 93% © Mats Bågesund 0 0 3 12 n=3 Months after TBI/BMT Conclusion 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 © Mats Bågesund glands is a contributing factor to the reduced whole salivary secretion rate seen one year after TBI/BMT. Sponsors Swedish Children’s Cancer Foundation Swedish Society of Pediatric Dentistry © Mats Bågesund ACTA research and travel foundation Mölnlycke Toiletries AB / Cederroth Public Dental Health Service Östergötland 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 © Mats Bågesund 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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