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Longitudinal scintigraphic study of parotid and submandibular gland function after total body irradiation at bone marrow transplantation Mats Bågesund.

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Presentation on theme: "Longitudinal scintigraphic study of parotid and submandibular gland function after total body irradiation at bone marrow transplantation Mats Bågesund."— Presentation transcript:

1 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 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

2 © 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: mats.bagesund@lio.se

3 Regions of interest © Mats Bågesund

4 Time-activity curve showing scintigraphic variables 15 30 45 60 Time from injection (minutes) % of dose injected 0 0 Fu US TMa RS DS Ma Mi S% © Mats Bågesund

5 Percentage secretion S%=100% x (Ma-Mi) / Ma Time from injection % of dose injected Ma Mi S% © Mats Bågesund

6 Objective 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) © Mats Bågesund

7 Patients examined  BeforeAfter After TBI/BMT3 months 12 months n=9n=5n=3 Sex1F, 8M1F, 4M3M Mean age (years) 13.9 15.4 17.3  Range8-288-28 9-29  BeforeAfter After TBI/BMT3 months 12 months n=9n=5n=3 Sex1F, 8M1F, 4M3M Mean age (years) 13.9 15.4 17.3  Range8-288-28 9-29 © Mats Bågesund

8 Patients examined  BeforeAfter After TBI/BMT3 months 12 months Diagnose n=9n=5n=3  Lymphoma222  AML111  CML11  ALL41  SAA1  BeforeAfter After TBI/BMT3 months 12 months Diagnose n=9n=5n=3  Lymphoma222  AML111  CML11  ALL41  SAA1 © Mats Bågesund

9 Conditioning  Cyclophosphamide  10 Gy TBI GVH-prophylaxis  Methotrexate  Cyclosporine A Conditioning  Cyclophosphamide  10 Gy TBI GVH-prophylaxis  Methotrexate  Cyclosporine A © Mats Bågesund

10 Method Whole salivary secretion rate  Unstimulated (USSR)15 minutes  Chewing stimulated (SSSR)5 minutes Salivary gland scintigraphy60 minutes Whole salivary secretion rate  Unstimulated (USSR)15 minutes  Chewing stimulated (SSSR)5 minutes Salivary gland scintigraphy60 minutes © Mats Bågesund

11 Subtraction of background radiation Bågesund et al. Dentomaxillofac Radiol 2000; 29: 264-71. © Mats Bågesund

12 Statistical method Wilcoxon Signed Rank Test © Mats Bågesund

13 Unstimulated (USSR) and stimulated (SSSR) salivary secretion rate (n=5) 0 0 1 1 2 2 ml/min months after TBI / BMT 0 0 3 3 12 USSR SSSR © Mats Bågesund

14 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  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 © Mats Bågesund

15 Scintigraphic differences in parotid glands before vs. 3 months after TBI/BMT 15 30 45 60 Time from injection (minutes) % of dose injected 0 0 TMa S% P=0.043 n=5 © Mats Bågesund

16 0 0 100 Before TBI/BMT 3 months after Parotid secretion (S%Par) % of maximal uptake 79% 51% P=0.043 n=5 © Mats Bågesund

17 Parotid secretion (S%Par) % of maximal uptake Months after TBI/BMT n=3 0 0 100 0 0 3 3 12 0% © Mats Bågesund

18 Scintigraphic differences in submandibular glands before vs. 3 months after TBI/BMT 15 30 45 60 Time from injection (minutes) % of dose injected 0 0 Fu Ma Mi S% P=0.043 n=5 © Mats Bågesund

19 0 0 100 Before TBI/BMT 3 months after Submandibular secretion (S%Sub) % of maximal uptake 95% 44% P=0.043 n=5 © Mats Bågesund

20 Submandibular secretion (S%Sub) % of maximal uptake Months after TBI/BMT n=3 0 0 100 0 0 3 3 12 93% © Mats Bågesund

21 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 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. © Mats Bågesund

22 Swedish Children’s Cancer Foundation Swedish Society of Pediatric Dentistry ACTA research and travel foundation Mölnlycke Toiletries AB / Cederroth Public Dental Health Service Östergötland Swedish Children’s Cancer Foundation Swedish Society of Pediatric Dentistry ACTA research and travel foundation Mölnlycke Toiletries AB / Cederroth Public Dental Health Service Östergötland Sponsors © Mats Bågesund

23 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. © Mats Bågesund

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