- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04584164
Interest of the Sialendoscopy Associated With a Local Injection of Corticosteroids in the Treatment of Radio-induced Xerostomia in Comparison With the Hygiene Rules (SIALORAD)
Interest of the Sialendoscopy Associated With a Local Injection of Corticosteroids in the Treatment of Radio-induced Xerostomia in Comparison With the Hygiene Rules: a Prospective Randomized and Controlled Study
Study Overview
Detailed Description
Post-radiation xerostomia appears from the first days after irradiation and for very low doses (from a dose received of 5 Gy). A first phase appears in the first 10 days following radiotherapy, with regression of salivary secretion by blocking the muscarinic membrane receptors of acinar cells and destruction of the endothelial cells responsible for glandular angiogenesis. With increasing doses, apoptosis of stem cells and acinar cells of the salivary glands follows, leading to atrophy and irreversible fibrosis beyond 60 Gy, due to the lack of renewal of acinar stem cells. Four phases in the pathophysiology of post-radial xerostomia are thus described. Phases 1 and 2, appearing respectively between 0-10 days and 10-60 days, are characterized by a severe decrease in saliva production, first without a decrease in amylase production or in the number of acinar cells in phase 1 and then with a decrease in amylase and in the number of acinar cells in phase 2. This acute phase, initially reversible, is thought to be related either to apoptosis of acinar cells or to acinar cell membrane dysfunction. Then phases 3 and 4, appearing respectively between 60-120 days (stability of the secretion and number of acinar cells) and between 120 and 240 days, are characterized by a senescence of mature acinar cells, which are not renewed due to sterilization of the glandular stem cells, leading to a definitive deterioration of the secretory functions by glandular atrophy and irreversible fibrosis. A study by the QUANTEC (Quantitative Analyses of Normal Tissue Effects in the Clinic) group showed that severe xerostomia (defined as a decrease of more than 25% in the amount of saliva produced) could be seen in IMRT when the four major salivary glands were given a dose >25Gy or if at least one parotid gland was not preserved at a dose <20Gy. The pathophysiology of post-radial xerostomia has similarities with that of other causes of xerostomia. Gougerot-Sjögren's syndrome is characterized by salivary gland infiltration by B and T macrophages and lymphocytes targeting salivary muscarinic receptors. This is followed by inflammation and lymphocytic infiltration with replacement of glandular acinar cells by fibrosis associated with cellular apoptosis and thus glandular atrophy. The complaint of xerostomia and objective reduction of saliva secretion are frequently found in post-irradiation therapy, used for the treatment of thyroid cancer. Indeed, salivary glandular cells have a strong affinity for Iodine-131 leading to inflammation of the ductal epithelium and endothelial cells, resulting in ductal and glandular fibrosis. These pathophysiological changes during Gougerot-Sjögren and post-irradiotherapy are correlated with sialendoscopic findings: stenosis, sialadenitis, sialadochitis, mucous plugs, erythema... . However, studies have shown the effectiveness of sialendoscopy in improving the symptomatology of xerostomia and in increasing salivary production, by simple irrigation (of serum alone or associated with local injection of corticosteroids) and root canal dilatation in patients with these non-lithiasic pathologies. Therapeutic success would be attributable to the removal of mucosal plugs, removal of stenosis and reduction of inflammation (25). This is all the more so since the saliva flow produced by the acinar cells and the salivary ionic composition (by ductal ionic reabsorption) are strongly dependent on the ductal flow, and therefore on the presence of possible stenosis or mucous plugs. The improvement of the symptomatology and salivary production would be visible in the immediate postoperative period (from the first weeks), with a prolonged therapeutic effect beyond several months, after a single sialendoscopy. Recently, a study has shown the efficacy of sialendoscopy to improve chemotherapy-induced xerostomy symptoms using Ac-PSMA-617 for the treatment of prostate cancer, which is also the cause of Grade 1 xerostomia. Our study is based on the pathophysiological similarity of post-radial xerostomy with Gougerot-Sögren's syndrome and post-irradial xerostomy. The promising results of recently published sialendoscopic studies in these two pathologies allow us to envisage a potential benefit of sialendoscopy in a post-radial context.
In the context of this work, the investigators will compare sialendoscopy associated with a local injection of corticosteroids to the usual management based on the hygieno-dietary rules (HDR) consisting of regular drinking and a diet with a high dose of corticosteroids.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Elisabeth SAUVAGET, MD
- Phone Number: + 33 01 44 12 74 92
- Email: esauvaget@ghpsj.fr
Study Locations
-
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Ile-de-France
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Paris, Ile-de-France, France, 75014
- Recruiting
- Groupe Hospitalier Paris Saint Joseph
-
Contact:
- Helene BEAUSSIER, PharmD, PhD
- Phone Number: +33 01 44 12 70 38
- Email: hbeaussier@ghpsj.fr
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Contact:
- DRC
- Phone Number: +33 01 44 12 70 33
- Email: crc@ghpsj.fr
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patient whose age is ≥ 18 years old
- Negative pregnancy test for women of childbearing age
- Patient with head and neck cancer who has had parotid and submaxillary gland irradiation at a received dose greater than or equal to 60 Gy and whose end of treatment by radiotherapy is less than 6 months.
- Patient with a complaint of xerostomia/dry mouth ≥1 month and wishing to benefit from therapeutic treatment
- Patient affiliated to a social security system
- Francophone patient
- Patient who has given free, informed and written consent.
Exclusion Criteria:
- History of surgery of the 4 salivary glands (parotidectomy, under maxillectomy, pelvectomy) or prior sialendoscopy
- Current episode of submaxillitis or acute infectious parotitis
- Presence of a lithiasis pathology on the post-radiotherapy control CT scan
- Patient under guardianship or curatorship
- Patient deprived of liberty
- Patient under legal protection
- Pregnant or nursing patient.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control arm
This arm involves patients applying the basic hygiene rules (with mouthwashes) without the sialendoscopy method.
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Experimental: Sialendoscopy arm
This arm involves patients applying the hygiene rule and benifiting in addition a sialendoscopy treatment with a local injection of corticostéroïdes (at the end of the procedure) in the treatment for Xerostomia.
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The patients applying the hygiene rule and benifiting in addition a sialendoscopy treatment with a local injection of corticostéroïdes (at the end of the procedure) in the treatment for Xerostomia.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Superiority of sialendoscopy combined with local injection of corticosteroids (intervention group) in improving the symptoms of post-radial xerostomia, compared to the usual HDR-based treatment
Time Frame: 6 months
|
Difference in mean scores of the Xerostomia Questionnaire (XQ) 6 months after the start of treatment between the 2 groups of patients.
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6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To compare the efficacy of sialendoscopy associated with local corticosteroid injection compared to the usual HDR-based treatment on the early improvement of patient-reported symptoms of post-radial xerostomia
Time Frame: 1 month
|
Difference between the two groups of patients in the mean of the Xerostomia Self Questionnaire scores 1 month after the start of treatment
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1 month
|
To compare the efficacy of sialendoscopy associated with a local corticosteroid injection compared to usual HDR-based treatment on the prolonged improvement of post-radial xerostomy symptoms reported by patients.
Time Frame: 1 year
|
Difference between the two groups of patients in the mean scores of the Xerostomia Questionnaire (XQ)1 year after the start of treatment
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1 year
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To compare the effectiveness of sialendoscopy associated with a local corticosteroid injection compared to that of standard HHR-based treatment in improving quality of life.
Time Frame: 1 month
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Difference between the two groups of patients in the mean of the Quality of Life Self Questionnaire (EORTC-QLQ-C30 HN35) scores 1 month after the start of treatment
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1 month
|
To compare the effectiveness of sialendoscopy associated with a local corticosteroid injection compared to the usual HDR-based treatment on the improvement of stimulated and non-stimulated saliva production.
Time Frame: 1 month
|
Difference between the two groups of patients in the mean amount of saliva produced stimulated and unstimulated (sialometry) 1 month after the start of treatment
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1 month
|
To compare the efficacy of sialendoscopy associated with local corticosteroid injection compared to usual HDR-based treatment on the improvement of post-radial xerostomy symptoms reported by patients according to the rate of salivary gland irradiation.
Time Frame: 1 month
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Difference between the two groups of patients in the mean of the Xerostomia Self-Dose Questionnaire scores by site in Gy (dose-volume histograms) 1 month after the start of treatment.
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1 month
|
To compare the efficacy of the intervention group compared to the usual HDR-based treatment on the improvement of stimulated and non-stimulated saliva production according to the rate of irradiation of the salivary glands.
Time Frame: 1 month
|
Difference between the two groups of patients in the average amount of saliva produced stimulated and unstimulated (sialometry) as a function of the dose received in Gy (dose-volume histograms) 1 month after the start of treatment
|
1 month
|
Describe the post-radial sialendocopic appearance at the parotid and submaxillary levels.
Time Frame: Day 1
|
In patients in the sialendoscopy group: intraoperative aspects of the extra and intraglandular parotid and submaxillary salivary ducts in sialendoscopy: stenosis, lithiasis, mucous plug, inflammation, erythema, pallor.
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Day 1
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Describe post sialendoscopy complications in this field
Time Frame: 1 month
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In patients in the sialendoscopy group: frequency of complications of sialendoscopy.
Complications are classified as minor (pain, oedema, infection, hemorrhage, paresthesia of the lingual nerve) or major (need to return to the operating room, death), with their duration of early (if ≤ 7 days postoperatively) or delayed (≤ 30 days) onset.
|
1 month
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Collaborators and Investigators
Investigators
- Principal Investigator: Elisabeth SAUVAGET, MD, Groupe Hospitalier Paris Saint Joseph
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- SIALORAD
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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