Radiotherapie voor speekselvloed bij amyotrofische laterale sclerose en de ziekte van Parkinson*

Objective

To determine whether sialorrhoea in amyotrophic lateral sclerosis (ALS) and in Parkinson’s disease can be inhibited by irradiation with a relatively low dose to the major salivary glands.

Design

Retrospective study.

Method

Fifty-three patients who attended the Radiotherapy Department at the Academic Medical Center, Amsterdam, the Netherlands, from January 1996-December 2008, were irradiated locally one or more times for sialorrhoea. Forty-three of them had ALS and 10 had Parkinson’s disease. The irradiation dose was 12 Gy in two fractions. The clinical response and side effects were scored according to predefined criteria.

Results

After initial irradiation, a partial or complete response was achieved in 35 (66%) patients. The mean survival rate after the first irradiation for all patients was 13.7 months, for ALS patients 11.6 months and for Parkinson’s disease patients 26.8 months. The mean duration of successful palliation was 6.9 months in ALS and 6.5 months in Parkinson’s disease. This indicates that the sialorrhoea of these critically ill patients was palliated for, on average, 50% and 25% of their residual life span, respectively. The mean time until re-irradiation was 11.9 months. The second irradiation session also resulted in a response in 21 of 26 patients (81%), but this was usually only a partial response (62%). Ten patients temporarily experienced minor or moderate side effects, such as thick mucus, dry mouth or mild local pain.

Conclusion

In two-thirds of patients with ALS or Parkinson’s disease, low-dose radiotherapy was an effective, simple and rapid palliative treatment for sialorrhoea, with minor toxicity.

Conflict of interest: none declared. Financial support: none declared.