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To investigate the strength of correlation between measured saliva flow rates and various toxicity endpoints commonly used in head and neck cancer (HNC) treatment.All patients enrolled in a phase II study using intensity modulated radiotherapy (IMRT) for HNC treatment underwent whole mouth saliva flow measurements (stimulated and unstimulated). They were also assessed for salivary gland toxicity using Radiation Therapy Oncology Group (RTOG) late toxicity grading and 9 items representing patient-graded toxicities from 2 questionnaires (Xerostomia questionnaire and University of Washington quality of life). For each patient, saliva flow rates and quality of life (QOL) data were collected preradiotherapy (RT) and at 3 intervals post-RT (3, 6, and 12 months).A total of 188 sets of coregistered data were obtained for 47 patients over a period of approximately 4 years. Saliva production and mean QOL dropped significantly immediately after RT, but there was a statistically significant recovery in both parameters between 3- and 12-month post-RT. By 12 months, post-RT the mean QOL scores had returned to pre-RT baseline, although mean stimulated saliva production remained 58% below baseline.Patients with HNC treated with IMRT experienced a small drop in QOL which recovered to baseline by 12 months post-RT. There was no statistically significant correlation seen between global health-related QOL scores and stimulated saliva production rates in the post-RT period.

Thirty-three patients with rheumatoid arthritis had computed tomographic examination of the craniocervical junction. This demonstrated soft tissue features which have not previously been described in published reports. A low attenuation lesion between the odontoid and the transverse ligament shown in 11 patients was considered a premonitory sign of rupture of the transverse ligament or a manifestation of active disease. Computed tomography revealed spinal cord compression in 3 patients and ligamentous changes in the transverse ligament and the alar and spinal ligaments in 26 patients. Erosion of the odontoid was shown in 19 patients and subluxation in 20 patients. No relationship could be found between the clinical signs and symptoms and the radiological abnormalities except in the case of cord compression.

Fifty-six consecutive patients with pain due to cancer were admitted to a prospective study designed to test a clinical staging system for cancer pain. The system classifies patients in stage 1 (good prognosis) to stage 3 (poor prognosis) according to the mechanism of pain, characteristics of pain, previous narcotic exposure, cognitive function, psychological distress, tolerance and past history of drug addiction or alcoholism. During day 1 patients were staged after being seen by one of the investigators. Patients were treated for 21 days, when a final diagnosis of pain control was made. Eighteen of 22 patients in stage 1 achieved good pain control (82%) vs. 2/22 patients in stage 3 (10%; P less than 0.01). Sensitivity, specificity and negative predictive value of the system were 0.75, 0.86 and 0.80, respectively. We conclude that this is a simple and reliable system for clinical staging that can be used for clinical research and management of patients with cancer pain.