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The objective is to assess diurnal variation in xerostomia post curative intent radiotherapy / chemoradiotherapy in HNC patients and possibly to identify factors (the patient, tumor and  treatment factors) influencing it. 

HNC squamous cell carcinoma of  treated with curative intent & who completed minimum  6 months, disease free  were enrolled in this study. Patients were  treated with radical or adjuvant external beam radiotherapy with conventional or volumetric arc radiotherapy (VMAT) with or without concomitant chemotherapy. Xerostomia evaluation was done using Groningen radiation induced xerostomia (GRIX scale) questionnaire by each patient  once, on follow-up. On GRIX scale, a 14-question questionnaire were filled by the patient. The responses were recorded  and analysis  was done using SPSS. Xerostomia correlation of variables with patient, tumor and treatment factors was done.

In our study of 100 consecutive treated cases of head and neck cancer patients on follow-up, we aimed to evaluate diurnal variation in xerostomia and factors affecting xerostomia. Our cohort comprised majority of oral cavity cancer patients with buccal mucosa and gingivo-buccal complex lesions being the commonest sub site. Seventy one patients received adjuvant radiation, remaining definitive radiotherapy. Fifty eight patients were treated with VMAT technique remaining with conventional technique.Fifty eight patients were evaluated within 1 year post radiation.Thirty five patients had moderate to severe dry mouth during the day, while only 22 patients had moderate to severe dry mouth during night (p= 0.04).Forty five patients had to drink more water during day due to dry mouth, while only 22 patients had to drink more water during night (p=0.0005). Nineteen patients had sticky saliva during day time, while only 9 patients had it during night time (p=0.04).VMAT technique, time gap of more than 1 year post radiotherapy treatment, lower contralateral parotid and submandibular gland doses were associated with lesser xerostomia. Concurrent chemotherapy, intent of treatment, tobacco use had no significant impact on xerostomia. There is diurnal variation in xerostomia with day time xerostomia being more common than night time xerostomia. Use of IMRT or VMAT with sparing of contralateral parotid and submandibular doses should be advocated for all cases of head and neck cancer patients whenever feasible. 

Xerostomia and diurnal variation  can be  significantly reduced by VMAT.Radiation doses to  parotids and submandibular glands predominantly determine the degree of diurnal variation.We need to evaluate this in larger cohort and at baseline and at multiple time points post radiotherapy to understand impact of radiation on xerostomia in a better detailed way.