Treatment for head and neck cancers may lead to salivary gland hypofunction and xerostomia, particularly where external-beam radiation therapy is used. Salivary gland hypofunction is also seen in patients in cases where radioactive iodine, total body irradiation, high-dose chemotherapy with hematopoietic stem cell transplantation, and moderate-dose chemotherapy for solid tumors are used, although function loss and associated symptoms seem to be less severe and long-lasting in these settings.
Saliva plays a crucial role in maintenance of tooth integrity, mechanical cleansing of the oral cavity, oral comfort, antimicrobial activity preventing oral infections, and the performance of upper GI functions (e.g., taste perception, bolus formation). Thus, salivary gland hypofunction is associated with increased risk of oral infections, carious destruction of teeth, oral mucosal discomfort, and a worsened nutritional state.
Abstract:
Purpose: To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies.
Methods: Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials published between January 2009 and June 2020. The guideline also incorporated two previous systematic reviews conducted by MASCC/ISOO, which included studies published from 1990 through 2008.
Results: For the prevention of salivary gland hypofunction and/or xerostomia in patients with head and neck cancer, there is high-quality evidence for tissue-sparing radiation modalities. Evidence is weaker or insufficient for other interventions. For the management of salivary gland hypofunction and/or xerostomia, intermediate-quality evidence supports the use of topical mucosal lubricants, saliva substitutes, and agents that stimulate the salivary reflex.
Recommendations: For patients who receive radiation therapy for head and neck cancer, tissue-sparing radiation modalities should be used when possible to reduce the risk of salivary gland hypofunction and xerostomia. Other risk-reducing interventions that may be offered during radiation therapy for head and neck cancer include bethanechol and acupuncture. For patients who develop salivary gland hypofunction and/or xerostomia, interventions include topical mucosal lubricants, saliva substitutes, and sugar-free lozenges or chewing gum. For patients with head and neck cancer, oral pilocarpine and oral cevimeline, acupuncture, or transcutaneous electrostimulation may be offered after radiation therapy.
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