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Prevention of Xerostomia and salivary gland hypofunction induced by nonsurgical cancer therapies: Updated guidelines
USA: Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO have released a new guideline for the prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies. The guideline is published in the Journal of Clinical Oncology.
ISOO/MASCC/ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. The online databases 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.
A total of 58 publications were identified: 46 addressed preventive interventions and 12 addressed therapeutic interventions.
Key recommendations include:
- Intensity-modulated radiation therapy should be used to spare major and minor salivary glands from a higher dose of radiation to reduce the risk of salivary gland hypofunction and xerostomia in patients with head and neck cancer.
- Other radiation modalities that limit cumulative dose to and irradiated volume of major and minor salivary glands as or more effectively than intensity-modulated radiation therapy may be offered to reduce salivary gland hypofunction and xerostomia.
- Acupuncture may be offered during radiation therapy for head and neck cancer to reduce the risk of developing xerostomia.
- Systemic administration of the sialogogue bethanechol may be offered during radiation therapy for head and neck cancer to reduce the risk of salivary gland hypofunction and xerostomia.
- Vitamin E or other antioxidants should not be used to reduce the risk of radiation-induced salivary gland hypofunction and xerostomia because of the potential adverse impact on cancer-related outcomes and the lack of evidence of benefit.
- Evidence remains insufficient for a recommendation for or against the use of submandibular gland transfer administered before head and neck cancer treatment to reduce the risk of salivary gland hypofunction and xerostomia because of insufficient evidence with contemporary radiation modalities.
- Evidence remains insufficient for a recommendation for or against the use of the following interventions during radiation therapy for head and neck cancer: Oral pilocarpine, amifostine (with contemporary radiation modalities), or low-level laser therapy.
- Evidence remains insufficient for a recommendation for or against the use of the following interventions to reduce the risk of salivary gland hypofunction or xerostomia in patients with head and neck cancer: n-acetylcysteine oral rinse, traditional Chinese medicine–based herbal mouthwash, local clonidine, concurrent chemotherapy with nedaplatin, boost radiation therapy, hyperfractionated or hypofractionated radiation therapy, intra-arterial chemoradiation, minocycline, melatonin, nimotuzumab, zinc sulfate, propolis, viscosity-reducing mouth spray, transcutaneous electrical nerve stimulation (TENS), parotid gland massage, thyme honey, and human epidermal growth factor.
- Topical mucosal lubricants or saliva substitutes (agents directed at ameliorating xerostomia and other salivary gland hypofunction-related symptoms) may be offered to improve xerostomia induced by nonsurgical cancer therapies.
- Gustatory and masticatory salivary reflex stimulation by sugar-free lozenges, acidic (nonerosive and sugar-free special preparation if dentate patients) candies, or sugar-free, nonacidic chewing gum may be offered to produce transitory increased saliva flow rate and transitory relief from xerostomia by stimulating residual capacity of salivary gland tissue.
- Oral pilocarpine, and cevimeline where available, may be offered after radiation therapy in patients with head and neck cancer for transitory improvement of xerostomia and salivary gland hypofunction by stimulating residual capacity of salivary gland tissue. However, improvement of salivary gland hypofunction may be limited.
- Acupuncture may be offered after radiation therapy in patients with head and neck cancer for improvement of xerostomia.
- Transcutaneous electrostimulation or acupuncture-like transcutaneous electrostimulation of the salivary glands may be offered after radiation therapy in patients with head and neck cancer for improvement of salivary gland hypofunction and xerostomia.
- Evidence remains insufficient for a recommendation for or against the use of the following interventions for improvement of salivary gland hypofunction and xerostomia: Extract of ginger and mesenchymal stem cell therapy.
MASCC/ISOO and ASCO believe that cancer clinical trials are vital to inform medical decisions and improve cancer care, and that all patients should have the opportunity to participate.
Reference:
Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline, is published in the Journal of Clinical Oncology.
DOI: https://ascopubs.org/doi/10.1200/JCO.21.01208
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751