Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jan 10, 2019; 10(1): 1-13
Published online Jan 10, 2019. doi: 10.5306/wjco.v10.i1.1
Long-term outcomes of interventions for radiation-induced xerostomia: A review
Sung Jun Ma, Charlotte I Rivers, Lucas M Serra, Anurag K Singh
Sung Jun Ma, Charlotte I Rivers, Lucas M Serra, Anurag K Singh, University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14214, United States
Sung Jun Ma, Charlotte I Rivers, Lucas M Serra, Anurag K Singh, Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
Author contributions: Ma SJ and Rivers CI completed the initial literature review and drafted the manuscript and tables. Serra LM assisted in analyzing the data, compiling the tables, and drafting the manuscript. Singh AK developed the concept and led the editing process. All authors contributed to critical revision, editing, and approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Anurag K Singh, MD, Attending Doctor, Professor, Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, United States.
Telephone: +1-716-8455715 Fax: +1-716-845-7616
Received: September 29, 2018
Peer-review started: September 29, 2018
First decision: October 26, 2018
Revised: December 7, 2018
Accepted: December 17, 2018
Article in press: December 17, 2018
Published online: January 10, 2019

Xerostomia, or dry mouth, is a significant problem affecting quality of life in patients treated with radiation therapy for head and neck cancer. Strategies for reduction of xerostomia burden vary widely, with options including: sialagogue medications, saliva substitutes, acupuncture, vitamins, hyperbaric oxygen, submandibular gland transfer, and acupuncture or associated treatments. In this review, we sought to evaluate long-term outcomes of patients treated with various interventions for radiation-induced xerostomia. A literature search was performed using the terms “xerostomia” and “radiation” or “radiotherapy”; all prospective clinical trials were evaluated, and only studies that reported 1 year follow up were included. The search results yielded 2193 studies, 1977 of which were in English. Of those, 304 were clinical trials or clinical studies. After abstract review, 23 trials were included in the review evaluating the following treatment modalities: pilocarpine (three); cevimeline (one); amifostine (eleven); submandibular gland transfer (five); acupuncture like transcutaneous electrical nerve stimulation (ALTENS) (one); hyperbaric oxygen (one); and acupuncture (one). Pilocarpine, cevimeline, and amifostine have been shown in some studies to improve xerostomia outcomes, at the cost of toxicity. ALTENS has similar efficacy with fewer side effects. Submandibular gland transfer is effective but requires an elective surgery, and thus may not always be appropriate or practical. The use of intensity-modulated radiation therapy, in addition to dose de-escalation in select patients, may result in fewer patients with late xerostomia, reducing the need for additional interventions.

Keywords: Xerostomia, Radiation therapy, Radiotherapy, Head and neck cancer, Quality of life

Core tip: Xerostomia is a common side effect of radiation for head and neck cancer, and can impact patient quality of life even years after treatment. In this review, we sought to evaluate the current literature regarding long-term outcomes of interventions for radiation-induced xerostomia, including medical management, submandibular gland transfer, acupuncture, acupuncture like transcutaneous electrical nerve stimulation, and hyperbaric oxygen.