Published online Jan 10, 2019. doi: 10.5306/wjco.v10.i1.1
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.
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.