Management of xerostomia related to radiotherapy for head and neck cancer.
Xerostomia is a permanent and devastating sequela of head and neck irradiation, and its consequences are numerous. Pharmaceutical therapy attempts to preserve or salvage salivary gland function through systemic administration of various protective compounds, most commonly amifostine (Ethyol) or pilocarpine. When these agents are ineffective or the side effects too bothersome, patients often resort to palliative care, for example, with tap water, saline, bicarbonate solutions, mouthwashes, or saliva substitutes. A promising surgical option is the Seikaly-Jha procedure, a method of preserving a single submandibular gland by surgically transferring it to the submental space before radiotherapy. Improved radiation techniques, including intensity-modulated radiotherapy and tomotherapy, allow more selective delivery of radiation to defined targets in the head and neck, preserving normal tissue and the salivary glands. Acupuncture may be another option for patients with xerostomia. All of these therapies need to be further studied to establish the most effective protocol to present to patients before radiotherapy has begun.
Kahn
Shannon T
ST
Radiation Oncology Department, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Johnstone
Peter A S
PA
D015670:Acupuncture Therapy; D004999:Amifostine / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D018721:Muscarinic Agonists / Q000627:therapeutic use; D010166:Palliative Care; D010862:Pilocarpine / Q000627:therapeutic use; D011812:Quinuclidines / Q000627:therapeutic use; D011837:Radiation-Protective Agents / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D013363:Submandibular Gland / Q000601:surgery; D013876:Thiophenes / Q000627:therapeutic use; D014987:Xerostomia / Q000209:etiology / Q000628:therapy*
D018721:Muscarinic Agonists; D011812:Quinuclidines; D011837:Radiation-Protective Agents; D013876:Thiophenes; D010862:Pilocarpine; C059240:cevimeline; D004999:Amifostine