title: Is Pilocarpine Effective in Preventing Radiation-Induced Xerostomia? A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  To evaluate the efficacy of concomitant administration of pilocarpine on radiation-induced xerostomia in patients with head and neck cancers.
  
  
  METHODS
  The PubMed, Web of Science, Cochrane Library, and ClinicalTrials were searched to identify randomized, controlled trials studying the effect of concomitant administration of pilocarpine for radiation-induced xerostomia. Included trials were systematically reviewed, and quantifiable outcomes were pooled for meta-analysis. Outcomes of interest included salivary flow, clinician-rated xerostomia grade, patient-reported xerostomia scoring, quality of life, and adverse effects.
  
  
  RESULTS
  Six prospective, randomized, controlled trials in 8 articles were included in this systematic review. The total number of patients was 369 in the pilocarpine group and 367 in the control group. Concomitant administration of pilocarpine during radiation could increase the unstimulated salivary flow rate in a period of 3 to 6 months after treatment, and also reduce the clinician-rated xerostomia grade. Patient-reported xerostomia was not significantly impacted by pilocarpine in the initial 3 months but was superior at 6 months. No significant difference of stimulated salivary flow rate could be confirmed between the 2 arms. Adverse effects of pilocarpine were mild and tolerable.
  
  
  CONCLUSIONS
  The concomitant administration of pilocarpine during radiation increases unstimulated salivary flow rate and reduces clinician-rated xerostomia grade after radiation. It also relieves patients' xerostomia at 6 months and possibly at 12 months. However, pilocarpine has no effect on stimulated salivary flow rate.
authors: Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
authors: Wei-fa
authors: WF
authors: Yang
authors: Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
authors: Gui-qing
authors: GQ
authors: Liao
authors: Department of Oral and Maxillofacial Surgery, University of Lübeck, Lübeck, Germany.
authors: Samer G
authors: SG
authors: Hakim
authors: Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China.
authors: Dai-qiao
authors: DQ
authors: Ouyang
authors: Department of Radiation Oncology, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada.
authors: Jolie
authors: J
authors: Ringash
authors: Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong, China. Electronic address: richsu@hku.hk.
authors: Yu-xiong
authors: YX
authors: Su
mesh_terms: D018679:Cholinergic Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D010862:Pilocarpine / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012472:Salivation / Q000187:drug effects* / Q000528:radiation effects; D014987:Xerostomia / Q000209:etiology / Q000517:prevention & control*
chemical_list: D018679:Cholinergic Agonists; D010862:Pilocarpine