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Open Access 01-02-2025 | Radiotherapy | Review

A systematic review of salivary gland hypofunction and/or xerostomia induced by non-surgical cancer therapies: prevention strategies

Authors: Valeria Mercadante, Derek K. Smith, Ragda Abdalla-Aslan, Ana Andabak-Rogulj, Michael T. Brennan, Graziella Chagas Jaguar, Haley Clark, Eduardo Fregnani, Luiz Alcino Gueiros, Allan Hovan, Seema Kurup, Alexa M. G. A. Laheij, Charlotte Duch Lynggaard, Joel J. Napeñas, Douglas E. Peterson, Sharon Elad, Stephanie Van Leeuwen, Arjan Vissink, Jonn Wu, Deborah P. Saunders, Siri Beier Jensen

Published in: Supportive Care in Cancer | Issue 2/2025

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Abstract

Purpose

This systematic review aimed to assess the updated literature for the prevention of salivary gland hypofunction and xerostomia induced by non-surgical cancer therapies.

Methods

Electronic databases of MEDLINE/PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCT) that investigated interventions to prevent salivary gland hypofunction and/or xerostomia. Literature search began from the 2010 systematic review publications from the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) up to February 2024. Two independent reviewers extracted information regarding study design, study population, cancer treatment modality, interventions, outcome measures, methods, results, risk of bias (RoB version 2), and conclusions for each article.

Results

A total of 51 publications addressing preventive interventions were included. Eight RCTs on tissue-sparing radiation modalities were included showing significant lower prevalence of xerostomia, with unclear effect on salivary gland hypofunction. Three RCTs on preventive acupuncture showed reduced prevalence of xerostomia but not of salivary gland hypofunction. Two RCTs on muscarinic agonist stimulation with bethanechol suggested a preventive effect on saliva flow rate and xerostomia in patients undergoing head and neck radiation or radioactive iodine therapy. Two studies on submandibular gland transfer showed higher salivary flow rates compared to pilocarpine and lower prevalence of xerostomia compared to no active intervention. There is insufficient evidence on the effectiveness of vitamin E, amifostine, photobiomodulation, and miscellaneous preventive interventions.

Conclusion

This systematic review continues to support the potential of tissue-sparing tecniques and intensity-modulated radiation therapy (IMRT) to preserve salivary gland function in patients with head and neck cancer, with limited evidence on other preventive strategies, including acupuncture and bethanecol. Preventive focus should be on optimized and new approaches developed to further reduce radiation dose to the parotid, the submandibular, and minor salivary glands. As these glands are major contributors to moistening of the oral cavity, limiting the radiation dose to the salivary glands through various modalities has demonstrated reduction in prevalence and severity of salivary gland hypofunction and xerostomia. There remains no evidence on preventive approaches for checkpoint inhibitors and other biologicals due to the lack of RCTs.
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Metadata
Title
A systematic review of salivary gland hypofunction and/or xerostomia induced by non-surgical cancer therapies: prevention strategies
Authors
Valeria Mercadante
Derek K. Smith
Ragda Abdalla-Aslan
Ana Andabak-Rogulj
Michael T. Brennan
Graziella Chagas Jaguar
Haley Clark
Eduardo Fregnani
Luiz Alcino Gueiros
Allan Hovan
Seema Kurup
Alexa M. G. A. Laheij
Charlotte Duch Lynggaard
Joel J. Napeñas
Douglas E. Peterson
Sharon Elad
Stephanie Van Leeuwen
Arjan Vissink
Jonn Wu
Deborah P. Saunders
Siri Beier Jensen
Publication date
01-02-2025
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 2/2025
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-024-09113-x

ASH 2024 Annual Meeting Coverage

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Please note, this webinar is not intended for healthcare professionals based in the US and UK.

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Chaired by: Prof. Martin Dreyling
Developed by: Springer Healthcare
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