Xerostomia induced by radiotherapy: an overview of the physiopathology, clinical evidence, and management of the oral damage

Abstract

BackgroundThe irradiation of head and neck cancer (HNC) often causes damage to the salivary glands. The resulting salivary gland hypofunction and xerostomia seriously reduce the patient’s quality of life.PurposeTo analyze the literature of actual management strategies for radiation-induced hypofunction and xerostomia in HNC patients.MethodsMEDLINE/PubMed and the Cochrane Library databases were electronically evaluated for articles published from January 1, 1970, to June 30, 2013. Two reviewers independently screened and included papers according to the predefined selection criteria.ResultsSixty-one articles met the inclusion criteria. The systematic review of the literature suggests that the most suitable methods for managing the clinical and pathophysiological consequences of HNC radiotherapy might be the pharmacological approach, for example, through the use of cholinergic agonists when residual secretory capacity is still present, and the use of salivary substitutes. In addition, a modified diet and the patient’s motivation to enhance oral hygiene can lead to a significant improvement.ConclusionRadiation-induced xerostomia could be considered a multifactorial disease. It could depend on the type of cancer treatment and the cumulative radiation dose to the gland tissue. A preventive approach and the correct treatment of the particular radiotherapeutic patient can help to improve the condition of xerostomia.

Assessment of xerostomia and its impact on quality of life in head and neck cancer patients undergoing radiation therapy

“…Patients complaining of xerostomia do not always suffer from hyposalivation (13), while qualitative changes in saliva may well affect the feeling of xerostomia, despite adequate saliva production (14). Moreover, methodological issues, such as sample selection bias, may affect the conclusions.…”

“…In that context, our results are likely more representative of the patients' daily symptoms, best reflecting their basic saliva production. Examining mean cohort levels of xerostomia may also be misleading, as patients who have a flow ratio below the critical cut-off (<25%) appeared to complain the most of a dry mouth (14,15). In the present study, hyposalivation was not prominent (minimum baseline salivary flow rate >0.1 ml/min following RT) and, due to the exclusion criteria, patients with severe comorbidities or metastatic disease were excluded, whereas no deaths were reported during the follow-up period.…”

Avaliação Da Xerostomia Em Pacientes Com Câncer De Cabeça E Pescoço Submetidos Ao Tratamento Radioterápico

“…Durante a radioterapia muitos pacientes com câncer de cabeça e pescoço experimentam algum grau de toxicidade de acordo com a área irradiada, tipo de radiação ionizante, fração e dose terapêutica entregue, e fatores como idade, uso de medicações, quimioterapia concomitante, doenças sistêmicas podem acentuá-las (PINNA et al, 2015). As glândulas salivares são caracterizadas como órgãos de risco durante o tratamento radioterápico devido a sua radiossensibilidade.…”

“…Esta toxicidade pode ser temporária ou irreversível se houver acúmulo de dose de 26-39 Gy (PINNA et al, 2015). Adicionalmente, a redução do fluxo salivar tende a disparar desordens como halitose, disgeusia, odinofagia, mucosite, alterações dentárias, dislalia, anorexia, perda de peso, e assim, afetar a qualidade de vida do paciente (DENG et al, 2015).…”

Xerostomia: reasons and methods of correction

“…В онкологии ранее не уделялось пристальное внимание проблеме ксеростомии, однако в последнее время подход кардинально изменился [23]. Синдром сухого рта выявляет-ся с высокой частотой у пациентов с опухолями головы и шеи, после проведения радиотерапии, химиотерапии и лучевой терапии [24][25][26][27].…”