Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies
Publication Date: July 17, 2021
Last Updated: September 2, 2022
Prevention
Intensity-modulated radiation therapy (IMRT) should be used to spare major and minor salivary glands from a higher dose of radiation to reduce the risk of salivary gland hypofunction and xerostomia in patients with head and neck cancer. ( EB , H , S )
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Other radiation modalities that limit cumulative dose to and irradiated volume of major and minor salivary glands as or more effectively than IMRT may be offered in order to reduce salivary gland hypofunction and xerostomia. ( IC , L , S )
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Acupuncture may be offered during radiation therapy for head and neck cancer to reduce the risk of developing xerostomia. ( EB , I , M )
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Systemic administration of the sialagogue bethanechol may be offered during radiation therapy for head and neck cancer to reduce the risk of salivary gland hypofunction and xerostomia. ( EB , L , W )
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Vitamin E or other antioxidants should not be used to reduce the risk of radiation-induced salivary gland hypofunction and xerostomia due to the potential adverse impact on cancer-related outcomes and the lack of evidence of benefit. ( IC , L , W )
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Evidence remains insufficient for a recommendation for or against the use of submandibular gland transfer administered before head and neck cancer treatment to reduce the risk of salivary gland hypofunction and xerostomia due to insufficient evidence with contemporary radiation modalities. (, Ins , )
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Evidence remains insufficient for a recommendation for or against the use of the following interventions during radiation therapy for head and neck cancer: Oral pilocarpine, amifostine (with contemporary radiation modalities), or low-level laser therapy. (, Ins , )
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Evidence remains insufficient for a recommendation for or against the use of the following interventions to reduce the risk of salivary gland hypofunction or xerostomia in patients with head and neck cancer: n-acetylcysteine oral rinse, traditional Chinese medicine-based herbal mouthwash, local clonidine, concurrent chemotherapy with nedaplatin, boost radiation therapy, hyperfractionated or hypofractionated radiation therapy, intraarterial chemoradiation, minocycline, melatonin, nimotuzumab, zinc sulfate, propolis, viscosity-reducing mouth spray, transcutaneous electrical nerve stimulation (TENS), parotid gland massage, thyme honey, and human epidermal growth factor. (, Ins , )
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Management
Topical mucosal lubricants/saliva substitutes (agents directed at ameliorating xerostomia and other salivary gland hypofunction-related symptoms) may be offered to improve xerostomia induced by non-surgical cancer therapies. ( EB , I , S )
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Other radiation modalities that limit cumulative dose to and irradiated volume of major and minor salivary glands as or more effectively than IMRT may be offered in order to reduce salivary gland hypofunction and xerostomia. (Gustatory and masticatory salivary reflex stimulation by sugar-free lozenges, acidic (non-erosive and sugar-free special preparation if dentate patients) candies, or sugar-free, non-acidic chewing gum may be offered to produce transitory increased saliva flow rate and transitory relief from xerostomia by stimulating residual capacity of salivary gland tissue. ( EB , I , M )
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Oral pilocarpine, and cevimeline where available, may be offered post-radiation therapy in patients with head and neck cancer for transitory improvement of xerostomia and salivary gland hypofunction by stimulating residual capacity of salivary gland tissue. However, improvement of salivary gland hypofunction may be limited. ( EB , H , S )
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Acupuncture may be offered post-radiation therapy in head and neck cancer patients for improvement of xerostomia. ( EB , L , W )
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Transcutaneous electrostimulation or acupuncture-like transcutaneous electrostimulation of the salivary glands may be offered post-radiation therapy in head and neck cancer patients for improvement of salivary gland hypofunction and xerostomia. ( EB , L , W )
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Evidence remains insufficient for a recommendation for or against the use of the following interventions for improvement of salivary gland hypofunction and xerostomia: Extract of ginger and mesenchymal stem cell therapy. (, Ins , )
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Title
Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies
Authoring Organizations
American Society of Clinical Oncology
Multinational Association of Supportive Care in Cancer
Publication Month/Year
July 17, 2021
Last Updated Month/Year
July 14, 2023
Country of Publication
US
Document Objectives
To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies.
Target Patient Population
Adult patients with cancer who are scheduled to receive or who have received nonsurgical cancer therapy.
Target Provider Population
Oncologists and other physicians, dentists, dental specialists, dental hygienists, oncology nurses, clinical researchers, advanced practitioners, and patients with cancer
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient, Radiology services
Intended Users
Dentist, nurse, nurse practitioner, physician, physician assistant
Scope
Management, Prevention
Diseases/Conditions (MeSH)
D014987 - Xerostomia, D018987 - Salivary Ducts, D012469 - Salivary Glands
Keywords
head and neck cancer, Head and Neck Carcinomas, salivary gland malignancy, xerostomia, salivary gland
Source Citation
Mercadante V, Jensen SB, Smith DK, Bohlke K, Bauman J, Brennan MT, Coppes RP, Jessen N, Malhotra NK, Murphy B, Rosenthal DI, Vissink A, Wu J, Saunders DP, Peterson DE. Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline. J Clin Oncol. 2021 Sep 1;39(25):2825-2843. doi: 10.1200/JCO.21.01208. Epub 2021 Jul 20. PMID: 34283635.
Methodology
Number of Source Documents
158
Literature Search Start Date
January 1, 2009
Literature Search End Date
June 12, 2020