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A systematic reviewof salivary glandhypofunction and/orxerostomia induced bynon-surgical cancertherapies: preventionstrategies Valeria MercadanteDerek K. SmithRagda Abdalla‐Aslan2025 год

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

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Аннотация: 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.
Год издания: 2025
Авторы: Valeria Mercadante, Derek K. Smith, Ragda Abdalla‐Aslan, Ana Andabak Rogulj, Michael T. Brennan, Graziella Chagas Jaguar, Haley Clark, Eduardo Rodrigues Fregnani, Luiz Alcino Gueiros, Allan Hovan, Seema Kurup, Alexa M. G. A. Laheij, Charlotte Duch Lynggaard, Joel J. Napeñas, Douglas E. Peterson, Elad Sharon, Stephanie J. M. van Leeuwen, Arjan Vissink, Jonn Wu, Deborah Saunders, Siri Beier Jensen
Издательство: Springer Science+Business Media
Источник: Supportive Care in Cancer
Ключевые слова: Head and Neck Cancer Studies, Oral health in cancer treatment, Salivary Gland Tumors Diagnosis and Treatment
Другие ссылки: Supportive Care in Cancer (HTML)
PubMed (HTML)