Systematic Review of Radiation-Induced Xerostomia
DOI:
https://doi.org/10.22317/jcms.v11i6.2052Keywords:
Xerostomia, Head and Neck Neoplasms, Radiotherapy, Intensity-Modulated, Amifostine, Acupuncture TherapyAbstract
Objective: To comprehensively evaluate and synthesize current evidence on the prevention and management of radiation-induced xerostomia (RIX) in patients with head and neck cancer (HNC).
Methods: The review included studies involving adult HNC patients undergoing radiotherapy and evaluated interventions such as advanced radiotherapy techniques, radioprotectants, sialogogues, surgical procedures, and complementary therapies. Primary outcomes were objective measures of salivary flow and patient-reported xerostomia. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) was performed.
Results: Twenty-four studies were included in the qualitative synthesis. The evidence indicates that intensity-modulated radiotherapy (IMRT) remains the cornerstone of RIX prophylaxis, considerably reducing its incidence. The radioprotectant amifostine was shown to reduce both acute and chronic xerostomia, though its use is limited by side effects. Sialogogues such as pilocarpine and cevimeline provided effective symptomatic relief for established RIX. Submandibular gland transfer (SGT) demonstrated a substantial and durable protective effect in select patients. Acupuncture showed benefits for both prevention and treatment of RIX, with an excellent safety profile.
Conclusion: The management of RIX requires a multimodal, patient-tailored approach. IMRT should serve as the standard prophylactic strategy. SGT provides the strongest protective benefit for appropriately selected surgical candidates, while sialogogues and acupuncture are effective options for symptomatic management. Future research should prioritize the standardization of outcome measures and the investigation of novel regenerative approaches.
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