Supportive Care in Cancer

, Volume 18, Issue 8, pp 1061–1079 | Cite as

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact

  • S. B. Jensen
  • A. M. L. Pedersen
  • A. Vissink
  • E. Andersen
  • C. G. Brown
  • A. N. Davies
  • J. Dutilh
  • J. S. Fulton
  • L. Jankovic
  • N. N. F. Lopes
  • A. L. S. Mello
  • L. V. Muniz
  • C. A. Murdoch-Kinch
  • R. G. Nair
  • J. J. Napeñas
  • A. Nogueira-Rodrigues
  • D. Saunders
  • B. Stirling
  • I. von Bültzingslöwen
  • D. S. Weikel
  • L. S. Elting
  • F. K. L. Spijkervet
  • M. T. Brennan
  • Salivary Gland Hypofunction/Xerostomia Section
  • Oral Care Study Group
  • Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)
Review Article

Abstract

Purpose

This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations.

Methods

The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. For each article, two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results, and conclusions.

Results

Seventy-two interventional studies met the inclusion criteria. In addition, 49 intensity-modulated radiation therapy (IMRT) studies were included as a management strategy aiming for less salivary gland damage. Management guideline recommendations were drawn up for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer.

Conclusions

There is evidence that salivary gland hypofunction and xerostomia induced by cancer therapies can be prevented or symptoms be minimized to some degree, depending on the type of cancer treatment. Management guideline recommendations are provided for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. Fields of sparse literature identified included effects of gustatory and masticatory stimulation, specific oral mucosal lubricant formulas, submandibular gland transfer, acupuncture, hyperbaric oxygen treatment, management strategies in pediatric cancer populations, and the economic consequences of salivary gland hypofunction and xerostomia.

Keywords

Cancer therapy Salivary gland hypofunction Xerostomia Management strategies Economic impact 

References

  1. 1.
    Jensen SB, Pedersen AML, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NNF, Mello ALS, Muniz LV, Murdoch-Kinch CA, Nair RG, Napeñas JJ, Nogueira-Rodrigues A, Saunders D, Stirling B, von Bültzingslöwen I, Weikel DS, Elting LS, Spijkervet FKL, Brennan MT (2010) A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer doi:10.1007/s00520-010-0827-8
  2. 2.
    National Institutes of Health Consensus Development Conference Consensus Statement (1989) Oral complications of cancer therapies: diagnosis, prevention, and treatment. Natl Inst Health Consens Dev Conf Consens Statement 7:1–11Google Scholar
  3. 3.
    National Institutes of Health Consensus Development Conference. Oral complications of cancer therapies: diagnosis, prevention, and treatment. Bethesda, MD, USA, April 17–19,1989 (1990) NCI Monogr 9:1–184Google Scholar
  4. 4.
    Abok K, Brunk U, Jung B, Ericsson J (1984) Morphologic and histochemical studies on the differing radiosensitivity of ductular and acinar cells of the rat submandibular gland. Virchows Arch B Cell Pathol Incl Mol Pathol 45:443–460PubMedCrossRefGoogle Scholar
  5. 5.
    Norberg LE, Forsberg B (1987) Alpha-adrenergic stimulation and radiosensitivity on the rat submaxillary gland. ORL J Otorhinolaryngol Relat Spec 49:302–313PubMedGoogle Scholar
  6. 6.
    Norberg LE, Lundquist PG (1989) Aspects of salivary gland radiosensitivity: effects of sialagogues and irradiation. Arch Oto-Rhino-Laryngol 246:200–204CrossRefGoogle Scholar
  7. 7.
    Greenspan D, Daniels TE (1987) Effectiveness of pilocarpine in postradiation xerostomia. Cancer 59:1123–1125PubMedCrossRefGoogle Scholar
  8. 8.
    Wolff A, Atkinson JC, Macynski AA, Fox PC (1990) Oral complications of cancer therapies. Pretherapy interventions to modify salivary dysfunction. NCI Monogr 87–90Google Scholar
  9. 9.
    Utley JF, Marlowe C, Waddell WJ (1976) Distribution of 35S-labeled WR-2721 in normal and malignant tissues of the mouse1, 2. Radiat Res 68:284–291PubMedCrossRefGoogle Scholar
  10. 10.
    Sodicoff M, Conger AD, Trepper P, Pratt NE (1978) Short-term radioprotective effects of WR-2721 on the rat parotid glands. Radiat Res 75:317–326PubMedCrossRefGoogle Scholar
  11. 11.
    Sodicoff M, Conger AD, Pratt NE, Trepper P (1978) Radioprotection by WR-2721 against long-term chronic damage to the rat parotid gland. Radiat Res 76:172–179PubMedCrossRefGoogle Scholar
  12. 12.
    Takahashi I, Nagai T, Miyaishi K, Maehara Y, Niibe H (1986) Clinical study of the radioprotective effects of Amifostine (YM-08310, WR-2721) on chronic radiation injury. Int J Radiat Oncol Biol Phys 12:935–938PubMedGoogle Scholar
  13. 13.
    Matzker J, Schreiber J (1972) Synthetic saliva in the treatment of hyposialies, especially in radiation sialadenitis. Z Laryngol Rhinol Otol 51:422–428PubMedGoogle Scholar
  14. 14.
    Shannon IL, McCrary BR, Starcke EN (1977) A saliva substitute for use by xerostomic patients undergoing radiotherapy to the head and neck. Oral Surg Oral Med Oral Pathol 44:656–661PubMedCrossRefGoogle Scholar
  15. 15.
    ‘s Gravenmade EJ, Roukema PA, Panders AK (1974) The effect of mucin-containing artificial saliva on severe xerostomia. Int J Oral Surg 3:435–439PubMedCrossRefGoogle Scholar
  16. 16.
    Vissink A, ‘s Gravenmade EJ, Panders AK, Vermey A, Petersen JK, Visch LL, Schaub RM (1983) A clinical comparison between commercially available mucin- and CMC-containing saliva substitutes. Int J Oral Surg 12:232–238PubMedCrossRefGoogle Scholar
  17. 17.
    Visch LL, ‘s Gravenmade EJ, Schaub RM, Van Putten WL, Vissink A (1986) A double-blind crossover trial of CMC- and mucin-containing saliva substitutes. Int J Oral Maxillofac Surg 15:395–400PubMedCrossRefGoogle Scholar
  18. 18.
    Duxbury AJ, Thakker NS, Wastell DG (1989) A double-blind cross-over trial of a mucin-containing artificial saliva. Br Dent J 166:115–120PubMedCrossRefGoogle Scholar
  19. 19.
    Vissink A, Schaub RM, van Rijn LJ, ‘s Gravenmade EJ, Panders AK, Vermey A (1987) The efficacy of mucin-containing artificial saliva in alleviating symptoms of xerostomia. Gerodontology 6:95–101PubMedCrossRefGoogle Scholar
  20. 20.
    Vissink A, Waterman HA, ‘s Gravenmade EJ, Panders AK, Vermey A (1984) Rheological properties of saliva substitutes containing mucin, carboxymethylcellulose or polyethylenoxide. J Oral Pathol 13:22–28PubMedCrossRefGoogle Scholar
  21. 21.
    Vissink A, De Jong HP, Busscher HJ, Arends J, ‘s Gravenmade EJ (1986) Wetting properties of human saliva and saliva substitutes. J Dent Res 65:1121–1124PubMedGoogle Scholar
  22. 22.
    Brennan MT, Elting LS, Spijkervet FKL (2010) Systematic reviews of oral complications from cancer therapies, Oral Care Study Group, MASCC/ISOO: Methodology and quality of the literature. Support Care Cancer (in press)Google Scholar
  23. 23.
    Baccaglini L, Brennan MT, Lockhart PB, Patton LL (2007) World Workshop on Oral Medicine IV: process and methodology for systematic review and developing management recommendations. Reference manual for management recommendations writing committees. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(Suppl):S3–S19PubMedGoogle Scholar
  24. 24.
    Louis CU, Paulino AC, Gottschalk S, Bertuch AA, Chintagumpala M, Heslop HE, Russell HV (2007) A single institution experience with pediatric nasopharyngeal carcinoma: high incidence of toxicity associated with platinum-based chemotherapy plus IMRT. J Pediatr Hematol Oncol 29:500–505PubMedCrossRefGoogle Scholar
  25. 25.
    Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA, Low DA (2001) A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys 49:907–916PubMedGoogle Scholar
  26. 26.
    Chao KS, Majhail N, Huang CJ, Simpson JR, Perez CA, Haughey B, Spector G (2001) Intensity-modulated radiation therapy reduces late salivary toxicity without compromising tumor control in patients with oropharyngeal carcinoma: a comparison with conventional techniques. Radiother Oncol 61:275–280PubMedCrossRefGoogle Scholar
  27. 27.
    Eisbruch A, Kim HM, Terrell JE, Marsh LH, Dawson LA, Ship JA (2001) Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 50:695–704PubMedGoogle Scholar
  28. 28.
    Amosson CM, Teh BS, Van TJ, Uy N, Huang E, Mai WY, Frolov A, Woo SY, Chiu JK, Carpenter LS, Lu HH, Grant WH III, Butler EB (2003) Dosimetric predictors of xerostomia for head-and-neck cancer patients treated with the smart (simultaneous modulated accelerated radiation therapy) boost technique. Int J Radiat Oncol Biol Phys 56:136–144PubMedGoogle Scholar
  29. 29.
    Chao KS, Ozyigit G, Blanco AI, Thorstad WL, Deasy JO, Haughey BH, Spector GJ, Sessions DG (2004) Intensity-modulated radiation therapy for oropharyngeal carcinoma: impact of tumor volume. Int J Radiat Oncol Biol Phys 59:43–50PubMedGoogle Scholar
  30. 30.
    Lu TX, Mai WY, Teh BS, Zhao C, Han F, Huang Y, Deng XW, Lu LX, Huang SM, Zeng ZF, Lin CG, Lu HH, Chiu JK, Carpenter LS, Grant WH III, Woo SY, Cui NJ, Butler EB (2004) Initial experience using intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 58:682–687PubMedGoogle Scholar
  31. 31.
    Jabbari S, Kim HM, Feng M, Lin A, Tsien C, Elshaikh M, Terrel JE, Murdoch-Kinch C, Eisbruch A (2005) Matched case–control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer: initial report. Int J Radiat Oncol Biol Phys 63:725–731PubMedGoogle Scholar
  32. 32.
    Ng MK, Porceddu SV, Milner AD, Corry J, Hornby C, Hope G, Rischin D, Peters LJ (2005) Parotid-sparing radiotherapy: does it really reduce xerostomia? Clin Oncol (R Coll Radiol) 17:610–617Google Scholar
  33. 33.
    Nishimura Y, Nakamatsu K, Shibata T, Kanamori S, Koike R, Okumura M, Suzuki M (2005) Importance of the initial volume of parotid glands in xerostomia for patients with head and neck cancers treated with IMRT. Jpn J Clin Oncol 35:375–379PubMedCrossRefGoogle Scholar
  34. 34.
    Pacholke HD, Amdur RJ, Morris CG, Li JG, Dempsey JF, Hinerman RW, Mendenhall WM (2005) Late xerostomia after intensity-modulated radiation therapy versus conventional radiotherapy. Am J Clin Oncol 28:351–358PubMedCrossRefGoogle Scholar
  35. 35.
    Rosenbluth BD, Serrano V, Happersett L, Shaha AR, Tuttle RM, Narayana A, Wolden SL, Rosenzweig KE, Chong LM, Lee NY (2005) Intensity-modulated radiation therapy for the treatment of nonanaplastic thyroid cancer. Int J Radiat Oncol Biol Phys 63:1419–1426PubMedCrossRefGoogle Scholar
  36. 36.
    Hsiung CY, Ting HM, Huang HY, Lee CH, Huang EY, Hsu HC (2006) Parotid-sparing intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma: preserved parotid function after IMRT on quantitative salivary scintigraphy, and comparison with historical data after conventional radiotherapy. Int J Radiat Oncol Biol Phys 66:454–461PubMedGoogle Scholar
  37. 37.
    Lee NY, de Arruda FF, Puri DR, Wolden SL, Narayana A, Mechalakos J, Venkatraman ES, Kraus D, Shaha A, Shah JP, Pfister DG, Zelefsky MJ (2006) A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys 66:966–974PubMedGoogle Scholar
  38. 38.
    Meirovitz A, Murdoch-Kinch CA, Schipper M, Pan C, Eisbruch A (2006) Grading xerostomia by physicians or by patients after intensity-modulated radiotherapy of head-and-neck cancer. Int J Radiat Oncol Biol Phys 66:445–453PubMedGoogle Scholar
  39. 39.
    Nangia S, Chufal KS, Arivazhagan V, Srinivas P, Tyagi A, Ghosh D (2006) Compensator-based intensity-modulated radiotherapy in head and neck cancer: our experience in achieving dosimetric parameters and their clinical correlation. Clin Oncol (R Coll Radiol) 18:485–492Google Scholar
  40. 40.
    Pow EH, Kwong DL, McMillan AS, Wong MC, Sham JS, Leung LH, Leung WK (2006) Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys 66:981–991PubMedGoogle Scholar
  41. 41.
    Vosmik M, Odrazka K, Dolezel M, Vaculikova M, Kordac P, Zouhar M, Petera J, Jansa J, Zoul Z, Paluska P, Vokurka J (2006) IMRT with the use of simultaneous integrated boost in treatment of head and neck cancer: acute toxicity evaluation. Acta Medica (Hradec Kralove) 49:167–173Google Scholar
  42. 42.
    Wendt TG, Abbasi-Senger N, Salz H, Pinquart I, Koscielny S, Przetak SM, Wiezorek T (2006) 3D-conformal-intensity modulated radiotherapy with compensators for head and neck cancer: clinical results of normal tissue sparing. Radiat Oncol 1:18PubMedCrossRefGoogle Scholar
  43. 43.
    Wolden SL, Chen WC, Pfister DG, Kraus DH, Berry SL, Zelefsky MJ (2006) Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys 64:57–62PubMedGoogle Scholar
  44. 44.
    Daly ME, Lieskovsky Y, Pawlicki T, Yau J, Pinto H, Kaplan M, Fee WE, Koong A, Goffinet DR, Xing L, Le QT (2007) Evaluation of patterns of failure and subjective salivary function in patients treated with intensity modulated radiotherapy for head and neck squamous cell carcinoma. Head Neck 29:211–220PubMedCrossRefGoogle Scholar
  45. 45.
    Fang FM, Tsai WL, Chen HC, Hsu HC, Hsiung CY, Chien CY, Ko SF (2007) Intensity-modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma: comparisons of four radiotherapy techniques. Cancer 109:313–321PubMedCrossRefGoogle Scholar
  46. 46.
    Graff P, Lapeyre M, Desandes E, Ortholan C, Bensadoun RJ, Alfonsi M, Maingon P, Giraud P, Bourhis J, Marchesi V, Mege A, Peiffert D (2007) Impact of intensity-modulated radiotherapy on health-related quality of life for head and neck cancer patients: matched-pair comparison with conventional radiotherapy. Int J Radiat Oncol Biol Phys 67:1309–1317PubMedGoogle Scholar
  47. 47.
    Kam MK, Leung SF, Zee B, Chau RM, Suen JJ, Mo F, Lai M, Ho R, Cheung KY, Yu BK, Chiu SK, Choi PH, Teo PM, Kwan WH, Chan AT (2007) Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol 25:4873–4879PubMedCrossRefGoogle Scholar
  48. 48.
    Munter MW, Hoffner S, Hof H, Herfarth KK, Haberkorn U, Rudat V, Huber P, Debus J, Karger CP (2007) Changes in salivary gland function after radiotherapy of head and neck tumors measured by quantitative pertechnetate scintigraphy: comparison of intensity-modulated radiotherapy and conventional radiation therapy with and without amifostine. Int J Radiat Oncol Biol Phys 67:651–659PubMedGoogle Scholar
  49. 49.
    Rades D, Fehlauer F, Wroblesky J, Albers D, Schild SE, Schmidt R (2007) Prognostic factors in head-and-neck cancer patients treated with surgery followed by intensity-modulated radiotherapy (IMRT), 3D-conformal radiotherapy, or conventional radiotherapy. Oral Oncol 43:535–543PubMedCrossRefGoogle Scholar
  50. 50.
    Anand AK, Chaudhoory AR, Shukla A, Negi PS, Sinha SN, Babu AA, Munjal RK, Dewan AK, Kumar K, Doval DC, Vaid AK (2008) Favourable impact of intensity-modulated radiation therapy on chronic dysphagia in patients with head and neck cancer. Br J Radiol 81:865–871PubMedCrossRefGoogle Scholar
  51. 51.
    Huang K, Xia P, Chuang C, Weinberg V, Glastonbury CM, Eisele DW, Lee NY, Yom SS, Phillips TL, Quivey JM (2008) Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma: the University of California-San Francisco experience. Cancer 113:497–507PubMedCrossRefGoogle Scholar
  52. 52.
    Klem ML, Mechalakos JG, Wolden SL, Zelefsky MJ, Singh B, Kraus D, Shaha A, Shah J, Pfister DG, Lee NY (2008) Intensity-modulated radiotherapy for head and neck cancer of unknown primary: toxicity and preliminary efficacy. Int J Radiat Oncol Biol Phys 70:1100–1107PubMedGoogle Scholar
  53. 53.
    Madani I, Vakaet L, Bonte K, Boterberg T, De NW (2008) Intensity-modulated radiotherapy for cervical lymph node metastases from unknown primary cancer. Int J Radiat Oncol Biol Phys 71:1158–1166PubMedGoogle Scholar
  54. 54.
    Rusthoven KE, Raben D, Ballonoff A, Kane M, Song JI, Chen C (2008) Effect of radiation techniques in treatment of oropharynx cancer. Laryngoscope 118:635–639PubMedCrossRefGoogle Scholar
  55. 55.
    Seung S, Bae J, Solhjem M, Bader S, Gannett D, Hansen EK, Louie J, Underhill K, Cha C (2008) Intensity-modulated radiotherapy for head-and-neck cancer in the community setting. Int J Radiat Oncol Biol Phys 72:1075–1081PubMedGoogle Scholar
  56. 56.
    van Rij CM, Oughlane-Heemsbergen WD, Ackerstaff AH, Lamers EA, Balm AJ, Rasch CR (2008) Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life. Radiat Oncol 3:41PubMedCrossRefGoogle Scholar
  57. 57.
    Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA (1999) Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 45:577–587PubMedGoogle Scholar
  58. 58.
    Lin A, Kim HM, Terrell JE, Dawson LA, Ship JA, Eisbruch A (2003) Quality of life after parotid-sparing IMRT for head-and-neck cancer: a prospective longitudinal study. Int J Radiat Oncol Biol Phys 57:61–70PubMedGoogle Scholar
  59. 59.
    Blanco AI, Chao KS, El Naqa I, Franklin GE, Zakarian K, Vicic M, Deasy JO (2005) Dose-volume modeling of salivary function in patients with head-and-neck cancer receiving radiotherapy. Int J Radiat Oncol Biol Phys 62:1055–1069PubMedGoogle Scholar
  60. 60.
    Saarilahti K, Kouri M, Collan J, Hamalainen T, Atula T, Joensuu H, Tenhunen M (2005) Intensity modulated radiotherapy for head and neck cancer: evidence for preserved salivary gland function. Radiother Oncol 74:251–258PubMedCrossRefGoogle Scholar
  61. 61.
    de Arruda FF, Puri DR, Zhung J, Narayana A, Wolden S, Hunt M, Stambuk H, Pfister D, Kraus D, Shaha A, Shah J, Lee NY (2006) Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol Biol Phys 64:363–373PubMedGoogle Scholar
  62. 62.
    Liu WS, Lee SP, Lee JK, Su MC, Chen GD, Lee HS, Lee H (2006) Factors influencing the parotid function in nasopharyngeal carcinoma treated with parotid-sparing radiotherapy. Jpn J Clin Oncol 36:626–631PubMedCrossRefGoogle Scholar
  63. 63.
    Liu WS, Kuo HC, Lin JC, Su MC, Lee JK, Chou MJ, Chou MC, Lee H (2006) Assessment of salivary function change in nasopharyngeal carcinoma treated by parotid-sparing radiotherapy. Cancer J 12:494–500PubMedCrossRefGoogle Scholar
  64. 64.
    Li Y, Taylor JM, Ten Haken RK, Eisbruch A (2007) The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy. Int J Radiat Oncol Biol Phys 67:660–669PubMedGoogle Scholar
  65. 65.
    Sultanem K, Shu HK, Xia P, Akazawa C, Quivey JM, Verhey LJ, Fu KK (2000) Three-dimensional intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: the University of California-San Francisco experience. Int J Radiat Oncol Biol Phys 48:711–722PubMedGoogle Scholar
  66. 66.
    Kam MK, Teo PM, Chau RM, Cheung KY, Choi PH, Kwan WH, Leung SF, Zee B, Chan AT (2004) Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys 60:1440–1450PubMedGoogle Scholar
  67. 67.
    Munter MW, Karger CP, Hoffner SG, Hof H, Thilmann C, Rudat V, Nill S, Wannenmacher M, Debus J (2004) Evaluation of salivary gland function after treatment of head-and-neck tumors with intensity-modulated radiotherapy by quantitative pertechnetate scintigraphy. Int J Radiat Oncol Biol Phys 58:175–184PubMedCrossRefGoogle Scholar
  68. 68.
    Anand AK, Jain J, Negi PS, Chaudhoory AR, Sinha SN, Choudhury PS, Kumar R, Munjal RK (2006) Can dose reduction to one parotid gland prevent xerostomia?—A feasibility study for locally advanced head and neck cancer patients treated with intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol) 18:497–504Google Scholar
  69. 69.
    Lee NY, O’Meara W, Chan K, la-Bianca C, Mechalakos JG, Zhung J, Wolden SL, Narayana A, Kraus D, Shah JP, Pfister DG (2007) Concurrent chemotherapy and intensity-modulated radiotherapy for locoregionally advanced laryngeal and hypopharyngeal cancers. Int J Radiat Oncol Biol Phys 69:459–468PubMedGoogle Scholar
  70. 70.
    Roesink JM, Moerland MA, Battermann JJ, Hordijk GJ, Terhaard CH (2001) Quantitative dose-volume response analysis of changes in parotid gland function after radiotherapy in the head-and-neck region. Int J Radiat Oncol Biol Phys 51:938–946PubMedGoogle Scholar
  71. 71.
    Saarilahti K, Kouri M, Collan J, Kangasmaki A, Atula T, Joensuu H, Tenhunen M (2006) Sparing of the submandibular glands by intensity modulated radiotherapy in the treatment of head and neck cancer. Radiother Oncol 78:270–275PubMedCrossRefGoogle Scholar
  72. 72.
    Murdoch-Kinch CA, Kim HM, Vineberg KA, Ship JA, Eisbruch A (2008) Dose–effect relationships for the submandibular salivary glands and implications for their sparing by intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 72:373–382PubMedGoogle Scholar
  73. 73.
    Lin SC, Jen YM, Chang YC, Lin CC (2008) Assessment of xerostomia and its impact on quality of life in head and neck cancer patients undergoing radiotherapy, and validation of the Taiwanese version of the xerostomia questionnaire. J Pain Symptom Manage 36:141–148PubMedCrossRefGoogle Scholar
  74. 74.
    Brizel DM, Wasserman TH, Henke M, Strnad V, Rudat V, Monnier A, Eschwege F, Zhang J, Russell L, Oster W, Sauer R (2000) Phase III randomized trial of amifostine as a radioprotector in head and neck cancer. J Clin Oncol 18:3339–3345PubMedGoogle Scholar
  75. 75.
    Wasserman TH, Brizel DM, Henke M, Monnier A, Eschwege F, Sauer R, Strnad V (2005) Influence of intravenous amifostine on xerostomia, tumor control, and survival after radiotherapy for head-and-neck cancer: 2-year follow-up of a prospective, randomized, phase III trial. Int J Radiat Oncol Biol Phys 63:985–990PubMedGoogle Scholar
  76. 76.
    Hensley ML, Hagerty KL, Kewalramani T, Green DM, Meropol NJ, Wasserman TH, Cohen GI, Emami B, Gradishar WJ, Mitchell RB, Thigpen JT, Trotti A III, von Hoff D, Schuchter LM (2009) American Society of Clinical Oncology 2008 clinical practice guideline update: use of chemotherapy and radiation therapy protectants. J Clin Oncol 27:127–145PubMedCrossRefGoogle Scholar
  77. 77.
    Vacha P, Fehlauer F, Mahlmann B, Marx M, Hinke A, Sommer K, Richter E, Feyerabend T (2003) Randomized phase III trial of postoperative radiochemotherapy +/− amifostine in head and neck cancer. Is there evidence for radioprotection? Strahlenther Onkol 179:385–389PubMedGoogle Scholar
  78. 78.
    Antonadou D, Pepelassi M, Synodinou M, Puglisi M, Throuvalas N (2002) Prophylactic use of amifostine to prevent radiochemotherapy-induced mucositis and xerostomia in head-and-neck cancer. Int J Radiat Oncol Biol Phys 52:739–747PubMedCrossRefGoogle Scholar
  79. 79.
    Karacetin D, Yucel B, Leblebicioglu B, Aksakal O, Maral O, Incekara O (2004) A randomized trial of amifostine as radioprotector in the radiotherapy of head and neck cancer. J BUON 9:23–26PubMedGoogle Scholar
  80. 80.
    Buntzel J, Glatzel M, Mucke R, Micke O, Bruns F (2007) Influence of amifostine on late radiation-toxicity in head and neck cancer—a follow-up study. Anticancer Res 27:1953–1956PubMedGoogle Scholar
  81. 81.
    Kouloulias VE, Kouvaris JR, Kokakis JD, Kostakopoulos A, Mallas E, Metafa A, Vlahos LJ (2004) Impact on cytoprotective efficacy of intermediate interval between amifostine administration and radiotherapy: a retrospective analysis. Int J Radiat Oncol Biol Phys 59:1148–1156PubMedCrossRefGoogle Scholar
  82. 82.
    Buentzel J, Micke O, Adamietz IA, Monnier A, Glatzel M, de Vries A (2006) Intravenous amifostine during chemoradiotherapy for head-and-neck cancer: a randomized placebo-controlled phase III study. Int J Radiat Oncol Biol Phys 64:684–691PubMedGoogle Scholar
  83. 83.
    Bohuslavizki KH, Klutmann S, Brenner W, Kroger S, Buchert R, Bleckmann C, Mester J, Henze E, Clausen M (1999) Radioprotection of salivary glands by amifostine in high-dose radioiodine treatment. Results of a double-blinded, placebo-controlled study in patients with differentiated thyroid cancer. Strahlenther Onkol 175(Suppl 4):6–12PubMedGoogle Scholar
  84. 84.
    Rudat V, Meyer J, Momm F, Bendel M, Henke M, Strnad V, Grotz K, Schulte A (2000) Protective effect of amifostine on dental health after radiotherapy of the head and neck. Int J Radiat Oncol Biol Phys 48:1339–1343PubMedGoogle Scholar
  85. 85.
    Veerasarn V, Phromratanapongse P, Suntornpong N, Lorvidhaya V, Sukthomya V, Chitapanarux I, Tesavibul C, Swangsilpa T, Khorprasert C, Shotelersuk K, Kongthanarat Y, Panichevaluk A, Chiewvit S, Pusuwan P, Aekmahachai M, Ratchadara S, Sirilipoche S, Saengsuda Y (2006) Effect of amifostine to prevent radiotherapy-induced acute and late toxicity in head and neck cancer patients who had normal or mild impaired salivary gland function. J Med Assoc Thail 89:2056–2067Google Scholar
  86. 86.
    Rudat V, Munter M, Rades D, Grotz KA, Bajrovic A, Haberkorn U, Brenner W, Debus J (2008) The effect of amifostine or IMRT to preserve the parotid function after radiotherapy of the head and neck region measured by quantitative salivary gland scintigraphy. Radiother Oncol 89:71–80PubMedCrossRefGoogle Scholar
  87. 87.
    Ozsahin M, Betz M, Matzinger O, Bron L, Luthi F, Pasche P, Azria D, Mirimanoff RO, Zouhair A (2006) Feasibility and efficacy of subcutaneous amifostine therapy in patients with head and neck cancer treated with curative accelerated concomitant-boost radiation therapy. Arch Otolaryngol Head Neck Surg 132:141–145PubMedCrossRefGoogle Scholar
  88. 88.
    Law A, Kennedy T, Pellitteri P, Wood C, Christie D, Yumen O (2007) Efficacy and safety of subcutaneous amifostine in minimizing radiation-induced toxicities in patients receiving combined-modality treatment for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 69:1361–1368PubMedGoogle Scholar
  89. 89.
    Brizel DM, Overgaard J (2003) Does amifostine have a role in chemoradiation treatment? Lancet Oncol 4:378–381PubMedCrossRefGoogle Scholar
  90. 90.
    Fox PC, Atkinson JC, Macynski AA, Wolff A, Kung DS, Valdez IH, Jackson W, Delapenha RA, Shiroky J, Baum BJ (1991) Pilocarpine treatment of salivary gland hypofunction and dry mouth (xerostomia). Arch Intern Med 151:1149–1152PubMedCrossRefGoogle Scholar
  91. 91.
    Wiseman LR, Faulds D (1995) Oral pilocarpine: a review of its pharmacological properties and clinical potential in xerostomia. Drugs 49:143–155PubMedCrossRefGoogle Scholar
  92. 92.
    Johnson JT, Ferretti GA, Nethery WJ, Valdez IH, Fox PC, Ng D, Muscoplat CC, Gallagher SC (1993) Oral pilocarpine for post-irradiation xerostomia in patients with head and neck cancer. N Engl J Med 329:390–395PubMedCrossRefGoogle Scholar
  93. 93.
    LeVeque FG, Montgomery M, Potter D, Zimmer MB, Rieke JW, Steiger BW, Gallagher SC, Muscoplat CC (1993) A multicenter, randomized, double-blind, placebo-controlled, dose-titration study of oral pilocarpine for treatment of radiation-induced xerostomia in head and neck cancer patients. J Clin Oncol 11:1124–1131PubMedGoogle Scholar
  94. 94.
    Davies AN, Singer J (1994) A comparison of artificial saliva and pilocarpine in radiation-induced xerostomia. J Laryngol Otol 108:663–665PubMedCrossRefGoogle Scholar
  95. 95.
    Rieke JW, Hafermann MD, Johnson JT, LeVeque FG, Iwamoto R, Steiger BW, Muscoplat C, Gallagher SC (1995) Oral pilocarpine for radiation-induced xerostomia: integrated efficacy and safety results from two prospective randomized clinical trials. Int J Radiat Oncol Biol Phys 31:661–669PubMedGoogle Scholar
  96. 96.
    Hamlar DD, Schuller DE, Gahbauer RA, Buerki RA, Staubus AE, Hall J, Altman JS, Elzinga DJ, Martin MR (1996) Determination of the efficacy of topical oral pilocarpine for postirradiation xerostomia in patients with head and neck carcinoma. Laryngoscope 106:972–976PubMedCrossRefGoogle Scholar
  97. 97.
    Nyarady Z, Nemeth A, Ban A, Mukics A, Nyarady J, Ember I, Olasz L (2006) A randomized study to assess the effectiveness of orally administered pilocarpine during and after radiotherapy of head and neck cancer. Anticancer Res 26:1557–1562PubMedGoogle Scholar
  98. 98.
    Taweechaisupapong S, Pesee M, Aromdee C, Laopaiboon M, Khunkitti W (2006) Efficacy of pilocarpine lozenge for post-radiation xerostomia in patients with head and neck cancer. Aust Dent J 51:333–337PubMedCrossRefGoogle Scholar
  99. 99.
    Chitapanarux I, Kamnerdsupaphon P, Tharavichitkul E, Sumitsawan Y, Sittitrai P, Pattarasakulchai T, Lorvidhaya V, Sukthomya V, Pukanhaphan N, Traisatit P (2008) Effect of oral pilocarpine on post-irradiation xerostomia in head and neck cancer patients: a single-center, single-blind clinical trial. J Med Assoc Thail 91:1410–1415Google Scholar
  100. 100.
    Silberstein EB (2008) Reducing the incidence of 131I-induced sialadenitis: the role of pilocarpine. J Nucl Med 49:546–549PubMedCrossRefGoogle Scholar
  101. 101.
    Jacobs CD, van der Pas M (1996) A multicenter maintenance study of oral pilocarpine tablets for radiation-induced xerostomia. Oncology (Williston Park) 10:16–20Google Scholar
  102. 102.
    Singhal S, Powles R, Treleaven J, Rattenbury H, Mehta J (1997) Pilocarpine hydrochloride for symptomatic relief of xerostomia due to chronic graft-versus-host disease or total-body irradiation after bone-marrow transplantation for hematologic malignancies. Leuk Lymphoma 24:539–543PubMedCrossRefGoogle Scholar
  103. 103.
    Niedermeier W, Matthaeus C, Meyer C, Staar S, Muller RP, Schulze HJ (1998) Radiation-induced hyposalivation and its treatment with oral pilocarpine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:541–549PubMedCrossRefGoogle Scholar
  104. 104.
    Horiot JC, Lipinski F, Schraub S, Maulard-Durdux C, Bensadoun RJ, Ardiet JM, Bolla M, Coscas Y, Baillet F, Coche-Dequeant B, Urbajtel M, Montbarbon X, Bourdin S, Wibault M, Alfonsi M, Calais G, Desprez P, Pene F, Lapeyre M, Vinke J, Maral J (2000) Post-radiation severe xerostomia relieved by pilocarpine: a prospective French cooperative study. Radiother Oncol 55:233–239PubMedCrossRefGoogle Scholar
  105. 105.
    Ringash J, Warde P, Lockwood G, O’Sullivan B, Waldron J, Cummings B (2005) Postradiotherapy quality of life for head-and-neck cancer patients is independent of xerostomia. Int J Radiat Oncol Biol Phys 61:1403–1407PubMedGoogle Scholar
  106. 106.
    Aframian DJ, Helcer M, Livni D, Markitziu A (2006) Pilocarpine for the treatment of salivary glands’ impairment caused by radioiodine therapy for thyroid cancer. Oral Dis 12:297–300PubMedCrossRefGoogle Scholar
  107. 107.
    Aframian DJ, Helcer M, Livni D, Robinson SD, Markitziu A, Nadler C (2007) Pilocarpine treatment in a mixed cohort of xerostomic patients. Oral Dis 13:88–92PubMedCrossRefGoogle Scholar
  108. 108.
    Daniels TE, Wu AJ (2000) Xerostomia—clinical evaluation and treatment in general practice. J Calif Dent Assoc 28:933–941PubMedGoogle Scholar
  109. 109.
    Bernardi R, Perin C, Becker FL, Ramos GZ, Gheno GZ, Lopes LR, Pires M, Barros HM (2002) Effect of pilocarpine mouthwash on salivary flow. Braz J Med Biol Res 35:105–110PubMedCrossRefGoogle Scholar
  110. 110.
    Valdez IH, Wolff A, Atkinson JC, Macynski AA, Fox PC (1993) Use of pilocarpine during head and neck radiation therapy to reduce xerostomia and salivary dysfunction. Cancer 71:1848–1851PubMedCrossRefGoogle Scholar
  111. 111.
    Licht R, Kampinga HH, Coppes RP (2002) Salivary gland-sparing prophylactic pilocarpine treatment has no effect on tumor regrowth after irradiation. Radiat Res 157:596–598PubMedCrossRefGoogle Scholar
  112. 112.
    Lajtman Z, Krajina Z, Krpan D, Vincelj J, Borcic V, Popovic-Kovacic J (1999) Pilocarpine in the prevention of postirradiation xerostomia. Acta Med Croatica 54:65–67Google Scholar
  113. 113.
    Sangthawan D, Watthanaarpornchai S, Phungrassami T (2001) Randomized double blind, placebo-controlled study of pilocarpine administered during head and neck irradiation to reduce xerostomia. J Med Assoc Thail 84:195–203Google Scholar
  114. 114.
    Haddad P, Karimi M (2002) A randomized, double-blind, placebo-controlled trial of concomitant pilocarpine with head and neck irradiation for prevention of radiation-induced xerostomia. Radiother Oncol 64:29–32PubMedCrossRefGoogle Scholar
  115. 115.
    Warde P, O’Sullivan B, Aslanidis J, Kroll B, Lockwood G, Waldron J, Payne D, Bayley A, Ringash J, Kim J, Liu FF, Maxymiw W, Sprague S, Cummings BJ (2002) A phase III placebo-controlled trial of oral pilocarpine in patients undergoing radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 54:9–13PubMedGoogle Scholar
  116. 116.
    Fisher J, Scott C, Scarantino CW, LeVeque FG, White RL, Rotman M, Hodson DI, Meredith RF, Foote R, Bachman DG, Lee N (2003) Phase III quality-of-life study results: impact on patients’ quality of life to reducing xerostomia after radiotherapy for head-and-neck cancer-RTOG 97-09. Int J Radiat Oncol Biol Phys 56:832–836PubMedGoogle Scholar
  117. 117.
    Gornitsky M, Shenouda G, Sultanem K, Katz H, Hier M, Black M, Velly AM (2004) Double-blind randomized, placebo-controlled study of pilocarpine to salvage salivary gland function during radiotherapy of patients with head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:45–52PubMedCrossRefGoogle Scholar
  118. 118.
    Gorsky M, Epstein JB, Parry J, Epstein MS, Le ND, Silverman S Jr (2004) The efficacy of pilocarpine and bethanechol upon saliva production in cancer patients with hyposalivation following radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97:190–195PubMedCrossRefGoogle Scholar
  119. 119.
    Scarantino C, LeVeque F, Swann RS, White R, Schulsinger A, Hodson DI, Meredith R, Foote R, Brachman D, Lee N (2006) Effect of pilocarpine during radiation therapy: results of RTOG 97-09, a phase III randomized study in head and neck cancer patients. J Support Oncol 4:252–258PubMedGoogle Scholar
  120. 120.
    Burlage FR, Roesink JM, Kampinga HH, Coppes RP, Terhaard C, Langendijk JA, van LP S, MA VA (2008) Protection of salivary function by concomitant pilocarpine during radiotherapy: a double-blind, randomized, placebo-controlled study. Int J Radiat Oncol Biol Phys 70:14–22PubMedGoogle Scholar
  121. 121.
    Zimmerman RP, Mark RJ, Tran LM, Juillard GF (1997) Concomitant pilocarpine during head and neck irradiation is associated with decreased posttreatment xerostomia. Int J Radiat Oncol Biol Phys 37:571–575PubMedGoogle Scholar
  122. 122.
    Mateos JJ, Setoain X, Ferre J, Rovirosa A, Navalpotro B, Martin F, Ortega M, Lomena F, Fuster D, Pavia J, Pons F (2001) Salivary scintigraphy for assessing the protective effect of pilocarpine in head and neck irradiated tumours. Nucl Med Commun 22:651–656PubMedCrossRefGoogle Scholar
  123. 123.
    Chambers MS, Posner M, Jones CU, Biel MA, Hodge KM, Vitti R, Armstrong I, Yen C, Weber RS (2007) Cevimeline for the treatment of postirradiation xerostomia in patients with head and neck cancer. Int J Radiat Oncol Biol Phys 68:1102–1109PubMedGoogle Scholar
  124. 124.
    Chambers MS, Jones CU, Biel MA, Weber RS, Hodge KM, Chen Y, Holland JM, Ship JA, Vitti R, Armstrong I, Garden AS, Haddad R (2007) Open-label, long-term safety study of cevimeline in the treatment of postirradiation xerostomia. Int J Radiat Oncol Biol Phys 69:1369–1376PubMedGoogle Scholar
  125. 125.
    Jham BC, Teixeira IV, Aboud CG, Carvalho AL, Coelho MM, Freire AR (2007) A randomized phase III prospective trial of bethanechol to prevent radiotherapy-induced salivary gland damage in patients with head and neck cancer. Oral Oncol 43:137–142PubMedCrossRefGoogle Scholar
  126. 126.
    Senahayake F, Piggott K, Hamilton-Miller JM (1998) A pilot study of Salix SST (saliva-stimulating lozenges) in post-irradiation xerostomia. Curr Med Res Opin 14:155–159PubMedCrossRefGoogle Scholar
  127. 127.
    Jensdottir T, Nauntofte B, Buchwald C, Hansen HS, Bardow A (2006) Effects of sucking acidic candies on saliva in unilaterally irradiated pharyngeal cancer patients. Oral Oncol 42:317–322PubMedCrossRefGoogle Scholar
  128. 128.
    Duncan GG, Epstein JB, Tu D, El SS, Bezjak A, Ottaway J, Pater J (2005) Quality of life, mucositis, and xerostomia from radiotherapy for head and neck cancers: a report from the NCIC CTG HN2 randomized trial of an antimicrobial lozenge to prevent mucositis. Head Neck 27:421–428PubMedCrossRefGoogle Scholar
  129. 129.
    Nakada K, Ishibashi T, Takei T, Hirata K, Shinohara K, Katoh S, Zhao S, Tamaki N, Noguchi Y, Noguchi S (2005) Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer? J Nucl Med 46:261–266PubMedGoogle Scholar
  130. 130.
    Epstein JB, Emerton S, Le ND, Stevenson-Moore P (1999) A double-blind crossover trial of Oral Balance gel and Biotene toothpaste versus placebo in patients with xerostomia following radiation therapy. Oral Oncol 35:132–137PubMedCrossRefGoogle Scholar
  131. 131.
    Shahdad SA, Taylor C, Barclay SC, Steen IN, Preshaw PM (2005) A double-blind, crossover study of Biotene Oralbalance and BioXtra systems as salivary substitutes in patients with post-radiotherapy xerostomia. Eur J Cancer Care (Engl) 14:319–326CrossRefGoogle Scholar
  132. 132.
    Nagy K, Urban E, Fazekas O, Thurzo L, Nagy E (2007) Controlled study of lactoperoxidase gel on oral flora and saliva in irradiated patients with oral cancer. J Craniofac Surg 18:1157–1164PubMedCrossRefGoogle Scholar
  133. 133.
    Dirix P, Nuyts S, Vander Poorten V, Delaere P, Van den Bogaert W (2007) Efficacy of the BioXtra dry mouth care system in the treatment of radiotherapy-induced xerostomia. Support Care Cancer 15:1429–1436PubMedCrossRefGoogle Scholar
  134. 134.
    Epstein JB, Stevenson-Moore P (1992) A clinical comparative trial of saliva substitutes in radiation-induced salivary gland hypofunction. Spec Care Dentist 12:21–23PubMedCrossRefGoogle Scholar
  135. 135.
    Andersson G, Johansson G, Attstrom R, Edwardsson S, Glantz PO, Larsson K (1995) Comparison of the effect of the linseed extract Salinum and a methyl cellulose preparation on the symptoms of dry mouth. Gerodontology 12:12–17PubMedCrossRefGoogle Scholar
  136. 136.
    Momm F, Volegova-Neher NJ, Schulte-Monting J, Guttenberger R (2005) Different saliva substitutes for treatment of xerostomia following radiotherapy. A prospective crossover study. Strahlenther Onkol 181:231–236PubMedCrossRefGoogle Scholar
  137. 137.
    Johansson G, Andersson G, Attstrom R, Glantz PO, Larsson K (1994) The effect of Salinum on the symptoms of dry mouth: a pilot study. Gerodontology 11:46–49PubMedCrossRefGoogle Scholar
  138. 138.
    Momm F, Guttenberger R (2002) Treatment of xerostomia following radiotherapy: does age matter? Support Care Cancer 10:505–508PubMedCrossRefGoogle Scholar
  139. 139.
    Jellema AP, Langendijk H, Bergenhenegouwen L, van der Reijden W, Leemans R, Smeele L, Slotman BJ (2001) The efficacy of Xialine in patients with xerostomia resulting from radiotherapy for head and neck cancer: a pilot-study. Radiother Oncol 59:157–160PubMedCrossRefGoogle Scholar
  140. 140.
    Regelink G, Vissink A, Reintsema H, Nauta JM (1998) Efficacy of a synthetic polymer saliva substitute in reducing oral complaints of patients suffering from irradiation-induced xerostomia. Quintessence Int 29:383–388PubMedGoogle Scholar
  141. 141.
    Jha N, Seikaly H, Harris J, Williams D, Liu R, McGaw T, Hofmann H, Robinson D, Hanson J, Barnaby P (2003) Prevention of radiation induced xerostomia by surgical transfer of submandibular salivary gland into the submental space. Radiother Oncol 66:283–289PubMedCrossRefGoogle Scholar
  142. 142.
    Pathak KA, Bhalavat RL, Mistry RC, Deshpande MS, Bhalla V, Desai SB, Malpani BL (2004) Upfront submandibular salivary gland transfer in pharyngeal cancers. Oral Oncol 40:960–963PubMedCrossRefGoogle Scholar
  143. 143.
    Seikaly H, Jha N, Harris JR, Barnaby P, Liu R, Williams D, McGaw T, Rieger J, Wolfaardt J, Hanson J (2004) Long-term outcomes of submandibular gland transfer for prevention of postradiation xerostomia. Arch Otolaryngol Head Neck Surg 130:956–961PubMedCrossRefGoogle Scholar
  144. 144.
    Al-Qahtani K, Hier MP, Sultanum K, Black MJ (2006) The role of submandibular salivary gland transfer in preventing xerostomia in the chemoradiotherapy patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:753–756PubMedCrossRefGoogle Scholar
  145. 145.
    Jha N, Seikaly H, Harris J, Williams D, Sultanem K, Hier M, Ghosh S, Black M, Butler J, Sutherland D, Kerr P, Barnaby P (2009) Phase III randomized study: oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation-induced xerostomia. Head Neck 31:234–243PubMedCrossRefGoogle Scholar
  146. 146.
    Johnstone PA, Peng YP, May BC, Inouye WS, Niemtzow RC (2001) Acupuncture for pilocarpine-resistant xerostomia following radiotherapy for head and neck malignancies. Int J Radiat Oncol Biol Phys 50:353–357PubMedCrossRefGoogle Scholar
  147. 147.
    Blom M, Dawidson I, Fernberg JO, Johnson G, Angmar-Mansson B (1996) Acupuncture treatment of patients with radiation-induced xerostomia. Eur J Cancer B Oral Oncol 32B:182–190PubMedCrossRefGoogle Scholar
  148. 148.
    Blom M, Lundeberg T (2000) Long-term follow-up of patients treated with acupuncture for xerostomia and the influence of additional treatment. Oral Dis 6:15–24PubMedCrossRefGoogle Scholar
  149. 149.
    Cho JH, Chung WK, Kang W, Choi SM, Cho CK, Son CG (2008) Manual acupuncture improved quality of life in cancer patients with radiation-induced xerostomia. J Altern Complement Med 14:523–526PubMedCrossRefGoogle Scholar
  150. 150.
    Gerlach NL, Barkhuysen R, Kaanders JH, Janssens GO, Sterk W, Merkx MA (2008) The effect of hyperbaric oxygen therapy on quality of life in oral and oropharyngeal cancer patients treated with radiotherapy. Int J Oral Maxillofac Surg 37:255–259PubMedGoogle Scholar
  151. 151.
    Harding SA, Hodder SC, Courtney DJ, Bryson PJ (2008) Impact of perioperative hyperbaric oxygen therapy on the quality of life of maxillofacial patients who undergo surgery in irradiated fields. Int J Oral Maxillofac Surg 37:617–624PubMedCrossRefGoogle Scholar
  152. 152.
    Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ (2008) Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol 26:3770–3776PubMedCrossRefGoogle Scholar
  153. 153.
    Baum BJ, Zheng C, Cotrim AP, McCullagh L, Goldsmith CM, Brahim JS, Atkinson JC, Turner RJ, Liu S, Nikolov N, Illei GG (2009) Aquaporin-1 gene transfer to correct radiation-induced salivary hypofunction. Handb Exp Pharmacol 403–418Google Scholar
  154. 154.
    Coppes RP, van der Goot A, Lombaert IM (2009) Stem cell therapy to reduce radiation-induced normal tissue damage. Semin Radiat Oncol 19:112–121PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • S. B. Jensen
    • 1
  • A. M. L. Pedersen
    • 1
  • A. Vissink
    • 2
  • E. Andersen
    • 3
  • C. G. Brown
    • 4
  • A. N. Davies
    • 5
  • J. Dutilh
    • 6
  • J. S. Fulton
    • 7
  • L. Jankovic
    • 8
  • N. N. F. Lopes
    • 9
  • A. L. S. Mello
    • 10
  • L. V. Muniz
    • 11
  • C. A. Murdoch-Kinch
    • 12
  • R. G. Nair
    • 13
  • J. J. Napeñas
    • 14
  • A. Nogueira-Rodrigues
    • 15
  • D. Saunders
    • 16
  • B. Stirling
    • 14
  • I. von Bültzingslöwen
    • 17
  • D. S. Weikel
    • 18
  • L. S. Elting
    • 19
  • F. K. L. Spijkervet
    • 2
  • M. T. Brennan
    • 14
  • Salivary Gland Hypofunction/Xerostomia Section
  • Oral Care Study Group
  • Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO)
  1. 1.Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Institute of Odontology, Faculty of Health SciencesUniversity of CopenhagenCopenhagen NDenmark
  2. 2.Department of Oral & Maxillofacial SurgeryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  3. 3.Department of OncologyHerlev University HospitalHerlevDenmark
  4. 4.School of Nursing, College of Health SciencesUniversity of DelawareNewarkUSA
  5. 5.Department of Palliative MedicineRoyal Marsden HospitalSuttonUK
  6. 6.Dutilh Instituto de Reabilitação Facial e OralTaquaralBrazil
  7. 7.Department of Adult HealthIndiana University School of NursingIndianapolisUSA
  8. 8.Clinic for Periodontology and Oral Medicine, Faculty of StomatologyUniversity of BelgradeBelgradeSerbia
  9. 9.Pediatric Dentistry, Service of Oral MedicineIOP–Pediatric Oncology Institute/GRAACC, Federal University of São PauloSão PauloBrazil
  10. 10.Department of EndocrinologyFederal University of São Paulo, Medicine Paulista SchoolSão PauloBrazil
  11. 11.Department of Odontology, Associação do Combate ao Câncer do Centro Oeste de Minas GeraisInstituto de Pesquisas Oncológicas Minas Gerais, IPOM, Hospital do Câncer Centro Oeste de Minas GeraisMinas GeraisBrazil
  12. 12.Department of Oral and Maxillofacial Surgery/Hospital Dentistry, School of DentistryUniversity of MichiganAnn ArborUSA
  13. 13.Centre for Medicine and Oral HealthGriffith University, Gold Coast CampusGold CoastAustralia
  14. 14.Department of Oral MedicineCarolinas Medical CenterCharlotteUSA
  15. 15.Department of Oncology and Research, Associação do Combate ao Câncer do Centro Oeste de Minas GeraisInstituto de Pesquisas Oncológicas Minas Gerais, IPOM, Hospital do Câncer Centro Oeste de Minas GeraisMinas GeraisBrazil
  16. 16.Department of Dentistry, Sudbury Regional Hospital Cancer ProgramHôpital régional de Sudbury Regional HospitalSudburyCanada
  17. 17.Departments of Oral Immunology and Oral Medicine, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  18. 18.Department of Pathology and Diagnostic SciencesUniversity of Maryland Dental School and Greenebaum Cancer CenterBaltimoreUSA
  19. 19.Department of BiostatisticsThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

Personalised recommendations