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. (Strong recommendation; EB-H)
➤ 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. (Strong recommendation; IC-L)
➤ Acupuncture may be offered during radiation therapy for head and
neck cancer to reduce the risk of developing xerostomia. (Moderate
recommendation; EB-I)
➤ 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. (Weak recommendation; EB-L)
➤ 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. (Weak recommendation; IC-L)
➤ 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. (N-Ins)
➤ 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. (N-Ins)
➤ 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. (N-Ins)
