Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline

Valeria Mercadante; Siri Beier Jensen; Derek K. Smith; Kari Bohlke; Jessica Bauman; Michael T. Brennan; Robert P. Coppes; Niels Jessen; Narinder K. Malhotra; Barbara Murphy; David I. Rosenthal; Arjan Vissink; Jonn Wu; Deborah P. Saunders; Douglas E. Peterson

doi:10.1200/JCO.21.01208

Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline

Valeria Mercadante, Siri Beier Jensen, Derek K. Smith, Kari Bohlke, Jessica Bauman, Michael T. Brennan, Robert P. Coppes, Niels Jessen, Narinder K. Malhotra, Barbara Murphy, David I. Rosenthal, Arjan Vissink, Jonn Wu, Deborah P. Saunders, Douglas E. Peterson

Department of Dentistry and Oral Health - Institutledelsen, Odontologi og Oral Sundhed

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

68 Citations (Scopus)

Abstract

PURPOSE To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials published between January 2009 and June 2020. The guideline also incorporated two previous systematic reviews conducted by MASCC/ISOO, which included studies published from 1990 through 2008. RESULTS A total of 58 publications were identified: 46 addressed preventive interventions and 12 addressed therapeutic interventions. A majority of the evidence focused on the setting of radiation therapy for head and neck cancer. For the prevention of salivary gland hypofunction and/or xerostomia in patients with head and neck cancer, there is high-quality evidence for tissue-sparing radiation modalities. Evidence is weaker or insufficient for other interventions. For the management of salivary gland hypofunction and/or xerostomia, intermediate-quality evidence supports the use of topical mucosal lubricants, saliva substitutes, and agents that stimulate the salivary reflex. RECOMMENDATIONS For patients who receive radiation therapy for head and neck cancer, tissue-sparing radiation modalities should be used when possible to reduce the risk of salivary gland hypofunction and xerostomia. Other risk-reducing interventions that may be offered during radiation therapy for head and neck cancer include bethanechol and acupuncture. For patients who develop salivary gland hypofunction and/or xerostomia, interventions include topical mucosal lubricants, saliva substitutes, and sugar-free lozenges or chewing gum. For patients with head and neck cancer, oral pilocarpine and oral cevimeline, acupuncture, or transcutaneous electrostimulation may be offered after radiation therapy.

Original language	English
Journal	Journal of Clinical Oncology
Volume	39
Issue	25
Pages (from-to)	2825-2843
Number of pages	19
ISSN	0732-183X
DOIs	https://doi.org/10.1200/JCO.21.01208
Publication status	Published - Sept 2021

Keywords

3-DIMENSIONAL CONFORMAL RADIOTHERAPY
ADVANCED NASOPHARYNGEAL CARCINOMA
CHEMOTHERAPY-INDUCED MUCOSITIS
COMMUNICATION AMERICAN SOCIETY
INTENSITY-MODULATED RADIOTHERAPY
LOCALLY ADVANCED HEAD
LOW-LEVEL LASER
QUALITY-OF-LIFE
RADIATION-INDUCED XEROSTOMIA
SQUAMOUS-CELL CARCINOMA

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10.1200/JCO.21.01208

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Mercadante, V., Jensen, S. B., Smith, D. K., Bohlke, K., Bauman, J., Brennan, M. T., Coppes, R. P., Jessen, N., Malhotra, N. K., Murphy, B., Rosenthal, D. I., Vissink, A., Wu, J., Saunders, D. P., & Peterson, D. E. (2021). Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline. Journal of Clinical Oncology, 39(25), 2825-2843. https://doi.org/10.1200/JCO.21.01208

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title = "Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline",

abstract = "PURPOSE To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials published between January 2009 and June 2020. The guideline also incorporated two previous systematic reviews conducted by MASCC/ISOO, which included studies published from 1990 through 2008. RESULTS A total of 58 publications were identified: 46 addressed preventive interventions and 12 addressed therapeutic interventions. A majority of the evidence focused on the setting of radiation therapy for head and neck cancer. For the prevention of salivary gland hypofunction and/or xerostomia in patients with head and neck cancer, there is high-quality evidence for tissue-sparing radiation modalities. Evidence is weaker or insufficient for other interventions. For the management of salivary gland hypofunction and/or xerostomia, intermediate-quality evidence supports the use of topical mucosal lubricants, saliva substitutes, and agents that stimulate the salivary reflex. RECOMMENDATIONS For patients who receive radiation therapy for head and neck cancer, tissue-sparing radiation modalities should be used when possible to reduce the risk of salivary gland hypofunction and xerostomia. Other risk-reducing interventions that may be offered during radiation therapy for head and neck cancer include bethanechol and acupuncture. For patients who develop salivary gland hypofunction and/or xerostomia, interventions include topical mucosal lubricants, saliva substitutes, and sugar-free lozenges or chewing gum. For patients with head and neck cancer, oral pilocarpine and oral cevimeline, acupuncture, or transcutaneous electrostimulation may be offered after radiation therapy.",

keywords = "3-DIMENSIONAL CONFORMAL RADIOTHERAPY, ADVANCED NASOPHARYNGEAL CARCINOMA, CHEMOTHERAPY-INDUCED MUCOSITIS, COMMUNICATION AMERICAN SOCIETY, INTENSITY-MODULATED RADIOTHERAPY, LOCALLY ADVANCED HEAD, LOW-LEVEL LASER, QUALITY-OF-LIFE, RADIATION-INDUCED XEROSTOMIA, SQUAMOUS-CELL CARCINOMA",

author = "Valeria Mercadante and Jensen, {Siri Beier} and Smith, {Derek K.} and Kari Bohlke and Jessica Bauman and Brennan, {Michael T.} and Coppes, {Robert P.} and Niels Jessen and Malhotra, {Narinder K.} and Barbara Murphy and Rosenthal, {David I.} and Arjan Vissink and Jonn Wu and Saunders, {Deborah P.} and Peterson, {Douglas E.}",

year = "2021",

month = sep,

doi = "10.1200/JCO.21.01208",

language = "English",

volume = "39",

pages = "2825--2843",

journal = "Journal of Clinical Oncology",

issn = "0732-183X",

publisher = "Lippincott Williams and Wilkins",

number = "25",

}

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 2021, 'Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline', Journal of Clinical Oncology, vol. 39, no. 25, pp. 2825-2843. https://doi.org/10.1200/JCO.21.01208

Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline. / Mercadante, Valeria; Jensen, Siri Beier; Smith, Derek K. et al.
In: Journal of Clinical Oncology, Vol. 39, No. 25, 09.2021, p. 2825-2843.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies

T2 - ISOO/MASCC/ASCO Guideline

AU - Mercadante, Valeria

AU - Jensen, Siri Beier

AU - Smith, Derek K.

AU - Bohlke, Kari

AU - Bauman, Jessica

AU - Brennan, Michael T.

AU - Coppes, Robert P.

AU - Jessen, Niels

AU - Malhotra, Narinder K.

AU - Murphy, Barbara

AU - Rosenthal, David I.

AU - Vissink, Arjan

AU - Wu, Jonn

AU - Saunders, Deborah P.

AU - Peterson, Douglas E.

PY - 2021/9

Y1 - 2021/9

N2 - PURPOSE To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials published between January 2009 and June 2020. The guideline also incorporated two previous systematic reviews conducted by MASCC/ISOO, which included studies published from 1990 through 2008. RESULTS A total of 58 publications were identified: 46 addressed preventive interventions and 12 addressed therapeutic interventions. A majority of the evidence focused on the setting of radiation therapy for head and neck cancer. For the prevention of salivary gland hypofunction and/or xerostomia in patients with head and neck cancer, there is high-quality evidence for tissue-sparing radiation modalities. Evidence is weaker or insufficient for other interventions. For the management of salivary gland hypofunction and/or xerostomia, intermediate-quality evidence supports the use of topical mucosal lubricants, saliva substitutes, and agents that stimulate the salivary reflex. RECOMMENDATIONS For patients who receive radiation therapy for head and neck cancer, tissue-sparing radiation modalities should be used when possible to reduce the risk of salivary gland hypofunction and xerostomia. Other risk-reducing interventions that may be offered during radiation therapy for head and neck cancer include bethanechol and acupuncture. For patients who develop salivary gland hypofunction and/or xerostomia, interventions include topical mucosal lubricants, saliva substitutes, and sugar-free lozenges or chewing gum. For patients with head and neck cancer, oral pilocarpine and oral cevimeline, acupuncture, or transcutaneous electrostimulation may be offered after radiation therapy.

AB - PURPOSE To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials published between January 2009 and June 2020. The guideline also incorporated two previous systematic reviews conducted by MASCC/ISOO, which included studies published from 1990 through 2008. RESULTS A total of 58 publications were identified: 46 addressed preventive interventions and 12 addressed therapeutic interventions. A majority of the evidence focused on the setting of radiation therapy for head and neck cancer. For the prevention of salivary gland hypofunction and/or xerostomia in patients with head and neck cancer, there is high-quality evidence for tissue-sparing radiation modalities. Evidence is weaker or insufficient for other interventions. For the management of salivary gland hypofunction and/or xerostomia, intermediate-quality evidence supports the use of topical mucosal lubricants, saliva substitutes, and agents that stimulate the salivary reflex. RECOMMENDATIONS For patients who receive radiation therapy for head and neck cancer, tissue-sparing radiation modalities should be used when possible to reduce the risk of salivary gland hypofunction and xerostomia. Other risk-reducing interventions that may be offered during radiation therapy for head and neck cancer include bethanechol and acupuncture. For patients who develop salivary gland hypofunction and/or xerostomia, interventions include topical mucosal lubricants, saliva substitutes, and sugar-free lozenges or chewing gum. For patients with head and neck cancer, oral pilocarpine and oral cevimeline, acupuncture, or transcutaneous electrostimulation may be offered after radiation therapy.

KW - 3-DIMENSIONAL CONFORMAL RADIOTHERAPY

KW - ADVANCED NASOPHARYNGEAL CARCINOMA

KW - CHEMOTHERAPY-INDUCED MUCOSITIS

KW - COMMUNICATION AMERICAN SOCIETY

KW - INTENSITY-MODULATED RADIOTHERAPY

KW - LOCALLY ADVANCED HEAD

KW - LOW-LEVEL LASER

KW - QUALITY-OF-LIFE

KW - RADIATION-INDUCED XEROSTOMIA

KW - SQUAMOUS-CELL CARCINOMA

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DO - 10.1200/JCO.21.01208

M3 - Journal article

C2 - 34283635

AN - SCOPUS:85115440641

SN - 0732-183X

VL - 39

SP - 2825

EP - 2843

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

IS - 25

ER -

Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline

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