Management of Radiation Induced Xerostomia in Head and Neck Cancers

Abstract

Head and neck squamous cell carcinoma is the most diverse class of malignancies lumped together under one diagnostic heading, occurring in several different sites and linked only by a common squamous histology. For cure in head and neck cancer dose of radiotherapy more than 60Gy are needed though the tolerance of normal organs e.g. salivary glands varies between 32Gy to 46Gy. Xerostomia is a major complication in patients who are receiving curative radiotherapy for head and neck cancer. Xerostomia is the main clinical effect that interferes with nutrition & use of dentures, deteriorates oral hygiene and predisposes patients to oral candidiasis and dental problems (e.g. dental caries). In the worst case, dry mouth can lead to osteoradionecrosis of the mandible. Treatment of radiation induced xerostomia calls for good hydration, optimal oral hygiene and prophylaxis of candidiasis. Therapeutic options are artificial saliva substitutes, mouth wetting agents and drugs like pilocarpine and amifostine. Modern radiotherapeutic techniques requiring meticulous planning may lead to prevention of radiation induced xerostomia, however once xerostomia establishes the satisfactory measures of control are limited.