University College London and University College London Hospitals Trust, London, United Kingdom.
Aarhus University, Aarhus, Denmark.
J Clin Oncol. 2021 Sep 1;39(25):2825-2843. doi: 10.1200/JCO.21.01208. Epub 2021 Jul 20.
To provide evidence-based recommendations for prevention and management of salivary gland hypofunction and xerostomia induced by nonsurgical cancer therapies.
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.
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.
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.Additional information can be found at www.asco.org/supportive-care-guidelines.
为非手术癌症治疗引起的唾液腺功能低下和口干提供循证预防和管理建议。
多国支持治疗癌症协会/国际口腔肿瘤学会（MASCC/ISOO）和美国临床肿瘤学会（ASCO）召集了一个多学科专家小组，对证据进行评估并制定建议。检索了 2009 年 1 月至 2020 年 6 月期间发表的随机对照试验的 PubMed、EMBASE 和 Cochrane 图书馆。该指南还纳入了 MASCC/ISOO 之前进行的两项系统评价，其中包括 1990 年至 2008 年发表的研究。
共确定了 58 篇文献：46 篇涉及预防干预，12 篇涉及治疗干预。大部分证据集中在头颈部癌症的放射治疗方面。对于头颈部癌症患者唾液腺功能低下和/或口干的预防，有高质量证据表明可以采用保护组织的放射治疗方式。对于其他干预措施的证据较弱或不足。对于唾液腺功能低下和/或口干的治疗，有中等质量证据支持使用局部粘膜润滑剂、唾液替代品和刺激唾液反射的药物。
对于接受头颈部癌症放射治疗的患者，应尽可能使用保护组织的放射治疗方式，以降低唾液腺功能低下和口干的风险。头颈部癌症放射治疗期间可能提供的其他降低风险的干预措施包括氨甲酰胆碱和针灸。对于出现唾液腺功能低下和/或口干的患者，干预措施包括局部粘膜润滑剂、唾液替代品、无糖含片或咀嚼口香糖。对于头颈部癌症患者，可在放射治疗后提供口腔毛果芸香碱和口腔西维美林、针灸或经皮电刺激。更多信息可在 www.asco.org/supportive-care-guidelines 上找到。
