Does lower dose pilocarpine have a role in radiation-induced xerostomia in the modern radiotherapy era? A single-center experience based on patient-reported outcome measures.

Autor: Gül D; S.B.-Marmara University Pendik Education and Research Hospital Radiation Oncology Clinic, Istanbul, Turkey., Atasoy BM; Department of Radiation Oncology, School of Medicine, Marmara University, Istanbul, Turkey. bmatasoy@marmara.edu.tr.; Marmara Üniversitesi Pendik EAH Radyasyon Onkolojisi Kliniği, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No: 8, 34899, Istanbul, Turkey. bmatasoy@marmara.edu.tr., Ercan E; Department of Radiation Oncology, School of Medicine, Marmara University, Istanbul, Turkey., Başkan Z; Department of Radiation Oncology, School of Medicine, Marmara University, Istanbul, Turkey., Bektaş Kayhan K; Department of Oral and Maxillofacial Surgery, İstanbul University Faculty of Dentistry, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2024 Jul; Vol. 281 (7), pp. 3727-3733. Date of Electronic Publication: 2024 Apr 04.
DOI: 10.1007/s00405-024-08616-x
Abstrakt: Purpose: This study aims to investigate the efficacy of lower dose pilocarpine in alleviating late dry mouth symptoms in head and neck cancer patients received radiotherapy.
Methods: Eighteen head and neck cancer patients experiencing persistent dry mouth were enrolled in this study. All participants started pilocarpine treatment a median of 6 months post-radiotherapy. Initially, patients received pilocarpine at 5 mg/day, with a gradual increase to the recommended dose of 15 mg/day. A Patient-Reported Outcome Measurement (PROMs) questionnaire assessed symptoms' severity related to hyposalivation.
Results: All patients reported symptomatic dry mouth above grade 2 before starting the medication. Pilocarpine treatment continued based on patients' self-assessment, with a median duration of 12 months (range, 3-36 months). The median daily maintenance dose was 10 mg (range, 5 to 20 mg). Total PROMs scores significantly decreased following medication, from 13 points (range 7-18 points) to 7 points (range 4-13 points) (p = 0.001). Significant improvements were observed in questions related to dry mouth (p < 0.001), water intake during eating (p = 0.01), carrying water (p = 0.01), taste (p < 0.001), and water intake during speech (p < 0.001). Initial and maintenance doses of pilocarpine were lower, and the duration of pilocarpine usage was shorter in patients treated with intensity-modulated radiation therapy compared to conformal radiotherapy (12 months vs. 25 months, p = 0.04).
Conclusion: Pilocarpine may be considered at doses lower for late-term dry mouth. With modern radiotherapy techniques effectively preserving the parotid gland, short-term use may be recommended in these patients. Future studies may enhance the development of a more robust patient selection criteria model.
(© 2024. The Author(s).)
Databáze: MEDLINE
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