Efficacy of Pilocarpine and Bromhexine in Improving Radiotherapy-induced Xerostomia

Repair Index in Examination of Nuclear Changes in the Buccal Mucosa of Smokers: A Useful Method for Screening of Oral Cancer

Background: Smoking is one of the major risk factors for cancers, especially in the oral cavity. Nuclear changes occur in the early stages of cancer. The aim of this study was therefore to investigate nuclear changes and calculate a “repair index” for the buccal mucosa of smokers. Material and Methods: This historical cohort study was conducted by selecting samples including smokers and non-smokers. In addition, the smoker group were divided into 2 subgroups with a smoking history of >10 and ≤10 years. Buccal mucosa smears were obtained and Papanicolaou staining was employed to detect nuclear changes. Micronuclei, karyorrhexis and karyolysis were assessed and eventually a repair index was calculated. Statistical analysis was performed using the t-test. Results: In the 60 samples studied, differences were significant in smopkers vs. nonsmokers for micronuclei, (P=0.002) but not karyorrhexis or karyolysis. (P=0.789 and P=0.578, respectively). Also, the repair index demonstrated no statistically significant variation (P=0.107). Comparison of the two subgroups of smokers demonstrated that the frequency of micronuclei in those with a history >10 years was significantly higher and the RI was significantly lower than with ≤10 years (P=0.0001 and 0.04, respectively). While karyorrhexis and karyolysis were also higher in the longer exposure individuals the differences were not significant (P=0.07 and 0.78, respectively). Conclusion: Among the nuclear changes investigated, micronuclei proved the more reliable indicator to assess the adverse effects of smoking on the oral mucosa, becoming prominent with increase in smoking history. In addition, while a “repair index” may have benefits for assessment of nuclear damage caused by smoking, further research is necessary in this field.

Products based on olive oil, betaine, and xylitol in the post-radiotherapy xerostomia

AIM

The objective of this study was determining if the use of products based in olive oil, betaine and xylitol are efficacious to decrease the impact of the dry mouth in the quality of life of the patients with xerostomia due to radiotherapy treatment.

BACKGROUND

Following therapeutic irradiation of the head and neck, patients with profound xerostomia have complaints associated with oral dryness, speech, and taste. There is no strong evidence that any topical therapy is effective for relieving the symptom of dry mouth.

MATERIAL AND METHODS

40 patients who had been treated with radiotherapy for head and neck carcinoma and reported symptoms of dry mouth were included in the study. A xerostomia-related quality of life questionnaire, visual analogue scale questionnaire for subjective assessment of salivary dysfunction and salivary flow were reported before and 15 days after the use of topical products based on olive oil, betaina and xylitol.

RESULTS

The four primary quality of life areas demonstrated significantly greater improvement after the use of topical products and all eight VAS items had favourable changes. The reduction of symptoms was statistically significant in 7 of the 8 items. After the use of the products, there were improvements in salivary flow in 45%.

CONCLUSIONS

The use of products based on olive oil, betaine and xylitol, shaped like collutory, toothpaste, gel and spray significantly improved most symptoms and the quality of life limitations produced by dry mouth in patients treated with radiotherapy.

Parasympathomimetic drugs for the treatment of salivary gland dysfunction due to radiotherapy

BACKGROUND

This is an updated version of the original Cochrane review on parasympathomimetic drugs for the treatment of salivary gland dysfunction due to radiotherapy (published in Issue 3, 2007). Salivary gland dysfunction is a predictable side effect of radiotherapy to the head and neck region. Pilocarpine hydrochloride (a choline ester) is licensed in many countries for the treatment of radiation-induced salivary gland dysfunction. Other parasympathomimetics have also been used 'off licence' in the treatment of this condition.

OBJECTIVES

To determine the efficacy and tolerability of parasympathomimetic drugs in the treatment of radiation-induced salivary gland dysfunction (specifically radiation-induced xerostomia).

SEARCH METHODS

For this update, we ran searches of the Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 6), MEDLINE, EMBASE, and CINAHL in July 2015. We checked the reference lists of retrieved articles for additional studies, contacted experts in the field for unpublished and ongoing trials, and contacted relevant pharmaceutical companies for unpublished and ongoing trials.

SELECTION CRITERIA

The selection criteria for the review were: 1) randomised controlled trials; 2) people suffering from radiation-induced salivary gland dysfunction; 3) people treated with parasympathomimetic drugs; and 4) assessable data available on primary outcome measure.

DATA COLLECTION AND ANALYSIS

The two review authors independently collected data from the full-text version of relevant papers including: 1) citation details; 2) participants; 3) interventions; 4) assessments; 5) outcomes (that is efficacy, tolerability); and 6) quality issues.Due to a lack of appropriate data, we were unable to perform a meta-analysis.

MAIN RESULTS

In the original review, three studies, including a total of 298 participants, fulfilled the inclusion criteria. All three studies involved the use of pilocarpine hydrochloride. We have included no additional studies in the update of the review; we have excluded eight additional studies.The data suggest that pilocarpine hydrochloride is more effective than placebo and at least as effective as artificial saliva. The response rate was 42% to 51%. The time to response was up to 12 weeks. The overall side effect rate was high, and side effects were the main reason for withdrawal (6% to 15% of participants taking 5 mg three times a day had to withdraw). The side effects were usually the result of generalised parasympathomimetic stimulation (for example sweating, headaches, urinary frequency, vasodilatation). Response rates were not dose dependent, but side effect rates were dose dependent.

AUTHORS' CONCLUSIONS

There is limited evidence to support the use of pilocarpine hydrochloride in the treatment of radiation-induced xerostomia. Currently, there is little evidence to support the use of other parasympathomimetic drugs in the treatment of radiation-induced xerostomia. Available studies suggest that approximately half of patients will respond, but side effects can be problematic. The conclusions of the update are the same as the conclusions of the original review, since no new relevant studies have been published in the interim.