A multicenter, randomized, double-blind, placebo-controlled, dose-titration study of oral pilocarpine for treatment of radiation-induced xerostomia in head and neck cancer patients.

LeVeque, Francis G.; Montgomery, Margaret A.; Potter, D; Zimmer, M B; Rieke, J.; Steiger, Barry W.; Gallagher, Susan C.; Muscoplat, Charles C

doi:10.1200/jco.1993.11.6.1124

Cited by 265 publications

(169 citation statements)

References 13 publications

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“…Xerostomia after external irradiation increases the caries rate (12,13) and, thus, saliva substitutes, sialogogues (18), water, sugarless sweets, or gum are used for secondary prevention (13). Our data indicate detrimental effects on dental health also by postradioiodine xerostomia and we observed increasing tooth extraction rates with increasing cumulative radioiodine activities.…”

Section: Discussionsupporting

confidence: 54%

The Dental Safety Profile of High-Dose Radioiodine Therapy for Thyroid Cancer: Long-Term Results of a Longitudinal Cohort Study

Walter¹,

Turtschi²,

Schindler³

et al. 2007

Journal of Nuclear Medicine

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The long-term dental safety profile of high-dose radioiodine therapy remained elusive despite more than 6 decades of clinical use. Methods: In a cohort study, we investigated the incidence of sialadenitis, xerostomia, caries, and tooth extractions after high-dose radioiodine therapy for differentiated thyroid cancer and explored risk factors by multiple regression models. Results: One hundred seventy-six participants were recruited (median follow-up, 6.6 y; range, 1.1-32.6 y; patient-years: 8,472 before and 1,421 after radioiodine therapy). Scintigraphic salivary gland uptake during radioiodine treatment predicted development of sialadenitis (odds ratio: 1.31 [1.05-1.63], P 5 0.015) and xerostomia (odds ratio: 1.58 [1.16-2.16], P 5 0.004). The caries risk increased by postradioiodine xerostomia (% increase: 98.8 [26.5-212], P 5 0.003). The long-term risk for postradioiodine tooth extractions increased with increasing cumulative radioiodine activities (% increase [per gigabequerel]: 8.14 [1.07, 15.7], P 5 0.02). Conclusion: High-dose radioiodine treatment can impair the long-term dental health, depending on the cumulative radioiodine activity and individual salivary gland radioiodine uptake.

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Section: Discussionsupporting

confidence: 54%

The Dental Safety Profile of High-Dose Radioiodine Therapy for Thyroid Cancer: Long-Term Results of a Longitudinal Cohort Study

Walter¹,

Turtschi²,

Schindler³

et al. 2007

Journal of Nuclear Medicine

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“…Salivary production was measured and symptoms were assessed by a visual analogue scale. In both studies, pilocarpine improved symptoms compared with a placebo, but in only one (LeVeque et al, 1993) was salivary production increased to a statistically significant degree, although the volume increase was small. It is possible that qualitative differences in saliva production rather than quantitative differences helped to improve symptoms, particularly production of more mucin, which is a more long-lasting lubricant and mucosal wetting agent.…”

Section: Pilocarpinementioning

confidence: 81%

“…Two placebo-controlled double-blind trials have shown the value of this alkaloid (Johnson et al, 1993;LeVeque et al, 1993). Both multicentre studies were similar in design and contained 207 and 162 patients respectively.…”

Section: Pilocarpinementioning

confidence: 99%

Treatment-induced mucositis: an old problem with new remedies

Symonds

1998

Br J Cancer

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Summary Mucositis may be a painful, debilitating, dose-limiting side-effect of both chemotherapy and radiotherapy for which there is no widely accepted prophylaxis or effective treatment. The basis of management is pain relief, prevention of dehydration and adequate nutrition. When tested vigorously, most antiseptic mouthwashes and anti-ulcer agents are ineffective. Simple mechanical cleansing by saline is the most effective traditional measure. A variety of new agents are effective. Granulocyte macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) act outwith the haemopoeitic system and can reduce mucositis, but the best schedule, dosage and method of administration is not known or which is the best growth factor to prevent this side-effect. A placebo-controlled randomized trial of antibiotic pastilles has shown a significant reduction in mucositis and weight loss during radiotherapy for head and neck cancer. Another method to reduce radiation effects in normal tissue is to stimulate cells to divide before radiotherapy by silver nitrate or interleukin 1. These methods may be particularly effective when given along with hyperfractionated radiation treatment such as CHART.

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“…Salivary substitutes containing methylcellulose or mucopolysaccharides may be indicated. 37,[57][58][59][60] Although they have not been evaluated in clinical trials, topical fluorides that are applied as (brushing) gels, rinses, and vacuum-formed vinyl splints loaded with fluoride gel are frequently used to prevent caries and mucositis in the course of radiotherapy because they induce fluoride incorporation into tooth enamel and dentin. They also reduce oral bacterial load.…”

mentioning

confidence: 99%

Oral Mucositis Complicating Chemotherapy and/or Radiotherapy: Options for Prevention and Treatment

Köstler

Hejna

Wenzel

et al. 2001

CA: A Cancer Journal for Clinicians

294

252

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The incidence and severity of oral mucositis is influenced by the type of antineoplastic treatment administered and by patient-related factors. Severe courses of oral mucositis are observed during simultaneous radiochemotherapy, which Oral Mucositis Complicating Chemotherapy and/or Radiotherapy: Options for Prevention and TreatmentWolfgang J. Köstler, MD; Michael Hejna, MD; Catharina Wenzel, MD; and Christoph C. Zielinski, MD 290 CA A Cancer Journal for Clinicians ABSTRACT Chemotherapy-and radiotherapy-induced oral mucositis represents a therapeutic challenge frequently encountered in cancer patients. This side effect causes significant morbidity and may delay the treatment plan, as well as increase therapeutic expenses.The pathogenesis of this debilitating side effect can be attributed to the direct mucosal toxicity of cytotoxic agents and ionizing radiation and to indirect mucosal damage caused by a concomitant inflammatory reaction exacerbated in the presence of neutropenia, and the emergence of bacterial, mycotic, and viral infections. affects virtually all patients with head and neck cancer who receive this therapeutic modality. 8 However, up to 40% of patients treated with conventional chemotherapy and the more than 70% of patients undergoing conditioning therapy for bone marrow transplantation also experience oral treatment-related complications. 9,10The pathogenesis of oral mucositis is not fully understood, yet it is thought to involve direct and indirect mechanisms. Direct mucosal injury by radiation and chemotherapy interfere with the average 5-to 14-day turnover time of the oral epithelium 11 and induce apoptosis. Indirect stomatotoxic effects that result from the release of inflammatory mediators, loss of protective salivary constituents, and therapyinduced neutropenia have been postulated to contribute to the development of oral mucositis and also promote the emergence of bacteria, fungi, and viruses on damaged mucosa.12 Although a linear relationship among the occurrence of oral mucositis, oral and systemic granulocyte counts, and a coincidence of resolution of mucositis with neutrophil recovery, has been demonstrated, 10,[13][14][15] significant mucositis can occur in the absence of myelotoxicity. 16,17 In addition, the prophylactic or therapeutic elimination of the pathogenic mucosal flora frequently observed in patients developing oral mucositis by various antiseptic and antimicrobial agents can at most alleviate the course of oral mucositis (see Antimicrobal Agents p. 302).Based upon these considerations, newer pathophysiologic concepts have emerged characterizing oral mucositis as having an initial inflammatory/vascular phase, an epithelial phase, a (pseudomembraneous) ulcerative/bacteriological phase and a healing phase.18 During the inflammatory phase, tissue injury induces release of free radicals, modified proteins and proinflammatory cytokines including interleukin-1β, prostaglandins and tumor necrosis factor-α (TNF-α) by epithelial, endothelial, and connective tissue cells. These ...

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A multicenter, randomized, double-blind, placebo-controlled, dose-titration study of oral pilocarpine for treatment of radiation-induced xerostomia in head and neck cancer patients.

Abstract: It is concluded that pilocarpine produces clinically significant benefits for the symptomatic treatment of postradiation xerostomia. Best results were obtained with continuous treatment for 8 to 12 weeks with doses greater than 2.5 mg three times per day.

Cited by 265 publications

References 13 publications

The Dental Safety Profile of High-Dose Radioiodine Therapy for Thyroid Cancer: Long-Term Results of a Longitudinal Cohort Study

The Dental Safety Profile of High-Dose Radioiodine Therapy for Thyroid Cancer: Long-Term Results of a Longitudinal Cohort Study

Treatment-induced mucositis: an old problem with new remedies

Oral Mucositis Complicating Chemotherapy and/or Radiotherapy: Options for Prevention and Treatment

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