Evidence map›Paper›PMID 39792256›Full record

SynthesisSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2025

A systematic review of salivary gland hypofunction and/or xerostomia induced by non-surgical cancer therapies: prevention strategies.

Valeria Mercadante, Derek K Smith, Ragda Abdalla-Aslan, Ana Andabak-Rogulj, Michael T Brennan, Graziella Chagas Jaguar, Haley Clark, Eduardo Rodrigues Fregnani, Luiz Alcino Gueiros, Allan Hovan and 11 more

Erratum issuedAbstract readSystematic Review
In one paragraph

Synthesis in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed.

  1. Pulmonary infections in an acute palliative care unit.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Observational
  2. Oral microbiota associated with radiation-related caries among nasopharyngeal carcinoma patients following radiation therapy: analysis based on a longitudinal study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Article
  3. Article
  4. Review
  5. Article
  6. Article
  7. Article
  8. Effects of Clarified Açaí Supplementation and Photobiomodulation on the Parotid Glands of Rats Submitted to Chemotherapy.Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology · 2026
    Article
  9. Review
  10. Article
  11. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors.

Valeria MercadanteEastman Dental Institute, University College London, London, England. v.mercadante@ucl.ac.uk.
Derek K SmithVanderbilt University, Nashville, TN, USA.
Ragda Abdalla-AslanBruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.ORCID http://orcid.org/0000-0002-0649-1512
Ana Andabak-RoguljDepartment of Oral Medicine, University of Zagreb School of Dental Medicine, Zagreb, Croatia.ORCID http://orcid.org/0000-0002-8369-1024
Michael T BrennanDepartment of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA.
Graziella Chagas JaguarStomatology Department - A.C. Camargo Cancer Center, Sao Paulo, Brazil.
Haley ClarkDepartment of Medical Physics, BC Cancer, Surrey, BC, Canada.ORCID http://orcid.org/0000-0003-4780-8093
Eduardo Rodrigues FregnaniCentro de Oncologia Molecular, Hospital Sírio-Libanês, São Paulo, Brazil.ORCID http://orcid.org/0000-0001-5196-7631
Luiz Alcino GueirosDepartamento de Clínica E Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil.ORCID http://orcid.org/0000-0003-4979-4318
Allan HovanOral Oncology/Dentistry, British Columbia Cancer Agency-Vancouver Centre, Vancouver, BC, Canada.
Seema KurupDepartment of Oral & Maxillofacial Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT, USA.
Alexa M G A LaheijDepartment of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands.ORCID http://orcid.org/0000-0003-1291-2798
Charlotte Duch LynggaardDepartment of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Joel J NapeñasDepartment of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA.
Douglas E PetersonSchool of Dental Medicine and Neag Comprehensive Cancer Center, UConn Health, Farmington, CT, USA.
Sharon EladEastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
Stephanie Van LeeuwenDepartment of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands.ORCID http://orcid.org/0000-0002-4522-3705
Arjan VissinkDepartment of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.ORCID http://orcid.org/0000-0003-2581-4361
Jonn WuBritish Columbia Cancer Agency, University of British Columbia, Vancouver, Canada.
Deborah P SaundersNorth East Cancer Center, Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada.
Siri Beier JensenDepartment of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark.ORCID http://orcid.org/0000-0003-3698-6337

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis systematic review aimed to assess the updated literature for the prevention of salivary gland hypofunction and xerostomia induced by non-surgical cancer therapies.

methodsElectronic databases of MEDLINE/PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCT) that investigated interventions to prevent salivary gland hypofunction and/or xerostomia. Literature search began from the 2010 systematic review publications from the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) up to February 2024. Two independent reviewers extracted information regarding study design, study population, cancer treatment modality, interventions, outcome measures, methods, results, risk of bias (RoB version 2), and conclusions for each article.

resultsA total of 51 publications addressing preventive interventions were included. Eight RCTs on tissue-sparing radiation modalities were included showing significant lower prevalence of xerostomia, with unclear effect on salivary gland hypofunction. Three RCTs on preventive acupuncture showed reduced prevalence of xerostomia but not of salivary gland hypofunction. Two RCTs on muscarinic agonist stimulation with bethanechol suggested a preventive effect on saliva flow rate and xerostomia in patients undergoing head and neck radiation or radioactive iodine therapy. Two studies on submandibular gland transfer showed higher salivary flow rates compared to pilocarpine and lower prevalence of xerostomia compared to no active intervention. There is insufficient evidence on the effectiveness of vitamin E, amifostine, photobiomodulation, and miscellaneous preventive interventions.

conclusionThis systematic review continues to support the potential of tissue-sparing tecniques and intensity-modulated radiation therapy (IMRT) to preserve salivary gland function in patients with head and neck cancer, with limited evidence on other preventive strategies, including acupuncture and bethanecol. Preventive focus should be on optimized and new approaches developed to further reduce radiation dose to the parotid, the submandibular, and minor salivary glands. As these glands are major contributors to moistening of the oral cavity, limiting the radiation dose to the salivary glands through various modalities has demonstrated reduction in prevalence and severity of salivary gland hypofunction and xerostomia. There remains no evidence on preventive approaches for checkpoint inhibitors and other biologicals due to the lack of RCTs.

Indexed as

XerostomiaAcupuncture TherapyHumansMuscarinic AgonistsNeoplasmsRandomized Controlled Trials as TopicSalivary Gland DiseasesSalivary GlandsMuscarinic AgonistsCheckpoint inhibitorsChemotherapyRadiotherapySalivary gland hypofunctionXerostomia

Identifiers

PMID39792256
PMCPMC11723892

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.