What do systematic reviews say?

Amifostine vs no treatment/placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT to 12 months postRT
  Insufficient evidence of a difference in stimulated salivary flow at any time point: end of RT MD -0.09 (95% CI -1.48 to 1.30); 3 months MD 0.38 (95% CI -1.43 to 2.19); 12 months MD 0.82 (95% CI -0.47 to 2.11);…
  2 studies
  GRADE not reported

Antimicrobial lozenge vs placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  Over 6 months
  Insufficient evidence of a difference: dryness in mouth RR 1.18 (95% CI 0.97 to 1.42), diarrhoea RR 1.97 (95% CI 0.51 to 7.54), constipation RR 0.91 (95% CI 0.59 to 1.42) (Duncan 2005)
  1 study
  GRADE not reported

Antiseptic mouthrinse vs placebo

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No data on xerostomia were reported.
  0 studies
  No studies found

Pilocarpine vs no treatment/placebo

Pilocarpine led to higher speech difficulties (VAS 0-100 mm) compared with no treatment/placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT
  MD 20.20 [1.93, 38.47]
  1 study · 34 participants
  GRADE not reported

Amifostine vs no treatment/placebo

Amifostine led to higher salivary flow rate (incidence of > 0.1 g saliva/5 min, unstimulated) compared with no treatment/placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  12 months postRT
  RR 1.45 [1.13, 1.86]
  1 study · 175 participants
  GRADE not reported

Amifostine 200 mg/m2 three times weekly vs Amifostine 200 mg/m2 five times weekly

Amifostine 200 mg/m2 three times weekly showed no clear difference in vomiting (adverse effect) compared with amifostine 200 mg/m2 five times weekly; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RR 0.25 [0.06, 1.08]
  1 study · 60 participants
  GRADE not reported

Pilocarpine vs no treatment/placebo

Pilocarpine may leads to higher sweating (adverse effect) compared with no treatment/placebo (low certainty).

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RR 2.98 [1.43, 6.22]
  5 studies · 389 participants
  Low

Amifostine 200 mg/m2 three times weekly vs Amifostine 200 mg/m2 five times weekly

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT and 6, 12, 18, 24 months postRT
  No significant differences between the three treatment arms (Jellema 2006)
  1 study
  GRADE not reported

Venalot Depot (coumarin plus troxerutin) vs placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  Sialometric data dropped to an unmeasurable level in both groups; abandoned as a marker of efficacy (Grotz 2001)
  1 study
  GRADE not reported

Amifostine vs no treatment/placebo

Amifostine may leads to higher hypotension (adverse effect) compared with no treatment/placebo (low certainty).

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RR 9.20 [2.84, 29.83]
  3 studies · 376 participants
  Low

Biperiden plus pilocarpine vs no treatment

Biperiden plus pilocarpine showed no clear difference in dysphagia (WHO grade 3+) compared with no treatment; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  12 months postRT
  RR 0.25 [0.03, 2.11]
  1 study · 60 participants
  GRADE not reported

Amifostine vs no treatment/placebo

It is very uncertain whether amifostine changes quality of life (Patient Benefit Questionnaire, 10-point scale) compared with no treatment/placebo (very low certainty).

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  12 months postRT
  MD 0.70 [0.20, 1.20]
  1 study · 180 participants
  Very low

Biperiden plus pilocarpine vs no treatment

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT
  Insufficient evidence, from a single trial of 60 participants, to determine the effect on unstimulated salivary flow rate at the end of RT (Rode 1999; Analysis 2.1)
  1 study · 60 participants
  GRADE not reported

Bethanechol vs Artificial saliva

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No data on either quality of life or other oral related symptoms were reported.
  0 studies
  No studies found

Selenium vs no intervention

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No data on salivary flow rates were reported.
  0 studies
  No studies found

Biperiden plus pilocarpine vs no treatment

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No xerostomia data related to the effectiveness of biperiden and pilocarpine were reported (Rode 1999).
  0 studies
  No studies found

Antimicrobial lozenge vs placebo

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No data on salivary flow rates were reported.
  0 studies
  No studies found

Surgery vs Radiotherapy alone

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: grade 2+ treatment-related events similar (31/34 radiotherapy vs 33/34 surgery; RR 0.94, 0.83 to 1.06); more hearing loss/neutropenia/constipation/tinnitus with radiotherapy, more oral bleeding/trismus…
  1 study · 68 participants
  Very low

Surgery vs Radiotherapy alone

Surgery showed no clear difference in total mortality compared with radiotherapy alone (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 0.83 [0.09, 7.46]
  1 study · 68 participants
  Low

Surgery vs Radiotherapy alone

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Locoregional recurrence: not reported.
  0 studies
  No studies found