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ISSUE 1 FEBRUARY
Letters to the Editor

Xerostomia

  • Professor Ian Olver, JF Walsh

The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

 

Letter to the Editor

Editor, – I found the article on xerostomia (Aust Prescr 2006;29:97-8) to be both timely and informative. As a dentist I have experience in the UK, South Africa and the USA helping patients deal with the problems they experience post-radiotherapy for head and neck cancers.

When I attempt to discuss these issues with my Australian medical colleagues, they commonly reply that no patients experience any problems. This is in contrast to my own records which agree with the figure that 90% of patients suffer problems after radiotherapy.

There are as Professor Olver suggested a number of options being investigated to treat xerostomia. Amifostine is of benefit, but there are problems with the high incidence of nausea associated with its use (50%). The use of antioxidants is currently being investigated by the National Cancer Institute in the USA. Two forms of nitroxide are currently being examined. These are not approved by the US Food and Drug Administration for clinical use, other than for topical use to prevent hair loss and for a number of ophthalmic conditions.

I have had some success in prevention of xerostomia by employing intra-oral screens and other available antioxidants which are currently approved as dietary supplements. This is of course anecdotal and not scientifically proven but better to accept that a problem exists than to be in denial.

JF Walsh
Kojonup, WA

 

Author's comments

Professor Ian Olver, author of the article, comments:

I am pleased that Dr Walsh highlights the importance of recognising the symptomatic distress caused by xerostomia. The symptoms are difficult to manage so prevention is clearly important to investigate. Amifostine as a radioprotector has not been widely used because of its other adverse effects. Nitroxide, an antioxidant and chemoprotective drug acting partly via the p53 suppressor, is a radioprotector which has been shown to reduce radiation-induced xerostomia in mice when used topically in the mouth.1It is an excellent candidate for further trials in patients receiving radiotherapy, where it will be important to ascertain that the tumour is not also protected from the radiation. Anecdotal accounts of the efficacy of other drugs are useful in stimulating further clinical research in this field.

 

References

  1. Cotrim AP, Sowers AL, Lodde BM, Vitolo JM, Kingman A, Russo A, et al. Kinetics of tempol for prevention of xerostomia following head and neck irradiation in a mouse model. Clin Cancer Res 2005;11:7564-8.

Professor Ian Olver

JF Walsh

Kojonup, WA