Top Line: Salivary dysfunction and mucositis have major impacts on life after head and neck cancer treatment.
The Studies: This randomized phase 2 trial sought to determine if maxillofacial and oral massage (MOM) could reduce mucositis in patients receiving definitive RT for nasopharyngeal carcinoma. Over 150 patients were randomized to routine oral care +/- MOM. MOM consisted of two parts: 1) external massage of the cheeks, upper jaw, lower jaw, and lips, and 2) mucosal massage of the tongue, palate, gingiva, and cheeks using a soft (i.e. silicone) finger toothbrush. The goal was ~1 minute massage for each subsite 3-5 times per day. Salivary gland and oral cavity dosimetry were similar between groups. While there was no difference in the rate of overall mucositis, MOM significantly reduced the rate of both grade 3 (46.8→ 26.3%) and grade 4 (15.2→ 3.9%) mucositis. MOM delayed the time to grade 3+ mucositis from a median of 19→ 28.5 days and also decreased median duration from 13→ 8 days. This resulted in a lower rate of pain, xerostomia, and dysphagia after treatment. While we’re at it, ASCO recently released guidelines for managing salivary dysfunction after cancer treatment. The best preventive measures include IMRT (strong rec), acupuncture during RT (intermediate rec), and medications such as bethanechol, vitamin E, or other antioxidants (all weak rec). When it comes to management of existing dysfunction, topical lubricants and saliva substitutes (strong), pilocarpine (strong), stimulatory lozenges (moderate) and acupuncture (weak) can be considered to replace or stimulate residual salivary gland capacity.
TBL: Simple patient massage of the face and oral cavity during radiation may help reduce the onset, severity, and duration of severe mucositis. | Yang, Radiother Oncol 2021 and Mercadante, J Clin Oncol 2021