CONCOMITANT PILOCARPINE DURING HEAD AND NECK IRRADIATION IS ASSOCIATED WITH DECREASED POSTTREATMENT XEROSTOMIA

Purpose: To retrospectively compare subjective postirradiation xerosto mia scores of patients who received concomitant oral pilocarpine durin g radiotherapy for head and neck cancer and 3 months thereafter with t hose of similar cohorts who did not receive pilocarpine. Methods and M aterials: Subjective xerostomia was assessed using a visual analog sca le xerostomia questionnaire that measured oral dryness, oral comfort, difficulty with sleep, speech, and eating, The concomitant pilocarpine group had both parotid glands in the initial field treated to at leas t 45 Gy and received 5 mg pilocarpine hydrochloride four times per day (q.i.d.) beginning on the first day of radiotherapy and continuing fo r 3 months after completion of radiation, The control cohort had also received at least 45 Gy to both parotid glands and had not received pi locarpine at the time of evaluation. Scores on the visual analog scale were averaged and compared using the Student's t-test. Results: Seven teen patients who received concomitant pilocarpine during head and nec k irradiation and 18 patients who had not been treated with pilocarpin e were available for follow-up. The mean intervals between completion of radiation and evaluation of xerostomia were 17 months and 16 months , respectively. Only one of the pilocarpine-treated patients was still taking pilocarpine at the time of evaluation. For each of the individ ual components of xerostomia scored on the visual analog scale, as wel l as the composite of all components, the group that had received oral pilocarpine during radiation had significantly less xerostomia (p < 0 .01 for each). Conclusions: The use of 5 mg oral pilocarpine q.i.d. du ring radiotherapy for head and neck cancer and 3 months thereafter was associated with significantly less subjective xerostomia than that re ported by a similar cohort of patients who had not received pilocarpin e. The continued use of pilocarpine does not appear to be necessary to maintain this benefit in most patients. (C) 1997 Elsevier Science Inc .