The effect of pilocarpine and biperiden on salivary secretion during and after radiotherapy in head and neck cancer patients

Purpose: The influence of parasympathicomimetic pilocarpine and anticholine rgic biperiden on salivation in patients irradiated for malignant tumors of the head and neck region was assessed in a prospectively designed clinical study. Methods and Materials: Sixty-nine patients, irradiated for head and neck ca ncer with salivary glands included in the irradiation fields, were randomly assigned into three groups (A, B, and C). Group A consisted of patients re ceiving pilocarpine, group B of those who were receiving biperiden during r adiotherapy and pilocarpine for 6 weeks after its completion, while group C comprised patients not receiving any xerostomy prevention therapy during o r after radiotherapy. The quantity of secreted unstimulated saliva was meas ured before the beginning of radiotherapy, after 30 Gy of irradiation, on c ompleted irradiation, and 3, 6, and 12 months after completion of radiother apy. Results: Saliva secretion has been found to be the least affected by i rradiation treatment in the group of patients receiving biperiden throughou t the course of radiotherapy. Six months after completed irradiation, the d ifferences in the quantity of secreted saliva between groups C and B as wel l as between groups A and B were statistically significant (P = 0.002 and 0 .05 respectively). In patients receiving pilocarpine during radiotherapy, a nd those in the control group, further decrease in saliva secretion was obs erved. One year after completed therapy, the quantity of secreted saliva co uld only be measured in the patients receiving biperiden during radiotherap y: it amounted to 16% of the average quantity of saliva secreted before the beginning of irradiation. Conclusion: It seems that the inhibition of saliva production during irradi ation treatment and the stimulation after completed radiotherapy may contri bute to the preservation of salivary gland function after therapy. (C) 1999 Elsevier Science Inc.