Does lower dose pilocarpine have a role in radiation-induced xerostomia in the modern radiotherapy era? A single-center experience based on patient-reported outcome measures

TL;DR

This study explores whether lower doses of pilocarpine can help reduce dry mouth symptoms in head and neck cancer patients after radiotherapy.

Contribution

The study demonstrates that lower doses of pilocarpine can effectively alleviate late dry mouth symptoms in patients undergoing modern radiotherapy.

Findings

Lower doses of pilocarpine significantly reduced dry mouth symptoms as measured by PROMs.

Patients treated with intensity-modulated radiotherapy required shorter treatment durations and lower doses.

Significant improvements were observed in multiple dry mouth-related symptoms.

Abstract

This study aims to investigate the efficacy of lower dose pilocarpine in alleviating late dry mouth symptoms in head and neck cancer patients received radiotherapy.

Eighteen head and neck cancer patients experiencing persistent dry mouth were enrolled in this study. All participants started pilocarpine treatment a median of 6 months post-radiotherapy. Initially, patients received pilocarpine at 5 mg/day, with a gradual increase to the recommended dose of 15 mg/day. A Patient-Reported Outcome Measurement (PROMs) questionnaire assessed symptoms’ severity related to hyposalivation.

All patients reported symptomatic dry mouth above grade 2 before starting the medication. Pilocarpine treatment continued based on patients’ self-assessment, with a median duration of 12 months (range, 3–36 months). The median daily maintenance dose was 10 mg (range, 5 to 20 mg). Total PROMs scores significantly decreased following medication, from 13 points (range 7–18 points) to 7 points (range 4–13 points) (p = 0.001). Significant improvements were observed in questions related to dry mouth (p < 0.001), water intake during eating (p = 0.01), carrying water (p = 0.01), taste (p < 0.001), and water intake during speech (p < 0.001). Initial and maintenance doses of pilocarpine were lower, and the duration of pilocarpine usage was shorter in patients treated with intensity-modulated radiation therapy compared to conformal radiotherapy (12 months vs. 25 months, p = 0.04).

Pilocarpine may be considered at doses lower for late-term dry mouth. With modern radiotherapy techniques effectively preserving the parotid gland, short-term use may be recommended in these patients. Future studies may enhance the development of a more robust patient selection criteria model.