# Assessment of combined efficacy of Drakshaguduchyadi gargling and Khadiradi Vati lozenges in curative-intent radiotherapy-induced xerostomia in head-and-neck cancer

## TL;DR

This study evaluates the effectiveness of two Ayurvedic treatments in managing dry mouth caused by radiotherapy in head-and-neck cancer patients.

## Contribution

The study introduces a novel combination of Ayurvedic interventions for managing radiation-induced xerostomia.

## Key findings

- Significant improvement in subjective symptoms like oral dryness and difficulty swallowing after 30 days of treatment.
- Objective measures such as salivary flow and pH also showed statistically significant improvement.
- The combination of Drakshaguduchyadi gargling and Khadiradi Vati lozenges is suggested as a treatment option for xerostomia.

## Abstract

Xerostomia is a common adverse effect of radiotherapy for head-and-neck cancers, leading to significant impairment of oral health and overall quality of life. Evidence-based guidelines for managing radiation-induced xerostomia remain limited, and the majority of available options provide only temporary symptomatic relief. In Ayurveda, this condition is described under mukharoga (oral diseases).

The objective of the study was to evaluate the combined effect of Drakshaguduchyadi Kavala (gargling) and Khadiradi Vati lozenges on symptoms of radiotherapy-induced xerostomia using subjective questionnaires, sialometry, and salivary pH measurements.

A total of 20 patients were enrolled with clinically diagnosed radiotherapy-induced xerostomia. Subjective outcomes were assessed using a xerostomia questionnaire and analyzed using the Wilcoxon signed-rank test. Objective outcomes, including unstimulated salivary flow, stimulated salivary flow, and salivary pH, were evaluated using sialometry and analyzed using the paired t-test. Patients received Khadiradi Vati lozenges followed by Drakshaguduchyadi Kavala (gargling) three times daily for 30 days.

After 30 days of intervention, significant improvement was observed in multiple subjective symptoms, including oral dryness, chewing and swallowing difficulty, choking sensation, sticky saliva, impaired enjoyment of food, and difficulty in speech. Objective parameters—unstimulated and stimulated sialometry values and salivary pH—also exhibited statistically significant improvement.

Drakshaguduchyadi Kavala (gargling) and Khadiradi Vati lozenges can be considered as a treatment option in radiotherapy-induced xerostomia.

Identifier CTRI/2019/12/022396.