Abstract
Radiotherapy remains the major course of treatment for Head and Neck cancer patients. A common consequence of radiation treatment is dysfunction of the salivary glands, which leads to a number of oral complications including xerostomia and dysphagia, for which there is no existent cure. Here, we briefly describe the current palliative treatments available for patients undergoing these conditions, such as oral lubricants, saliva substitutes, and saliva stimulants. None of these options achieves restoration of normal quality of life due to their limited effectiveness, and in some cases, adverse side effects of their own. Other therapies under development, such as acupuncture and electrostimulation have also yielded mixed results in clinical trials. Due to the ineffectiveness of palliative care to restore quality of life, it is reasonable to aim for the development of regenerative therapies that allow restoration of function of the salivary epithelium following radiation treatment. Adult stem cells are a necessary component of wound healing, and play important roles in preserving normal function of adult tissues. Thus, the present review mainly focuses on the effects of radiation on adult stem cells in a variety of tissues, which may be at play in the response of salivary glands to radiation treatment. This is of clinical importance because progenitor cells of the salivary glands have shown partial regenerative potential in mouse transplantation assays. Therefore, understanding how these progenitor cells are affected by radiation offers potential for development of new therapies for patients with xerostomia.
Highlights
The current standard treatment for head and neck cancer utilizes a multimodality approach, which includes surgery, in combination with radiotherapy and chemotherapy [1]
Palliative care exists to alleviate the symptoms of mouth dryness and difficulty swallowing, there are no definitive cures for xerostomia and dysphagia
Adult stem cells are a necessary component of wound healing [36,37,38,39] and it is of great importance to understand the effects radiation treatment has upon these cells, in tissues such as salivary glands, in which radiation-induced damage leads to a progressive and permanent loss of function, and regeneration does not naturally occur [20,40,41]
Summary
The current standard treatment for head and neck cancer utilizes a multimodality approach, which includes surgery, in combination with radiotherapy and chemotherapy [1]. Most common side effects of radiotherapy treatment for head and neck cancer is dysfunction of the salivary glands [2]. Hypofunction of the salivary glands results in xerostomia, a condition characterized by patient reported severe oral dryness [3,4]. Reduction in saliva production and oral dryness can have a devastating effect on oral health that potentially leads to malnutrition and poorer quality of life [2,6,7]. Patients often need a feeding tube as they present with varying degrees of dysphagia, which predisposes to life-threatening pulmonary conditions [9]. Palliative care exists to alleviate the symptoms of mouth dryness and difficulty swallowing, there are no definitive cures for xerostomia and dysphagia
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