Cytoprotection in head and neck cancer: issues in oral care

Efforts to enhance the therapeutic index in the treatment of head and neck cancer by improving efficacy and limiting toxicity involve both physical and cytoprotective approaches. Although intensity-modulated radiation therapy is moderately effective for reducing damage to the parotid glands and protecting the part of salivary activity produced by those glands, it has not proven effective for protecting the submandibular glands, which are responsible for the saliva that provides oral comfort. Cytoprotective agents, such as amifostine, and salivary gland stimulants, such as pilocarpine, are used to prevent or compensate for some of the xerostomia that follows radiotherapy or combined chemoradiotherapy for cancers of the head and neck.