Guidelines for Complications of Cancer Treatment Vol VIII Part B

difference in the disease related parameters in both armssuggesting that amifostine selectively protects thesalivary glands and not the tumor cells. The doserecommended was 200 mg/m 2 of amifostine given dailyas a slow i.v. push over 3 minutes, 15-30 minutes beforeeach fraction of radiotherapy. A systematic review bySasse AD et al., suggests that amifostine significantlyreduces the side effects of radiation therapy. The efficacyof radiotherapy was itself not affected by the use of thisdrug and patients receiving amifostine were able toachieve higher rates of complete response.Though the US FDA has approved the use of Amifostine toprevent RT induced xerostomia, its use is suggested only in aprotocol setting till further robust evidence is available tosupport its routine use. This is because there remain concernsregarding the possible protection of tumor, the logistics ofdaily administration and the incidence of significant sideeffectswith its administration. The use of amifostine has alsobeen evaluated through the subcutaneous route to evaluate itsefficacy and obviate the problem of daily i.v. administration(Koukourakis MI).Salivary gland transfer techniques:Various salivary gland transfer techniques to transfer theuninvolved salivary gland into areas not within theradiation portals have been used. These are especiallyeffective for the submandibular salivary glands as theseare responsible for resting saliva production.Salivary gland sparing radiotherapy techniques:The incidence and severity of xerostomia is a directfunction of the radiotherapy doses, the volume irradiated,the dose per fraction and the type of radiation. Variousmeasures like the use of brachytherapy, use of customizedblocks in an attempt to protect adjacent critical structureshave been used over the years. The recent thrust however171