Radiation therapy for benign lymphoepithelial cysts of parotid glands in HIV patients

World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia

OBJECTIVE

The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth.

STUDY DESIGN

A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized.

RESULTS

From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains.

CONCLUSION

There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.

Nonsurgical management of human immunodeficiency virus-associated parotid cysts: A systematic review and meta-analysis

BACKGROUND

The purpose of this clinical review was to analyze the effectiveness of nonsurgical management options for human immunodeficiency virus (HIV)-associated parotid cysts.

METHODS

We conducted systematic and meta-analysis reviews. Primary outcomes were complete or partial responses.

RESULTS

Systematic review identified 12 relevant studies. The average rates of complete response for antiretroviral therapy (ART), sclerotherapy, and fine-needle aspiration (FNA) were 52.8%, 55.5%, and 33.3%, respectively. Three radiotherapy studies, totaling 104 patients, were included in a meta-analysis. Patients receiving high-dose therapy achieved complete and partial response rates of 65.8% (95% confidence interval [CI] 54.3%-76.2%) and 25.2% (95% CI 16.1%-36.3%), respectively. Patients receiving low-dose therapy achieved complete and partial response rates of 23.2% (95% CI 1.2%-60.9%) and 22.3% (95% CI 5.2%-87.8%), respectively. The rate of complete response was significantly greater for high-dose radiotherapy compared to low-dose (P < .001).

CONCLUSION

Among nonsurgical treatment modalities for HIV-associated parotid cysts, radiotherapy has the highest number of reported outcomes in the literature and our analysis suggests that higher dose radiotherapy has higher rates of achieving complete response.

Management algorithm for HIV-associated parotid lymphoepithelial cysts

We report an evidence-based management algorithm for benign lymphoepithelial cysts (BLEC) of the parotid glands in HIV patients based on long-term outcomes after radiation therapy. From 1987 to 2013, 72 HIV-positive patients with BLEC of the parotid glands treated at our institutions were identified and their medical records were reviewed and analyzed. The primary endpoint of our study was to determine a dose response in HIV patients with BLEC. In group A (≤18 Gy), which received a median dose of 10 Gy (8-18), overall response (OvR), complete response (CR), partial response (PR), and local failure (LF) was experienced by 7, 7, 0, and 93 %, respectively. In group B (≥22.5 Gy), which received a median dose of 24 Gy (22.5-30), OvR, CR, PR, and LF was experienced by 88, 65, 23, and 12 %. Logistic regression revealed that higher dose (≥22.5 Gy) predicted for cosmetic control (p = 0.0003). Multiple regression analysis revealed higher dose predicted for cosmetic control (p = 0.0001) after adjusting for confounding variables (age, gender, race, HAART use, BLEC duration, and fractionation size). No patients in either group experienced RTOG grade ≥3 toxicities. A radiation dose of 24 Gy delivered in 12-16 fractions of 1.5-2 Gy per fraction provides long-term cosmetic control in HIV-positive patients with BLEC of the parotid glands.

Salivary gland disorders

Patients with salivary gland disease present with certain objective and/or subjective signs. An accurate diagnosis for these patients requires a range of techniques that includes the organized integration of information derived from their history, clinical examination, imaging, serology, and histopathology. This article highlights the signs and symptoms of the salivary gland disorders seen in the Salivary Gland Center, and emphasizes the methodology used to achieve a definitive diagnosis and therapy.

DC-CIK biotherapy for a recurrent benign lymphoepithelial lesion of the salivary gland: A case report and literature review

A benign lymphoepithelial lesion (BLEL) is an idiopathic inflammation of the parotid gland, characterized by hyperplasia, lymphocyte infiltration and the formation of epimyoepithelial islands, as well as atrophy of the gland parenchyma. Common treatment methods include immunosuppression and glucocorticoid therapies, in addition to surgical dissections. Cytokine-induced killer (CIK) cells sensitized to specific antigens by dendritic cells (DCs) are used in DC-CIK biotherapy. The present study reports the case of a 22-year-old female suffering from a postoperative recurrent BLEL on the left parotid gland, which was gradually increasing. Following initial unsuccessful conservative treatment attempts, a 10-day course of DC-CIK therapy was initiated, after which the lesion in the gland area was reduced in size and local infection and skin ulcerations were improved. DC-CIK biotherapy was continued for three months (four sessions of 10-day treatments with a 10-day break in between) until the lesion disappeared and the skin ulceration was healed. Computerized tomography scans of the parotid gland revealed complete remission of the primary lesion and recovery of the bone destruction. The patient was discharged and remained stable with no sign of recurrence during a 10-month follow-up period. In the present case report, a successful DC-CIK adoptive cellular immunotherapy treatment for a BLEL was described for the first time.