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Hunter N, Allen D, Xiao D, Cox M, Jain K. Patient education resources for oral mucositis: a google search and ChatGPT analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08913-5. [PMID: 39198303 DOI: 10.1007/s00405-024-08913-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 08/11/2024] [Indexed: 09/01/2024]
Abstract
PURPOSE Oral mucositis affects 90% of patients receiving chemotherapy or radiation for head and neck malignancies. Many patients use the internet to learn about their condition and treatments; however, the quality of online resources is not guaranteed. Our objective was to determine the most common Google searches related to "oral mucositis" and assess the quality and readability of available resources compared to ChatGPT-generated responses. METHODS Data related to Google searches for "oral mucositis" were analyzed. People Also Ask (PAA) questions (generated by Google) related to searches for "oral mucositis" were documented. Google resources were rated on quality, understandability, ease of reading, and reading grade level using the Journal of the American Medical Association benchmark criteria, Patient Education Materials Assessment Tool, Flesch Reading Ease Score, and Flesh-Kincaid Grade Level, respectively. ChatGPT-generated responses to the most popular PAA questions were rated using identical metrics. RESULTS Google search popularity for "oral mucositis" has significantly increased since 2004. 78% of the Google resources answered the associated PAA question, and 6% met the criteria for universal readability. 100% of the ChatGPT-generated responses answered the prompt, and 20% met the criteria for universal readability when asked to write for the appropriate audience. CONCLUSION Most resources provided by Google do not meet the criteria for universal readability. When prompted specifically, ChatGPT-generated responses were consistently more readable than Google resources. After verification of accuracy by healthcare professionals, ChatGPT could be a reasonable alternative to generate universally readable patient education resources.
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Affiliation(s)
- Nathaniel Hunter
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David Allen
- Department of Otorhinolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Daniel Xiao
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Madisyn Cox
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kunal Jain
- Department of Otorhinolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Jayapriya T, Keluskar V, Lagali-Jirge V, Sridhar M. Efficacy of bioadhesives in the management of oral mucositis in patients undergoing radio-chemotherapy for treatment of head and neck cancer-a systematic review and meta-analysis. Support Care Cancer 2023; 31:470. [PMID: 37458879 DOI: 10.1007/s00520-023-07920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Management of head and neck cancers requires a multidisciplinary approach where surgery followed by radio and chemotherapy is the mainstay of treatment. The above-mentioned treatment can cause mucositis, a severely debilitating side effect. This can have a significant impact on quality of life. A recent advancing mode of drug delivery is the bioadhesive system. This interacts with mucosa by adhering to it and thereby improving the efficacy of the therapeutic agent delivered. AIM AND OBJECTIVE The purpose of this systematic review is to evaluate the effectiveness of bioadhesives in reducing oral mucositis and relieving pain associated with mucositis in head and neck cancer patients receiving radio-chemotherapy. MATERIALS AND METHOD Studies assessing the effectiveness of bioadhesives for the treatment of radiation-induced oral mucositis were retrieved from specialized databases (PubMed/MEDLINE, Scopus, ProQuest, Google Scholar, LILACS, OpenGrey) as well as institutional repositories. Data on incidence, pain reduction, resolution, and improvement of oral mucositis using bioadhesive were compiled. A Cochrane tool was used for randomized controlled trials and a JBI tool for non-randomized controlled trials and observational studies to assess the quality of included studies. Based on the eligible study data, a meta-analysis was conducted with STATA version 16, 2019 software, and 95% confidence intervals and p values greater than 0.05. RESULTS A total of 15 studies were included which assessed the effectiveness of bioadhesives in managing mucositis and its associated pain. Studies included in the review described either reduction, resolution, or incidence of oral mucositis respectively. A total of three meta-analyses were conducted to assess the incidence of oral mucositis and the pain associated with it, as well as the reduction in incidence. Bioadhesives showed statistically significant differences in the incidence of severe mucositis (p = 0.04). A meta-analysis comparing bioadhesives efficacy in reducing mucositis and pain associated with it found no statistically significant differences (p = 0.36). CONCLUSION Bioadhesives are emerging as a novel drug delivery method for treating radio-chemotherapy-induced oral mucositis because of their rapid absorption and easy application. Regardless of its benefits, clinical trials comparing it with conventional treatment methods are necessary to assess its efficacy in treating oral mucositis.
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Affiliation(s)
- T Jayapriya
- Department of Oral Medicine & Radiology KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Constituent Unit of KLE Academy of Higher Education & Research, Nehru Nagar, Belagavi, Karnataka, 590010, India
| | - Vaishali Keluskar
- Department of Oral Medicine & Radiology KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Constituent Unit of KLE Academy of Higher Education & Research, Nehru Nagar, Belagavi, Karnataka, 590010, India
| | - Vasanti Lagali-Jirge
- Department of Oral Medicine & Radiology KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Constituent Unit of KLE Academy of Higher Education & Research, Nehru Nagar, Belagavi, Karnataka, 590010, India
| | - M Sridhar
- Department of Oral Medicine & Radiology KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Constituent Unit of KLE Academy of Higher Education & Research, Nehru Nagar, Belagavi, Karnataka, 590010, India.
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Liu L, Wu D, Tu H, Cao M, Li M, Peng L, Yang J. Applications of Hydrogels in Drug Delivery for Oral and Maxillofacial Diseases. Gels 2023; 9:gels9020146. [PMID: 36826316 PMCID: PMC9956178 DOI: 10.3390/gels9020146] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/12/2023] Open
Abstract
Oral and maxillofacial diseases have an important impact on local function, facial appearance, and general health. As a multifunctional platform, hydrogels are widely used in the biomedical field due to their excellent physicochemical properties. In recent years, a large number of studies have been conducted to adapt hydrogels to the complex oral and maxillofacial environment by modulating their pore size, swelling, degradability, stimulus-response properties, etc. Meanwhile, many studies have attempted to use hydrogels as drug delivery carriers to load drugs, cytokines, and stem cells for antibacterial, anticancer, and tissue regeneration applications in oral and maxillofacial regions. This paper reviews the application and research progress of hydrogel-based drug delivery systems in the treatment of oral and maxillofacial diseases such as caries, endodontic diseases, periodontal diseases, maxillofacial bone diseases, mucosal diseases, oral cancer, etc. The characteristics and applications of hydrogels and drug-delivery systems employed for the treatment of different diseases are discussed in order to provide a reference for further research on hydrogel drug-delivery systems in the future.
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Affiliation(s)
- Lijia Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Dan Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Heng Tu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Mengjiao Cao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Mengxin Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Li Peng
- Key Laboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, Chengdu 610065, China
| | - Jing Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Correspondence:
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Kouri M, Rekatsina M, Vadalouca A, Siafaka I, Vardas E, Papadopoulou E, Paladini A, Varrassi G. Pharmacological Management of Neuropathic Pain after Radiotherapy in Head and Neck Cancer Patients: A Systematic Review. J Clin Med 2022; 11:4877. [PMID: 36013118 PMCID: PMC9409819 DOI: 10.3390/jcm11164877] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Neuropathic pain (NP) in head and neck cancer (HNC) patients represents a treatment challenge. Most studies investigating drugs against NP are conducted in patients suffering with diabetic neuropathy or postherpetic neuralgia, while data are limited in cancer pain management. Additionally, regarding cancer therapy-related NP, most of the studies do not focus on HNC patients. The aim of this review is to identify the studies on systematically administered medication for NP management that included HNC patients under radiotherapy. Methods: A systematic literature search was performed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in PubMed, Cochrane Library, Web of Science and ClinicalTrials.gov on 30 October 2021. The medical subject heading (MeSH) terms were (“head and neck cancer” OR “tumor”) AND “neuropathic pain” AND “medication” AND “radiotherapy.” The Cochrane Collaboration tool was used for quality assessment. Results: The search identified 432 articles. Three more articles were identified after searching the reference lists of the retrieved articles. A total of 10 articles met the eligibility inclusion criteria and were included in this review; 6 on gabapentin, 1 on pregabalin, 1 on nortriptyline, 1 on methadone, and 1 on ketamine. Statistically significant results in pain reduction compared to placebo or standard pain medication were found in the studies on pregabalin (p = 0.003), methadone (p = 0.03), ketamine (p = 0.012), and in two out of six gabapentin studies (p < 0.004). Two of the studies (both concerning gabapentin) had no comparison arm. Conclusions: Treatments including pregabalin, methadone, ketamine, and gabapentin were found to provide pain relief against HNC NP. While there is a plethora of pharmacological treatments available for the management of NP, only a few studies have been conducted regarding the pharmacological management of therapy-related NP in HNC patients. More studies should be conducted regarding the pharmacological approaches in HNC therapy-related NP so that specific treatment algorithms can be developed.
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Affiliation(s)
- Maria Kouri
- A’ Anesthesiology Clinic, Pain Management and Palliative Care Center, Aretaieio University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Dental Oncology Unit, Department of Oral Medicine and Pathology and Hospital Dentistry, Dental School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Martina Rekatsina
- Department of Anesthesia Pain Therapy and Palliative Care, Aretaieio University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Ioanna Siafaka
- A’ Anesthesiology Clinic, Pain Management and Palliative Care Center, Aretaieio University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Emmanouil Vardas
- Dental Oncology Unit, Department of Oral Medicine and Pathology and Hospital Dentistry, Dental School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Erofili Papadopoulou
- Dental Oncology Unit, Department of Oral Medicine and Pathology and Hospital Dentistry, Dental School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Miyano K, Hasegawa S, Asai N, Uzu M, Yatsuoka W, Ueno T, Nonaka M, Fujii H, Uezono Y. The Japanese Herbal Medicine Hangeshashinto Induces Oral Keratinocyte Migration by Mediating the Expression of CXCL12 Through the Activation of Extracellular Signal-Regulated Kinase. Front Pharmacol 2022; 12:695039. [PMID: 35145397 PMCID: PMC8822321 DOI: 10.3389/fphar.2021.695039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022] Open
Abstract
Several clinical studies have reported that Japanese herbal medicine Hangeshashinto (HST) has beneficial effects on chemotherapy-induced oral ulcerative mucositis (OUM). Our previous research demonstrated that HST improves chemotherapy-induced OUM through human oral keratinocyte (HOK) migration, which was suppressed by mitogen-activated protein kinase (MAPK) and C-X-C chemokine receptor 4 (CXCR4) inhibitors. However, the association between these molecules and HOK migration was unclear. Here, we examined the effects of HST on the expression of CXCR4/CXCR7 and C-X-C motif chemokine ligands 11 and 12 (CXCL11/CXCL12) in HOKs. Our results indicated that HST upregulated CXCL12, but not CXCR4, CXCR7, nor CXCL11 in HOKs. HST-induced expression of CXCL12 was significantly suppressed by an inhibitor of extracellular signal-regulated kinase (ERK), but not of p38 and c-Jun N-terminal kinase (JNK). In addition, HST induced phosphorylation of ERK in HOKs. These findings suggest that HST enhances HOK migration by upregulating CXCL12 via ERK.
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Affiliation(s)
- Kanako Miyano
- Division of Cancer Pathophysiology, National Cancer Research Institute, Tokyo, Japan
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Seiya Hasegawa
- Laboratory of Medicinal Chemistry, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Noriho Asai
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
- Laboratory of Medicinal Chemistry, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Miaki Uzu
- Vitrigel Project Research Team, Institute of Agrobiological Sciences, National Agriculture and Food Research Organization, Tsukuba, Japan
| | - Wakako Yatsuoka
- Dental Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Japan
| | - Takao Ueno
- Dental Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Japan
| | - Miki Nonaka
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideaki Fujii
- Laboratory of Medicinal Chemistry, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Yasuhito Uezono
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
- Supportive and Palliative Care Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
- *Correspondence: Yasuhito Uezono,
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Ingrosso G, Saldi S, Marani S, Wong AYW, Bertelli M, Aristei C, Zelante T. Breakdown of Symbiosis in Radiation-Induced Oral Mucositis. J Fungi (Basel) 2021; 7:jof7040290. [PMID: 33921294 PMCID: PMC8068946 DOI: 10.3390/jof7040290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/06/2023] Open
Abstract
Oral mucositis is an acute side effect of radiation therapy that is especially common with head and neck cancer treatment. In recent years, several studies have revealed the predisposing factors for mucositis, leading to the pre-treatment of patients to deter the development of opportunistic oral fungal infections. Although many clinical protocols already advise the use of probiotics to counteract inflammation and fungal colonization, preclinical studies are needed to better delineate the mechanisms by which a host may acquire benefits via co-evolution with oral microbiota, probiotics, and fungal commensals, such as Candida albicans, especially during acute inflammation. Here, we review the current understanding of radiation therapy-dependent oral mucositis in terms of pathology, prevention, treatment, and related opportunistic infections, with a final focus on the oral microbiome and how it may be important for future therapy.
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Affiliation(s)
- Gianluca Ingrosso
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy; (G.I.); (S.M.); (C.A.)
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Simonetta Saldi
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Simona Marani
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy; (G.I.); (S.M.); (C.A.)
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Alicia Y. W. Wong
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, 141 86 Stockholm, Sweden;
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy; (G.I.); (S.M.); (C.A.)
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Teresa Zelante
- Pathology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
- Correspondence: ; Tel.: +39-075-585-8236
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Won HR, Lee GH, Kim JH, Lee SH, Kwon SY, Baek SK, Ryu CH, Lee SJ, Park IS, Shin SC, Lee DW, Chung PS, Koo BS. Effects of N-acetylcysteine inhalation therapy on the quality of life of patients with head and neck cancer who are receiving radiation therapy: a prospective non-randomized controlled multi-center study. J Cancer Res Clin Oncol 2020; 147:539-547. [PMID: 32803294 DOI: 10.1007/s00432-020-03347-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/04/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUNDS AND PURPOSE Radiation therapy is an important mode of treatment for patients with head and neck cancers, but some associated complications can reduce the quality of life. We investigated whether N-acetylcysteine inhalation therapy improved the quality of life of such patients. MATERIALS AND METHODS We designed a prospective, non-randomized controlled multi-center study involving 10 institutions. We enrolled 120 patients (80 in the experimental group and 40 in the control group). Patients in the experimental group inhaled nebulized liquid N-acetylcysteine (2400 mg daily) for 8 weeks from the start of radiation therapy. Quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire H&N 35. RESULTS N-acetylcysteine inhalation was not associated with any side effect or discomfort. The reduction in painkiller use from the end of N-acetylcysteine inhalation therapy to the 1-month follow-up was greater in the experimental group than in the control group (P = 0.014). Dry mouth symptoms also improved significantly in the experimental group (P = 0.019). CONCLUSION N-acetylcysteine inhalation improves the quality of life of patients with head and neck cancers who are receiving radiation therapy, without any specific side effect.
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Affiliation(s)
- Ho-Ryun Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, 640 Daesa-Dong, Chung-Gu, Daejeon, 301-721, Republic of Korea
| | - Geon Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, 640 Daesa-Dong, Chung-Gu, Daejeon, 301-721, Republic of Korea
| | - Jin Hwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Sang Hyuk Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soon Young Kwon
- Department of Otolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, College of Medicine, Ansan, Republic of Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea
| | - Sang Joon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, 201 Manghyang-ro Dongnam-gu, Cheonan, 31116, Republic of Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, Republic of Korea
| | - Dong Wook Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, 201 Manghyang-ro Dongnam-gu, Cheonan, 31116, Republic of Korea.
| | - Bon Seok Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, 640 Daesa-Dong, Chung-Gu, Daejeon, 301-721, Republic of Korea.
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Saunders DP, Rouleau T, Cheng K, Yarom N, Kandwal A, Joy J, Bektas Kayhan K, van de Wetering M, Brito-Dellan N, Kataoka T, Chiang K, Ranna V, Vaddi A, Epstein J, Lalla RV, Bossi P, Elad S. Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 2020; 28:2473-2484. [PMID: 32052137 DOI: 10.1007/s00520-019-05181-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/07/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To update the clinical practice guidelines for the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and/or treatment of oral mucositis (OM). METHODS A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible. RESULTS A total of 9 new papers were identified within the scope of this section, adding to the 62 papers reviewed in this section previously. A new Suggestion was made for topical 0.2% morphine for the treatment of OM-associated pain in head and neck (H&N) cancer patients treated with RT-CT (modification of previous guideline). A previous Recommendation against the use of sucralfate-combined systemic and topical formulation in the prevention of OM in solid cancer treatment with CT was changed from Recommendation Against to No Guideline Possible. Suggestion for doxepin and fentanyl for the treatment of mucositis-associated pain in H&N cancer patients was changed to No Guideline Possible. CONCLUSIONS Of the agents studied for the management of OM in this paper, the evidence supports a Suggestion in favor of topical morphine 0.2% in H&N cancer patients treated with RT-CT for the treatment of OM-associated pain.
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Affiliation(s)
- Deborah P Saunders
- Dental Oncology Program, Health Sciences North, North East Cancer Center, Northern Ontario School of Medicine, 41 Ramsey Lake Road, Sudbury, Ontario, P3E 5J1, Canada.
| | - Tanya Rouleau
- Dental Oncology Program, Health Sciences North, North East Cancer Center, Northern Ontario School of Medicine, 41 Ramsey Lake Road, Sudbury, Ontario, P3E 5J1, Canada
| | - Karis Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel and School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abhishek Kandwal
- Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himayalan University, Dehradun, Uttarakhand, India
| | - Jamie Joy
- Clinical Pharmacy, Cancer Treatment Centers of America, Boca Raton, FL, USA
| | - Kivanc Bektas Kayhan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İstanbul University, Istanbul, Turkey
| | - Marianne van de Wetering
- Paediatric Oncology Department, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Norman Brito-Dellan
- Division of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tomoko Kataoka
- Multi-institutional Clinical Trials Section, Research Management Division, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Karen Chiang
- Pharmacy Department, St Vincent's Hospital Melbourne, Electronic Medical Records Department, Melbourne Health, Jane Bell House, Melbourne, Victoria, Australia
| | - Vinisha Ranna
- Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Anusha Vaddi
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Joel Epstein
- Cedars-Sinai Health System, Los Angeles CA and City of Hope National Medical Center, Duarte, CA, USA
| | - Rajesh V Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Paolo Bossi
- Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Sharon Elad
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
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9
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Miyano K, Eto M, Hitomi S, Matsumoto T, Hasegawa S, Hirano A, Nagabuchi K, Asai N, Uzu M, Nonaka M, Omiya Y, Kaneko A, Ono K, Fujii H, Higami Y, Kono T, Uezono Y. The Japanese herbal medicine Hangeshashinto enhances oral keratinocyte migration to facilitate healing of chemotherapy-induced oral ulcerative mucositis. Sci Rep 2020; 10:625. [PMID: 31953420 PMCID: PMC6969174 DOI: 10.1038/s41598-019-57192-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/19/2019] [Indexed: 12/11/2022] Open
Abstract
Chemotherapy often induces oral ulcerative mucositis (OUM) in patients with cancer, characterized by severe painful inflammation. Mouth-washing with the Japanese herbal medicine hangeshashinto (HST) ameliorates chemotherapy-induced OUM in patients with colorectal cancer. Previously, we demonstrated that HST decreased interleukin 1β-induced prostaglandin E2 production in human oral keratinocytes (HOKs) and OUM-induced mechanical or spontaneous pain in rats. However, HST effects on tissue repair functions in HOKs remain unclear. Here, we examined the effects of HST on scratch-induced wound healing in vitro and in vivo. In vitro, HST enhanced wound healing mainly through scratch-induced HOK migration. Screening of the seven constituent medicinal herbs and their major components revealed that Scutellaria root, processed ginger, and Glycyrrhiza components mainly induced the scratch-induced HOK migration. Pharmacokinetic analyses indicated that the active ingredient concentrations in rat plasma following oral HST administration were below the effective doses for HOK migration, suggesting direct effects of HST in OUM. Mitogen-activated protein kinase and C-X-C chemokine receptor 4 inhibitors significantly suppressed HST-induced HOK migration. Moreover, HST enhanced tissue repair in our OUM rat model. Thus, HST likely enhanced OUM tissue repair through oral keratinocyte migration upon MAPK and CXCR4 activation and may be useful in patients with cancer-associated OUM.
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Affiliation(s)
- Kanako Miyano
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
| | - Moeko Eto
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
- Laboratory of Molecular Pathology and Metabolic Disease, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, 278-8510, Japan
| | - Suzuro Hitomi
- Division of Physiology, Kyushu Dental University, Fukuoka, 803-8580, Japan
| | - Takashi Matsumoto
- Tsumura Kampo Research Laboratories, Tsumura & Co., Ibaraki, 300-1192, Japan
| | - Seiya Hasegawa
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
- Department of Medicinal Chemistry, School of Pharmacy, Kitasato University, Tokyo, 108-8641, Japan
| | - Ayane Hirano
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
- Department of Medicinal Chemistry, School of Pharmacy, Kitasato University, Tokyo, 108-8641, Japan
| | - Kaori Nagabuchi
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
- Department of Medicinal Chemistry, School of Pharmacy, Kitasato University, Tokyo, 108-8641, Japan
| | - Noriho Asai
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
- Department of Medicinal Chemistry, School of Pharmacy, Kitasato University, Tokyo, 108-8641, Japan
| | - Miaki Uzu
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
| | - Miki Nonaka
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
| | - Yuji Omiya
- Tsumura Kampo Research Laboratories, Tsumura & Co., Ibaraki, 300-1192, Japan
| | - Atsushi Kaneko
- Tsumura Kampo Research Laboratories, Tsumura & Co., Ibaraki, 300-1192, Japan
| | - Kentaro Ono
- Division of Physiology, Kyushu Dental University, Fukuoka, 803-8580, Japan
| | - Hideaki Fujii
- Department of Medicinal Chemistry, School of Pharmacy, Kitasato University, Tokyo, 108-8641, Japan
| | - Yoshikazu Higami
- Laboratory of Molecular Pathology and Metabolic Disease, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, 278-8510, Japan
- Translational Research Center, Research Institute of Science and Technology, Tokyo University of Science, Chiba, 278-8510, Japan
| | - Toru Kono
- Center for Clinical and Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido, Japan
| | - Yasuhito Uezono
- Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan.
- Division of Supportive Care Research, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, 104-0045, Japan.
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, 104-0045, Japan.
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10
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Chitosan oral patches inspired by mussel adhesion. J Control Release 2020; 317:57-66. [DOI: 10.1016/j.jconrel.2019.11.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
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11
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Anderson CM, Lee CM, Saunders DP, Curtis A, Dunlap N, Nangia C, Lee AS, Gordon SM, Kovoor P, Arevalo-Araujo R, Bar-Ad V, Peddada A, Colvett K, Miller D, Jain AK, Wheeler J, Blakaj D, Bonomi M, Agarwala SS, Garg M, Worden F, Holmlund J, Brill JM, Downs M, Sonis ST, Katz S, Buatti JM. Phase IIb, Randomized, Double-Blind Trial of GC4419 Versus Placebo to Reduce Severe Oral Mucositis Due to Concurrent Radiotherapy and Cisplatin For Head and Neck Cancer. J Clin Oncol 2019; 37:3256-3265. [PMID: 31618127 PMCID: PMC6881100 DOI: 10.1200/jco.19.01507] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oral mucositis (OM) remains a common, debilitating toxicity of radiation therapy (RT) for head and neck cancer. The goal of this phase IIb, multi-institutional, randomized, double-blind trial was to compare the efficacy and safety of GC4419, a superoxide dismutase mimetic, with placebo to reduce the duration, incidence, and severity of severe OM (SOM). PATIENTS AND METHODS A total of 223 patients (from 44 institutions) with locally advanced oral cavity or oropharynx cancer planned to be treated with definitive or postoperative intensity-modulated RT (IMRT; 60 to 72 Gy [≥ 50 Gy to two or more oral sites]) plus cisplatin (weekly or every 3 weeks) were randomly assigned to receive 30 mg (n = 73) or 90 mg (n = 76) of GC4419 or to receive placebo (n = 74) by 60-minute intravenous administration before each IMRT fraction. WHO grade of OM was assessed biweekly during IMRT and then weekly for up to 8 weeks after IMRT. The primary endpoint was duration of SOM tested for each active dose level versus placebo (intent-to-treat population, two-sided α of .05). The National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03, was used for adverse event grading. RESULTS Baseline patient and tumor characteristics as well as treatment delivery were balanced. With 90 mg GC4419 versus placebo, SOM duration was significantly reduced (P = .024; median, 1.5 v 19 days). SOM incidence (43% v 65%; P = .009) and severity (grade 4 incidence, 16% v 30%; P = .045) also were improved. Intermediate improvements were seen with the 30-mg dose. Safety was comparable across arms, with no significant GC4419-specific toxicity nor increase of known toxicities of IMRT plus cisplatin. The 2-year follow-up for tumor outcomes is ongoing. CONCLUSION GC4419 at a dose of 90 mg produced a significant, clinically meaningful reduction of SOM duration, incidence, and severity with acceptable safety. A phase III trial (ROMAN; ClinicalTrials.gov identifier: NCT03689712) has begun.
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Affiliation(s)
| | | | - Deborah P Saunders
- North East Cancer Centre, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | | | - Neal Dunlap
- University of Louisville/James Graham Brown Cancer Center, Louisville, KY
| | | | | | | | | | | | | | | | - Kyle Colvett
- Mountain States Health Alliance, Johnson City, TN
| | | | - Anshu K Jain
- Ashland-Bellefonte Cancer Center, Ashland, KY.,Yale School of Medicine, New Haven, CT
| | | | - Dukagjin Blakaj
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Marcelo Bonomi
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | | | | | | | | | | | - Matt Downs
- Statistics Collaborative, Washington, DC
| | | | | | - John M Buatti
- University of Iowa Hospitals and Clinics, Iowa City, IA
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12
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Stempniewicz A, Ceranowicz P, Warzecha Z. Potential Therapeutic Effects of Gut Hormones, Ghrelin and Obestatin in Oral Mucositis. Int J Mol Sci 2019; 20:ijms20071534. [PMID: 30934722 PMCID: PMC6479885 DOI: 10.3390/ijms20071534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022] Open
Abstract
Chemotherapy and/or head and neck radiotherapy are frequently associated with oral mucositis. Oral pain, odynophagia and dysphagia, opioid use, weight loss, dehydration, systemic infection, hospitalization and introduction of a feeding tube should be mentioned as the main determinated effect of oral mucositis. Oral mucositis leads to a decreased quality of life and an increase in treatment costs. Moreover, oral mucositis is a life-threatening disease. In addition to its own direct life-threatening consequences, it can also lead to a reduced survival due to the discontinuation or dose reduction of anti-neoplasm therapy. There are numerous strategies for the prevention or treatment of oral mucositis; however, their effectiveness is limited and does not correspond to expectations. This review is focused on the ghrelin and obestatin as potentially useful candidates for the prevention and treatment of chemo- or/and radiotherapy-induced oral mucositis.
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Affiliation(s)
- Agnieszka Stempniewicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16 St., 31-531 Krakow, Poland.
| | - Piotr Ceranowicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16 St., 31-531 Krakow, Poland.
| | - Zygmunt Warzecha
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16 St., 31-531 Krakow, Poland.
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13
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Mapuskar KA, Anderson CM, Spitz DR, Batinic-Haberle I, Allen BG, E Oberley-Deegan R. Utilizing Superoxide Dismutase Mimetics to Enhance Radiation Therapy Response While Protecting Normal Tissues. Semin Radiat Oncol 2019; 29:72-80. [PMID: 30573187 DOI: 10.1016/j.semradonc.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Symptomatic normal tissue injury is a common side effect following definitive therapeutic radiation and chemotherapy treatment for a variety of malignancies. These cancer therapy related toxicities may occur acutely during treatment resulting in reduced or missed therapy agent administration or after the completion of therapy resulting in significant chronic morbidities that significantly diminish patient quality of life. Radiation and chemotherapy induce the formation of reactive oxygen species (ROS) both in normal tissues and tumor cells. One type of ROS common to both chemotherapy and radiation therapy is the formation of superoxide (O2•-). Fortunately, due to metabolic differences between cancer and normal cell metabolism, as well as improved targeting techniques, ROS generation following radiation and chemotherapy is generally greater in cancer cells compared to normal tissues. However, the levels of ROS generated in normal tissues are capable of inducing significant toxicity. Thus, several groups are focusing on metabolism-based approaches to mitigate normal tissue effects occurring both during and following cancer therapy. This review will summarize the most current preclinical and clinical data available demonstrating the efficacy of small molecule, superoxide dismutase mimetics in minimizing radiation and chemotherapy-induced normal tissue injury, resulting in enhanced patient outcomes.
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Affiliation(s)
- Kranti A Mapuskar
- From the Free Radical and Radiation Biology Program, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA.; Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Carryn M Anderson
- Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Douglas R Spitz
- From the Free Radical and Radiation Biology Program, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA.; Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ines Batinic-Haberle
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC
| | - Bryan G Allen
- From the Free Radical and Radiation Biology Program, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA.; Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA..
| | - Rebecca E Oberley-Deegan
- Department of Biochemistry and Molecular Biology, College of Medicine, Nebraska Medical Center, Omaha, NE..
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14
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Roldan CJ, Chai T, Erian J, Welker J. Oral pain associated with cancer therapy, a pain medicine perspective. Pain Manag 2018; 8:487-493. [DOI: 10.2217/pmt-2018-0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Cancer therapy-induced oral mucositis (CTIOM) can cause intolerable oral pain resulting in difficulty in chewing, swallowing and speaking. Thus, leading to patients requiring aggressive measures, such as parenteral feeding, the placement of gastric feeding tubes and discontinuation of oncologic treatments. Although, pain is the debilitating symptom, current efforts seem to focus independently in the histological damage, not in pain and symptom care. Current strategies for managing pain from CTIOM entail maintaining oral hygiene and the use of oral rinses, topical anesthetics, prophylactic antimicrobials and systemic analgesics such as opioids. Novel therapies, such as methylene blue oral rinse, are being investigated, with positive outcomes. Therefore, there is a need to identify treatment modalities for pain of CTIOM. Ideally, this should be noninvasive, safe and cost-effective, while providing sustained analgesia.
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Affiliation(s)
- Carlos J Roldan
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thomas Chai
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer Erian
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Welker
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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15
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Campos JC, Cunha JD, Ferreira DC, Reis S, Costa PJ. Challenges in the local delivery of peptides and proteins for oral mucositis management. Eur J Pharm Biopharm 2018; 128:131-146. [PMID: 29702221 DOI: 10.1016/j.ejpb.2018.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/20/2022]
Abstract
Oral mucositis, a common inflammatory side effect of oncological treatments, is a disorder of the oral mucosa that can cause painful ulcerations, local motor disabilities, and an increased risk of infections. Due to the discomfort it produces and the associated health risks, it can lead to cancer treatment restrains, such as the need for dose reduction, cycle delays or abandonment. Current mucositis management has low efficiency in prevention and treatment. A topical drug application for a local action can be a more effective approach than systemic routes when addressing oral cavity pathologies. Local delivery of growth factors, antibodies, and anti-inflammatory cytokines have shown promising results. However, due to the peptide and protein nature of these novel agents, and the several anatomic, physiological and environmental challenges of the oral cavity, their local action might be limited when using traditional delivering systems. This review is an awareness of the issues and strategies in the local delivery of macromolecules for the management of oral mucositis.
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Affiliation(s)
- João C Campos
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1).
| | - João D Cunha
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
| | - Domingos C Ferreira
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
| | - Salette Reis
- LAQV, REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
| | - Paulo J Costa
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
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16
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Kufta K, Forman M, Swisher-McClure S, Sollecito TP, Panchal N. Pre-Radiation dental considerations and management for head and neck cancer patients. Oral Oncol 2018; 76:42-51. [DOI: 10.1016/j.oraloncology.2017.11.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/22/2017] [Accepted: 11/25/2017] [Indexed: 12/20/2022]
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17
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McCullough RW. US oncology-wide incidence, duration, costs and deaths from chemoradiation mucositis and antimucositis therapy benefits. Future Oncol 2017; 13:2823-2852. [PMID: 29192505 DOI: 10.2217/fon-2017-0418] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Approximate oncology-wide incidence, duration, costs and deaths associated with mucositis and identify health economic benefits of antimucositis therapies. Review the literature relevant to the clinical experience of mucositis by pathophysiology, incidence, duration, costs and deaths. Use US insurance actuarial and epidemiology on cancer to generalize an oncology-wide impact of toxic mucositis. Toxic mucositis causes oropharyngoesophageal ulcerations, chemo-induced nausea, vomiting and diarrhea. Acutely, it lasts 102 days/six cycles of chemotherapy, 60 days in human stem-cell transplantation patients and 70-84 days in head and neck cancer patients at annual costs of US$13.23 billion/522,166 treated patients (US$20,892/erosive-type mucositis patient, US$25,337/physiologic mucositis patient) and 46,699 deaths. Using antimucositis therapies prior to 2013 provided fractional benefits at high costs. By completely preventing and rapidly reversing mucositis, high-potency polymerized cross-linked sucralfate promises superior health economic benefits.
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Affiliation(s)
- Ricky W McCullough
- Translational Medicine Clinic & Research Center, Department of Medical Research, 1768 Storrs Road, Storrs, CT 06268, USA.,Department of Medicine, Veterans Administration Medical Center Providence, Brown University Teaching Affliate, 830 Chaulkstone Ave, Providence, RI 02804, USA
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18
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Anderson CM, Sonis ST, Lee CM, Adkins D, Allen BG, Sun W, Agarwala SS, Venigalla ML, Chen Y, Zhen W, Mould DR, Holmlund JT, Brill JM, Buatti JM. Phase 1b/2a Trial of the Superoxide Dismutase Mimetic GC4419 to Reduce Chemoradiotherapy-Induced Oral Mucositis in Patients With Oral Cavity or Oropharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2017; 100:427-435. [PMID: 29174131 DOI: 10.1016/j.ijrobp.2017.10.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/26/2017] [Accepted: 10/10/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess the safety of the superoxide dismutase mimetic GC4419 in combination with radiation and concurrent cisplatin for patients with oral cavity or oropharyngeal cancer (OCC) and to assess the potential of GC4419 to reduce severe oral mucositis (OM). PATIENTS AND METHODS Patients with locally advanced OCC treated with definitive or postoperative intensity modulated radiation therapy (IMRT) plus cisplatin received GC4419 by 60-minute intravenous infusion, ending <60 minutes before IMRT, Monday through Friday for 3 to 7 weeks, in a dose and duration escalation study. Oral mucositis was assessed twice weekly during and weekly after IMRT. RESULTS A total of 46 patients received GC4419 in 11 separate dosing and duration cohorts: dose escalation occurred in 5 cohorts receiving 15 to 112 mg/d over 3 weeks (n=20), duration escalation in 3 cohorts receiving 112 mg/d over 4 to 6 weeks (n=12), and then 3 additional cohorts receiving 30 or 90 mg/d over 6 to 7 weeks (n=14). A maximum tolerated dose was not reached. One dose-limiting toxicity (grade 3 gastroenteritis and vomiting with hyponatremia) occurred in each of 2 separate cohorts at 112 mg. Nausea/vomiting and facial paresthesia during infusion seemed to be GC4419 dose-related. Severe OM occurred through 60 Gy in 4 of 14 patients (29%) dosed for 6 to 7 weeks, with median duration of only 2.5 days. CONCLUSIONS The safety of GC4419 concurrently with chemoradiation for OCC was acceptable. Toxicities included nausea/vomiting and paresthesia. Doses of 30 and 90 mg/d administered for 7 weeks were selected for further study. In an exploratory analysis, severe OM seemed less frequent and briefer than expected.
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Affiliation(s)
- Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Stephen T Sonis
- Biomodels and Division of Oral Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Douglas Adkins
- Section of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Bryan G Allen
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Wenqing Sun
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sanjiv S Agarwala
- Department of Medical Oncology, St. Luke's University Hospital and Temple University, Easton, Pennsylvania
| | | | - Yuhchyau Chen
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Weining Zhen
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Diane R Mould
- Projections Research Inc., Phoenixville, Pennsylvania
| | | | | | - John M Buatti
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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19
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Maria OM, Eliopoulos N, Muanza T. Radiation-Induced Oral Mucositis. Front Oncol 2017; 7:89. [PMID: 28589080 PMCID: PMC5439125 DOI: 10.3389/fonc.2017.00089] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 04/21/2017] [Indexed: 01/11/2023] Open
Abstract
Radiation-induced oral mucositis (RIOM) is a major dose-limiting toxicity in head and neck cancer patients. It is a normal tissue injury caused by radiation/radiotherapy (RT), which has marked adverse effects on patient quality of life and cancer therapy continuity. It is a challenge for radiation oncologists since it leads to cancer therapy interruption, poor local tumor control, and changes in dose fractionation. RIOM occurs in 100% of altered fractionation radiotherapy head and neck cancer patients. In the United Sates, its economic cost was estimated to reach 17,000.00 USD per patient with head and neck cancers. This review will discuss RIOM definition, epidemiology, impact and side effects, pathogenesis, scoring scales, diagnosis, differential diagnosis, prevention, and treatment.
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Affiliation(s)
- Osama Muhammad Maria
- Faculty of Medicine, Experimental Medicine Department, McGill University, Montreal, QC, Canada
- Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Nicoletta Eliopoulos
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Faculty of Medicine, Surgery Department, McGill University, Montreal, QC, Canada
| | - Thierry Muanza
- Faculty of Medicine, Experimental Medicine Department, McGill University, Montreal, QC, Canada
- Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Oncology Department, McGill University, Montreal, QC, Canada
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20
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Bertl K, Gotfredsen K, Jensen SS, Bruckmann C, Stavropoulos A. Adverse reaction after hyaluronan injection for minimally invasive papilla volume augmentation. A report on two cases. Clin Oral Implants Res 2016; 28:871-876. [PMID: 27252126 DOI: 10.1111/clr.12892] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To report two cases of adverse reaction after mucosal hyaluronan (HY) injection around implant-supported crowns, with the aim to augment the missing interdental papilla. MATERIAL AND METHODS Two patients with single, non-neighbouring, implants in the anterior maxilla, who were treated within the frames of a randomized controlled clinical trial testing the effectiveness of HY gel injection to reconstruct missing papilla volume at single implants, presented an adverse reaction. Injection of HY was performed bilaterally using a 3-step technique: (i) creation of a reservoir in the mucosa directly above the mucogingival junction, (ii) injection into the attached gingiva/mucosa below the missing papilla, and (iii) injection 2-3 mm apically to the papilla tip. The whole-injection session was repeated once after approximately 4 weeks. RESULTS Both patients presented with swelling and extreme tenderness with a burning sensation on the lip next to the injection area, after the second injection session. In one of the cases, a net-like skin discoloration (livedo reticularis) was also noted. The symptoms lasted for up to 7 days, and in both cases, symptoms resolved without any signs of skin or mucosal necrosis or any permanent damage. CONCLUSION Most likely, water attraction over time by the highly hygroscopic HY, exerted progressively an external vascular compression and at least partial occlusion of neighbouring blood vessels. An infection or an allergic reaction seems unlikely, since all symptoms gradually disappeared within a week irrespective use of antimicrobials, while an allergic reaction most likely would not have been restricted to one side.
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Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Klaus Gotfredsen
- Department of Oral Rehabilitation, School of Dentistry, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simon S Jensen
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Corinna Bruckmann
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
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21
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De Sanctis V, Bossi P, Sanguineti G, Trippa F, Ferrari D, Bacigalupo A, Ripamonti CI, Buglione M, Pergolizzi S, Langendjik JA, Murphy B, Raber-Durlacher J, Russi EG, Lalla RV. Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus statements. Crit Rev Oncol Hematol 2016; 100:147-66. [DOI: 10.1016/j.critrevonc.2016.01.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 11/30/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022] Open
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22
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Ardito F, Giuliani M, Perrone D, Giannatempo G, Di Fede O, Favia G, Campisi G, Colella G, Lo Muzio L. Expression of salivary biomarkers in patients with oral mucositis: evaluation by SELDI-TOF/MS. Oral Dis 2016; 22:209-19. [PMID: 26613366 DOI: 10.1111/odi.12405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/15/2015] [Accepted: 11/18/2015] [Indexed: 01/15/2023]
Affiliation(s)
- F Ardito
- Department of Clinical and Experimental Medicine; Foggia University; Foggia Italy
| | - M Giuliani
- Department of Clinical and Experimental Medicine; Foggia University; Foggia Italy
| | - D Perrone
- Department of Clinical and Experimental Medicine; Foggia University; Foggia Italy
| | - G Giannatempo
- Department of Clinical and Experimental Medicine; Foggia University; Foggia Italy
| | - O Di Fede
- Department of Surgical, Oncological and Stomatological Sciences; University of Palermo; Palermo Italy
| | - G Favia
- Department of Odontostomatology and Surgery; University of Bari; Bari Italy
| | - G Campisi
- Department of Surgical, Oncological and Stomatological Sciences; University of Palermo; Palermo Italy
| | - G Colella
- Department of Medical, Surgical and Dental Specialties; Second University of Naples; Naples Italy
| | - L Lo Muzio
- Department of Clinical and Experimental Medicine; Foggia University; Foggia Italy
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Casale M, Moffa A, Sabatino L, Pace A, Oliveto G, Vitali M, Baptista P, Salvinelli F. Hyaluronic Acid: Perspectives in Upper Aero-Digestive Tract. A Systematic Review. PLoS One 2015; 10:e0130637. [PMID: 26120837 PMCID: PMC4487693 DOI: 10.1371/journal.pone.0130637] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/21/2015] [Indexed: 11/18/2022] Open
Abstract
Background To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the mucosa of the upper aerodigestive tract (UADT). The use of topical drugs, which are able to reduce mucosal inflammation and to improve healing tissues, can represent a relevant therapeutic advance. Topical sodium hyaluronate (SH) has recently been recognized as adjuvant treatment in the chronic inflammatory disease of the UADT. Aims The aim of our work was to review the published literature regarding all the potential therapeutic effects of SH in the chronic inflammatory disease of UADT. Methods Relevant published studies were searched in Pubmed, Google Scholar, Ovid using keywords (“sodium hyaluronate” and “upper airways”) or Medical Subject Headings. Results At the end of our selection process, sixteen publications have been included. Six of them in the post-operative period of nasal-sinus surgery, 2 of them in pediatric patients affected by recurrent upper respiratory tract infections, 4 of them in reducing symptoms and preventing exacerbations of chronic upper airways in adult population, 4 of them in patients with chronic inflammatory disease of UADT, including gastro-esophageal reflux disease (GERD). Conclusions Topical administration of SH plays a pivotkey role in the postoperative phase of patients undergoing FESS and nasal surgery, and positive results are generally observed in all the patients suffering from UADT chronic inflammatory disease.
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Affiliation(s)
- Manuele Casale
- Area of Otolaringology, University Campus Bio-Medico, Via Alvaro del Portillo 21, Rome, Italy
- * E-mail:
| | - Antonio Moffa
- Area of Otolaringology, University Campus Bio-Medico, Via Alvaro del Portillo 21, Rome, Italy
| | - Lorenzo Sabatino
- Area of Otolaringology, University Campus Bio-Medico, Via Alvaro del Portillo 21, Rome, Italy
| | - Annalisa Pace
- Area of Otolaringology, University Campus Bio-Medico, Via Alvaro del Portillo 21, Rome, Italy
| | - Giuseppe Oliveto
- Area of Otolaringology, University Campus Bio-Medico, Via Alvaro del Portillo 21, Rome, Italy
| | - Massimiliano Vitali
- Bio-Statistical Department, University Campus Bio-Medico, Via Alvaro del Portillo 21, Rome, Italy
| | - Peter Baptista
- Department of Otolaringology, University of Navarra, Campus Universitario, Pamplona, Spain
| | - Fabrizio Salvinelli
- Area of Otolaringology, University Campus Bio-Medico, Via Alvaro del Portillo 21, Rome, Italy
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Reliability and validity of the Head and Neck Cancer Inventory (HNCI) in Japanese patients. Palliat Support Care 2015; 13:1373-80. [PMID: 25620032 DOI: 10.1017/s1478951514001345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This project evaluated the psychometric properties of a translated version of the Head and Neck Cancer Inventory (HNCI) for use with Japanese patients. The HNCI is a measure for assessing the quality of life (QoL) of head and neck cancer patients and survivors. The present study was aimed at investigating the reliability and validity of this translated instrument. METHOD Some 165 patients with head and neck cancer (HNC) were enrolled at the Tokyo Medical and Dental University Hospital. The instrument's internal consistency and test-retest reliability were evaluated. Criterion-related validity was assessed by correlations between the HNCI and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) scales. RESULTS Some 29 of the 30 items in the original version were selected to comprise the Japanese version of the HNCI (Japanese HNCI). Investigation of criterion-related validity using the FACT-H&N demonstrated significant correlations (Spearman's ρ = 0.47-0.63). The value of Cronbach's α for each subscale ranged from 0.84 to 0.87. Test-retest reliability showed an intraclass correlation coefficient (ICC) of 0.62-0.79. SIGNIFICANCE OF RESULTS The reliability and validity of the Japanese HNCI were evaluated. Although its classification is different from the original U.S. version, the Japanese HNCI is a self-administered questionnaire that can assess quality of life (QoL) in patients with head and neck cancer.
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Eilers J, Harris D, Henry K, Johnson LA. Evidence-Based Interventions for Cancer Treatment-Related Mucositis: Putting Evidence Into Practice. Clin J Oncol Nurs 2014; 18 Suppl:80-96. [DOI: 10.1188/14.cjon.s3.80-96] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Effects of professional oral health care on reducing the risk of chemotherapy-induced oral mucositis. Support Care Cancer 2014; 22:2935-40. [PMID: 24854326 PMCID: PMC4183888 DOI: 10.1007/s00520-014-2282-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/06/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Recent years have seen remarkable progress in cancer therapy, although treatment-induced adverse reactions and complications are not uncommon. Approximately 40 % of patients undergoing chemotherapy for cancer experience adverse reactions in the oral cavity, with nearly half of them developing severe oral mucositis that necessitates postponing therapy and/or changing the drug dosage. The objective of this study was to assess the usefulness of prophylactic professional oral health care (POHC) for preventing mucositis in patients undergoing chemotherapy. METHODS Twenty-six female patients scheduled for chemotherapy for breast cancer were included in this study and randomized to the self-care or POHC groups. Assessment parameters included oral cavity photographs, plaque control records, Saxon test scores, Oral Assessment Guide scores, and grading using the Common Terminology Criteria for Adverse Events. Beginning before surgery and continuing through the completion of chemotherapy, the POHC patient group received weekly professional oral health care, including scaling, professional cleaning of the tooth surfaces, brushing instructions, and nutritional and lifestyle guidance. RESULTS More patients in the self-care group developed oral mucositis than in the POHC group. The Oral Assessment Guide score, which was used as an index of oral mucositis, was also significantly lower in the POHC group. Based on the Oral Assessment Guide and plaque control records, there was almost no deterioration of the oral environment in the POHC group, whereas deterioration was observed in the self-care group. CONCLUSIONS These findings demonstrate the efficacy of regular POHC in reducing the risk of oral mucositis in breast cancer patients undergoing chemotherapy.
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Hopper SM, McCarthy M, Tancharoen C, Lee KJ, Davidson A, Babl FE. Topical Lidocaine to Improve Oral Intake in Children With Painful Infectious Mouth Ulcers: A Blinded, Randomized, Placebo-Controlled Trial. Ann Emerg Med 2014; 63:292-9. [DOI: 10.1016/j.annemergmed.2013.08.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 08/18/2013] [Accepted: 08/23/2013] [Indexed: 02/06/2023]
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Campos MIDAC, Campos CN, Aarestrup FM, Aarestrup BJV. Oral mucositis in cancer treatment: Natural history, prevention and treatment. Mol Clin Oncol 2014; 2:337-340. [PMID: 24772297 DOI: 10.3892/mco.2014.253] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/20/2014] [Indexed: 11/05/2022] Open
Abstract
Oral mucositis is a condition that is characterized by ulcerative lesions in the mucosa of patients undergoing radiotherapy or chemotherapy. Oral mucositis is currently considered to be the most severe complication of anticancer therapy, affecting 40-80% of patients undergoing chemotherapy and almost all those undergoing radiotherapy of the head and neck. Although they do not prevent lesions from appearing, drugs for the treatment of oral mucositis are required to minimize its clinical aggressiveness and improve the nutritional status, hydration and quality of life of the affected patients. Furthermore, the prevention and control of oral ulcers is crucial for cancer prognosis, since the establishment of severe lesions may lead to temporary or permanent treatment discontinuation and compromise cancer control. The objective of this study was to present a review on this condition, its causes and its treatment to professional clinical dentists, in order to help minimize patient suffering. A search was conducted through PubMed, Lilacs and MedLine, to retrieve related articles published between 1994 and 2013.
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Affiliation(s)
- Maria Ines DA Cruz Campos
- Postgraduate Programme in Brazilian Health, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Celso Neiva Campos
- Department of Dental Clinic, Dental School, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Fernando Monteiro Aarestrup
- Laboratory of Immunopathology and Clinical Immunology, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Beatriz Julião Vieira Aarestrup
- Department of Morphology (Histology and Embryology), Institute of Biological Sciences Research, Federal University of Juiz de Fora, Minas Gerais, Brazil
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Saunders DP, Epstein JB, Elad S, Allemano J, Bossi P, van de Wetering MD, Rao NG, Potting C, Cheng KK, Freidank A, Brennan MT, Bowen J, Dennis K, Lalla RV. Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients. Support Care Cancer 2013; 21:3191-207. [PMID: 23832272 DOI: 10.1007/s00520-013-1871-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/21/2013] [Indexed: 02/01/2023]
Abstract
PURPOSE The aim of this project was to develop clinical practice guidelines on the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and management of oral mucositis (OM) in cancer patients. METHODS A systematic review of the available literature was conducted. The body of evidence for the use of each agent, in each setting, was assigned a level of evidence. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, or no guideline possible. RESULTS A recommendation was developed in favor of patient-controlled analgesia with morphine in hematopoietic stem cell transplant (HSCT) patients. Suggestions were developed in favor of transdermal fentanyl in standard dose chemotherapy and HSCT patients and morphine mouth rinse and doxepin rinse in head and neck radiation therapy (H&N RT) patients. Recommendations were developed against the use of topical antimicrobial agents for the prevention of mucositis. These included recommendations against the use of iseganan for mucositis prevention in HSCT and H&N RT and against the use of antimicrobial lozenges (polymyxin-tobramycin-amphotericin B lozenges/paste and bacitracin-clotrimazole-gentamicin lozenges) for mucositis prevention in H&N RT. Recommendations were developed against the use of the mucosal coating agent sucralfate for the prevention or treatment of chemotherapy-induced or radiation-induced OM. No guidelines were possible for any other agent due to insufficient and/or conflicting evidence. CONCLUSION Additional well-designed research is needed on prevention and management approaches for OM.
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Affiliation(s)
- Deborah P Saunders
- Department of Dental Oncology, North East Cancer Center, Health Sciences North, Sudbury, Ontario, Canada,
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Vokurka S, Skardova J, Hruskova R, Kabatova-Maxova K, Svoboda T, Bystricka E, Steinerova K, Koza V. The effect of polyvinylpyrrolidone-sodium hyaluronate gel (Gelclair) on oral microbial colonization and pain control compared with other rinsing solutions in patients with oral mucositis after allogeneic stem cells transplantation. Med Sci Monit 2012; 17:CR572-6. [PMID: 21959611 PMCID: PMC3539478 DOI: 10.12659/msm.881983] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Gelclair is an oral lubricating gel used in the management of oral mucositis (OM). We evaluated its efficacy, tolerance and impact on oral cavity microbial colonization in patients with OM after allogeneic hematopoietic stem cells transplantation. Material/Method Gelclair was administered in a group of 22 patients with active OM. A control group of 15 patients used other rinsing solutions (chlorhexidine, benzydamine, salvia). Tests with oral cavity swabs for microbiology analysis were performed once a week. Results The characteristics of OM in both groups were comparable, and rinsing solutions had satisfactory tolerability. There was no difference in the median improvement of oral intake and OM-related pain relief, which was assessed mostly as “slight effect”. In the Gelclair group, the effect duration was longer (median 3 [0–5] vs. 1 [0–3] hours, p=0.001). There was significant increase of Enterococcus faecalis and Candida sp. colonization of the oral cavity over the course of the hospitalization and significantly reduced incidence of such colonization in patients with OM in the Gelclair group: 1/22 (5%) vs. 6/15 (40%), p=0.01. In vitro tests showed inhibited growth of Enterococcus faecalis and Candida sp. colonies within the area of the Gelclair application. Conclusions Gelclair may be individually helpful in the management of OM and pain in patients after allogeneic stem cells transplantation. Its use did not lead to worsened oral bacterial and yeast colonization and probably even helped to protect mucosa from Enterococcus and Candida sp. Further studies based on larger cohorts are needed.
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Affiliation(s)
- Samuel Vokurka
- Department of Haemato-Oncology, University Hospital in Pilsen, Pilsen, Czech Republic.
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Rodríguez-Caballero A, Torres-Lagares D, Robles-García M, Pachón-Ibáñez J, González-Padilla D, Gutiérrez-Pérez JL. Cancer treatment-induced oral mucositis: a critical review. Int J Oral Maxillofac Surg 2011; 41:225-38. [PMID: 22071451 DOI: 10.1016/j.ijom.2011.10.011] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 10/01/2011] [Accepted: 10/10/2011] [Indexed: 01/09/2023]
Abstract
Head and neck cancer represents one of the main oncological problems. Its treatment, radiotherapy and chemotherapy leads to mucositis, and other side effects. The authors reviewed high-quality evidence published over the last 25 years on the treatment of cancer treatment-induced oral mucositis. A Medline search for double blind randomized controlled clinical trials between 1985 and 2010 was carried out. The keywords were oral mucositis, radiotherapy, chemotherapy, and head and neck. The different therapeutic approaches found for cancer treatment-induced oral mucositis included: intensive oral hygiene care; use of topical antiseptics and antimicrobial agents; use of anti-inflammatory agents; cytokines and growth factors; locally applied non-pharmacological methods; antioxidants; immune modulators; and homoeopathic agents. To date, no intervention has been able to prevent and treat oral mucositis on its own. It is necessary to combine interventions that act on the different phases of mucositis. It is still unclear which strategies reduce oral mucositis, as there is not enough evidence that describes a treatment with a proven efficiency and is superior to the other treatments for this condition.
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Clarkson JE, Worthington HV, Furness S, McCabe M, Khalid T, Meyer S. Interventions for treating oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2010; 2010:CD001973. [PMID: 20687070 PMCID: PMC6669240 DOI: 10.1002/14651858.cd001973.pub4] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Treatment of cancer is increasingly effective but associated with short and long term side effects. Oral side effects, including oral mucositis (mouth ulceration), remain a major source of illness despite the use of a variety of agents to treat them. OBJECTIVES To assess the effectiveness of interventions for treating oral mucositis or its associated pain in patients with cancer receiving chemotherapy or radiotherapy or both. SEARCH STRATEGY Electronic searches of Cochrane Oral Health Group and PaPaS Trials Registers (to 1 June 2010), CENTRAL via The Cochrane Library (to Issue 2, 2010), MEDLINE via OVID (1950 to 1 June 2010), EMBASE via OVID (1980 to 1 June 2010), CINAHL via EBSCO (1980 to 1 June 2010), CANCERLIT via PubMed (1950 to 1 June 2010), OpenSIGLE (1980 to 1 June 2010) and LILACS via the Virtual Health Library (1980 to 1 June 2010) were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information. SELECTION CRITERIA All randomised controlled trials comparing agents prescribed to treat oral mucositis in people receiving chemotherapy or radiotherapy or both. Outcomes were oral mucositis, time to heal mucositis, oral pain, duration of pain control, dysphagia, systemic infection, amount of analgesia, length of hospitalisation, cost and quality of life. DATA COLLECTION AND ANALYSIS Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation, blindness and withdrawals. Risk of bias assessment was carried out on six domains. The Cochrane Collaboration statistical guidelines were followed and risk ratio (RR) values calculated using fixed-effect models (less than 3 trials in each meta-analysis). MAIN RESULTS Thirty-two trials involving 1505 patients satisfied the inclusion criteria. Three comparisons for mucositis treatment including two or more trials were: benzydamine HCl versus placebo, sucralfate versus placebo and low level laser versus sham procedure. Only the low level laser showed a reduction in severe mucositis when compared with the sham procedure, RR 5.28 (95% confidence interval (CI) 2.30 to 12.13).Only 3 comparisons included more than one trial for pain control: patient controlled analgesia (PCA) compared to the continuous infusion method, therapist versus control, cognitive behaviour therapy versus control. There was no evidence of a difference in mean pain score between PCA and continuous infusion, however, less opiate was used per hour for PCA, mean difference 0.65 mg/hour (95% CI 0.09 to 1.20), and the duration of pain was less 1.9 days (95% CI 0.3 to 3.5). AUTHORS' CONCLUSIONS There is weak and unreliable evidence that low level laser treatment reduces the severity of the mucositis. Less opiate is used for PCA versus continuous infusion. Further, well designed, placebo or no treatment controlled trials assessing the effectiveness of interventions investigated in this review and new interventions for treating mucositis are needed.
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Affiliation(s)
- Jan E Clarkson
- University of DundeeDental Health Services Research UnitThe Mackenzie BuildingKirsty Semple WayDundeeUKDD2 4BF
| | - Helen V Worthington
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Susan Furness
- The University of ManchesterCochrane Oral Health Group, School of DentistryCoupland III Bldg, Oxford RdManchesterUKM13 9PL
| | - Martin McCabe
- University of ManchesterSchool of Cancer and Enabling Sciences, Manchester Academic Health Science CentreAcademic Unit of Paediatric and Adolescent Oncology, Young Oncology UnitThe Christie NHS Foundation Trust, Wilmslow RoadManchesterUKM20 4BX
| | - Tasneem Khalid
- Royal Manchester Children's HospitalDepartment of Haematology/OncologyOxford RoadManchesterUKM13 9WL
| | - Stefan Meyer
- The University of ManchesterPaediatric and Adolescent Oncology, Royal Manchester Children's and Christie Hospital, School of Cancer and Enabling Sciences, Manchester Academic Health Science CentreYoung Oncology Unit, Christie HospitalWilmslow RoadManchesterUKM20 4BX
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López-Jornet P, Camacho-Alonso F, Martinez-Canovas A. Clinical evaluation of polyvinylpyrrolidone sodium hyaluronate gel and 0.2% chlorhexidine gel for pain after oral mucosa biopsy: a preliminary study. J Oral Maxillofac Surg 2010; 68:2159-63. [PMID: 20538398 DOI: 10.1016/j.joms.2009.09.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 06/30/2009] [Accepted: 09/15/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE To study the symptoms of patients during the 7 days after incisional biopsy of the oral mucosa and the application of polyvinylpyrrolidone-sodium hyaluronate (Aloclair) gel or 0.2% chlorhexidine digluconate gel. MATERIALS AND METHODS A total of 90 consecutive patients with lesions requiring histopathologic analysis were studied. These patients were divided randomly into 3 groups. Group I (control group) received no topical treatment. For group II, the site of surgical intervention was treated topically with polyvinylpyrrolidone sodium hyaluronate (Aloclair; Sinclair Pharma, Surrey, United Kingdom) gel 3 times daily for 1 week. Group III was treated the same as group II but with 0.2% chorhexidine digluconate gel. Using a visual analog scale, we determined the interval at which the postoperative pain was maximal, and which parts of the mouth experienced the most postoperative complications. RESULTS The most intense peaks of maximal pain were recorded in the control group, with the maximal pain occurring 2 hours (median 2.2, range 0 to 8.5) after surgery, after which it tended to diminish gradually during the week of the study period. The maximal level of pain was significantly lower in groups II and III than in the control group (P = .048 and P = .054, respectively). The lip was the site most likely to experience maximal pain. CONCLUSION Topical application of polyvinylpyrrolidone sodium hyaluronate and chlorhexidine digluconate decreases the symptoms of oral mucosa biopsy.
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Affiliation(s)
- Pia López-Jornet
- Department of Oral Medicine, University of Murcia Faculty of Medicine and Odontology, Murcia, Spain.
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Epstein JB, Hong C, Logan RM, Barasch A, Gordon SM, Oberle-Edwards L, Oberlee-Edwards L, McGuire D, Napenas JJ, Elting LS, Spijkervet FKL, Brennan MT. A systematic review of orofacial pain in patients receiving cancer therapy. Support Care Cancer 2010; 18:1023-31. [PMID: 20544225 DOI: 10.1007/s00520-010-0897-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 04/23/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE We present the findings of a structured systematic review of the literature assessing orofacial pain induced by malignant disease and/or its therapy (excluding mucositis). This evaluation of the literature published after the 1989 NIH Development Consensus conference on the oral complications of cancer therapies is an effort to assess the prevalence of pain, quality of life and economic impact, and management strategies for cancer therapy-induced orofacial pain. METHODS A systematic medical literature search was conducted with assistance from a research librarian in MEDLINE/PubMed and EMBASE databases for articles published between January 1, 1990 and December 31, 2008. Each study was independently assessed by two reviewers with expertise in the field of oral oncology. RESULTS Thirty-nine studies assessed pain in the head and neck region. The measure was commonly embedded in quality of life studies. Most of these studies described pain in head and neck cancer (HNC) patients, which therefore became the focus of the report. Pain is common in patients with HNC and is reported by approximately half of patients prior to cancer therapy, 81% during therapy, 70% at the end of therapy, and by 36% at 6 months after treatment. Pain is experienced beyond the 6-month period by approximately one third of patients and is typically more severe than pre-treatment cancer-induced pain. CONCLUSIONS This systematic review identified the presence of pain before cancer therapy, likely attributable to the cancer; an increase in pain during therapy and the common persistence of pain following cancer treatment. Continuing research should use validated tools to prospectively assess orofacial pain, its causes and pathophysiology, and its effect on quality of life and economic impact. Clinical trials of pain management in this setting are also warranted.
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Affiliation(s)
- Joel B Epstein
- Department Oral Medicine and Diagnostic Sciences, University of Illinois, Chicago, IL 60612, USA.
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Regimen-related gastrointestinal toxicities in cancer patients. Curr Opin Support Palliat Care 2010; 4:26-30. [PMID: 20040879 DOI: 10.1097/spc.0b013e328335fb76] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Gastrointestinal toxicities are a common side effect of many forms of cytotoxic cancer therapy. Of the gastrointestinal toxicities, mucositis is among the most common and results in a range of symptoms that negatively impact patients' quality of life, ability to tolerate their cancer therapy, and health resource use. The purpose of this review is to describe the scope, risk factors, pathobiology, and treatment opportunities for mucositis. RECENT FINDINGS The historical paradigm by which mucositis occurs has been markedly revised in the past decade. The pathogenesis of mucositis is now recognized to consist of a series of complex biological events that ultimately result in the disruption of the integrity of the gastrointestinal tract. Risk factors for mucositis have been identified that are associated with its biology. Treatment strategies that target mucositis' mechanistic pathways hold significant promise. SUMMARY Mucosal injury induced by radiation or chemotherapy is a common, painful, function disrupting toxicity that, currently, has limited treatment options. The evolving understanding of the pathobiology of the condition provides multiple treatment targets that should ultimately result in amelioration of the condition.
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Scarpace SL, Brodzik FA, Mehdi S, Belgam R. Treatment of head and neck cancers: issues for clinical pharmacists. Pharmacotherapy 2009; 29:578-92. [PMID: 19397465 DOI: 10.1592/phco.29.5.578] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Head and neck cancers are a heterogeneous group of diseases involving the oral cavity, pharyngeal tube, and larynx. Given the drug therapy options available, clinical pharmacists can play an important role in the care of this patient population. They can recommend a regimen based on efficacy, toxicity, and patient-specific factors; ensure that the prescribed regimen has been studied and reported in the literature; verify dosages; and monitor and counsel patients about adverse effects. Chemotherapy plus radiation (chemoradiation) is often the standard treatment for patients with stage III or nonmetastatic stage IV head and neck cancer. Cisplatin-based regimens are preferred, although carboplatin may be appropriate in some circumstances. Induction therapy with a docetaxel-based regimen is recommended for some patients; however, this therapy has been associated with a high frequency of grade 3 and 4 neutropenia and febrile neutropenia. Cetuximab, an epidermal growth factor receptor inhibitor, is the newest agent approved for treatment of head and neck cancer. Although evidence supports cetuximab combined with cisplatin versus cisplatin alone for patients with metastatic disease, the role of combination therapy is less clear in patients undergoing chemoradiation. Patients with head and neck cancer may experience swallowing difficulties or mouth pain, possibly interfering with drug administration and adherence; thus, pharmacists in all practice settings should be knowledgeable about different regimens and alternative routes of administration. Xerostomia and mucositis are common adverse effects of radiation therapy, and it is critical that good oral hygiene practices are maintained. Patients may achieve symptomatic relief from xerostomia with saliva substitutes, and clinical experience suggests that use of pilocarpine is worthwhile. Until more evidence becomes available, prevention of xerostomia and mucositis with amifostine is still controversial. Salt-water rinses, bioadherent oral gel, and honey are relatively inexpensive and nontoxic agents for managing mucositis. Because of the expense of palifermin, it is best reserved for refractory cases. Skin toxicities are common with radiation. Rash is also a common adverse effect of cetuximab. When used together, they may produce complicated skin toxicities. It is important to become familiar with the grading of these rashes so that appropriate therapy can be recommended. As pharmacotherapy for head and neck cancers continues to evolve, clinical pharmacists will continue to have an important role in optimizing treatment for patients by balancing efficacy and toxicity.
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Affiliation(s)
- Sarah L Scarpace
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue,Albany, NY 12208, USA.
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Oral mucositis: a phenomenological study of pediatric patients’ and their parents’ perspectives and experiences. Support Care Cancer 2009; 17:829-37. [DOI: 10.1007/s00520-009-0618-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 03/16/2009] [Indexed: 10/21/2022]
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Keefe DM, Sonis ST, Bowen JM. Emerging drugs for chemotherapy-induced mucositis. Expert Opin Emerg Drugs 2008; 13:511-22. [PMID: 18764726 DOI: 10.1517/14728214.13.3.511] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Chemotherapy-induced mucositis is an increasingly recognized problem in cancer management, preventing full doses of treatment being given, compromising cure rates and reducing quality of life. Symptoms include mouth pain and ulceration, esophagitis, abdominal pain, bloating, and diarrhea. It is associated with increased infections and occasional mortality, and its palliation is very expensive. The pathobiology of mucositis is complex, and agents that target mechanisms to prevent mucositis or accelerate healing are in high demand. OBJECTIVES To review existing and potential treatments for chemotherapy-induced mucositis in the context of current knowledge of pathobiology. METHODS We searched for mucositis of any region of the gastrointestinal tract using Medline, the Pharmaprojects database and listed patents. RESULTS/CONCLUSIONS There are many agents in varying stages of development for chemotherapy-induced mucositis. The field is complicated by the question of whether treatments should be developed as drugs or as medical foods, and whether the burden of proof of efficacy and safety should be different.
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Affiliation(s)
- Dorothy M Keefe
- Royal Adelaide Hospital, RAH Cancer Centre, North Terrace, Adelaide, SA 5000, Australia.
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Buchsel PC, Murphy PJM. Polyvinylpyrrolidone–sodium hyaluronate gel (Gelclair®): a bioadherent oral gel for the treatment of oral mucositis and other painful oral lesions. Expert Opin Drug Metab Toxicol 2008; 4:1449-54. [DOI: 10.1517/17425255.4.11.1449] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ngeow WC, Chai WL, Zain RB. Management of radiation therapy-induced mucositis in head and neck cancer patients. Part II: supportive treatments. Oncol Rev 2008. [DOI: 10.1007/s12156-008-0072-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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