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Guedea M, Sánchez M, Lozano A, Ferrer M, Pont A, Guedea F, Clotet S, Juárez M, Araguas P, Ventura M, d'Oliveira NG, Ustrell JM. The EORTC QLQ43 and FACT H&N questionnaires of quality of life at 1 and 5 years after treatment and dental care in head and neck cancer patients: a pilot study. Clin Transl Oncol 2024:10.1007/s12094-024-03567-5. [PMID: 38909324 DOI: 10.1007/s12094-024-03567-5] [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: 04/30/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE This study aimed to examine health-related quality of life (HRQoL) in head and neck cancer patients at 1 and 5 years after successful treatment of their tumors, and to explore the usefulness of 2 instruments for assessing the need of dental care services. METHODS This cross-sectional pilot study included 20 adult patients with head and neck cancer who completed the Functional Assessment of Cancer Therapy-Head and Neck (FACT H&N) Symptom Index and the European Organization for Research and Treatment of Cancer Quality of Life Head and Neck Module (EORTC QLQ-H&N43) after 1 and 5 years of treatment. RESULTS Mean (standard deviation, SD) scores of the FACT H&N Symptom Index were higher (better HRQoL) at 5 years than at 1 year (24.1 [4.4] vs. 21.1 [6.4]; p = 0.236). Only three of the ten items of FACT H&N (swallow, pain in mouth/throat or neck, and solid foods) evaluated oral health. In the EORTC QLQ-H&N43 questionnaire, scores were lower at 5 years (better HRQoL) in almost all multi- and single-item symptoms. This questionnaire includes four multi-item scales (pain in the mouth, social eating, swallowing, and problems with teeth) measuring dental and orthodontic needs. CONCLUSION HRQoL in patients with head and neck cancer improved with the length of follow-up. The EORTC QLQ-H&N43 has more items addressing oral health compared to the FACT H&N Symptom Index and may be more adequate to assess the need of dental therapy in clinical practice.
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Affiliation(s)
- Marc Guedea
- Orthodontics Department, Facultat de Medicina i Ciències de la Salut, University of Barcelona (UB), Barcelona, Spain
| | - Meritxell Sánchez
- Orthodontics Department, Facultat de Medicina i Ciències de la Salut, University of Barcelona (UB), Barcelona, Spain
| | - Alicia Lozano
- Radiation Oncology Department, Institut Català d'Oncologia (ICO), Hospital Duran I Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
- Head and Neck Cancer Tumor Board, Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Research Institut - IMIM, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Pompeu Fabra, Barcelona, Spain
| | - Angels Pont
- Health Services Research Group, Hospital del Mar Research Institut - IMIM, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Pompeu Fabra, Barcelona, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d'Oncologia (ICO), Hospital Duran I Reynals, L'Hospitalet de Llobregat, Barcelona, Spain.
- Clinical Sciences Departament, Facultat de Medicina i Ciències de la Salut. University of Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Sandra Clotet
- Radiation Oncology Department, Institut Català d'Oncologia (ICO), Hospital Duran I Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Juárez
- Radiation Oncology Department, Institut Català d'Oncologia (ICO), Hospital Duran I Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Araguas
- Radiation Oncology Department, Institut Català d'Oncologia (ICO), Hospital Duran I Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montse Ventura
- Radiation Oncology Department, Institut Català d'Oncologia (ICO), Hospital Duran I Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuno Gustavo d'Oliveira
- Orthodontics Department, Facultat de Medicina i Ciències de la Salut, University of Barcelona (UB), Barcelona, Spain
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Nath J, Singh PK, Sarma G. Dental Care in Head and Neck Cancer Patients Undergoing Radiotherapy. Indian J Otolaryngol Head Neck Surg 2022; 74:6219-6224. [PMID: 36742621 PMCID: PMC9895163 DOI: 10.1007/s12070-021-02941-x] [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: 09/12/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
External beam radiotherapy is an integral part of the management of head and neck cancer. Radiotherapy for head and neck cancer lead to many treatment-related toxicities, including a wide range of dental morbidities. These complications depend on the various patient and treatment-related factors. Patients with poor oral hygiene, pre-existing periodontal disease, and the conventional mode of radiotherapy delivery are major factors leading to acute and severe late dental problems. Most of the complications are preventable with proper oral and dental care before, during and after radiotherapy. Pre radiotherapy dental evaluation to diagnose patients with potential risk and timely intervention can reduce long-term morbidities like carries, osteoradionecrosis, etc., thereby improving patients' quality of life. This article highlights the various aspects of dental care and management in head neck cancer patients before, during and after radiation therapy.
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Affiliation(s)
- Jyotiman Nath
- Department of Radiation Oncology, Dr B Boorach Cancer Institute, Guwahati, Assam 781016 India
| | | | - Gautam Sarma
- Department of Radiation Oncology, Dr B Boorach Cancer Institute, Guwahati, Assam 781016 India
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Poor dental condition is a factor of imbalance of the nutritional status at the outset of management of head and neck cancer. Clin Oral Investig 2021; 26:1251-1259. [PMID: 34415435 DOI: 10.1007/s00784-021-04097-y] [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: 03/03/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine whether deterioration of dental condition at the outset of management of head and neck cancer (HNC) is a nutritional risk and whether social deprivation is a cause of the poor dental condition observed in HNC patients. MATERIAL AND METHODS A nutritional assessment form (NAF) and the Nutrition Risk Index (NRI) were used to standardize the nutritional status of 108 patients at the outset of management of HNC (2017-2019). The NAF includes assessment of weight loss over the past 3 months, the amount and difficulty of food intake, and the presence of digestive disorders. Dental condition was assessed by the decayed, filled, and missing teeth acopre (DFM) index and the masticatory coefficient (MC). Dental status and social deprivation were correlated with the EPICES score. RESULTS A correlation was found between the extent of weight loss and dental condition. The MC was higher in absence of weight loss (46% vs. 27%, p = 0.03) and the DMF lower when weight loss was less than 5% (22.3 vs. 26.9 if > 5% loss of weight, p = 0.005). No correlation was found between dental status and nutritional status. Social deprivation was associated with a lower MC (26% vs. 50%, p < 0.001). CONCLUSION Dental condition is a risk factor for weight loss at the outset of management of HNC but is not a determinant of nutritional status. Clinical relevance Dental condition is no longer considered simply as a source of potential complications after radiotherapy but also as an important factor for nutritional status.
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Bhandari S, Soni BW, Ghoshal S. Impact of non-compliance with oral care on radiation caries in head and neck cancer survivors. Support Care Cancer 2021; 29:4783-4790. [PMID: 33527227 DOI: 10.1007/s00520-021-06033-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE A cross-sectional study was performed to quantify radiation caries (RC); explore the possible influence of various covariates like elapsed time since radiotherapy, cancer site and stage, treatment modality(ies), grades of xerostomia (GOX), and inter-incisal mouth opening on RC; and also to estimate the unmet treatment needs in head and neck cancer (HNC) survivors, where personal and professional oral care was neglected before and after completion of the treatment. METHODOLOGY Clinical status of the dentition was recorded using decayed missing filled surface/decayed missing filled teeth (DMFS/DMFT) index. Patients were grouped according to the respective covariates, and relevant statistical analysis was performed considering p value ≤ 0.05 as statistically significant. RESULTS Eighty nine patients, 72 males and 17 females, with a mean age of 52.37±11.19 (range 18-70) years were included in this study. Overall, 85% (76/89) and 78% (29/37), 87.5% (35/40), and 100% (12/12) of patients reporting within 1, 1-3, and 3-5 years after RT, respectively, were affected with RC. The mean DMFS/DMFT score, range, and standard deviation in the included patients up to 5 years post-RT were 61.12/15.99, 0-128/0-28, and 36.608/8.66, respectively. Unmet treatment needs concerning dental decay were 97%. A statistically significant difference was found between the mean DMFS with elapsed time since radiotherapy and different GOX, respectively. CONCLUSION Oral health will be worse, treatment needs will be high, and limitations to performing desirable treatment will be numerous in HNC patients, where the oral care component of their treatment is ignored. Future studies are required to identify the true relationship between various risk factors and the development and progression of RC.
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Affiliation(s)
- Sudhir Bhandari
- Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Bhavita Wadhwa Soni
- Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rouers M, Bornert F, Truntzer P, Dubourg S, Bourrier C, Antoni D, Noël G. Ability to Propose Optimal Prosthetic Rehabilitation can be Improved by Discussion between the Dentist and Radiation Oncologist Regarding Upstream Dosimetry. Eur J Dent 2019; 13:88-94. [PMID: 31170766 PMCID: PMC6635961 DOI: 10.1055/s-0039-1688523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective
Improvement of dental rehabilitation for patients who have undergone radiation therapy requires knowledge of the dose in the maxillary and mandible bones.
Materials and Methods
Forty-three patients with head and neck cancers underwent evaluation for dental rehabilitation before radiation treatment dosimetry. The delivered dose to the maxilla and mandible was determined. From the dose data in the literature, three levels of risk of implant failure were defined. According to the delivered doses, the authors calculated the percentage of patients who could be fully rehabilitated with an implant, as proposed by the dentist before radiation planning.
Results
Before dosimetry calculation, all of the completely edentulous arches and 94 partially edentulous (PESs) sextants could be optimally rehabilitated. After dose calculation, among the 14 arches of 7 patients who were completely edentulous, according to the mean and maximal delivered doses, 11 arches (78.6%) and 7 arches (50%) could receive an optimal prosthesis, respectively. For the three patients, who were PESs but with one arch that was completely edentulous, according to the mean and maximal delivered doses, one arch for each dose condition could receive an optimal prosthesis. Among the 94 PESs sextants, according to the mean and maximal delivered doses, 41 (43.6%) and 24 (25.5%) sextants could receive an optimal prosthesis, respectively.
Conclusion
By determining the sites of implantation before dosimetry, the radiation oncologist could shield specified areas, potentially improving the possibilities for dental rehabilitation. The dialogue between the dentist and the radiation oncologist can improve the possibilities for implants and decrease the risk of unsafe implantation.
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Affiliation(s)
- Mélanie Rouers
- Faculty of Dental Medicine, 1 Place de l'Hôpital, Strasbourg, France
| | - Fabien Bornert
- Faculty of Dental Medicine, 1 Place de l'Hôpital, Strasbourg, France
| | - Pierre Truntzer
- University Radiation Department, Centre Paul Strauss, Strasbourg, France
| | - Sarah Dubourg
- Faculty of Dental Medicine, 1 Place de l'Hôpital, Strasbourg, France
| | - Cyrielle Bourrier
- University Radiation Department, Centre Paul Strauss, Strasbourg, France
| | - Delphine Antoni
- University Radiation Department, Centre Paul Strauss, Strasbourg, France.,Strasbourg University, Radiobiology Lab, Centre Paul Strauss, Strasbourg, France
| | - Georges Noël
- University Radiation Department, Centre Paul Strauss, Strasbourg, France.,Strasbourg University, Radiobiology Lab, Centre Paul Strauss, Strasbourg, France
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Abstract
Radiotherapy is a key therapeutic modality used in the treatment of oral cavity and oropharyngeal cancers, whether as definitive treatment or postoperatively for those with high-risk factors after surgery. Although radiotherapy is a proven, effective treatment of cancer control, it can result in significant acute and late toxicities. Pretreatment patient education, supportive care, and posttreatment adherence to rehabilitative and preventive care can help mitigate toxicities. Advances in radiation delivery, such as through continued technological advances, or novel approaches to customizing radiation dose and volume, to maximize the therapeutic efficacy while minimizing side effects, are warranted.
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Affiliation(s)
- Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, TRC 2-West, Philadelphia, PA 19104, USA.
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Rouers M, Dubourg S, Bornert F, Truntzer P, Antoni D, Couchot J, Ganansia V, Bourrier C, Guihard S, Noël G. État buccodentaire des patients avant radiothérapie des voies aérodigestives supérieures : analyse prospective de 48 patients. Cancer Radiother 2016; 20:199-204. [PMID: 27131393 DOI: 10.1016/j.canrad.2015.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 12/12/2015] [Accepted: 12/16/2015] [Indexed: 12/21/2022]
Affiliation(s)
- M Rouers
- Faculté de chirurgie dentaire de Strasbourg, 8, rue Sainte-Élisabeth, 67000 Strasbourg, France
| | - S Dubourg
- Faculté de chirurgie dentaire de Strasbourg, 8, rue Sainte-Élisabeth, 67000 Strasbourg, France; Unité de pathologie-chirurgie buccale, pôle de médecine et de chirurgie buccodentaires, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - F Bornert
- Faculté de chirurgie dentaire de Strasbourg, 8, rue Sainte-Élisabeth, 67000 Strasbourg, France; Unité de pathologie-chirurgie buccale, pôle de médecine et de chirurgie buccodentaires, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - P Truntzer
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Fédération de médecine translationnelle de Strasbourg (FMTS), laboratoire EA 3430, université de Strasbourg, 67065 Strasbourg, France
| | - J Couchot
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - V Ganansia
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - C Bourrier
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - S Guihard
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - G Noël
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Fédération de médecine translationnelle de Strasbourg (FMTS), laboratoire EA 3430, université de Strasbourg, 67065 Strasbourg, France.
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Tensile Bond Strengths of Two Adhesives on Irradiated and Nonirradiated Human Dentin. BIOMED RESEARCH INTERNATIONAL 2016; 2015:798972. [PMID: 26783528 PMCID: PMC4689887 DOI: 10.1155/2015/798972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/11/2015] [Indexed: 11/18/2022]
Abstract
The aim of this study was to assess the effect of radiotherapy on bond efficiency of two different adhesive systems using tensile bond strength test. Twenty extracted teeth after radiotherapy and twenty nonirradiated extracted teeth were used. The irradiation was applied in vivo to a minimal dose of 50 Gy. The specimens of each group were randomly assigned to two subgroups to test two different adhesive systems. A three-step/etch-and-rinse adhesive system (Optibond FL) and a two-steps/self-etch adhesive system (Optibond XTR) were used. Composite buildups were performed with a nanohybrid composite (Herculite XTR). All specimens were submitted to thermocycling ageing (10000 cycles). The specimens were sectioned in 1 mm(2) sticks. Microtensile bond strength tests were measured. Nonparametric statistical analyses were performed due to nonnormality of data. Optibond XTR on irradiated and nonirradiated teeth did not show any significant differences. However, Optibond FL bond strength was more effective on nonirradiated teeth than on irradiated teeth. Within the limitations of an in vitro study, it can be concluded that radiotherapy had a significant detrimental effect on bond strength to human dentin. However, it seems that adhesive choice could be adapted to the substrata. According to the present study, the two-steps/self-etch (Optibond XTR) adhesive system tested could be more effective on irradiated dentin compared to three-steps/etch-and-rinse adhesive system (Optibond FL).
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[Dental state in patients with head and neck cancers]. Cancer Radiother 2015; 19:205-10; quiz 230, 234. [PMID: 25937188 DOI: 10.1016/j.canrad.2015.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/20/2015] [Accepted: 01/27/2015] [Indexed: 01/08/2023]
Abstract
In France, in 2005, there were approximately 16,000 new cases of head and neck cancer. These cancers have an unfavourable prognosis: the survival rates at 3 and 10 years are 50% and 10% respectively. The consumption of alcohol and tobacco is the most important risk factor; in some countries HPV infection was identified as a risk factor of head and neck tumours. Furthermore, a poor oral hygiene seems to raise this risk. We found many decay and periodontium problems in patients with an upper aerodigestive tract cancer. An evaluation of dental state is necessary before any cancer treatment. Treatments by radiotherapy engender noxious effects: hypocellular, hypovascularization, hypoxie of the irradiated tissues, which lead to immediate and chronically oral complications such as mucositis, fibrosis, xerostomia, decay, or osteoradionecrosis. An oral follow-up of these patients can prevent these complications, or reduce the severity of oral complications, and promote a good oral state.
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Beech N, Robinson S, Porceddu S, Batstone M. Dental management of patients irradiated for head and neck cancer. Aust Dent J 2014; 59:20-8. [PMID: 24495127 DOI: 10.1111/adj.12134] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 12/12/2022]
Abstract
Patients undergoing radiation therapy as either primary, adjuvant, combination therapy or palliative management of head and neck malignancies are prone to a range of dental complications. Strategies for prevention and management of such complications may be controversial. This article aims to highlight the current understanding and management of the dental needs for patients before, during and after radiation therapy.
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Affiliation(s)
- N Beech
- Royal Brisbane and Women's Hospitals, The University of Queensland
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Jaussaud S, Guihard S, Niederst C, Borel C, Meyer P, Hémar P, Schultz P, Noël G, Féki A. [Constraints of the dentist are consistent with the results of an optimal irradiation with modulated intensity in N0 oropharyngeal cancer]. Cancer Radiother 2013; 17:265-71. [PMID: 23726044 DOI: 10.1016/j.canrad.2013.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 12/26/2012] [Accepted: 01/31/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We compared intensity-modulated radiotherapy and 3D-conformal irradiation in oropharyngeal cancers according to the requirement of dentists. MATERIAL AND METHODS From the files of seven patients with cancer of the oropharynx, two dosimetry plannings for 3D-conformal radiotherapy and intensity-modulated radiotherapy with tomotherapy were performed. The dose distributions in the target volumes and organs at risk in relation to the dental sphere were compared. RESULTS For the planning target volume of the primitive tumour sites, average values of V95%, D2%, D98% and of the conformal index were statistically in favour of tomotherapy. For the planning target volume of node areas, averages values of V95%, D2%, D98% were statistically in favour of tomotherapy. For ipsi- and controlateral parotide glands, average values of V15Gy, V26Gy, V30Gy, V40Gy were significantly lower for tomotherapy. For the submaxillary glands, average values of mean doses and V40Gy were statistically in favour of tomotherapy. For the buccal cavity, the average values of V45Gy were statistically in favour of tomotherapy. For ipsi- and controlateral masseter muscles, the average values of mean doses were statistically in favour of tomotherapy. For the ipsi- and controlateral temporomandibular joints, average values of mean doses and V60Gy were statistically in favour of tomotherapy. For mandibular bone, average values of mean doses and V40Gy, V50Gy, V60Gy and V70Gy were statistically in favour of tomotherapy. For maxillary bone, average values of V40Gy, V50Gy and V60Gy were statistically in favour of tomotherapy. CONCLUSION The radiation oncologist can constrain the intensity-modulated radiotherapy dosimetry to the needs of dentists to prevent or improve dental care and quality of life.
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Affiliation(s)
- S Jaussaud
- Faculté Dentaire, Hôpital Civil, 67000 Strasbourg, France
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Deymier-Black AC, Singhal A, Yuan F, Almer JD, Brinson LC, Dunand DC. Effect of high-energy X-ray irradiation on creep mechanisms in bone and dentin. J Mech Behav Biomed Mater 2013; 21:17-31. [DOI: 10.1016/j.jmbbm.2013.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/08/2013] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
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Deymier-Black AC, Singhal A, Almer JD, Dunand DC. Effect of X-ray irradiation on the elastic strain evolution in the mineral phase of bovine bone under creep and load-free conditions. Acta Biomater 2013; 9:5305-12. [PMID: 22871638 DOI: 10.1016/j.actbio.2012.07.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/16/2012] [Accepted: 07/27/2012] [Indexed: 11/16/2022]
Abstract
Both the load partitioning between hydroxyapatite (HAP) and collagen during compressive creep deformation of bone and the HAP residual strain in unloaded bone have been shown in previous synchrotron X-ray diffraction studies to be affected by the X-ray irradiation dose. Here, through detailed analysis of the X-ray diffraction patterns of bovine bone, the effect of X-ray dose on (i) the rate of HAP elastic strain accumulation/shedding under creep conditions and (ii) the HAP lattice spacing and average root mean square (RMS) strain under load-free conditions are examined. These strain measurements exhibit three stages in response to increasing X-ray dose. Up to ∼75 kGy (stage I) no effect of dose is observed, indicating a threshold behavior. Between ∼75 and ∼300 kGy (stage II) in unloaded bone the HAP d-spacing increases and the RMS strain decreases with dose, indicating strain relaxation of HAP. Furthermore, under constant compressive load creep conditions, the rate of compressive elastic strain accumulation in HAP decreases with increasing dose until, at ∼115 kGy, it changes sign, indicating that the HAP phase is shedding load during creep deformation. These stage II behaviors are consistent with HAP-collagen interfacial damage, which allows the HAP elastic strain to relax within both the loaded and unloaded samples. Finally, for doses in excess of ∼300 kGy (stage III, measured up to 7771 kGy) the HAP lattice spacing and RMS strain for load-free samples and the rate of HAP elastic strain shedding for crept samples remain independent of dose, suggesting a saturation of damage and/or stiffening of the collagen matrix due to intermolecular cross-linking.
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Affiliation(s)
- Alix C Deymier-Black
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.
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Thariat J, Ramus L, Odin G, Vincent S, Darcourt V, Orlanducci MH, Dassonville O, Lacout A, Marcy PY, Cagnol G, Malandain G. [Revisiting the dose-effect correlations in irradiated head and neck cancer using automatic segmentation tools of the dental structures, mandible and maxilla]. Cancer Radiother 2011; 15:683-90. [PMID: 22100413 DOI: 10.1016/j.canrad.2011.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/04/2011] [Accepted: 05/26/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Manual delineation of dental structures is too time-consuming to be feasible in routine practice. Information on dose risk levels is crucial for dentists following irradiation of the head and neck to avoid postextraction osteoradionecrosis based on empirical dose-effects data established on bidimensional radiation therapy plans. MATERIAL AND METHODS We present an automatic atlas-based segmentation framework of the dental structures, called Dentalmaps, constructed from a patient image-segmentation database. RESULTS This framework is accurate (within 2 Gy accuracy) and relevant for the routine use. It has the potential to guide dental care in the context of new irradiation techniques. CONCLUSION This tool provides a user-friendly interface for dentists and radiation oncologists in the context of irradiated head and neck cancer patients. It will likely improve the knowledge of dose-effect correlations for dental complications and osteoradionecrosis.
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Affiliation(s)
- J Thariat
- Département de Radiothérapie, Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France.
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Thariat J, Ramus L, Darcourt V, Marcy PY, Guevara N, Odin G, Poissonnet G, Castillo L, Ali AM, Righini C. Compliance with fluoride custom trays in irradiated head and neck cancer patients. Support Care Cancer 2011; 20:1811-4. [PMID: 21947441 DOI: 10.1007/s00520-011-1279-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 09/13/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study is to assess compliance with fluoride gel custom trays in irradiated head and neck cancer patients. METHODS AND MATERIALS One hundred fifty-five consecutive patients on remission following radiation therapy of head and neck cancers were assessed retrospectively for dental care practices prior to radiation and prospectively for long-term compliance with custom trays from November 2009 to January 2010. A five-item questionnaire was filled in by patients in the waiting room, and a 15-item questionnaire by the physician in charge during the corresponding follow-up visit. RESULTS Ten percent of patients were edentulous at inclusion. Among dentate patients, 17% had total extractions. With a mean follow-up of 24 months, 19% of patients used custom trays for over a year. Primary stage, age, and tobacco consumption were correlated with compliance with custom trays. More than half of dentate patients developed carious lesions, and 8% had stage 1-3 osteoradionecrosis of the whole population of edentulous and dentate patients. CONCLUSION Compliance with custom trays was poor in this series. Specific postirradiation dental care follow-up visits and education have demonstrated their utility in the era of 2D irradiation. We currently advocate an 18-month compliance with custom trays in IMRT patients on the basis of the Parsport trial, after which we assess the quality of salivary recovery before recommending prolonged use or interruption. Data with innovative irradiation techniques are however required.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology/Institut Universitaire de la Face et du Cou fo J thariat, Cancer Center Antoine-Lacassagne, University Nice Sophia-Antipolis, 33 Av. Valombrose, 06189, NICE Cedex 2, France.
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Thariat J, Ramus L, Maingon P, Odin G, Gregoire V, Darcourt V, Guevara N, Orlanducci MH, Marcie S, Poissonnet G, Marcy PY, Bozec A, Dassonville O, Castillo L, Demard F, Santini J, Malandain G. Dentalmaps: automatic dental delineation for radiotherapy planning in head-and-neck cancer. Int J Radiat Oncol Biol Phys 2011; 82:1858-65. [PMID: 21621340 DOI: 10.1016/j.ijrobp.2011.03.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 03/04/2011] [Accepted: 03/12/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To propose an automatic atlas-based segmentation framework of the dental structures, called Dentalmaps, and to assess its accuracy and relevance to guide dental care in the context of intensity-modulated radiotherapy. METHODS AND MATERIALS A multi-atlas-based segmentation, less sensitive to artifacts than previously published head-and-neck segmentation methods, was used. The manual segmentations of a 21-patient database were first deformed onto the query using nonlinear registrations with the training images and then fused to estimate the consensus segmentation of the query. RESULTS The framework was evaluated with a leave-one-out protocol. The maximum doses estimated using manual contours were considered as ground truth and compared with the maximum doses estimated using automatic contours. The dose estimation error was within 2-Gy accuracy in 75% of cases (with a median of 0.9 Gy), whereas it was within 2-Gy accuracy in 30% of cases only with the visual estimation method without any contour, which is the routine practice procedure. CONCLUSIONS Dose estimates using this framework were more accurate than visual estimates without dental contour. Dentalmaps represents a useful documentation and communication tool between radiation oncologists and dentists in routine practice. Prospective multicenter assessment is underway on patients extrinsic to the database.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology/Institut de biologie et developpement du cancer (IBDC) centre national de la recherche scientifique (CNRS) unite mixte de recherche (UMR) 6543, Cancer Center Antoine-Lacassagne, University of Nice Sophia-Antipolis, Nice Cedex, France.
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