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Chen YC, Viet-Nhi NK, Dang LH, Su CH, Hung SH. Efficacy of Office-Based Salivary Ductal Steroid Irrigation for Managing Post-Irradiation Xerostomia in Head and Neck Cancer Patients: A Retrospective Study. Biomedicines 2024; 12:1033. [PMID: 38790995 PMCID: PMC11117565 DOI: 10.3390/biomedicines12051033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Post-irradiation xerostomia remains a significant quality of life concern for patients with head and neck cancers. Conventional therapies offer limited effectiveness. This study aims to investigate the therapeutic potential of office-based salivary ductal steroid irrigation in patients with post-irradiation xerostomia. This single-center observational study recruited 147 head and neck cancer patients suffering from post-irradiation xerostomia between November 2020 and October 2022. All included subjects received at least one round of successful salivary ductal cannulation and irrigation. The primary measure of efficacy was improvement in subjective xerostomia and objective salivary amylase levels. A logistic regression was employed to evaluate factors affecting treatment responsiveness. The response rate among nasopharyngeal cancer (NPC) patients was 74.8%, and that among non-NPC cancer was 65.6%, without significant intergroup differences. The statistical analysis revealed no significant influence of age, gender, or disease stage on treatment responsiveness. Post-treatment salivary amylase levels were significantly higher in responsive non-NPC patients. In conclusion, salivary ductal steroid irrigation emerged as a promising therapeutic modality for the management of post-irradiation xerostomia in head and neck cancer patients. While no explicit factors were predictive of responsiveness, the high rate of symptom improvement suggests that this therapy may be a viable alternative for patients that are refractory to standard treatments.
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Affiliation(s)
- Yen-Chun Chen
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Nguyen-Kieu Viet-Nhi
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Luong Huu Dang
- Department of Otolaryngology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam;
| | - Chin-Hui Su
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Otolaryngology, Mackay Memorial Hospital, Taipei 104217, Taiwan
| | - Shih-Han Hung
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei 116079, Taiwan
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2
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Zarzar AM, Sales PHDH, Barros AWP, Arreguy IMS, Carvalho AAT, Leão JC. Effectiveness of dental implants in patients undergoing radiotherapy for head and neck cancer: An umbrella review. SPECIAL CARE IN DENTISTRY 2024; 44:40-56. [PMID: 36852979 DOI: 10.1111/scd.12840] [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: 09/12/2022] [Revised: 12/17/2022] [Accepted: 02/12/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE The objective of this overview is to evaluate the effectiveness of dental implants placed in patients who underwent radiotherapy for the treatment of head and neck cancer, as well as to assess the methodological quality of the included systematic reviews. METHODS The study was conducted in four PubMed, Lilacs, Dare Cochrane and Google Scholar databases until July 2022, using the descriptors "Radiotherapy," "Dental implants," and "Head and Neck Cancer." RESULTS 958 studies were found in the initial search and after applying the inclusion and exclusion criteria, fifteen systematic reviews were selected to compose this overview and had their methodological quality evaluated by the AMSTAR 2 tool. RESULTS 24,996 implants in 5487 patients were evaluated with a rate of success rate of 86.2% in patients who underwent radiotherapy and 95.2% in patients who did not undergo radiotherapy. Only one of the systematic reviews was of high quality according to AMSTAR 2. CONCLUSION Oral rehabilitation with dental implants in patients with a history of head and neck cancer undergoing radiotherapy is a valid therapy. However, given the level of evidence found, further studies with better design are necessary to provide greater confidence in the clinical decision.
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Affiliation(s)
- Adriana Machado Zarzar
- Department of Prosthesis and Oral and Maxillofacial Surgery, Dental School, Federal University of Pernambuco, Recife, Brazil
| | - Pedro Henrique da Hora Sales
- Department of Prosthesis and Oral and Maxillofacial Surgery, Dental School, Federal University of Pernambuco, Recife, Brazil
| | - Ana Waleska Pessoa Barros
- Department of Prosthesis and Oral and Maxillofacial Surgery, Dental School, Federal University of Pernambuco, Recife, Brazil
| | | | | | - Jair Carneiro Leão
- Department of Clinical and Preventive Dentistry, Dental School, Federal University of Pernambuco, Recife, Brazil
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3
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Dörfler J, Freuding M, Zaiser C, Büntzel J, Keinki C, Käsmann L, Hübner J. Umbrella review: Summary of findings for acupuncture as treatment for radiation-induced xerostomia. Head Neck 2023; 45:1026-1044. [PMID: 36779370 DOI: 10.1002/hed.27297] [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: 07/19/2022] [Revised: 12/16/2022] [Accepted: 01/23/2023] [Indexed: 02/14/2023] Open
Abstract
Acupuncture is a common part of complementary medicine. However, traditional Chinese acupuncture has been built on concepts which are not in accordance with science-based medicine. Our aim was to critically assess the evidence presented in systematic reviews (SRs) and meta-analyses (MAs) about the effectiveness of acupuncture on radiotherapy induced xerostomia. A systematic search was conducted in February 2022. We evaluated all SRs/MAs using the AMSTAR-2 instrument. Eight SRs, with 12 controlled studies were included. All SRs summarize that the methodological drawbacks do not allow to give a clear statement about the effectiveness of acupuncture. While objective assessments in most SRs/MAs reported no difference between real and sham acupuncture, some favorable effects on subjective xerostomia symptoms are found. No clinical meaningful effectiveness of acupuncture on xerostomia has been proven so far, but positive subjective findings need to be explored more. While most SRs recommend further studies, studies involving patients with a serious cancer diagnosis are ethically questionable.
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Affiliation(s)
- Jennifer Dörfler
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Maren Freuding
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Christopher Zaiser
- Abteilung für Medizinische Statistik, Universitätsklinikum Jena, Jena, Germany
| | - Jens Büntzel
- Klinik für HNO-Erkrankungen, Kopf-Hals-Chirurgie, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - Christian Keinki
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Lukas Käsmann
- Abteilung für Radioonkologie, Universitätsklinikum, LMU München, Munich, Germany
| | - Jutta Hübner
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
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4
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Nam K, Dos Santos HT, Maslow F, Trump BG, Lei P, Andreadis ST, Baker OJ. Laminin-1 Peptides Conjugated to Fibrin Hydrogels Promote Salivary Gland Regeneration in Irradiated Mouse Submandibular Glands. Front Bioeng Biotechnol 2021; 9:729180. [PMID: 34631679 PMCID: PMC8498954 DOI: 10.3389/fbioe.2021.729180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Previous studies demonstrated that salivary gland morphogenesis and differentiation are enhanced by modification of fibrin hydrogels chemically conjugated to Laminin-1 peptides. Specifically, Laminin-1 peptides (A99: CGGALRGDN-amide and YIGSR: CGGADPGYIGSRGAA-amide) chemically conjugated to fibrin promoted formation of newly organized salivary epithelium both in vitro (e.g., using organoids) and in vivo (e.g., in a wounded mouse model). While these studies were successful, the model's usefulness for inducing regenerative patterns after radiation therapy remains unknown. Therefore, the goal of the current study was to determine whether transdermal injection with the Laminin-1 peptides A99 and YIGSR chemically conjugated to fibrin hydrogels promotes tissue regeneration in irradiated salivary glands. Results indicate that A99 and YIGSR chemically conjugated to fibrin hydrogels promote formation of functional salivary tissue when transdermally injected to irradiated salivary glands. In contrast, when left untreated, irradiated salivary glands display a loss in structure and functionality. Together, these studies indicate that fibrin hydrogel-based implantable scaffolds containing Laminin-1 peptides promote secretory function of irradiated salivary glands.
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Affiliation(s)
- Kihoon Nam
- Bond Life Sciences Center, University of Missouri, Columbia, MO, United States.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Harim T Dos Santos
- Bond Life Sciences Center, University of Missouri, Columbia, MO, United States.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Frank Maslow
- Bond Life Sciences Center, University of Missouri, Columbia, MO, United States.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Bryan G Trump
- School of Dentistry, University of Utah, Salt Lake City, UT, United States
| | - Pedro Lei
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Stelios T Andreadis
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States.,Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States.,Center of Bioinformatics and Life Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States.,Center of Cell, Gene and Tissue Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Olga J Baker
- Bond Life Sciences Center, University of Missouri, Columbia, MO, United States.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States.,Department of Biochemistry, University of Missouri, Columbia, MO, United States
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5
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Loy F, Isola M, Masala C, Isola R. Reactivity of human labial glands in response to cevimeline treatment. Anat Rec (Hoboken) 2021; 304:2879-2890. [PMID: 33704905 DOI: 10.1002/ar.24617] [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: 09/04/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/08/2022]
Abstract
Among the pathologies affecting the salivary glands, the Sjögren's syndrome (SS), an autoimmune disease, causes progressive destruction of the glandular tissue. The effect of SS is particularly evident on the labial glands and the morphological analysis of these minor glands is considered useful for diagnosis. Cevimeline hydrochloride (SNI), a selective muscarinic agonist drug, is one of the elective treatments for the hyposalivation due to SS, acting not only on major salivary glands, but also on labial glands since their secretion is primarily under parasympathetic control. Aim of this study is to describe the morphology of human labial glands treated with SNI by light, transmission, and high-resolution scanning electron microscopy. Moreover, a morphometric analysis was applied to the light and transmission electron microscopy micrographs to obtain data that were then compared with analogous data collected on control and carbachol-treated labial glands. Following SNI administration, the mucous tubules exhibited enlarged lumina, which were filled with a dense mucous secretion. Occasionally, small broken debris of the cells were retrieved into the lumen. In the mucous secretory cells, some mucous droplets fused to form a large vacuole-like structure. Similarly, the seromucous acini showed both dilated lumina and canaliculi. These above reported signs of secretion were confirmed through morphometric analysis and a milder action of SNI than carbachol on labial parenchyma was observed. This study confirmed that SNI also evoked secretion on labial glands and that its effect is more physiologic than that of the pan-muscarinic agonists.
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Affiliation(s)
- Francesco Loy
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Michela Isola
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Carla Masala
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Raffaella Isola
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
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6
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Brook I. Early side effects of radiation treatment for head and neck cancer. Cancer Radiother 2021; 25:507-513. [PMID: 33685809 DOI: 10.1016/j.canrad.2021.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/04/2021] [Indexed: 12/28/2022]
Abstract
Purpose of this review of medical literature is to present the immediate side effects of radiation therapy for head and neck cancer and their treatment. The likelihood and severity of these immediate side effects depends on a number of factors, including the total dose of radiation delivered, over what time it was delivered and what parts of the head and neck received radiation. Early side effects include: inflammation of the oropharyngeal mucosa (mucositis), painful swallowing (odynophagia), difficulty swallowing (dysphagia), hoarseness, lack of saliva (xerostomia), orofacial pain, laryngeal radionecrosis, dermatitis, hair loss, nausea, vomiting, inadequate nutrition and hydration, and weight loss. These complications can interfere with, and delay treatment. Most of these side effects generally dissipate over time. In conclusion, radiation treatment for the head and neck cancer causes significant early side effects. Many of these side effects present difficult challenges to the patients. Their recognition and treatment can significantly improve the patients' health, long-term survival and quality of life. The review provides information that can assist head and cancer survivors deal with radiation side effects.
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Affiliation(s)
- I Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington DC, USA.
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7
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Crary MA. Dysphagia and Head and Neck Cancer. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Tamaki A, Silverman DA, Ozer E. The Role of Hyperbaric Oxygen in Head and Neck Reconstruction and Facial Cosmetic Surgery. Facial Plast Surg 2020; 36:753-759. [PMID: 33368132 DOI: 10.1055/s-0040-1717095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Hyperbaric oxygen (HBO) is a treatment modality with the primary mechanism of therapy being the delivery of oxygen to hypoxic tissues. A review of HBO applications in the field of head and neck reconstruction and facial cosmetic surgery is provided. HBO can be useful in the management of radiation sequelae and treatment of compromised flaps and grafts. It may also have application in tissue compromise following cosmetic surgery and dermal fillers. We provide evidence from the available literature as well as highlight our experience in using HBO in head and neck reconstruction.
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Affiliation(s)
- Akina Tamaki
- Department of Otolaryngology - Head and Neck Surgery, James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Dustin A Silverman
- Department of Otolaryngology - Head and Neck Surgery, James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio
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9
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Hyperbaric oxygen therapy for the placement of dental implants in irradiated patients: systematic review and meta-analysis. Br J Oral Maxillofac Surg 2020; 59:625-632. [PMID: 33952404 DOI: 10.1016/j.bjoms.2020.08.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2022]
Abstract
This study was a systematic review with meta-analysis to evaluate the influence of hyperbaric oxygen therapy (HBOT) on the survival of dental implants placed in patients who had had radiotherapy for cancer of the head and neck. A systematic literature search was conducted using the PubMed/Medline, Science Direct, Embase and the Cochrane Library, between January 1985 and July 2018. The study observed the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) declaration and norms, and the systematic review was duly recorded in the PROSPERO (International prospective register of systematic reviews) database. Inclusion and exclusion criteria were applied, and all articles were selected on the basis of PICO questions. The process of eligibility and quality evaluation yielded three studies for statistical analysis. Based on the survival rates, there was no evidence that the risk of an implant failing was different between the patients who received HBOT and those who did not. Moreover, the risk of an implant failing did not depend on the anatomical site. HBOT exerted no beneficial influence on the survival rates of implants placed in irradiated patients, and the risk of an implant failing did not depend on its location.
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10
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Paterson C, Thomson M, Caldwell B, Young R, McLean A, Porteous S, Clark S, Messow C, Kean S, Grose D, Lamb C, Rizwannullah M, James A, Schipani S, Wilson C, Rulach R, Jones R. Radiotherapy-induced xerostomia: a randomised, double-blind, controlled trial of Visco-ease™ oral spray compared with placebo in patients with cancer of the head and neck. Br J Oral Maxillofac Surg 2019; 57:1119-1125. [DOI: 10.1016/j.bjoms.2019.10.300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/09/2019] [Indexed: 01/28/2023]
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11
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Birch S, Lee MS, Alraek T, Kim TH. Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: a narrative review. Integr Med Res 2019; 8:160-166. [PMID: 31304088 PMCID: PMC6600712 DOI: 10.1016/j.imr.2019.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022] Open
Abstract
Background Recently research on acupuncture for cancer related symptoms has significantly increased. To what extent have medical professionals recommended to use acupuncture in light of that evidence? Methods Evidence of effectiveness and safety was found by searching Pubmed for reviews to identify for what conditions and general results. Publications that recommend acupuncture in oncology were searched in the database of an ongoing general search for publications that recommend acupuncture. This database was developed by searching google for publications that recommend the use of acupuncture with the terms ‘name of symptom’ and ‘clinical practice guideline’ or ‘treatment guideline’. Results Acupuncture is moderately or weakly effective for 19 symptoms in patients with cancer and cancer survivors. Acupuncture is a safe therapy in cancer care if administered by trained acupuncturists. Acupuncture is targeted to improve symptoms associated with the cancer and different cancer treatments, not to treat the cancer itself. More than 350 publications by clinical practice guideline groups and expert groups, including public health statements made by national and government agencies recommended the use of acupuncture for 61 cancer related symptoms many with positive evidence of effectiveness. Conclusion The strength of evidence is weak for many indications, however the evidence for many standard therapies is either not very strong or if stronger, the incidence of adverse events is more, which makes acupuncture a treatment option despite the weak evidence. We have found evidence that many oncologists around the world have started to incorporate acupuncture into the treatment of various cancer related symptoms.
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Affiliation(s)
- Stephen Birch
- Department of Health Sciences, Kristiania University College, Oslo, Norway
| | - Myeong Soo Lee
- Clinical Medicine Division, Korean Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Terje Alraek
- Department of Health Sciences, Kristiania University College, Oslo, Norway.,National Research Centre in Complementary and Alternative Medicine, Faculty of Medicine, Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Tae-Hun Kim
- Clinical Trial Center, Kyung-Hee University, Korean Medical Hospital, Seoul, Republic of Korea
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12
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Hitomi S, Ujihara I, Sago-Ito M, Nodai T, Shikayama T, Inenaga K, Ono K. Hyposalivation due to chemotherapy exacerbates oral ulcerative mucositis and delays its healing. Arch Oral Biol 2019; 105:20-26. [PMID: 31238198 DOI: 10.1016/j.archoralbio.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 05/18/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Cancer therapy including chemotherapy causes gland atrophy, resulting in low salivary secretion in cancer patients. Since saliva plays an important role in oral health, the dysfunction may exacerbate oral ulcerative mucositis (OUM), which is another side effect. Here, we investigated the effect of hyposalivation on OUM using sialoadenectomized rats and examined the effects of anticancer drugs on the salivary glands. DESIGN As models for hyposalivation, the bilateral submandibular and sublingual glands except (2EXT) or together with (3EXT) the parotid glands were extracted. At 16 days after the procedure, OUM was experimentally developed by topical acetic acid treatment on the labial fornix region of the inferior incisors, and the severity and bacterial loading level were evaluated. The salivary gland weights and histology were analyzed after administration of the representative anticancer drugs 5-fluorouracil or cisplatin. RESULTS The severity of OUM was greater in both the 3EXT and 2EXT rats and delayed the healing process compared with that in sham rats without salivary gland extraction. The healing process in the 3EXT rats was longer than that in the 2EXT rats. The number of colony-forming units in the ulcerative region from the 3EXT rats was 10-fold greater than that in the sham rats. Both 5-fluorouracil and cisplatin reduced glands weights and damaged the salivary glands. CONCLUSIONS These results suggest that chemotherapy-induced hyposalivation exacerbates OUM and delays healing, most likely due to loss of salivary clearance and antimicrobial functions. This study illustrates the significance of oral health care for cancer patients undergoing chemotherapy.
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Affiliation(s)
- Suzuro Hitomi
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan.
| | - Izumi Ujihara
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Misa Sago-Ito
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan; Division of Orofacial Functions and Orthodontics, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Tomotaka Nodai
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan; Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Takemi Shikayama
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan; Division of Periodontology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Kiyotoshi Inenaga
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Kentaro Ono
- Division of Physiology, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu, Fukuoka, 803-8580, Japan
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13
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Garlapati K, Kammari A, Badam RK, B E S, Boringi M, Soni P. Meta-analysis on pharmacological therapies in the management of xerostomia in patients with Sjogren's syndrome. Immunopharmacol Immunotoxicol 2019; 41:312-318. [PMID: 30932714 DOI: 10.1080/08923973.2019.1593448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Sjogren's syndrome is an immunologic disorder, characterized by symptoms of dry mouth and dry eyes. Management of xerostomia is more difficult and challenging, various pharmacologic agents have been tried and evaluated in the management of xerostomia in these patients, but the results were inconsistent and variable. Hence, the present study is aimed at evaluation and comparison of different pharmacological agents in the management of xerostomia in patients with Sjogren's syndrome. Materials and methods: A meta-analysis of case-control studies was conducted on pharmacological management of xerostomia in patients with Sjogren's Syndrome and the collected data are subjected to exclusion and inclusion criteria and standard mean difference (SMD), ODD's ratio and confidence intervals (95% CI) were calculated by Review Manager software using fixed and random effects model from the data of five studies. Results: Both objective response and subjective response evaluation favored experimental group suggesting an increase in unstimulated salivary flow rate using pharmacological agents. Interferon alpha 150 IU three times daily had a good effect in increasing the unstimulated whole saliva flow rate with SMD 2.72 at 95% CI [2.43, 3.00] p < .00001. Cevimeline vs placebo showed good response with ODDS ratio 2.74 at 95% CI [1.58, 4.76] p = .0003. Conclusion: Interferon - α 150 IU thrice daily was proven to be effective in increasing salivary flow rate and also has an advantage of disease modification in SS patients attributing to its immunomodulatory action. Cevimeline 30 mg thrice daily also had a considerable therapeutic effect in SS patients compared to Pilocarpine.
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Affiliation(s)
- Komali Garlapati
- a Department of Oral Medicine and Radiology , Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre , Hyderabad , India
| | - Anuja Kammari
- a Department of Oral Medicine and Radiology , Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre , Hyderabad , India
| | - Raj Kumar Badam
- a Department of Oral Medicine and Radiology , Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre , Hyderabad , India
| | - Surekha B E
- a Department of Oral Medicine and Radiology , Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre , Hyderabad , India
| | - Mamatha Boringi
- a Department of Oral Medicine and Radiology , Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre , Hyderabad , India
| | - Pratima Soni
- b Department of Oral Medicine and Radiology , Government Dental College and Hospital , Hyderabad , India
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14
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See L, Mohammadi M, Han PP, Mulligan R, Enciso R. Efficacy of saliva substitutes and stimulants in the treatment of dry mouth. SPECIAL CARE IN DENTISTRY 2019; 39:287-297. [PMID: 30811076 DOI: 10.1111/scd.12370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the efficacy of saliva substitutes and stimulants compared to placebo in improving findings of dry mouth not caused by Sjӧgren's. METHODS AND RESULTS Four databases were searched (PubMed, Web of Science, Cochrane Library, and EMBASE) through March 2018. Only randomized controlled trials (RCT) using placebo interventions with dry mouth patients were included. Outcomes included salivary flow and self-reported patient improvement. The Cochrane Collaboration's tool for assessing risk of bias was used. A total of 348 references were reviewed, resulting in 7 RCTs with 257 dry mouth patients with 5 studies at high risk of bias, 1 unclear and 1 low risk being included. Topical spray of 1% malic acid increased unstimulated (Difference in Means [DM] = 0.096, 95% CI = 0.092-0.100; P < 0.001) and stimulated (DM = 0.203, 95% CI = 0.106-0.300; P < 0.001) salivary flow in 2 studies. Patients using 1% malic acid topical spray were 5.4 times more likely to report improvement compared to placebo (95% CI = 2.634-11.091; P < 0.001) in 2 studies. No significant improvements were found with other products when compared to placebo. CONCLUSION Use of 1% malic acid topical spray seems to improve dry mouth compared to placebo. Quality of the evidence was low due to risk of bias and imprecision.
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Affiliation(s)
- Lydia See
- Master Program in Geriatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
| | - Mehdi Mohammadi
- Master Program in Geriatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California.,Assistant Professor of Clinical Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
| | - Phuu P Han
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
| | - Roseann Mulligan
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
| | - Reyes Enciso
- Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California
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15
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Ma SJ, Rivers CI, Serra LM, Singh AK. Long-term outcomes of interventions for radiation-induced xerostomia: A review. World J Clin Oncol 2019; 10:1-13. [PMID: 30627521 PMCID: PMC6318483 DOI: 10.5306/wjco.v10.i1.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/07/2018] [Accepted: 12/17/2018] [Indexed: 02/06/2023] Open
Abstract
Xerostomia, or dry mouth, is a significant problem affecting quality of life in patients treated with radiation therapy for head and neck cancer. Strategies for reduction of xerostomia burden vary widely, with options including: sialagogue medications, saliva substitutes, acupuncture, vitamins, hyperbaric oxygen, submandibular gland transfer, and acupuncture or associated treatments. In this review, we sought to evaluate long-term outcomes of patients treated with various interventions for radiation-induced xerostomia. A literature search was performed using the terms "xerostomia" and "radiation" or "radiotherapy"; all prospective clinical trials were evaluated, and only studies that reported 1 year follow up were included. The search results yielded 2193 studies, 1977 of which were in English. Of those, 304 were clinical trials or clinical studies. After abstract review, 23 trials were included in the review evaluating the following treatment modalities: pilocarpine (three); cevimeline (one); amifostine (eleven); submandibular gland transfer (five); acupuncture like transcutaneous electrical nerve stimulation (ALTENS) (one); hyperbaric oxygen (one); and acupuncture (one). Pilocarpine, cevimeline, and amifostine have been shown in some studies to improve xerostomia outcomes, at the cost of toxicity. ALTENS has similar efficacy with fewer side effects. Submandibular gland transfer is effective but requires an elective surgery, and thus may not always be appropriate or practical. The use of intensity-modulated radiation therapy, in addition to dose de-escalation in select patients, may result in fewer patients with late xerostomia, reducing the need for additional interventions.
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Affiliation(s)
- Sung Jun Ma
- University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14214, United States
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Charlotte I Rivers
- University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14214, United States
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Lucas M Serra
- University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14214, United States
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Anurag K Singh
- University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14214, United States
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
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16
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Sherlock S, Way M, Tabah A. Hyperbaric oxygen treatment for the management of radiation-induced xerostomia. J Med Imaging Radiat Oncol 2018; 62:841-846. [PMID: 30113763 DOI: 10.1111/1754-9485.12789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/14/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hyperbaric oxygen therapy (HBOT) is widely used for the treatment of the late effects of radiation therapy. We report a prospective observational cohort study of 51 patients designed to examine the effectiveness of hyperbaric oxygen treatment (HBOT) for xerostomia following radiotherapy. METHODS Objective (saliva volume) and subjective (quality of life scoring and visual analogue scale (VAS) of discomfort) measurements associated with xerostomia were compared prior to commencement of HBOT, after 30 sessions (over 6 weeks) of HBOT at 243 kPa for 90 minutes daily for five days per week and at 6-week review (12 weeks from commencement). RESULTS One hundred and one courses of treatment in 99 patients were examined. For 53 (53%) courses in 51 patients, data were recorded before and after HBOT and so could be included in the analysis. Thirty-four (34%) of these patients had complete data for all three time points. The unit of study was per treatment course, not per person. There were no major complications to HBOT. There was a statistically significant difference in saliva volume following HBOT (P = 0.016). The mean saliva volume increase was 0.9 mL over a 5-min collection period (95% CI 0.2-1.5). There was also a statistically significant improvement in discomfort after HBOT (P < 0.001) and QOL (P < 0.001). The mean visual analogue scale for discomfort (VAS on a 0-10 scale) score decreased by 1.4 units (95% CI 0.7-2.1), whilst the mean QOL score was 10 points lower after treatment (95% CI 5.9-14.4). CONCLUSION Hyperbaric oxygen therapy may be a safe and effective treatment for symptoms of xerostomia after radiation therapy and should be considered when available.
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Affiliation(s)
- Susannah Sherlock
- Hyperbaric Medicine Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Anaesthesia and Perioperative Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mandy Way
- QIMR Berghofer Institute, Biostatistics, Brisbane, Queensland, Australia
| | - Alexis Tabah
- Hyperbaric Medicine Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
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Birch S, Lee MS, Alraek T, Kim TH. Overview of Treatment Guidelines and Clinical Practical Guidelines That Recommend the Use of Acupuncture: A Bibliometric Analysis. J Altern Complement Med 2018; 24:752-769. [PMID: 29912569 DOI: 10.1089/acm.2018.0092] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION As positive evidence emerges for the use of an intervention to treat a health problem, the intervention gradually becomes incorporated into treatment guidelines (TGs) or clinical practice guidelines (CPGs) that are related to that health problem. To assess whether this general hypothesis can apply to acupuncture, 96 health problems were identified for which positive conclusions in systematic reviews and meta-analyses regarding the effectiveness of acupuncture have been made and then searched for TGs or CPGs that have recommended the use of acupuncture. METHODS Through August 31, 2017, searches were performed in relevant medical databases and Google using "treatment guideline," "clinical practice guideline," and the names of the 96 medical conditions as search terms. A "snow-balling" search approach was adopted. All positive recommendations were added into the registry. RESULTS A total of 1311 publications were found that recommended using acupuncture published between 1991 and 2017. The number per year reached 50 in 2005 and 100 in 2009. In addition, 2189 positive recommendations were found for the use of acupuncture. Of these, 1486 were related to 107 pain indications and 703 were related to 97 nonpain indications. These recommendations were made by a wide range of groups, such as government health institutions, national guideline, and medical specialty groups. The recommendations came from around the world but were especially abundant in North America, Europe, and Australasia. DISCUSSION AND CONCLUSION Considerably more recommendations were found for the use of acupuncture than are known within the acupuncture or medical communities. A trend by year was also found; a rise in the number of positive statements about acupuncture was typically followed by a rise in the number of recommendations of acupuncture. Thus, the recommendations followed the emergent evidence for acupuncture. Better implementation plans need to be developed for the CPG/TG recommendations about acupuncture to be more effective/efficient.
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Affiliation(s)
- Stephen Birch
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway
| | - Myeong Soo Lee
- 2 Clinical Medicine Division, Korea Institute of Oriental Medicine , Daejeon, Republic of South Korea
| | - Terje Alraek
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway .,3 Department of Community Medicine, Faculty of Medicine, National Research Centre in Complementary and Alternative Medicine, UiT The Arctic University of Norway , Tromso, Norway
| | - Tae-Hun Kim
- 4 Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University , Seoul, Republic of Korea
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18
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Bockel S, Vallard A, Lévy A, François S, Bourdis M, Le Gallic C, Riccobono D, Annede P, Drouet M, Tao Y, Blanchard P, Deutsch É, Magné N, Chargari C. Pharmacological modulation of radiation-induced oral mucosal complications. Cancer Radiother 2018; 22:429-437. [PMID: 29776830 DOI: 10.1016/j.canrad.2017.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 12/12/2022]
Abstract
Radiation-induced mucositis is a common toxicity, especially in patients with head and neck cancers. Despite recent technological advances in radiation therapy, such as intensity-modulated radiotherapy, radiation-induced mucositis is still causing treatment disruptions, negatively affecting patients' long and short term quality of life, and impacting medical resources use with economic consequences. The objective of this article was to review the latest updates in the management of radiation-induced mucositis, with a focus on pharmaceutical strategies for the prevention or treatment of mucositis. Although numerous studies analysing the prevention and management of oral radiation-induced mucositis have been conducted, there are still few reliable data to guide daily clinical practice. Furthermore, most of the tested drugs have shown no (anti-inflammatory cytokine, growth factors) or limited (palifermin) effect. Therapies for acute oral mucositis are predominantly focused on improving oral hygiene and providing symptoms control. Although low-level laser therapy proved efficient in preventing radiation-induced oral mucositis in patients with head and neck cancer, this intervention requires equipment and trained medical staff, and is therefore insufficiently developed in clinical routine. New effective pharmacological agents able to prevent or reverse radio-induced mucositis are required.
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Affiliation(s)
- S Bockel
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - A Vallard
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - A Lévy
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - S François
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - M Bourdis
- Département interdisciplinaire des soins de support pour le patient en oncologie, institut de cancérologie Lucien-Neuwirth, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - C Le Gallic
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - D Riccobono
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - P Annede
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - M Drouet
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - Y Tao
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - P Blanchard
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - É Deutsch
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Inserm U1030, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - N Magné
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - C Chargari
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Inserm U1030, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France; Service de santé des armées, école du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France.
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Aldehyde dehydrogenase 3A1 activation prevents radiation-induced xerostomia by protecting salivary stem cells from toxic aldehydes. Proc Natl Acad Sci U S A 2018; 115:6279-6284. [PMID: 29794221 PMCID: PMC6004437 DOI: 10.1073/pnas.1802184115] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Radiation therapy for head and neck cancer often leads to dry mouth, a debilitating condition that affects speaking, swallowing, and other functions related to quality of life. Since salivary functional recovery after radiation is largely dependent on the number of surviving salivary stem/progenitor cells (SSPCs), we reasoned that protection of SSPCs from injury is critical for mitigating dry mouth. Following radiation, SSPCs accumulate toxic aldehydes that damage DNA, proteins, and lipids, leading to cell death. Here, we identified d-limonene as an activator of aldehyde dehydrogenase 3A1 (ALDH3A1) with a favorable safety profile for clinical use. ALDH3A1 activation decreases aldehyde accumulation in SSPCs, increases sphere-forming ability, reduces apoptosis, and preserves salivary gland structure and function following radiation without reducing the anticancer effects. Xerostomia (dry mouth) is the most common side effect of radiation therapy in patients with head and neck cancer and causes difficulty speaking and swallowing. Since aldehyde dehydrogenase 3A1 (ALDH3A1) is highly expressed in mouse salivary stem/progenitor cells (SSPCs), we sought to determine the role of ALDH3A1 in SSPCs using genetic loss-of-function and pharmacologic gain-of-function studies. Using DarkZone dye to measure intracellular aldehydes, we observed higher aldehyde accumulation in irradiated Aldh3a1−/− adult murine salisphere cells and in situ in whole murine embryonic salivary glands enriched in SSPCs compared with wild-type glands. To identify a safe ALDH3A1 activator for potential clinical testing, we screened a traditional Chinese medicine library and isolated d-limonene, commonly used as a food-flavoring agent, as a single constituent activator. ALDH3A1 activation by d-limonene significantly reduced aldehyde accumulation in SSPCs and whole embryonic glands, increased sphere-forming ability, decreased apoptosis, and improved submandibular gland structure and function in vivo after radiation. A phase 0 study in patients with salivary gland tumors showed effective delivery of d-limonene into human salivary glands following daily oral dosing. Given its safety and bioavailability, d-limonene may be a good clinical candidate for mitigating xerostomia in patients with head and neck cancer receiving radiation therapy.
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20
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Yıldırım YSS, Kaygusuz I, Ozercan IH, Cetiner H, Sakallioglu O, Akyigit A, Duzer S. Histopathological changes in parotid gland following submandibular gland failure: an experimental animal study. Braz J Otorhinolaryngol 2018; 85:422-426. [PMID: 29754976 PMCID: PMC9443012 DOI: 10.1016/j.bjorl.2018.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/19/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction Submandibular glands are exposed to many effects due to diseases and therapeutic interventions. A study evaluating the effect of submandibular gland dysfunction on the parotid gland has not been presented in the literature. Objective The aim of this study was to evaluate the histopathological changes in the parotid gland following submandibular gland failure. Methods Three groups of seven randomly selected female New Zealand rabbits weighing 2500–3000 g were studied. Unilateral and bilateral submandibular glands were removed in Groups 1 and 2, respectively. No procedure was performed in Group III, the control group. The parotid glands were removed 30 days later. Histological parameters were evaluated and graded between 0 (none) and 3 (severe). Differences between groups were compared using the Mann–Whitney U test. Results Mean mucus accumulation in acinar cells was 2.57 ± 0.53 and 1.71 ± 0.75 in Groups 1 and 2, respectively (p < 0.05). This value was 0.57 ± 0.53 in Group 3, which was significantly lower than in Groups 1 and 2 (p < 0.05). Mean dilatation of the intercalated ducts’ lumen was 1.28 ± 0.48 and 1.57 ± 0.53 in Groups 1 and 2, respectively (p > 0.05). This value was 0.28 ± 0.48 in Group 3, which was significantly lower than in Groups 1 and 2 (p < 0.05). Mean mucus accumulation in the intercalated ducts’ lumen was 2.00 ± 0.81 and 1.00 ± 0.57 in Groups 2 and 3, respectively (p < 0.05). Conclusion The findings of this study indicate that only 1 month after submandibular gland failure, the parotid glands exhibit significant changes.
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Affiliation(s)
| | - Irfan Kaygusuz
- University of Firat, School of Medicine, Department of Otorhinolaryngology, Elazig, Turkey
| | - Ibrahim Hanifi Ozercan
- University of Firat, School of Medicine, Department of Otorhinolaryngology, Elazig, Turkey
| | - Hasan Cetiner
- Elazig Education and Research Hospital, Department of Otorhinolaryngology, Elazig, Turkey.
| | - Oner Sakallioglu
- Elazig Education and Research Hospital, Department of Otorhinolaryngology, Elazig, Turkey
| | - Abdulvahap Akyigit
- Elazig Education and Research Hospital, Department of Otorhinolaryngology, Elazig, Turkey
| | - Sertac Duzer
- Elazig Education and Research Hospital, Department of Otorhinolaryngology, Elazig, Turkey
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21
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Palma LF, Gonnelli FAS, Marcucci M, Giordani AJ, Dias RS, Segreto RA, Segreto HRC. A novel method to evaluate salivary flow rates of head and neck cancer patients after radiotherapy: a pilot study. Braz J Otorhinolaryngol 2018; 84:227-231. [PMID: 28400176 PMCID: PMC9449237 DOI: 10.1016/j.bjorl.2017.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/09/2017] [Accepted: 03/04/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction The procedure used to evaluate salivary flow rate is called sialometry. It can be performed through several techniques, but none appears to be really efficient for post-radiotherapy patients. Objective To adequate sialometry tests for head and neck cancer patients submitted to radiotherapy. Methods 22 xerostomic patients post-radiotherapy (total radiation dose ranging from 60 to 70 Gy) were included in this study. Ten patients were evaluated using sialometries originally proposed by the Radiation Therapy Oncology Group and twelve were assessed by our modified methods. Unstimulated and stimulated sialometries were performed and the results were classified according a grading scale and compared between both groups. Results There was no statistically significant difference between the salivary evaluations of both groups (p = 0.4487 and p = 0.5615). Also, most of these rates were classified as very low and low. Conclusion This novel method seems to be suitable for patients submitted to radiotherapy.
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Abstract
Salivary gland cancers (SGCs), categorized as head and neck cancers (HNCs), constitute about 6% of head and neck cancer diagnoses based on estimate by American Head and Neck Society. Salivary gland tumors originate from different glandular cell types and are thus morphologically diverse. These tumors arise from any of the three major and various minor salivary glands. The incidence of SGCs has slowly increased during the last four decades. The etiology of SGCs is mostly unknown; however, specific gene mutations are associated with certain types of salivary tumors. Treatment options include surgical resection, radiation therapy (RT), chemotherapy, and multimodality therapy. HNC patients treated with RT often develop xerostomia and salivary hypofunction due to damaged salivary glands. In this review, we discuss etiology of SGCs, present findings on the role of autophagy in salivary tumorigenesis, review adverse effects of radiation treatment, and examine remedies for restoration of salivary function.
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Affiliation(s)
- H. Helen Lin
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010
| | | | - David K. Ann
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA 91010
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Park B, Noh H, Choi DJ. Herbal Medicine for Xerostomia in Cancer Patients: A Systematic Review of Randomized Controlled Trials. Integr Cancer Ther 2017; 17:179-191. [PMID: 28870110 PMCID: PMC6041902 DOI: 10.1177/1534735417728336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Xerostomia (dry mouth) causes many clinical problems, including oral infections, speech difficulties, and impaired chewing and swallowing of food. Many cancer patients have complained of xerostomia induced by cancer therapy. OBJECTIVE The aim of this systematic review is to assess the efficacy of herbal medicine for the treatment of xerostomia in cancer patients. MATERIALS AND METHODS Randomized controlled trials investigating the use of herbal medicines to treat xerostomia in cancer patients were included. We searched the following 12 databases without restrictions on time or language. The risk of bias was assessed using the Cochrane Risk of Bias Tool. RESULTS Twenty-five randomized controlled trials involving 1586 patients met the inclusion criteria. A total of 24 formulas were examined in the included trials. Most of the included trials were insufficiently reported in the methodology section. Five formulas were shown to significantly improve the salivary flow rate compared to comparators. Regarding the grade of xerostomia, all formulas with the exception of a Dark Plum gargle solution with normal saline were significantly effective in reducing the severity of dry mouth. Adverse events were reported in 4 trials, and adverse effects of herbal medicine were reported in 3 trials. CONCLUSIONS We found herbal medicines had potential benefits for improving salivary function and reducing the severity of dry mouth in cancer patients. However, methodological limitations and a relatively small sample size reduced the strength of the evidence. More high-quality trials reporting sufficient methodological data are warranted to enforce the strength of evidence regarding the effectiveness of herbal medicines.
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Affiliation(s)
- Bongki Park
- 1 Ilsan Oriental Hospital, Dongguk University Medical Centre, Gyeonggi, South Korea
| | - Hyeonseok Noh
- 2 Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Dong-Jun Choi
- 1 Ilsan Oriental Hospital, Dongguk University Medical Centre, Gyeonggi, South Korea
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Barbe AG. Long-term Use of the Sialogogue Medications Pilocarpine and Cevimeline Can Reduce Xerostomia Symptoms and Increase Salivary Flow in Head and Neck Cancer Survivors After Radiotherapy. J Evid Based Dent Pract 2017; 17:268-270. [DOI: 10.1016/j.jebdp.2017.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Onseng K, Johns NP, Khuayjarernpanishk T, Subongkot S, Priprem A, Hurst C, Johns J. Beneficial Effects of Adjuvant Melatonin in Minimizing Oral Mucositis Complications in Head and Neck Cancer Patients Receiving Concurrent Chemoradiation. J Altern Complement Med 2017; 23:957-963. [PMID: 28657801 DOI: 10.1089/acm.2017.0081] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Oral mucositis is a major cause of pain and delayed cancer treatment leading to poor survival in head and neck cancer patients receiving concurrent chemoradiation. The study evaluated the effect of adjuvant melatonin on minimizing oral mucositis complications to reduce these treatment delays and interruptions. DESIGN A randomized, double-blind, double dummy, placebo-controlled clinical trial. SETTING Ubon Ratchathani Cancer Hospital, Thailand. PARTICIPANTS Thirty-nine head and neck cancer patients receiving concurrent chemoradiation (5 days/week of radiation plus chemotherapy three or six cycles). METHODS Patients were randomized to receive 20 mg melatonin gargle (or matched placebo) before each irradiation, and 20 mg melatonin capsules (or matched placebo) taken nightly during 7 weeks of concurrent chemoradiation. Endpoints were oral mucositis events (incidence and time to grade 3 mucositis or grade 2 xerostomia), pain medication consumption and quality of life (QOL). RESULTS Melatonin group reported lower incidence of grade 3 oral mucositis (42% vs. 55%) and grade 2 xerostomia (20% vs. 21%); no statistical significance was detected. Melatonin regimen delayed onset of grade 3 mucositis (median 34 days vs. 50 days; p = 0.0318), allowing median time of 16 more patient visits before its onset and fewer interrupted treatments due to oral mucositis were reported (n = 1 vs. n = 5). There was no difference of grade 2 xerostomia (median 32 days vs. 50 days; p = 0.624). Morphine consumption was also reduced (median 57 mg vs. 0 mg; p = 0.0342), while QOL was comparable during the study period. CONCLUSION Adjuvant melatonin delayed the onset of oral mucositis, which enables uninterrupted cancer treatment and reduced the amount of morphine used for pain treatment.
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Affiliation(s)
- Kittipong Onseng
- 1 Melatonin Research Group, Faculty of Pharmaceutical Sciences, Khon Kaen University , Khon Kaen, Thailand
| | | | | | - Suphat Subongkot
- 3 Faculty of Pharmaceutical Sciences, Khon Kaen University , Khon Kaen, Thailand
| | - Aroonsri Priprem
- 3 Faculty of Pharmaceutical Sciences, Khon Kaen University , Khon Kaen, Thailand
| | - Cameron Hurst
- 4 Faculty of Medicine, Biostatistics Center, Chulalongkorn University , Bangkok, Thailand
| | - Jeffrey Johns
- 1 Melatonin Research Group, Faculty of Pharmaceutical Sciences, Khon Kaen University , Khon Kaen, Thailand
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Interventions for the management of radiotherapy-induced xerostomia and hyposalivation: A systematic review and meta-analysis. Oral Oncol 2017; 66:64-74. [PMID: 28249650 DOI: 10.1016/j.oraloncology.2016.12.031] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/29/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Salivary gland hypofunction is a common and permanent adverse effect of radiotherapy to the head and neck. Randomised trials of available treatment modalities have produced unclear results and offer little reliable guidance for clinicians to inform evidence-based therapy. We have undertaken this systematic review and meta-analysis to estimate the effectiveness of available interventions for radiotherapy-induced xerostomia and hyposalivation. METHODS We searched MEDLINE, Cochrane Central, EMBASE, AMED, and CINAHL database through July 2016 for randomised controlled trials comparing any topical or systemic intervention to active and/or non-active controls for the treatment of radiotherapy-induced xerostomia. The results of clinically and statistically homogenous studies were pooled and meta-analyzed. RESULTS 1732 patients from twenty studies were included in the systematic review. Interventions included systemic or topical pilocarpine, systemic cevimeline, saliva substitutes/mouthcare systems, hyperthermic humidification, acupuncture, acupuncture-like transcutaneous electrical nerve stimulation, low-level laser therapy and herbal medicine. Results from the meta-analysis, which included six studies, suggest that both cevimeline and pilocarpine can reduce xerostomia symptoms and increase salivary flow compared to placebo, although some aspects of the relevant effect size, duration of the benefit, and clinical meaningfulness remain unclear. With regard to interventions not included in the meta-analysis, we found no evidence, or very weak evidence, that they can reduce xerostomia symptoms or increase salivary flow in this population. CONCLUSIONS Pilocarpine and cevimeline should represent the first line of therapy in head and neck cancer survivors with radiotherapy-induced xerostomia and hyposalivation. The use of other treatment modalities cannot be supported on the basis of current evidence.
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Efficacy of Traditional Chinese Medicine in Xerostomia and Quality of Life during Radiotherapy for Head and Neck Cancer: A Prospective Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:8359251. [PMID: 27642359 PMCID: PMC5011503 DOI: 10.1155/2016/8359251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/17/2016] [Indexed: 12/31/2022]
Abstract
Xerostomia is one of the most common acute and late complications of radiotherapy for head and neck cancer, and it affects quality of life. We conducted a prospective study to evaluate the efficacy of traditional Chinese medicine (TCM) in toxicities and quality of life during radiotherapy. Head and neck cancer patients who were scheduled for radiotherapy were checked for inclusion/exclusion criteria before enrollment. Patients in the study group (inpatients) were hospitalized in a Chinese medicine ward and received concomitant TCM intervention during radiotherapy, while those in the control group (outpatients) received only conventional cancer treatments at the Western outpatient department. The primary end point was amelioration of postradiotherapy side effects. The secondary end points were quality of life during the cancer therapy and occurrence of adverse events following the TCM treatments. Thirty inpatients and 50 outpatients completed the study. Compared to the control group, those in the TCM group had decreased severity of xerostomia. There was no treatment-related impairment of renal or hepatic function among TCM group. Although better outcomes of social contact, dyspnea, physical and emotional function, and financial problems were found in the TCM group, we need further confirmation about the impact of hospitalization itself on these results.
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AAOM Clinical Practice Statement: Subject: Clinical management of cancer therapy-induced salivary gland hypofunction and xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:310-2. [PMID: 27432150 DOI: 10.1016/j.oooo.2016.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/12/2016] [Accepted: 04/22/2016] [Indexed: 11/21/2022]
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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: 88] [Impact Index Per Article: 11.0] [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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Abstract
Saliva is one of the most versatile, multifunctional substances produced by the body and has a critical role in the preservation of the oropharyngeal health. It comprises a serous and mucinous component and is secreted by the major salivary glands. The mucins in the saliva serve to protect and lubricate the hard and soft tissues of the mouth, protecting them from chemical and mechanical damage. Hyposalivation can be managed by various salivary substitutes, peripheral sialagogues, and central sialagogues.
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Affiliation(s)
- Michael D Turner
- Mount Sinai Beth Israel/Jacobi/Einstein Oral and Maxillofacial Surgery, Institute of Head and Neck and Thyroid Cancer, 10 Union Square East, Suite 5B New York, NY 10003, USA.
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Teymoortash A, Pfestroff A, Wittig A, Franke N, Hoch S, Harnisch S, Schade-Brittinger C, Hoeffken H, Engenhart-Cabillic R, Brugger M, Strauch K. Safety and Efficacy of Botulinum Toxin to Preserve Gland Function after Radiotherapy in Patients with Head and Neck Cancer: A Prospective, Randomized, Placebo-Controlled, Double-Blinded Phase I Clinical Trial. PLoS One 2016; 11:e0151316. [PMID: 26991494 PMCID: PMC4798778 DOI: 10.1371/journal.pone.0151316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 02/24/2016] [Indexed: 11/27/2022] Open
Abstract
This prospective, randomized, placebo-controlled, double-blinded phase I clinical trial investigates safety and efficacy of botulinum toxin (BoNT) to preserve gland function after radiotherapy in patients with head and neck cancer. Twelve patients with advanced head and neck cancer were injected with BoNT into the submandibular glands prior to primary radiochemotherapy. Six patients received BoNT/A and 6 patients BoNT/A and B, half of each subgroup into their left and the other half into their right gland. As an internal control, sodium chloride was injected into the respective contralateral gland (placebo). For the evaluation of the salivary gland function, technetium pertechnetate salivary gland scintigraphy was performed before and after the end of radiotherapy. BoNT/A and B were well tolerated. Analysis of the scintigraphic data revealed no statistically significant difference between BoNT and placebo regarding the scintigraphic uptake difference (pBoNT/A = 0.84 and pBoNT/A-B = 0.56 for BoNT/A vs. placebo and BoNT/A-B vs. placebo, respectively). We also found no significant difference in treatment between BoNT and placebo in terms of salivary excretion fraction (pBoNT/A = 0.44; pBoNT/A-B = 0.44). This study demonstrates that BoNT can be safely combined with radiochemotherapy. Dosing and timing of BoNT injection should be further investigated for efficacy analysis.
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Affiliation(s)
- Afshin Teymoortash
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
- * E-mail:
| | - Andreas Pfestroff
- Department of Nuclear Medicine, Philipp University, Marburg, Germany
| | - Andrea Wittig
- Department of Radiotherapy and Radio-Oncology, Philipp University, Marburg, Germany
| | - Nora Franke
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Stephan Hoch
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Susanne Harnisch
- Center for Clinical Trials, Philipp University, Marburg, Germany
| | | | - Helmut Hoeffken
- Department of Nuclear Medicine, Philipp University, Marburg, Germany
| | | | - Markus Brugger
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
| | - Konstantin Strauch
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Biometry and Epidemiology, Philipp University, Marburg, Germany
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Dysphagia and Head and Neck Cancer. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Donovan TE, Marzola R, Becker W, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP. Annual review of selected scientific literature: Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2015; 114:756-809. [PMID: 26611624 DOI: 10.1016/j.prosdent.2015.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Terence E Donovan
- Chair, Committee on Scientific Investigation, American Academy of Restorative Dentistry (AARD); and Professor and Chair for Biomaterials, Department of Operative Dentistry, University of North Carolina School of Dentistry at Chapel Hill, NC.
| | - Riccardo Marzola
- Adjunct Professor, Fixed Implant Prosthodontics, University of Bologna; and Private practice, Ferrara, Italy
| | - William Becker
- Clinical Professor, Advanced Education in Prosthodontics, Herman Ostrow School of Dentistry, Los Angeles, Calif
| | - David R Cagna
- Associate Dean, Professor and Director, Advanced Prosthodontics, University of Tennessee Health Sciences Center, Memphis, Tenn
| | - Frederick Eichmiller
- Vice President and Dental Director, Delta Dental of Wisconsin, Stevens Point, Wisc
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Is Pilocarpine Effective in Preventing Radiation-Induced Xerostomia? A Systematic Review and Meta-analysis. Int J Radiat Oncol Biol Phys 2015; 94:503-11. [PMID: 26867879 DOI: 10.1016/j.ijrobp.2015.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/29/2015] [Accepted: 11/04/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the efficacy of concomitant administration of pilocarpine on radiation-induced xerostomia in patients with head and neck cancers. METHODS AND MATERIALS The PubMed, Web of Science, Cochrane Library, and ClinicalTrials were searched to identify randomized, controlled trials studying the effect of concomitant administration of pilocarpine for radiation-induced xerostomia. Included trials were systematically reviewed, and quantifiable outcomes were pooled for meta-analysis. Outcomes of interest included salivary flow, clinician-rated xerostomia grade, patient-reported xerostomia scoring, quality of life, and adverse effects. RESULTS Six prospective, randomized, controlled trials in 8 articles were included in this systematic review. The total number of patients was 369 in the pilocarpine group and 367 in the control group. Concomitant administration of pilocarpine during radiation could increase the unstimulated salivary flow rate in a period of 3 to 6 months after treatment, and also reduce the clinician-rated xerostomia grade. Patient-reported xerostomia was not significantly impacted by pilocarpine in the initial 3 months but was superior at 6 months. No significant difference of stimulated salivary flow rate could be confirmed between the 2 arms. Adverse effects of pilocarpine were mild and tolerable. CONCLUSIONS The concomitant administration of pilocarpine during radiation increases unstimulated salivary flow rate and reduces clinician-rated xerostomia grade after radiation. It also relieves patients' xerostomia at 6 months and possibly at 12 months. However, pilocarpine has no effect on stimulated salivary flow rate.
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de Barros da Cunha SR, Ramos PAM, Nesrallah ACA, Parahyba CJ, Fregnani ER, Aranha ACC. The Effects of Ionizing Radiation on the Oral Cavity. J Contemp Dent Pract 2015; 16:679-687. [PMID: 26423505 DOI: 10.5005/jp-journals-10024-1740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The aim of this study is to present a literature review on the effects of the ionizing radiation from radiotherapy treatment on dental tissues. BACKGROUND Among the effects of increasing global life expectancy and longevity of the teeth in the oral cavity, increasing rates of neoplastic diseases have been observed. One of the important treatment modalities for head and neck neoplastic diseases is radiotherapy, which uses ionizing radiation as the main mechanism of action. Therefore, it is essential for dentists to be aware of the changes in oral and dental tissues caused by ionizing radiation, and to develop treatment and prevention strategies. RESULTS In general, there is still controversy about the effects of ionizing radiation on dental structures. However, qualitative and quantitative changes in saliva and oral microbiota, presence of oral mucositis and radiation-related caries are expected, as they represent the well-known side effects of treatment with ionizing radiation. Points that still remain unclear are the effects of radiotherapy on enamel and dentin, and on their mechanisms of bonding to contemporary adhesive materials. CONCLUSION Ionizing radiation has shown important interaction with organic tissues, since more deleterious effects have been shown on the oral mucosa, salivary glands and dentin, than on enamel. CLINICAL SIGNIFICANCE With the increasing number of patients with cancer seeking dental treatment before and after head and neck radiotherapy, it is important for dentists to be aware of the effects of ionizing radiation on the oral cavity.
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Affiliation(s)
- Sandra Ribeiro de Barros da Cunha
- PhD Student, Department of Restorative Dentistry, School of Dentistry University of Sao Paulo, Sao Paulo, Brazil, Phone: +55 11 30917645, e-mail:
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Radiotherapy-induced xerostomia, pre-clinical promise of LMS-611. Support Care Cancer 2015; 24:629-636. [DOI: 10.1007/s00520-015-2823-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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Gao L, Hu Y, Wang Y, Jiang W, He Z, Zhu C, Ma R, Huang Z. Exploring the variation of oral microbiota in supragingival plaque during and after head-and-neck radiotherapy using pyrosequencing. Arch Oral Biol 2015; 60:1222-30. [PMID: 26073028 DOI: 10.1016/j.archoralbio.2015.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 05/13/2015] [Accepted: 05/16/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this article was to study the variation in oral microflora of the subgingival plaque during and after radiotherapy. DESIGN During and after radiotherapy, microbial samples were collected at seven time points (early stage, medium stage, and later stage of radiotherapy, and 1 month, 3 months, 6 months, and 1 year after radiotherapy) in three subjects for a total of 21 samples. Polymerase chain reaction (PCR) amplification was carried out on the 16S rDNA hypervariable V1-V3 region, and then the PCR products were determined by high-throughput pyrosequencing. RESULTS The rarefaction curve indicating the richness of the microflora demonstrated that the number of operational taxonomic units (OTUs) was in decline from the early stage of radiotherapy to the time point 1 month after radiotherapy and then trended upward. The Shannon diversity index declined during radiotherapy (ranging from 4.59 to 3.73), and generally rose after radiotherapy, with the lowest value of 3.5 (1 month after radiotherapy) and highest value of 4.75 (6 months after radiotherapy). A total of 120 genera were found; five genera (Actinomyces, Veillonella, Prevotella, Streptococcus, Campylobacter) were found in all subjects across all time points. CONCLUSION The richness and diversity of oral ecology decreased with increased radiation dose, and it was gradually restored with time.
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Affiliation(s)
- Li Gao
- Department of Endodontics, Ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China
| | - Yuejian Hu
- Department of Endodontics, Ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China
| | - Yuxia Wang
- Department of Endodontics, Ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China
| | - Wenxin Jiang
- Department of Endodontics, Ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China
| | - Zhiyan He
- Department of Endodontics, Ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China
| | - Cailian Zhu
- Department of Endodontics, Ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China
| | - Rui Ma
- Department of Endodontics, Ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China.
| | - Zhengwei Huang
- Department of Endodontics, Ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China.
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Jaguar GC, Lima ENP, Kowalski LP, Pellizzon AC, Carvalho AL, Boccaletti KW, Alves FA. Double blind randomized prospective trial of bethanechol in the prevention of radiation-induced salivary gland dysfunction in head and neck cancer patients. Radiother Oncol 2015; 115:253-6. [PMID: 25890572 DOI: 10.1016/j.radonc.2015.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 12/24/2022]
Abstract
This study assessed the prophylactic bethanechol use to prevent salivary gland dysfunction during radiotherapy. A total of 97 head and neck cancer patients were allocated into two groups: Bethanechol or Placebo. Bethanechol group presented significantly improve of salivary parameters. Bethanechol was effective in decreasing the salivary gland damage.
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Affiliation(s)
| | | | | | | | | | | | - Fabio Abreu Alves
- Stomatology Department, A.C. Camargo Cancer Center, São Paulo, Brazil.
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Mercadante V, Lodi G, Porter S, Fedele S. Questionable validity of the systematic review and meta-analysis by Lovelace et al. on management of radiotherapy-induced salivary hypofunction and xerostomia in patients with oral or head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:120-1. [DOI: 10.1016/j.oooo.2014.07.538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 11/28/2022]
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Han P, Suarez-Durall P, Mulligan R. Dry mouth: A critical topic for older adult patients. J Prosthodont Res 2015; 59:6-19. [DOI: 10.1016/j.jpor.2014.11.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/05/2014] [Indexed: 11/24/2022]
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Montgomery-Cranny J, Hodgson T, Hegarty AM. Aetiology and management of xerostomia and salivary gland hypofunction. Br J Hosp Med (Lond) 2014; 75:509-10, 511-4. [PMID: 25216167 DOI: 10.12968/hmed.2014.75.9.509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jodie Montgomery-Cranny
- Specialist Registrar in Oral Medicine in the Department of Oral Medicine, Charles Clifford Dental Hospital
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