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Nieri CA, Benaim EH, Zhang YH, Garcia-Godoy F, Herr MJ, Zhang W, Schwartz D, Coca KK, Gleysteen JP, Gillespie MB. Botox for the prevention of radiation-induced Sialadenitis and xerostomia in head and neck cancer patients: A pilot study. Head Neck 2023; 45:2198-2206. [PMID: 37403447 DOI: 10.1002/hed.27449] [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: 04/24/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND To determine the safety of Botox and its potential effect on alleviating radiation therapy (RT)-induced sialadenitis in head and neck cancer patients. METHODS Twenty patients with stage III/IV head and neck cancer were randomized to receive Botox or saline injections into both submandibular glands (SMG). There were three visits: one before RT (V1); 1 week after RT (V2); and 6 weeks after RT (V3), each of which included saliva collection, a 24-h dietary recall, and a quality-of-life survey. RESULTS No adverse events were observed. While the control group was much older, the Botox group more commonly underwent induction chemotherapy compared with controls. From V1 to V2, salivary flow decreased in both groups, but only in the control group from V1 to V3. CXCL-1 (GRO), a neutrophil chemoattractant, was lower in the Botox group compared with the control group at V3. CONCLUSION Botox can be safely administered to the salivary glands prior to external beam radiation without observed complications or side-effects. After an initial reduction in salivary flow following RT, the Botox group showed lack of further flow reduction compared with controls. The inflammatory marker CXCL 1, which was reduced in the in Botox group at V3, may be a candidate for further studies of radiation-induced sialadenitis.
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Affiliation(s)
- Chad Alexander Nieri
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ezer Haim Benaim
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yanhui H Zhang
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- The Forsyth Institute, Cambridge, Massachusetts, USA
- Department of Surgery, Herbert Wertheim, College of Medicine, Florida International University, Miami, Florida, USA
| | - Michael J Herr
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Weiqiang Zhang
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kimberly K Coca
- Department of Otolaryngology, Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - John P Gleysteen
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Marion Boyd Gillespie
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Moral Nakamura D, da Graça Pinto H, Baena Elchin C, Thomazotti Berard L, Abreu Alves F, Azeredo Alves Antunes L, Pena Coto N. Efficacy of bethanechol chloride in the treatment of radiation-induced xerostomia in patients with head and neck cancer: A systematic review and meta-analysis. Radiother Oncol 2023; 186:109715. [PMID: 37207874 DOI: 10.1016/j.radonc.2023.109715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND PORPUSE Salivary glands sustain collateral damage following radiotherapy (RT) to treat cancers of the head and neck, leading to complications, including xerostomia and hyposalivation. This systematic review (SR) with meta-analysis was performed to determine the effectiveness of bethanechol chloride in preventing salivary gland dysfunction in this context. MATERIALS AND METHODS Medline/Pubmed, Embase, Scopus, LILACS via Portal Regional BVS and Web of Science were searched electronically in accordance with the Cochrane manual and reported PRISMA guidelines. RESULTS 170 patients from three studies were included. Results from the meta-analysis suggest that bethanechol chloride is associated with increases in: whole stimulating saliva (WSS) after RT (Std. MD 0.66, 95% CI 0.28 to 1.03, P < 0.001); whole resting saliva (WRS) during RT (Std. MD 0.4, 95% CI 0.04 to 0.76, P = 0.03); and WRS after RT (Std. MD 0.45, 95% CI 0.04 to 0.86, P = 0.03). CONCLUSION The present study suggests that bethanechol chloride therapy may be effective in patients with xerostomia and hyposalivation.
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Affiliation(s)
- Denise Moral Nakamura
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
| | - Henrique da Graça Pinto
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
| | - Cintia Baena Elchin
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
| | - Lucas Thomazotti Berard
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
| | - Fabio Abreu Alves
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
| | - Lívia Azeredo Alves Antunes
- School of Dentistry, Fluminense Federal University, R. Dr. Silvio Henrique Braune, 22, 28625-650 Nova Friburgo, RJ, Brazil.
| | - Neide Pena Coto
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
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Nathan CAO, Asarkar AA, Entezami P, Corry J, Strojan P, Poorten VV, Makitie A, Eisbruch A, Robbins KT, Smee R, St John M, Chiesa-Estomba C, Winter SC, Beitler JJ, Ferlito A. Current management of xerostomia in head and neck cancer patients. Am J Otolaryngol 2023; 44:103867. [PMID: 36996514 DOI: 10.1016/j.amjoto.2023.103867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Radiotherapy (RT) continues to play a key role in the management of head and neck cancer (HNC). Xerostomia remains a principal detriment to the quality of life (QoL) for 80 % of surviving patients receiving head and neck radiation. Radiation-induced injury to the salivary glands is dose-dependent, and thus efforts have been focused on decreasing radiation to the salivary glands. Decreased saliva production reduces both short-term and long-term quality of life in head and neck survivors by impacting on taste and contributing to dysphagia. Several radioprotective agents to the salivary gland have been investigated. Although not widely practiced, surgical transfer of the submandibular gland prior to RT is the mainstay of surgical options in preventing xerostomia. This review focuses on the strategies to improve xerostomia following radiation therapy in head and neck cancers.
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Affiliation(s)
- Cherie-Ann O Nathan
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, LA, USA; Otolaryngology Section, Surgical Service, Overton Brooks VA Medical Center, Shreveport, LA, USA.
| | - Ameya A Asarkar
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, LA, USA
| | - Payam Entezami
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, LA, USA; Otolaryngology Section, Surgical Service, Overton Brooks VA Medical Center, Shreveport, LA, USA
| | - June Corry
- Department of Radiation Oncology, Genesiscare St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Antti Makitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - K T Robbins
- Department of Otolaryngology/Head and Neck Surgery, Southern Illinois University, School of Medicine, Springfield, IL, USA
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | - Maie St John
- Department of Otolaryngology/Head and Neck Surgery, UCLA, CA, USA
| | - Carlos Chiesa-Estomba
- Otorhinolaryngology - Head & Neck Department - Donostia University Hospital, Biodonostia Research Institute, Deusto University, Spain
| | - Stuart C Winter
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Soto AP, Meyer SL. Oral Implications of Polypharmacy in Older Adults. Clin Geriatr Med 2023; 39:273-293. [PMID: 37045533 DOI: 10.1016/j.cger.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Over the next several decades, rates of aged populations will increase rapidly. These populations are susceptible to multimorbidities and polypharmacy (concurrently, prescribed 5 or more medications). Many medications have side effects that manifest orally. Therefore, it essential to possess current pharmacologic knowledge to diagnose and treat oral implications of commonly prescribed medications. This article details common medication-induced oral lesions and patient assessment of risk factors for polypharmacy and provides a template to integrate medication reconciliation into dental clinical practice.
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Affiliation(s)
- Annetty P Soto
- Division of General Dentistry, Department of Restorative Dental Sciences, University of Florida College of Dentistry, 1395 Center Drive, PO Box 100415, Gainesville, FL 32610-0415, USA.
| | - Sarah L Meyer
- University of Florida Health Science Center Libraries, 1600 Southwest Archer Road, PO Box 100206, Gainesville, FL 32610, USA
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Diagnosis, Prevention, and Treatment of Radiotherapy-Induced Xerostomia: A Review. JOURNAL OF ONCOLOGY 2022; 2022:7802334. [PMID: 36065305 PMCID: PMC9440825 DOI: 10.1155/2022/7802334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
In patients with head and neck cancer, irradiation (IR)-sensitive salivary gland (SG) tissue is highly prone to damage during radiotherapy (RT). This leads to SG hypofunction and xerostomia. Xerostomia is defined as the subjective complaint of dry mouth, which can cause other symptoms and adversely affect the quality of life. In recent years, diagnostic techniques have constantly improved with the emergence of more reliable and valid questionnaires as well as more accurate equipment for saliva flow rate measurement and imaging methods. Preventive measures such as the antioxidant MitoTEMPO, botulinum toxin (BoNT), and growth factors have been successfully applied in animal experiments, resulting in positive outcomes. Interventions, such as the new delivery methods of pilocarpine, edible saliva substitutes, acupuncture and electrical stimulation, gene transfer, and stem cell transplantation, have shown potential to alleviate or restore xerostomia in patients. The review summarizes the existing and new diagnostic methods for xerostomia, along with current and potential strategies for reducing IR-induced damage to SG function. We also aim to provide guidance on the advantages and disadvantages of the diagnostic methods. Additionally, most prevention and treatment methods remain in the stage of animal experiments, suggesting a need for further clinical research, among which we believe that antioxidants, gene transfer, and stem cell transplantation have broad prospects.
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Therapeutic Strategies for Dry Mouth Management with Emphasis on Electrostimulation as a Treatment Option. Int J Dent 2021; 2021:6043488. [PMID: 34691182 PMCID: PMC8536447 DOI: 10.1155/2021/6043488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives Xerostomia is a subjective sensation of dry mouth. It is commonly associated with salivary gland hypofunction. Both changes in the composition of the saliva and a reduction in the quantity secreted may be an objective finding of dry mouth. Although there are no currently available cures for the conditions resulting in dry mouth, there are several treatment options that give hope for patients who suffer from xerostomia. Individuals with some residual salivary gland function, which are contraindicated to pharmacological therapies, would benefit the most from identifying novel, alternative effective methods for stimulating production of saliva. The aim of this study was to give an overview of the latest and most relevant data related to treatment modalities for the management of dry mouth conditions. Data Resources and Study Selection. The present review was prepared by searching the National Library of Medicine database using the relevant medical terms and their combinations. A total of thirty-three studies met the inclusion criteria. Data were extracted by one author and verified by another. Conclusion A number of patients showed positive treatment outcomes, and the adverse effects of both electrical stimulation (ES) and acupuncture have been reported as mild and transient. In patients who have undergone radiotherapy, acupuncture is shown to increase salivation. However, in patients with Sjogren's syndrome, the effects of ES devices seem to be elusive. Moreover, due to the instability of the findings in relation to longevity of clinical effect, patient satisfaction, quality of life, and clinical effectiveness of such treatments, the results remain vague.
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Molecular and Biologic Targets for Radiation Fibrosis: Implications for Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Abstract
Over the next several decades, rates of aged populations will increase rapidly. These populations are susceptible to multimorbidities and polypharmacy (concurrently, prescribed 5 or more medications). Many medications have side effects that manifest orally. Therefore, it essential to possess current pharmacologic knowledge to diagnose and treat oral implications of commonly prescribed medications. This article details common medication-induced oral lesions and patient assessment of risk factors for polypharmacy and provides a template to integrate medication reconciliation into dental clinical practice.
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9
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Jensen SB, Vissink A, Limesand KH, Reyland ME. Salivary Gland Hypofunction and Xerostomia in Head and Neck Radiation Patients. J Natl Cancer Inst Monogr 2020; 2019:5551361. [PMID: 31425600 DOI: 10.1093/jncimonographs/lgz016] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The most manifest long-term consequences of radiation therapy in the head and neck cancer patient are salivary gland hypofunction and a sensation of oral dryness (xerostomia). METHODS This critical review addresses the consequences of radiation injury to salivary gland tissue, the clinical management of salivary gland hypofunction and xerostomia, and current and potential strategies to prevent or reduce radiation injury to salivary gland tissue or restore the function of radiation-injured salivary gland tissue. RESULTS Salivary gland hypofunction and xerostomia have severe implications for oral functioning, maintenance of oral and general health, and quality of life. Significant progress has been made to spare salivary gland function chiefly due to advances in radiation techniques. Other strategies have also been developed, e.g., radioprotectors, identification and preservation/expansion of salivary stem cells by stimulation with cholinergic muscarinic agonists, and application of new lubricating or stimulatory agents, surgical transfer of submandibular glands, and acupuncture. CONCLUSION Many advances to manage salivary gland hypofunction and xerostomia induced by radiation therapy still only offer partial protection since they are often of short duration, lack the protective effects of saliva, or potentially have significant adverse effects. Intensity-modulated radiation therapy (IMRT), and its next step, proton therapy, have the greatest potential as a management strategy for permanently preserving salivary gland function in head and neck cancer patients.Presently, gene transfer to supplement fluid formation and stem cell transfer to increase the regenerative potential in radiation-damaged salivary glands are promising approaches for regaining function and/or regeneration of radiation-damaged salivary gland tissue.
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Affiliation(s)
- Siri Beier Jensen
- Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center, Groningen, The Netherlands
| | | | - Mary E Reyland
- Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
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Botulinumtoxin in der HNO‑Heilkunde – ein Update. HNO 2017; 65:859-870. [DOI: 10.1007/s00106-017-0409-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burghartz M, Lennartz S, Schweinlin M, Hagen R, Kleinsasser N, Hackenberg S, Steußloff G, Scherzad A, Radeloff K, Ginzkey C, Walles H, Metzger M. Development of Human Salivary Gland-Like Tissue In Vitro. Tissue Eng Part A 2017; 24:301-309. [PMID: 28783453 DOI: 10.1089/ten.tea.2016.0466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The loss of salivary gland function caused by radiation therapy of the head and neck is a serious condition and it affects a patient's quality of life. The current lack of effective therapies demands new options to be explored. This study tested whether human salivary gland epithelial cells (SGECs) could be successfully cultured on a decellularized porcine gut matrix (SIS-muc) in both mono- and coculture with microvascular endothelial cells (mvECs). By performing immunofluorescence imaging, transmission as well as scanning electron microscopy (SEM), quantitative polymerase chain reaction (qPCR), and an amylase enzyme assay, it was investigated as to what extent the three-dimensional (3D)-cultured cells could maintain their molecular differentiation and the production of working α-amylase (α-AMY) compared with two-dimensional (2D) culture. In both 3D mono- and coculture, SGECs were successfully cultured and formed acinar-like structures. Those findings were confirmed by SEM imaging. Immunofluorescence imaging revealed that 3D-cultured cells expressed α-AMY, Claudin-1 (CL-1), and water channel protein aquaporin-5 (AQP-5). Two-dimensional-cultured cells only were positive for α-AMY. Real time (RT)-qPCR analysis showed that α-AMY relative gene expression was higher in both 3D mono- and coculture than in 2D culture. In α-AMY enzyme assay, cocultured SGECs showed about 25 times increased enzyme activity compared with 2D-cultured cells. In conclusion, the SIS-muc combined with endothelial coculture seems a suitable culture setting for the tissue engineering of functional human salivary gland tissue.
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Affiliation(s)
- Marc Burghartz
- 1 Department of Otorhinolaryngology, Head and Neck Surgery , Klinikum Stuttgart, Stuttgart, Germany
| | - Simon Lennartz
- 2 Institute of Diagnostic and Interventional Radiology, University Hospital Cologne , Cologne, Germany
| | - Matthias Schweinlin
- 3 Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Würzburg , Würzburg, Germany
| | - Rudolf Hagen
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Norbert Kleinsasser
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Stephan Hackenberg
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Gudrun Steußloff
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Agmal Scherzad
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Kathrin Radeloff
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Christian Ginzkey
- 5 Department of Otorhinolaryngology, Head and Neck Surgery "Otto-Körner", University Hospital Rostock , Rostock, Germany
| | - Heike Walles
- 3 Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Würzburg , Würzburg, Germany
| | - Marco Metzger
- 3 Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Würzburg , Würzburg, Germany
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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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Burghartz M, Ginzkey C, Hackenberg S, Hagen R. Two-stage autotransplantation of the human submandibular gland: First long-term results. Laryngoscope 2016; 126:1551-5. [DOI: 10.1002/lary.25854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Marc Burghartz
- Department of Otorhinolaryngology-Head and Neck Surgery; Klinikum Stuttgart; Stuttgart Germany
| | - Christian Ginzkey
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery; “Otto Körner,” Rostock University Medical Center; Rostock Germany
| | - Stephan Hackenberg
- University Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery; University Hospital Wuerzburg; Wuerzburg Germany
| | - Rudolf Hagen
- University Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery; University Hospital Wuerzburg; Wuerzburg Germany
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Zeidan YH, Xiao N, Cao H, Kong C, Le QT, Sirjani D. Botulinum Toxin Confers Radioprotection in Murine Salivary Glands. Int J Radiat Oncol Biol Phys 2015; 94:1190-7. [PMID: 26907915 DOI: 10.1016/j.ijrobp.2015.12.371] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE Xerostomia is a common radiation sequela, which has a negative impact on the quality of life of patients with head and neck cancer. Current treatment strategies offer only partial relief. Botulinum toxins (BTX) have been successfully used in treating a variety of radiation sequelae such as cystitis, proctitis, fibrosis, and facial pain. The purpose of this study was to evaluate the effect of BTX on radiation-induced salivary gland damage. METHODS AND MATERIALS We used a previously established model for murine salivary gland irradiation (IR). The submandibular glands (SMGs) of C5BL/6 mice (n=6/group) were injected with saline or BTX 72 hours before receiving 15 Gy of focal irradiation. Saliva flow was measured 3, 7, and 28 days after treatment. The SMGs were collected for immunohistochemistry, confocal microscopy, and Western blotting. A cytokine array consisting of 40 different mouse cytokines was used to evaluate cytokine profiles after radiation treatment. RESULTS Irradiated mice showed a 50% reduction in saliva flow after 3 days, whereas mice preinjected with BTX had 25% reduction in saliva flow (P<.05). Cell death detected by TUNEL staining was similar in SMG sections of both groups. However, neutrophil infiltrate, detected by myeloperoxidase staining, was 3-fold lower for the BTX treated mice. A cytokine array showed a 2-fold upregulation of LPS-induced chemokine (LIX/CXCL5) 3 days after IR. BTX pretreatment reduced LIX levels by 40%. At 4 weeks after IR, the saline (control) group showed a 40% reduction in basal SMG weight, compared with 20% in the BTX group. Histologically, BTX-pretreated glands showed relative preservation of acinar structures after radiation. CONCLUSIONS These data suggest that BTX pretreatment ameliorates radiation-induced saliva dysfunction. Moreover, we demonstrate a novel role for CXCL5 in the acute phase of salivary gland damage after radiation. These results carry important clinical implications for the treatment of xerostomia in patients with head and neck cancer.
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Affiliation(s)
- Youssef H Zeidan
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida.
| | - Nan Xiao
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Hongbin Cao
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Christina Kong
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California; Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Davud Sirjani
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
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Acauan MD, Figueiredo MAZ, Cherubini K, Gomes APN, Salum FG. Radiotherapy-induced salivary dysfunction: Structural changes, pathogenetic mechanisms and therapies. Arch Oral Biol 2015; 60:1802-10. [DOI: 10.1016/j.archoralbio.2015.09.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 01/01/2023]
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Hagen R, Scheich M, Kleinsasser N, Burghartz M. Two-stage autotransplantation of human submandibular gland: a novel approach to treat postradiogenic xerostomia. Eur Arch Otorhinolaryngol 2015; 273:2217-22. [DOI: 10.1007/s00405-015-3752-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 08/10/2015] [Indexed: 02/04/2023]
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18
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Salivary hypofunction: An update on aetiology, diagnosis and therapeutics. Arch Oral Biol 2015; 60:242-55. [DOI: 10.1016/j.archoralbio.2014.10.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 09/15/2014] [Accepted: 10/28/2014] [Indexed: 12/25/2022]
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19
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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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20
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Shear wave elastography: a new noninvasive tool to assess the intensity of fibrosis of irradiated salivary glands in head and neck cancer patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:157809. [PMID: 25202703 PMCID: PMC4150524 DOI: 10.1155/2014/157809] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/29/2014] [Accepted: 07/14/2014] [Indexed: 12/15/2022]
Abstract
The aim of the study was to assess salivary gland parenchyma by means of sonoelastography in patients irradiated for head and neck squamous cell carcinoma (HNSCC). The studied group consisted of 52 patients after radiotherapy (RT) and 54 healthy volunteers. All of the former were treated for advanced larynx (40), oropharynx (9), or maxilla (3) squamous cancers and suffered from chronic dryness. Ultrasonography (US) and elastography (ES) were performed, as well as an assessment of the amount of saliva and Common Terminology Criteria for Adverse Events (CTCAE) scale. There was a statistical difference between ES values in the RT group and in the controls for parotid glands (41.7 kPa versus 26.03 kPa, P = 0.0018) and for submandibular glands (37.6 kPa versus 22.4 kPa; P = 0.005). There was a significant correlation between the CTCAE scores and objective saliva amount (P = 0.0005), and the median amount of saliva in the examined group was lower than in the reference group (1.86 g versus 2.75 g, P = 0.0006). In conclusion sonoelastography adds a new parameter to ultrasonography in “one touch examination” and may be a useful tool for major salivary gland evaluation during the radiotherapy course and follow-up period.
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Kałużny J, Wierzbicka M, Nogala H, Milecki P, Kopeć T. Radiotherapy induced xerostomia: Mechanisms, diagnostics, prevention and treatment – Evidence based up to 2013. Otolaryngol Pol 2014; 68:1-14. [DOI: 10.1016/j.otpol.2013.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
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23
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Sasportas LS, Hosford DN, Sodini MA, Waters DJ, Zambricki EA, Barral JK, Graves EE, Brinton TJ, Yock PG, Le QT, Sirjani D. Cost-effectiveness landscape analysis of treatments addressing xerostomia in patients receiving head and neck radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e37-51. [PMID: 23643579 PMCID: PMC4018820 DOI: 10.1016/j.oooo.2013.02.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 11/30/2012] [Accepted: 02/20/2013] [Indexed: 12/11/2022]
Abstract
Head and neck (H&N) radiation therapy (RT) can induce irreversible damage to the salivary glands thereby causing long-term xerostomia or dry mouth in 68%-85% of the patients. Not only does xerostomia significantly impair patients' quality-of-life (QOL) but it also has important medical sequelae, incurring high medical and dental costs. In this article, we review various measures to assess xerostomia and evaluate current and emerging solutions to address this condition in H&N cancer patients. These solutions typically seek to accomplish 1 of the 4 objectives: (1) to protect the salivary glands during RT, (2) to stimulate the remaining gland function, (3) to treat the symptoms of xerostomia, or (4) to regenerate the salivary glands. For each treatment, we assess its mechanisms of action, efficacy, safety, clinical utilization, and cost. We conclude that intensity-modulated radiation therapy is both the most widely used prevention approach and the most cost-effective existing solution and we highlight novel and promising techniques on the cost-effectiveness landscape.
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Affiliation(s)
- Laura S Sasportas
- Department of Bioengineering, Biodesign Innovation Program, Stanford University, Stanford, CA 94305, USA.
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Vissink A, Mitchell JB, Baum BJ, Limesand KH, Jensen SB, Fox PC, Elting LS, Langendijk JA, Coppes RP, Reyland ME. Clinical management of salivary gland hypofunction and xerostomia in head-and-neck cancer patients: successes and barriers. Int J Radiat Oncol Biol Phys 2010; 78:983-91. [PMID: 20970030 DOI: 10.1016/j.ijrobp.2010.06.052] [Citation(s) in RCA: 221] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/12/2010] [Accepted: 06/20/2010] [Indexed: 12/22/2022]
Abstract
The most significant long-term complication of radiotherapy in the head-and-neck region is hyposalivation and its related complaints, particularily xerostomia. This review addresses the pathophysiology underlying irradiation damage to salivary gland tissue, the consequences of radiation injury, and issues contributing to the clinical management of salivary gland hypofunction and xerostomia. These include ways to (1) prevent or minimize radiation injury of salivary gland tissue, (2) manage radiation-induced hyposalivation and xerostomia, and (3) restore the function of salivary gland tissue damaged by radiotherapy.
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Affiliation(s)
- Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Grongingen, The Netherlands
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Abstract
Xerostomia (dry mouth) as a consequence of treatment of head and neck malignancy is almost always due to radiotherapy. The resultant salivary gland dysfunction can adversely affect oral and systemic health as well as lessen quality of life. While the present management of radiotherapy-associated salivary dysfunction is challenging there have been striking advances in preventative strategies and a number of possible treatment options may be over the near horizon.
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Advances in understanding of toxicities of treatment for head and neck cancer. Oral Oncol 2009; 45:844-8. [PMID: 19467918 DOI: 10.1016/j.oraloncology.2009.03.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 03/30/2009] [Accepted: 03/30/2009] [Indexed: 12/11/2022]
Abstract
Toxicities associated with head and neck cancer treatment are common events. Despite the fact that many side effects of cancer treatment are now well controlled, some, such as mucositis and salivary gland hypofunction, continue to be almost inevitable outcomes of cancer treatment. Furthermore, improvements in cancer treatment itself as well as new modalities, such as targeted treatments, may be associated with different toxicities. In this review, common toxicities associated with head and neck cancer treatment will be discussed including those reported to occur with targeted therapies. This review also considers the concept of toxicity clusters, risk factors for toxicity (for example genetics) and individualisation of cancer treatment.
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