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Ahmed SF, Bakr MA. Will Nigella sativa oil protect parotid glands of rats against cranium gamma irradiation? Histological and immunohistochemical evaluation. BMC Complement Med Ther 2024; 24:111. [PMID: 38448931 PMCID: PMC10916243 DOI: 10.1186/s12906-024-04410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Radiation plays an essential role in treating malignancies. Radiation exposure of salivary glands often results in permanent loss of their functions; therefore, their protection against radiation is crucial. Nigella sativa oil (NSO) is a useful antioxidant against free radicals. The purpose of this study was to investigate the radio-protective effect of NSO on oxidative injury of parotid glands of gamma-irradiated rats. METHODS Twenty-eight male albino rats were divided into four groups (n = 7): Group 1: Neither NSO nor radiation, Group 2: Rats received NSO 400 mg/kg, Group 3: Rats received 15 Gy cranium gamma irradiation & Group 4: Rats received gamma irradiation and NSO. Rats were sacrificed two weeks after the last NSO dose. Histological sections of parotid glands were stained with H&E, Masson's trichrome and anti-TGF-β antibodies. Area percentage of Masson's trichrome and TGF-β expression was morphometrically examined. RESULTS Parotid glands of control and NSO groups revealed normal morphology. Gamma-irradiated glands showed loss of normal acinar architecture and slight acinar shrinkage. NSO treatment of gamma-irradiated glands preserved acinar outline and architecture. Masson's trichrome stained samples revealed trace amounts of collagen fibers in control and NSO groups, and excessive amounts of collagen fibers in gamma-irradiated group, in addition to few collagen fibers for gamma-irradiated glands treated with NSO. Additionally, control and NSO groups showed negative TGF-β expression. Gamma-irradiated group showed high TGF-β expression, while NSO treated gamma-irradiated group showed moderate TGF-β expression. CONCLUSIONS Gamma-irradiation adversely affected parotid glands, and in contrast, NSO seemed to positively counteract this adverse effect.
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Affiliation(s)
- Salwa Farid Ahmed
- Health Radiation Research Dept., National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt.
| | - Mostafa A Bakr
- Health Radiation Research Dept., National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt
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Mercadante V, Hamad AA, McCaul J, Nutting C, Harrington K, Carnell D, Urbano TG, Kalavrezos N, Barber JA, Porter SR, Fedele S. Salivary Electrostimulation in the Treatment of Radiation Therapy-Induced Xerostomia (LEONIDAS-2): A Multicenter, Randomized, Double-Masked, Sham-Controlled, Phase 3 Trial. Int J Radiat Oncol Biol Phys 2024; 118:142-153. [PMID: 36933846 DOI: 10.1016/j.ijrobp.2023.03.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Radiation therapy-induced xerostomia significantly affects quality of life in head and neck cancer survivors. Neuro-electrostimulation of the salivary glands may safely increase natural salivation and reduce dry mouth symptoms. METHODS AND MATERIALS This multicenter, double-masked, randomized, sham-controlled clinical trial assessed the long-term effects of a commercially available intraoral neuro-electrostimulating device in lessening xerostomia symptoms, increasing salivary flow, and improving quality of life in individuals with radiation therapy-induced xerostomia. Using a computer-generated randomization list, participants were assigned (1:1) to an active intraoral custom-made removable electrostimulating device or a sham device to be used for 12 months. The primary outcome was the proportion of patients reporting a 30% improvement on the xerostomia visual analog scale at 12 months. A number of secondary and exploratory outcomes were also assessed through validated measurements (sialometry and visual analog scale) and quality-of-life questionnaires (EORTC QLQ-H&N35, OH-QoL16, and SF-36). RESULTS As per protocol, 86 participants were recruited. Intention-to-treat analyses showed no statistical evidence of a difference between the study groups with respect to the primary outcome or for any of the secondary clinical or quality-of-life outcomes. Exploratory analyses showed a statistically significant difference in the changes over time of the dry mouth subscale score of the EORTC QLQ-H&N35 in favor of the active intervention. CONCLUSIONS LEONIDAS-2 did not meet the primary and secondary outcomes.
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Affiliation(s)
- Valeria Mercadante
- Eastman Dental Institute, University College London, London, United Kingdom.
| | - Arwa Al Hamad
- Dental Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - James McCaul
- Maxillofacial Unit, Bradford Teaching Hospitals Foundation Trust and Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, United Kingdom
| | | | - Kevin Harrington
- Royal Marsden NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - Dawn Carnell
- Department of Oncology, University College London NHS Foundation Trust, London, United Kingdom
| | - Teresa Guerrero Urbano
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nicholas Kalavrezos
- Department of Head & Neck Surgery, University College London NHS Foundation Trust, London, United Kingdom
| | - Julie A Barber
- Department of Statistical Science, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Stephen R Porter
- Eastman Dental Institute, University College London, London, United Kingdom
| | - Stefano Fedele
- Eastman Dental Institute, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
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Kim LN, Rubenstein RN, Chu JJ, Allen RJ, Mehrara BJ, Nelson JA. Noninvasive Systemic Modalities for Prevention of Head and Neck Radiation-Associated Soft Tissue Injury: A Narrative Review. J Reconstr Microsurg 2022; 38:621-629. [PMID: 35213927 PMCID: PMC9402815 DOI: 10.1055/s-0042-1742731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Radiation-associated soft tissue injury is a potentially devastating complication for head and neck cancer patients. The damage can range from minor sequelae such as xerostomia, which requires frequent daily maintenance, to destructive degenerative processes such as osteoradionecrosis, which can contribute to flap failure and delay or reverse oral rehabilitation. Despite the need for effective radioprotectants, the literature remains sparse, primarily focused on interventions beyond the surgeon's control, such as maintenance of good oral hygiene or modulation of radiation dose. METHODS This narrative review aggregates and explores noninvasive, systemic treatment modalities for prevention or amelioration of radiation-associated soft tissue injury. RESULTS We highlighted nine modalities with the most clinical potential, which include amifostine, melatonin, palifermin, hyperbaric oxygen therapy, photobiomodulation, pentoxifylline-tocopherol-clodronate, pravastatin, transforming growth factor-β modulators, and deferoxamine, and reviewed the benefits and limitations of each modality. Unfortunately, none of these modalities are supported by strong evidence for prophylaxis against radiation-associated soft tissue injury. CONCLUSION While we cannot endorse any of these nine modalities for immediate clinical use, they may prove fruitful areas for further investigation.
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Affiliation(s)
- Leslie N. Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robyn N. Rubenstein
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jacqueline J. Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J. Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Research Value of Intensity Modulated Radiation Therapy in Alleviating Parotid Gland Function Injury in Patients with Stage N0 Nasopharyngeal Carcinoma from Physical and Dosimetric Aspects. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4651364. [PMID: 35860184 PMCID: PMC9293508 DOI: 10.1155/2022/4651364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
Objective To study the feasibility of intensity modulated radiation therapy (IMRT) for stage N0 nasopharyngeal carcinoma (NPC) and its parotid gland (PG) function preservation from physical and dosimetric aspects. Methods All the clinical data of 77 patients with pathologically confirmed T1-4N0M0 NPC who received radiotherapy between July 2017 and October 2019 in the Radiotherapy Center of Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University were analyzed retrospectively. Three-dimensional conformal radiotherapy (3D-CRT) and IMRT were used in 35 and 42 cases, respectively. The treatment efficiency and the dosimetry differences of the PG in the intensity modulation plan were compared between groups. Quantitative monitoring of 99mTc radionuclide imaging of PG was performed before, at the end of, and 3, 6, and 12 months after radiotherapy. The degree of PG function injury and xerostomia was compared between groups at the end of radiotherapy and 12 months later. Results Higher minimal, maximal, and average irradiation doses of PG were determined in 3D-CRT-treated patients compared with IMRT-treated cases (P < 0.05). Compared with before radiotherapy, the PG uptake index (UI) and excretion index (EI) of both cohorts of patients decreased to varying degrees at the end of radiotherapy, with PG function injury and xerostomia symptoms observed in all cases but with no obvious difference between groups (P > 0.05). To a certain extent, the PG function recovered and the xerostomia symptoms relieved in both groups 12 months after radiotherapy, with better improvements in IMRT group versus 3D-CRT group. Conclusion IMRT has similar short-term efficacy to 3D-CRT in treating patients with stage N0 NPC, but it can effectively reduce the dose of PG radiotherapy and protect the PG function on the premise of ensuring sufficient tumor coverage and dose, showing certain dosimetry advantages.
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Radioprotective effects and mechanism of HL-003 on radiation-induced salivary gland damage in mice. Sci Rep 2022; 12:8419. [PMID: 35589816 PMCID: PMC9120142 DOI: 10.1038/s41598-022-12581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
Ionizing radiation (IR) can cause damage to the structure and function of salivary glands. Our research group independently synthesized the ROS scavenger, HL-003. The aim of this study was to explore the protective effects and underlying mechanisms of HL-003 on radiation-induced salivary gland injury. Salivary flow rate measurement, H&E staining, immunohistochemistry, FRAP, TUNEL, and western blotting were used to evaluate the radioprotective effect on salivary glands. The results showed that HL-003 protected the salivary secretion function by protecting the AQP-5 protein, on the salivary epithelial cell membrane, from IR damage. HL-003 reduced oxidative stress in the salivary gland by regulating the expression of ROS-related proteins NOX4, SOD2, and 8-OHdG. Furthermore, HL-003 downregulated the expression of p-p53, Bax, caspase 3, and caspase 9, and upregulated the expression of Bcl-2, suggesting that it could inhibit the activation of p53 to reduce cell apoptosis. In conclusion, HL-003 is an effective radioprotector that prevents damage of the radiation-induced salivary gland.
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Tasaka S, Jingu K, Takahashi N, Umezawa R, Yamamoto T, Ishikawa Y, Takeda K, Suzuki Y, Kadoya N. The Long-Term Recovery of Parotid Glands in Nasopharyngeal Carcinoma Treated by Intensity-Modulated Radiotherapy. Front Oncol 2021; 11:665837. [PMID: 34026643 PMCID: PMC8138171 DOI: 10.3389/fonc.2021.665837] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/19/2021] [Indexed: 12/04/2022] Open
Abstract
Background Xerostomia is one of the most common adverse events of radiotherapy in head and neck cancer patients. There have been many reports on functional changes of the parotid gland after radiation therapy, but there have been few reports on the volume of the parotid gland and its relationship with oral quality of life (QOL) and even fewer reports on longitudinal change of the parotid gland volume. The purpose of this study was to evaluate the long-term change of the parotid gland volume after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma and the relationship between parotid irradiation dose and xerostomia symptoms. Methods We retrospectively analyzed 26 patients with nasopharyngeal cancer treated by IMRT. Longitudinal changes of parotid gland volumes after IMRT were evaluated on CT images. The parotid gland volumes in each period were converted to the ratio to parotid gland volumes before radiotherapy (relative parotid volume). Dunnett’s test was used to evaluate the longitudinal changes in relative parotid volumes at 0-6, 7-18, 19-30, 31-42, 43-54 and 55-66 months after IMRT. We assessed xerostomia 3 years or more after IMRT by measuring the degree of oral moisture using a moisture-checking device (Mucus, Life Co., Ltd.) and oral QOL evaluation by GOHAI (General Oral Health Assessment Index). Results The relative parotid volumes during radiotherapy and at 0-6, 7-18, 19-30, 31-42, 43-54 and 55-66 months after IMRT were 75.2 ± 14.3%, 67.2 ± 11.4%, 68.5 ± 15.9%, 72.4 ± 14.8%, 73.0 ± 13.8%, 76.2 ± 17.5%, and 77.1% ± 17.3%, respectively. The parotid volume had recovered significantly at 43-54 and 55-66 months after IMRT, especially in parotids receiving less than 40 Gy as the mean dose. The mean irradiated dose for bilateral parotids showed negative correlations with oral QOL score and oral moisture after a long period. Conclusions The parotid volume recovered gradually but had not reached a plateau even 3 years after radiotherapy, especially in parotids receiving less than 40 Gy as the mean dose.
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Affiliation(s)
- Shun Tasaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Suzuki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract
This review summarizes the beginning of radiotherapy, techniques of modern radiation therapy with different types, toxicities induced by radiotherapy and their management. Head and neck radiation therapy is still improving for the better management and control of the cancer and induced radiotherapy toxicities.
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Affiliation(s)
- Afnan F. Alfouzan
- From the Department of Prosthodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Afnan Alfouzan, Department of Prosthodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: http://orcid.org/0000-0003-2535-4641
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8
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Rakici SY, Tumkaya L, Edirvanli OC, Yazici U, Dursun E, Arpa M, Mercantepe T. Radioprotective effect of endogenous melatonin secretion associated with the circadian rhythm in irradiated rats. Int J Radiat Biol 2019; 95:1236-1241. [PMID: 31287351 DOI: 10.1080/09553002.2019.1642532] [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: 10/26/2022]
Abstract
Purpose: We investigated the radioprotective effect of endogenous melatonin release at different times associated with the circadian rhythm on head and neck radiotherapy. Materials and methods: Two groups of animals were subjected daily to 8 Gy single fraction radiotherapy in the head and neck region from 5:00 to 6:00 (the morning group) or from 19:00 to 20:00 (the evening group). Corresponding untreated groups served as controls. Submandibular glands from rats sacrificed on the seventh day after irradiation were assessed biochemically and histopathologically. Melatonin, malondialdehyde and superoxide dismutase levels in blood collected immediately prior to irradiation were measured with rat-specific ELISA kits. Results: In irradiated rats, melatonin, malondialdehyde and superoxide dismutase levels were significantly higher in the evening group than in the morning group. In nonirradiated rats, melatonin and superoxide dismutase levels were significantly higher in the evening group than in the morning group. The areas of seromucous acinar cells were similar between the irradiated and nonirradiated evening groups, but the area was higher in the evening irradiated group than in the morning irradiated group. Conclusion: Consideration of endogenous melatonin secretion associated with the circadian rhythm may offer new therapeutic solutions for the complications of head and neck radiotherapy.
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Affiliation(s)
- Sema Yilmaz Rakici
- Department of Radiation Oncology, Recep Tayyip Erdogan University , Rize , Turkey
| | - Levent Tumkaya
- Department of Histology and Embryology, Recep Tayyip Erdogan University , Rize , Turkey
| | | | - Ufuk Yazici
- Department of Radiation Oncology, Recep Tayyip Erdogan University , Rize , Turkey
| | - Engin Dursun
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University , Rize , Turkey
| | - Medeni Arpa
- Department of Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University , Rize , Turkey
| | - Tolga Mercantepe
- Department of Histology and Embryology, Recep Tayyip Erdogan University , Rize , Turkey
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Ianunzio JR, Peres KG, Haag DG, Peres MA. Direct effect of common mental disorders on xerostomia in adults estimated by marginal structural models: A population‐based study. Community Dent Oral Epidemiol 2019; 47:267-273. [DOI: 10.1111/cdoe.12454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/01/2019] [Accepted: 02/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - Karen Glazer Peres
- School of Dentistry and Oral HealthGriffith University Southport Queensland Australia
| | - Dandara Gabriela Haag
- Australian Research Centre for Population Oral HealthAdelaide Dental SchoolThe University of Adelaide Adelaide South Australia Australia
- BetterStart Child Health and Development Research GroupSchool of Public HealthThe University of Adelaide Adelaide South Australia Australia
| | - Marco Aurelio Peres
- School of Dentistry and Oral HealthGriffith University Southport Queensland Australia
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
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Kim JH, Kim KM, Jung MH, Jung JH, Kang KM, Jeong BK, Kim JP, Park JJ, Woo SH. Protective effects of alpha lipoic acid on radiation-induced salivary gland injury in rats. Oncotarget 2018; 7:29143-53. [PMID: 27072584 PMCID: PMC5045384 DOI: 10.18632/oncotarget.8661] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 03/16/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose Radiation therapy is a treatment for patients with head and neck (HN) cancer. However, radiation exposure to the HN often induces salivary gland (SG) dysfunction. We investigated the effect of α-lipoic acid (ALA) on radiation-induced SG injury in rats. Results ALA preserved acinoductal integrity and acinar cell secretary function following irradiation. These results are related to the mechanisms by which ALA inhibits oxidative stress by inhibiting gp91 mRNA and 8-OHdG expression and apoptosis of acinar cells and ductal cells by inactivating MAPKs in the early period and expression of inflammation-related factors including NF-κB, IκB-α, and TGF-β1 and fibrosis in late irradiated SG. ALA effects began in the acute phase and persisted for at least 56 days after irradiation. Materials and Methods Rats were assigned to followings: control, ALA only (100 mg/kg, i.p.), irradiated, and ALA administered 24 h and 30 min prior to irradiation. The neck area including the SG was evenly irradiated with 2 Gy per minute (total dose, 18 Gy) using a photon 6-MV linear accelerator. Rats were killed at 4, 7, 28, and 56 days after radiation. Conclusions Our results show that ALA could be used to ameliorate radiation-induced SG injury in patients with HN cancer.
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Affiliation(s)
- Jin Hyun Kim
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongnam, Republic of Korea.,Institute of Health Science, Jinju, Gyeongnam, Republic of Korea
| | - Kyung Mi Kim
- Department of Otolaryngology, Jinju, Gyeongnam, Republic of Korea
| | - Myeong Hee Jung
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongnam, Republic of Korea
| | - Jung Hwa Jung
- Institute of Health Science, Jinju, Gyeongnam, Republic of Korea.,Department of Internal Medicine, Jinju, Gyeongnam, Republic of Korea
| | - Ki Mun Kang
- Institute of Health Science, Jinju, Gyeongnam, Republic of Korea.,Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongnam, Republic of Korea
| | - Bae Kwon Jeong
- Institute of Health Science, Jinju, Gyeongnam, Republic of Korea.,Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongnam, Republic of Korea
| | - Jin Pyeong Kim
- Institute of Health Science, Jinju, Gyeongnam, Republic of Korea.,Department of Otolaryngology, Jinju, Gyeongnam, Republic of Korea
| | - Jung Je Park
- Institute of Health Science, Jinju, Gyeongnam, Republic of Korea.,Department of Otolaryngology, Jinju, Gyeongnam, Republic of Korea
| | - Seung Hoon Woo
- Institute of Health Science, Jinju, Gyeongnam, Republic of Korea.,Department of Otolaryngology, Jinju, Gyeongnam, Republic of Korea
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Follow-up and Survivorship in Head and Neck Cancer. Clin Oncol (R Coll Radiol) 2016; 28:451-8. [DOI: 10.1016/j.clon.2016.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/23/2016] [Accepted: 03/03/2016] [Indexed: 12/14/2022]
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Kaae JK, Stenfeldt L, Eriksen JG. Xerostomia after Radiotherapy for Oral and Oropharyngeal Cancer: Increasing Salivary Flow with Tasteless Sugar-free Chewing Gum. Front Oncol 2016; 6:111. [PMID: 27200297 PMCID: PMC4853382 DOI: 10.3389/fonc.2016.00111] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/18/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction Radiation-induced xerostomia is a frequent late side effect after treatment for oral and oropharyngeal cancers. This may induce swallowing difficulties, compromised oral well-being, reduced nutrition intake, or speech deficiencies. Consequently, quality of life is often impaired for these patients. Objectives The purpose of this study was to investigate the possibility to mechanically stimulate residual saliva function by using tasteless and sugar-free chewing gum. It was hypothesized that tasteless and sugar-free chewing gum could immediately increase salivary flow and potentially improve oral well-being when used on a regular basis. Methods From October to December 2014, 31 consecutive patients treated with primary radiotherapy (RT) and concomitant cisplatin (in locally advanced cases) for oral or oropharyngeal cancer consented to participate. All patients had finalized RT 2–8 months prior to participation and suffered from xerostomia. Samples of unstimulated and chewing gum-stimulated saliva were obtained at the entry into the study (Visit 1). For 2 weeks, patients used chewing gum on a regular basis whereupon saliva measurements were repeated to verify the changes (Visit 2). An abbreviated EORTC H&N35 questionnaire was completed for both visits. A small control group consisting of young and healthy individuals also tested the chewing gum. Results Twenty patients completed the study and an increase in saliva flow was observed for 14 patients. Before and after intervention with chewing gum, an increase in mean saliva output was seen between unstimulated and stimulated saliva for both Visit 1 and 2 (p = 0.008 and p = 0.05, respectively). No change in saliva output was seen in the control group. Conclusion The chewing gum was able to stimulate saliva output that was seen at the beginning and at the end of the intervention. No improvement in baseline saliva was seen. Relevant changes in subjective measures of xerostomia were seen after 2 weeks of chewing the gum.
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Affiliation(s)
| | - Lone Stenfeldt
- Department of Oncology, Odense University Hospital , Odense , Denmark
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Castelli J, Simon A, Louvel G, Henry O, Chajon E, Nassef M, Haigron P, Cazoulat G, Ospina JD, Jegoux F, Benezery K, de Crevoisier R. Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia. Radiat Oncol 2015; 10:6. [PMID: 25573091 PMCID: PMC4311461 DOI: 10.1186/s13014-014-0318-z] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large anatomical variations occur during the course of intensity-modulated radiation therapy (IMRT) for locally advanced head and neck cancer (LAHNC). The risks are therefore a parotid glands (PG) overdose and a xerostomia increase. The purposes of the study were to estimate: - the PG overdose and the xerostomia risk increase during a "standard" IMRT (IMRTstd); - the benefits of an adaptive IMRT (ART) with weekly replanning to spare the PGs and limit the risk of xerostomia. MATERIAL AND METHODS Fifteen patients received radical IMRT (70 Gy) for LAHNC. Weekly CTs were used to estimate the dose distributions delivered during the treatment, corresponding either to the initial planning (IMRTstd) or to weekly replanning (ART). PGs dose were recalculated at the fraction, from the weekly CTs. PG cumulated doses were then estimated using deformable image registration. The following PG doses were compared: pre-treatment planned dose, per-treatment IMRTstd and ART. The corresponding estimated risks of xerostomia were also compared. Correlations between anatomical markers and dose differences were searched. RESULTS Compared to the initial planning, a PG overdose was observed during IMRTstd for 59% of the PGs, with an average increase of 3.7 Gy (10.0 Gy maximum) for the mean dose, and of 8.2% (23.9% maximum) for the risk of xerostomia. Compared to the initial planning, weekly replanning reduced the PG mean dose for all the patients (p<0.05). In the overirradiated PG group, weekly replanning reduced the mean dose by 5.1 Gy (12.2 Gy maximum) and the absolute risk of xerostomia by 11% (p<0.01) (30% maximum). The PG overdose and the dosimetric benefit of replanning increased with the tumor shrinkage and the neck thickness reduction (p<0.001). CONCLUSION During the course of LAHNC IMRT, around 60% of the PGs are overdosed of 4 Gy. Weekly replanning decreased the PG mean dose by 5 Gy, and therefore by 11% the xerostomia risk.
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Affiliation(s)
- Joel Castelli
- Department of Radiotherapy, Centre Eugene Marquis, Avenue de la bataille Flandre Dunkerque, F-35000, Rennes, France.
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.
- INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France.
| | - Antoine Simon
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.
- INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France.
| | - Guillaume Louvel
- Department of Radiotherapy, Centre Eugene Marquis, Avenue de la bataille Flandre Dunkerque, F-35000, Rennes, France.
| | - Olivier Henry
- Department of Radiotherapy, Centre Eugene Marquis, Avenue de la bataille Flandre Dunkerque, F-35000, Rennes, France.
| | - Enrique Chajon
- Department of Radiotherapy, Centre Eugene Marquis, Avenue de la bataille Flandre Dunkerque, F-35000, Rennes, France.
| | - Mohamed Nassef
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.
- INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France.
| | - Pascal Haigron
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.
- INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France.
| | - Guillaume Cazoulat
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.
- INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France.
| | - Juan David Ospina
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.
- INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France.
| | | | | | - Renaud de Crevoisier
- Department of Radiotherapy, Centre Eugene Marquis, Avenue de la bataille Flandre Dunkerque, F-35000, Rennes, France.
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.
- INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France.
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14
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Saleh J, Figueiredo MAZ, Cherubini K, Braga-Filho A, Salum FG. Effect of Low-Level Laser Therapy on Radiotherapy-Induced Hyposalivation and Xerostomia: A Pilot Study. Photomed Laser Surg 2014; 32:546-52. [DOI: 10.1089/pho.2014.3741] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamil Saleh
- Oral Medicine Division, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul- PUCRS, Porto Alegre – RS, Brazil
| | | | - Karen Cherubini
- Oral Medicine Division, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul- PUCRS, Porto Alegre – RS, Brazil
| | - Aroldo Braga-Filho
- Radiotherapy Service, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul- PUCRS, Porto Alegre – RS, Brazil
| | - Fernanda Gonçalves Salum
- Oral Medicine Division, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul- PUCRS, Porto Alegre – RS, Brazil
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15
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Sim CPC, Wee J, Xu Y, Cheung YB, Soong YL, Manton DJ. Anti-caries effect of CPP-ACP in irradiated nasopharyngeal carcinoma patients. Clin Oral Investig 2014; 19:1005-11. [PMID: 25261399 DOI: 10.1007/s00784-014-1318-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 09/09/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on caries progression in irradiated nasopharyngeal carcinoma (NPC) patients. METHODS Twenty-one males and three females (median age, 50 years) were randomized into two groups before radiotherapy. Subjects had at least eight teeth after oral health clearance. The test group used 0.4 % stannous fluoride gel and a crème containing 10 % CPP-ACP daily; the control group used a similar crème without CPP-ACP and otherwise identical care. Subjects applied the crème three times daily and fluoride gel once daily. Caries status, saliva and plaque parameters were measured pre-radiotherapy, at 2 weeks and 3 months post-radiotherapy. RESULTS Baseline International Caries Detection and Assessment System (ICDAS) scores were 0-1126 surfaces (93.9 %), 1-28 surfaces (2.3 %), 2-40 surfaces (3.3 %) and 3-6 surfaces (0.5 %) for the control and 0-1186 surfaces (95.6 %), 1-31 surfaces (2.5 %), 2-15 surfaces (1.2 %) and 3-8 surfaces (0.7 %) for the test group. Twenty-two subjects returned at 3 months post-radiotherapy with reduced plaque pH, salivary flow, pH and buffering capacity. Nine test and 8 control subjects developed 32 and 59 new caries lesions, respectively. Test subjects showed lower caries progression than the controls: all surfaces (OR 0.51, 95 % CI 0.17∼1.59), occlusal (OR 0.20, 95 % CI 0.03∼1.29) and smooth surfaces (OR 0.61, 95 % CI 0.16∼2.38). The difference was not statistically significant. CONCLUSION Application of CPP-ACP did not significantly reduce caries progression in NPC patients in the first 3 months after radiotherapy as compared to controls. CLINICAL RELEVANCE Adjunct use of CPP-ACP with stannous fluoride gel in irradiated NPC patients gave comparable results compared to stannous fluoride gel alone in reducing caries progression.
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Affiliation(s)
- Christina P C Sim
- Department of Restorative Dentistry, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore, 168938, Singapore,
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16
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Dik EA, Willems SM, Ipenburg NA, Adriaansens SO, Rosenberg AJ, van Es RJ. Resection of early oral squamous cell carcinoma with positive or close margins: Relevance of adjuvant treatment in relation to local recurrence. Oral Oncol 2014; 50:611-5. [DOI: 10.1016/j.oraloncology.2014.02.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/16/2014] [Accepted: 02/20/2014] [Indexed: 01/19/2023]
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17
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Epstein JB, Güneri P, Barasch A. Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time. Support Care Cancer 2014; 22:1981-8. [PMID: 24676676 DOI: 10.1007/s00520-014-2228-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/21/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The identification of experienced and knowledgeable dental specialists to provide appropriate oral care for cancer patients, as well as the integration of this care within general oncology management, may be a challenge. This paper discusses the general and additional requirements for dental care providers to support the cancer patient and provide prevention and/or treatment for oral complications of cancer therapy. METHODS We performed a literature review of specific issues regarding the oral cavity and adjacent structures in the cancer patient, including detection and early diagnosis of oral malignancy. We incorporated the systemic effects of cancer and its therapy that affect oral disease and treatment. We present a summary of how to seek expert dental care for cancer patients and for referral from the dental and medical community. RESULTS Due to the complexity conferred by the disease and its treatment, cancer patients require educated, experienced dentists for treatment and/or prevention of oral-related morbidity. Correct diagnosis and evidence-based prophylactic and therapeutic oral care can significantly improve patient quality of life and reduce morbidity and healthcare costs. CONCLUSIONS The knowledge and expertise of dental professionals regarding prevention/treatment of complications and secondary malignant lesions in cancer patients are critical. Integration of oral care with the oncology care and in survivors requires effective communication between dental and medical providers beginning ideally at diagnosis. These clinicians may be identified at the cancer center, nearby hospital dental programs, and, less commonly, in the community.
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Affiliation(s)
- Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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18
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Beech N, Robinson S, Porceddu S, Batstone M. Dental management of patients irradiated for head and neck cancer. Aust Dent J 2014; 59:20-8. [PMID: 24495127 DOI: 10.1111/adj.12134] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 12/12/2022]
Abstract
Patients undergoing radiation therapy as either primary, adjuvant, combination therapy or palliative management of head and neck malignancies are prone to a range of dental complications. Strategies for prevention and management of such complications may be controversial. This article aims to highlight the current understanding and management of the dental needs for patients before, during and after radiation therapy.
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Affiliation(s)
- N Beech
- Royal Brisbane and Women's Hospitals, The University of Queensland
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19
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Bologna-Molina R, Maglia A, Castañeda-Castaneira RE, Molina-Frechero N. Stomatological management of head and neck cancer patients treated with chemotherapy and radiotherapy. World J Stomatol 2013; 2:71-78. [DOI: 10.5321/wjs.v2.i4.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 07/31/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
Treatment of head and neck cancer with radiotherapy and/or chemotherapy can cause oral damage. Long-term treatment can damage the salivary glands, the oral mucosa, and the maxilla, leading to altered production of saliva and to multiple infections. These lesions can be prevented, limited or avoided by thorough evaluation prior to treatment and by therapeutic follow-up and preventive measures. The dentist must have strong medical knowledge of the possible short-, medium-, and long-term oral complications of the cancer treatment, and must have knowledge of the protocols for oral management of cancer patients. The availability of a multidisciplinary medical team together with a dentist to attend to the patient prior to the cancer treatment, as well as close communication between team members during and after treatment, is crucial. The aim of the present study was review the stomatological management of head and neck cancer patients treated with chemotherapy and radiotherapy and summarizing current treatments, therapeutic innovation and tissue regeneration perspectives.
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20
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Furness S, Bryan G, McMillan R, Birchenough S, Worthington HV. Interventions for the management of dry mouth: non-pharmacological interventions. Cochrane Database Syst Rev 2013:CD009603. [PMID: 24006231 PMCID: PMC7100870 DOI: 10.1002/14651858.cd009603.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Xerostomia is the subjective sensation of dry mouth. Common causes of xerostomia include adverse effects of many commonly prescribed medications, disease (e.g. Sjogren's Syndrome) and radiotherapy treatment for head and neck cancers. Non-pharmacological techniques such as acupuncture or mild electrostimulation may be used to improve symptoms. OBJECTIVES To assess the effects of non-pharmacological interventions administered to stimulate saliva production for the relief of dry mouth. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 16th April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 3), MEDLINE via OVID (1948 to 16th April 2013), EMBASE via OVID (1980 to 16th April 2013), AMED via OVID (1985 to 16th April 2013), CINAHL via EBSCO (1981 to 16th April 2013), and CANCERLIT via PubMed (1950 to 16th April 2013). The metaRegister of Controlled Clinical Trials (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov) were also searched to identify ongoing and completed trials. References lists of included studies and relevant reviews were also searched. There were no restrictions on the language of publication or publication status. SELECTION CRITERIA We included parallel group randomised controlled trials of non-pharmacological interventions to treat dry mouth, where participants had dry mouth symptoms at baseline. DATA COLLECTION AND ANALYSIS At least two review authors assessed each of the included studies to confirm eligibility, assess risk of bias and extract data using a piloted data extraction form. We calculated mean difference (MD) and 95% confidence intervals (CI) for continuous outcomes or where different scales were used to assess an outcome, we calculated standardised mean differences (SMD) together with 95% CIs. We attempted to extract data on adverse effects of interventions. Where data were missing or unclear we attempted to contact study authors to obtain further information. MAIN RESULTS There were nine studies (total 366 participants randomised) included in this review of non-pharmacological interventions for dry mouth which were divided into three comparisons. Eight studies were assessed at high risk of bias in at least one domain and the remaining study was at unclear risk of bias.Five small studies (total 153 participants, with dry mouth following radiotherapy treatment) compared acupuncture with placebo. Four were assessed at high risk and one at unclear risk of bias. Two trials reported outcome data for dry mouth in a form suitable for meta-analysis. The pooled estimate of these two trials (70 participants, low quality evidence) showed no difference between acupuncture and control in dry mouth symptoms (SMD -0.34, 95% CI -0.81 to 0.14, P value 0.17, I(2) = 39%) with the confidence intervals including both a possible reduction or a possible increase in dry mouth symptoms. Acupuncture was associated with more adverse effects (tiny bruises and tiredness which were mild and temporary). There was a very small increase in unstimulated whole saliva (UWS) at the end of 4 to 6 weeks of treatment (three trials, 71 participants, low quality evidence) (MD 0.02 ml/minute, 95% CI 0 to 0.04, P value 0.04, I(2) = 57%), and this benefit persisted at the 12-month follow-up evaluation (two trials, 54 participants, low quality evidence) (UWS, MD 0.06 ml/minute, 95% CI 0.01 to 0.11, P value 0.03, I(2) = 10%). For the outcome of stimulated whole saliva (SWS, three trials, 71 participants, low quality evidence) there was a benefit favouring acupuncture (MD 0.19 ml/minute, 95% CI 0.07 to 0.31, P value 0.002, I(2) = 1%) an effect which also persisted at the 12-month follow-up evaluation (SWS MD 0.28 ml/minute, 95% CI 0.09 to 0.47, P value 0.004, I(2) = 0%) (two trials, 54 participants, low quality evidence).Two small studies, both at high risk of bias, compared the use of an electrostimulation device with a placebo device in participants with Sjögren's Syndrome (total 101 participants). A further study, also at high risk of bias, compared acupuncture-like electrostimulation of different sets of points in participants who had previously been treated with radiotherapy. None of these studies reported the outcome of dry mouth. There was no difference between electrostimulation and placebo in the outcomes of UWS or SWS at the end of the 4-week treatment period in the one study (very low that provided data for these outcomes. No adverse effects were reported.A single study at high risk of bias, compared the stimulatory effect of powered versus manual toothbrushing and found no difference for the outcomes of UWS or SWS. AUTHORS' CONCLUSIONS There is low quality evidence that acupuncture is no different from placebo acupuncture with regard to dry mouth symptoms, which is the most important outcome. This may be because there were insufficient participants included in the two trials to show a possible effect or it may be that there was some benefit due to 'placebo' acupuncture which could have biased the effect to the null. There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms. It is well known that dry mouth symptoms may be problematic even when saliva production is increased, yet only two of the trials that evaluated acupuncture reported dry mouth symptoms, a worrying reporting bias. There is some low quality evidence that acupuncture results in a small increase in saliva production in patients with dry mouth following radiotherapy.There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms or saliva production in patients with Sjögren's Syndrome. Reported adverse effects of acupuncture are mild and of short duration, and there were no reported adverse effects from electrostimulation.
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Affiliation(s)
- Susan Furness
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Coupland III Building, Oxford Rd, Manchester, UK, M13 9PL
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21
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Furness S, Bryan G, McMillan R, Worthington HV. Interventions for the management of dry mouth: non-pharmacological interventions. Cochrane Database Syst Rev 2013:CD009603. [PMID: 23996155 DOI: 10.1002/14651858.cd009603.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Xerostomia is the subjective sensation of dry mouth. Common causes of xerostomia include adverse effects of many commonly prescribed medications, disease (e.g. Sjogren's Syndrome) and radiotherapy treatment for head and neck cancers. Non-pharmacological techniques such as acupuncture or mild electrostimulation may be used to improve symptoms. OBJECTIVES To assess the effects of non-pharmacological interventions administered to stimulate saliva production for the relief of dry mouth. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 16th April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 3), MEDLINE via OVID (1948 to 16th April 2013), EMBASE via OVID (1980 to 16th April 2013), AMED via OVID (1985 to 16th April 2013), CINAHL via EBSCO (1981 to 16th April 2013), and CANCERLIT via PubMed (1950 to 16th April 2013). The metaRegister of Controlled Clinical Trials (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov) were also searched to identify ongoing and completed trials. References lists of included studies and relevant reviews were also searched. There were no restrictions on the language of publication or publication status. SELECTION CRITERIA We included parallel group randomised controlled trials of non-pharmacological interventions to treat dry mouth, where participants had dry mouth symptoms at baseline. DATA COLLECTION AND ANALYSIS At least two review authors assessed each of the included studies to confirm eligibility, assess risk of bias and extract data using a piloted data extraction form. We calculated mean difference (MD) and 95% confidence intervals (CI) for continuous outcomes or where different scales were used to assess an outcome, we calculated standardised mean differences (SMD) together with 95% CIs. We attempted to extract data on adverse effects of interventions. Where data were missing or unclear we attempted to contact study authors to obtain further information. MAIN RESULTS There were nine studies (total 366 participants randomised) included in this review of non-pharmacological interventions for dry mouth which were divided into three comparisons. Eight studies were assessed at high risk of bias in at least one domain and the remaining study was at unclear risk of bias.Five small studies (total 153 participants, with dry mouth following radiotherapy treatment) compared acupuncture with placebo. Four were assessed at high risk and one at unclear risk of bias. Two trials reported outcome data for dry mouth in a form suitable for meta-analysis. The pooled estimate of these two trials (70 participants, low quality evidence) showed no difference between acupuncture and control in dry mouth symptoms (SMD -0.34, 95% CI -0.81 to 0.14, P value 0.17, I(2) = 39%) with the confidence intervals including both a possible reduction or a possible increase in dry mouth symptoms. Acupuncture was associated with more adverse effects (tiny bruises and tiredness which were mild and temporary). There was a very small increase in unstimulated whole saliva (UWS) at the end of 4 to 6 weeks of treatment (three trials, 71 participants, low quality evidence) (MD 0.02 ml/minute, 95% CI 0 to 0.04, P value 0.04, I(2) = 57%), and this benefit persisted at the 12-month follow-up evaluation (two trials, 54 participants, low quality evidence) (UWS, MD 0.06 ml/minute, 95% CI 0.01 to 0.11, P value 0.03, I(2) = 10%). For the outcome of stimulated whole saliva (SWS, three trials, 71 participants, low quality evidence) there was a benefit favouring acupuncture (MD 0.19 ml/minute, 95% CI 0.07 to 0.31, P value 0.002, I(2) = 1%) an effect which also persisted at the 12-month follow-up evaluation (SWS MD 0.28 ml/minute, 95% CI 0.09 to 0.47, P value 0.004, I(2) = 0%) (two trials, 54 participants, low quality evidence).Two small studies, both at high risk of bias, compared the use of an electrostimulation device with a placebo device in participants with Sjögren's Syndrome (total 101 participants). A further study, also at high risk of bias, compared acupuncture-like electrostimulation of different sets of points in participants who had previously been treated with radiotherapy. None of these studies reported the outcome of dry mouth. There was no difference between electrostimulation and placebo in the outcomes of UWS or SWS at the end of the 4-week treatment period in the one study (very low that provided data for these outcomes. No adverse effects were reported.A single study at high risk of bias, compared the stimulatory effect of powered versus manual toothbrushing and found no difference for the outcomes of UWS or SWS. AUTHORS' CONCLUSIONS There is low quality evidence that acupuncture is no different from placebo acupuncture with regard to dry mouth symptoms, which is the most important outcome. This may be because there were insufficient participants included in the two trials to show a possible effect or it may be that there was some benefit due to 'placebo' acupuncture which could have biased the effect to the null. There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms. It is well known that dry mouth symptoms may be problematic even when saliva production is increased, yet only two of the trials that evaluated acupuncture reported dry mouth symptoms, a worrying reporting bias. There is some low quality evidence that acupuncture results in a small increase in saliva production in patients with dry mouth following radiotherapy.There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms or saliva production in patients with Sjögren's Syndrome. Reported adverse effects of acupuncture are mild and of short duration, and there were no reported adverse effects from electrostimulation.
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Affiliation(s)
- Susan Furness
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Coupland III Building, Oxford Rd, Manchester, UK, M13 9PL
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22
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Moore S, Burke MC, Fenlon MR, Banerjee A. The role of the general dental practitioner in managing the oral care of head and neck oncology patients. ACTA ACUST UNITED AC 2013; 39:694-6, 698-700, 702. [PMID: 23367634 DOI: 10.12968/denu.2012.39.10.694] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
UNLABELLED The general dental practitioner (GDP) plays a critical role in managing head and neck cancer patients. The first and most important role is to offer preventive services, particularly to smokers and to patients who drink alcohol to excess. It is of critical importance that every patient has a systematic examination of oral soft tissues when seen by a GDP. All patients with suspicious lesions should be referred for urgent attention to a specialist centre. Once oral cancer has been diagnosed, GDPs may be presented with patients requiring urgent dentistry, including extractions before commencement of treatment, requiring palliation of symptoms during treatment, or requiring general dentistry after treatment. Radiotherapy provides increased survival but has serious adverse consequences, which may be lifelong, including dry mouth, radiation caries, limitation of mouth opening and high risk of osteonecrosis after extractions. Extraction of teeth in irradiated bone should be referred to specialist centres. Improving survival rates and an ageing population mean that GDPs will see many more survivors of head and neck cancer in the future, with an increased burden of dental care in the longer-term and an increased need for monitoring and secondary prevention. CLINICAL RELEVANCE The management of patients with head and neck cancer is complex and involves a multi-disciplinary team, both in the primary treatment but also in the long-term care. This paper reviews the consequences of treatment for head and neck cancer and gives practical advice for GDPs and their team in the long-term care of these patients.
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Affiliation(s)
- Suzanne Moore
- Guy's and St Thomas' Hospitals Foundation Trust, London, UK
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23
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24
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Lim JY, Yi T, Choi JS, Jang YH, Lee S, Kim HJ, Song SU, Kim YM. Intraglandular transplantation of bone marrow-derived clonal mesenchymal stem cells for amelioration of post-irradiation salivary gland damage. Oral Oncol 2012; 49:136-43. [PMID: 22981389 DOI: 10.1016/j.oraloncology.2012.08.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/15/2012] [Accepted: 08/17/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES External irradiation in head and neck cancers may induce irreversible hyposalivation and consequent xerostomia, stemming from radiation damage to salivary glands (SGs). As cell-based therapy has been reported to be able to repair or restore damaged SG tissues, we attempted to determine whether bone marrow-derived clonal mesenchymal stem cells (BM-cMSCs) can ameliorate irradiation-induced salivary gland damage via a murine model. METHODS External irradiation at a dose of 15Gy was delivered to the neck fields of C57BL/6 mice. We directly administered either homologous mouse BM-cMSCs labeled with PKH26 (treatment group) or PBS (control group) into SGs 24h after irradiation. Salivary flow rate (SFR) and lag time of salivation were measured at 12weeks after transplantation. At 4 and 12weeks post-transplantation, we performed morphological, histological, and immunofluorescent examinations. Transdifferentiation of administered BM-cMSCs into salivary epithelial cells was observed by confocal microscopy. RESULTS SFR was significantly increased in BM-cMSCs-transplanted mice compared with PBS-injected mice at 12weeks after transplantation. Administration of BM-cMSCs preserved the microscopic morphologies of SGs, with more functional acini in BM-cMSC-transplanted SGs than in PBS-injected SGs. Immunofluorescent staining revealed less apoptotic cells and increased microvessel density in BM-cMSC-transplanted SGs compared with PBS-injected SGs. PKH-26 labeled BM-cMSCs were detected in transplanted SGs at 4weeks after transplantation and in vivo transdifferentiation of BM-cMSCs into acinar cells was also observed. CONCLUSION This study suggests that BM-cMSCs can ameliorate salivary damage following irradiation and can be used as a source of cell-based therapy for restoration of irradiation-induced salivary hypofunction.
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Affiliation(s)
- Jae-Yol Lim
- Department of Otorhinolaryngology - Head and Neck Surgery, Inha University School of Medicine, Incheon, Republic of Korea
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25
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McCaul LK. Oral and dental management for head and neck cancer patients treated by chemotherapy and radiotherapy. ACTA ACUST UNITED AC 2012; 39:135-8, 140. [DOI: 10.12968/denu.2012.39.2.135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lorna K McCaul
- Consultant in Restorative Dentistry and Oral Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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26
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Deng H, Sambrook PJ, Logan RM. The treatment of oral cancer: an overview for dental professionals. Aust Dent J 2012; 56:244-52, 341. [PMID: 21884138 DOI: 10.1111/j.1834-7819.2011.01349.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Oral cancer is a serious life-threatening disease. Dental professionals may be the first individuals to identify/suspect these lesions before referring to oral and maxillofacial surgeons and oral medicine specialists. Because the general dentist will likely follow on with the patient's future oral health, it is important that he or she has a basic understanding of the various treatments involved in treating oral malignancies and their respective outcomes. The four main modalities discussed in this review include surgery alone, radiotherapy alone, surgery with radiotherapy, and chemotherapy with or without surgery and radiotherapy. Chemotherapy has become an area of great interest with the introduction of new 'targeted therapies' demonstrating promising results in conjunction with surgery. Despite these results, the toxicities associated with chemotherapy regimens are frequent and can be severe, and therefore may not be suitable for all patients. Treatment modalities have improved significantly over the decades with overall decreases in recurrence rates, improved disease-free and overall survival, and an improved quality of life. Prognosis, however, is still ultimately dependent on the clinical stage of the tumour at the initial diagnosis with respect to size, depth, extent, and metastasis as recurrence rates and survival rates plummet with disease progression.
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Affiliation(s)
- H Deng
- School of Dentistry, Faculty of Health Sciences, The University of Adelaide, South Australia
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27
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Sunavala-Dossabhoy G, Palaniyandi S, Richardson C, De Benedetti A, Schrott L, Caldito G. TAT-mediated delivery of Tousled protein to salivary glands protects against radiation-induced hypofunction. Int J Radiat Oncol Biol Phys 2012; 84:257-65. [PMID: 22285666 DOI: 10.1016/j.ijrobp.2011.10.064] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 09/19/2011] [Accepted: 10/27/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE Patients treated with radiotherapy for head-and-neck cancer invariably suffer its deleterious side effect, xerostomia. Salivary hypofunction ensuing from the irreversible destruction of glands is the most common and debilitating oral complication affecting patients undergoing regional radiotherapy. Given that the current management of xerostomia is palliative and ineffective, efforts are now directed toward preventive measures to preserve gland function. The human homolog of Tousled protein, TLK1B, facilitates chromatin remodeling at DNA repair sites and improves cell survival against ionizing radiation (IR). Therefore, we wanted to determine whether a direct transfer of TLK1B protein to rat salivary glands could protect against IR-induced salivary hypofunction. METHODS The cell-permeable TAT-TLK1B fusion protein was generated. Rat acinar cell line and rat salivary glands were pretreated with TAT peptide or TAT-TLK1B before IR. The acinar cell survival in vitro and salivary function in vivo were assessed after radiation. RESULTS We demonstrated that rat acinar cells transduced with TAT-TLK1B were more resistant to radiation (D₀ = 4.13 ± 1.0 Gy; α/β = 0 Gy) compared with cells transduced with the TAT peptide (D₀ = 4.91 ± 1.0 Gy; α/β = 20.2 Gy). Correspondingly, retroductal instillation of TAT-TLK1B in rat submandibular glands better preserved salivary flow after IR (89%) compared with animals pretreated with Opti-MEM or TAT peptide (31% and 39%, respectively; p < 0.01). CONCLUSIONS The results demonstrate that a direct transfer of TLK1B protein to the salivary glands effectively attenuates radiation-mediated gland dysfunction. Prophylactic TLK1B-protein therapy could benefit patients undergoing radiotherapy for head-and-neck cancer.
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Affiliation(s)
- Gulshan Sunavala-Dossabhoy
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA.
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Hey J, Setz J, Gerlach R, Janich M, Hildebrandt G, Vordermark D, Gernhardt CR, Kuhnt T. Parotid gland-recovery after radiotherapy in the head and neck region--36 months follow-up of a prospective clinical study. Radiat Oncol 2011; 6:125. [PMID: 21951317 PMCID: PMC3201902 DOI: 10.1186/1748-717x-6-125] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 09/27/2011] [Indexed: 11/25/2022] Open
Abstract
Background The aim of the present study was to evaluate the recovery potential of the parotid glands after using either 3D-conformal-radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) by sparing one single parotid gland. Methods Between 06/2002 and 10/2008, 117 patients with head and neck cancer were included in this prospective, non-randomised clinical study. All patients were treated with curative intent. Salivary gland function was assessed by measuring stimulated salivary flow at the beginning, during and at the end of radiotherapy as well as 1, 6, 12, 24, and 36 months after treatment. Measurements were converted to flow rates and normalized relative to rates before treatment. Mean doses (Dmean) were calculated from dose-volume histograms based on computed tomographies of the parotid glands. Results Patients were grouped according to the Dmean of the spared parotid gland having the lowest radiation exposure: Group I - Dmean < 26 Gy (n = 36), group II - Dmean 26-40 Gy (n = 45), and group III - Dmean > 40 Gy (n = 36). 15/117 (13%) patients received IMRT. By using IMRT as compared to 3D-CRT the Dmean of the spared parotid gland could be significantly reduced (Dmean IMRT vs. 3D-CRT: 21.7 vs. 34.4 Gy, p < 0.001). The relative salivary flow rates (RFSR) as a function of the mean parotid dose after 24 and 36 months was in group I 66% and 74%, in group II 56% and 49%, and in group III 31% and 24%, respectively. Multiple linear regression analyses revealed that the parotid gland dose and the tumor site were the independent determinants 12 and 36 months after the end of RT. Patients of group I and II parotid gland function did recover at 12, 24, and 36 months after the end of RT. Conclusions If a Dmean < 26 Gy for at least one parotid gland can be achieved then this is sufficient to reach complete recovery of pre-RT salivary flow rates. The radiation volume which depends on tumor site did significantly impact on the Dmean of the parotids, and thus on the saliva flow and recovery of parotid gland.
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Affiliation(s)
- Jeremias Hey
- Department of Prosthetic Dentistry, University School of Dental Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Porter SR. PLENARY ABSTRACT: Xerostomia: prevalence, assessment, differential diagnosis and implications for quality of life. Oral Dis 2010. [DOI: 10.1111/j.1601-0825.2010.01745.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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