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Philipsen BB, Korsholm M, Rohde M, Wessel I, Forner L, Johansen J, Godballe C. The effect of hyperbaric oxygen therapy in head and neck cancer patients with radiation induced dysphagia-a systematic review. Clin Transl Oncol 2024:10.1007/s12094-024-03449-w. [PMID: 38704813 DOI: 10.1007/s12094-024-03449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/04/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE The aim of this systematic review was to assess the role of hyperbaric oxygen therapy (HBOT) in patients with dysphagia after radiation therapy for head and neck cancer. METHOD A systematic search was conducted in the electronic databases Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials for relevant studies until March 14, 2023. No restriction on language or publication date. The criteria for inclusion: patients with HNC who had received both radiation therapy and HBOT as 1) a preventive treatment against swallowing difficulties, 2) to preserve swallowing function, or 3) to promote swallowing difficulties. RESULTS We identified 1396 records. After removal of 31 duplicates, 1365 records were accessible for title and abstract screening. This yielded 53 studies for full text assessment. Six studies met the eligibility criteria and were included for qualitative analysis. CONCLUSION Evidence of HBOT benefits in patients with dysphagia after radiation therapy for head and neck cancer is inconsistent. Well-designed studies using validated outcome measures and long-term follow-up are warranted.
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Affiliation(s)
- Bahareh Bakhshaie Philipsen
- Department of ORL - Head & Neck Surgery and Audiology, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Malene Korsholm
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Max Rohde
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Irene Wessel
- Department of ORL Head & Neck Surgery and Audiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lone Forner
- Department Of Oral and Maxillofacial Surgery Oral and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Christian Godballe
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
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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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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
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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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Chibly AM, Aure MH, Patel VN, Hoffman MP. Salivary Gland Function, Development and Regeneration. Physiol Rev 2022; 102:1495-1552. [PMID: 35343828 DOI: 10.1152/physrev.00015.2021] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Salivary glands produce and secrete saliva, which is essential for maintaining oral health and overall health. Understanding both the unique structure and physiological function of salivary glands, as well as how they are affected by disease and injury will direct the development of therapy to repair and regenerate them. Significant recent advances, particularly in the OMICS field, increase our understanding of how salivary glands develop at the cellular, molecular and genetic levels; the signaling pathways involved, the dynamics of progenitor cell lineages in development, homeostasis and regeneration and the role of the extracellular matrix microenvironment. These provide a template for cell and gene therapies as well as bioengineering approaches to repair or regenerate salivary function.
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Affiliation(s)
- Alejandro Martinez Chibly
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, United States
| | - Marit H Aure
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, United States
| | - Vaishali N Patel
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, United States
| | - Matthew Philip Hoffman
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, United States
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Chiu YH, Tseng WH, Ko JY, Wang TG. Radiation-induced swallowing dysfunction in patients with head and neck cancer: A literature review. J Formos Med Assoc 2021; 121:3-13. [PMID: 34246510 DOI: 10.1016/j.jfma.2021.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/28/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Swallowing dysfunction is a prevailing state following radiotherapy in patients with head and neck cancer. Following the advancement of cancer treatment in recent years, the survival rate of head and neck cancer has gradually increased. Simultaneously, patients with head and neck cancer suffer due to the long-duration and more prominent swallowing dysfunction states. Based on an extensive literature review, we aimed to explore the mechanisms, risk factors, and clinical evaluations of swallowing dysfunction and their related symptoms following radiotherapy. These include functional changes of the muscles, trismus, xerostomia, neuropathy, and lymphedema. When swallowing dysfunction occurs, patients usually seek medical help and are referred for rehabilitation therapy, such as muscle strengthening and tongue resistance exercise. Furthermore, clinicians should discuss with patients how and when to place the feeding tube. Only through detailed evaluation and management can swallowing dysfunction resolve and improve the quality of life of patients with head and neck cancer following radiotherapy.
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Affiliation(s)
- Yi-Hsiang Chiu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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8
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Huang SH, de Almeida JR, Watson E, Glogauer M, Xu W, Keshavarzi S, O'Sullivan B, Ringash J, Hope A, Bayley A, Bratman SV, Cho J, Giuliani M, Kim J, Waldron J, Spreafico A, Goldstein DP, Chepeha DB, Li T, Hosni A. Short-term and long-term unstimulated saliva flow following unilateral vs bilateral radiotherapy for oropharyngeal carcinoma. Head Neck 2020; 43:456-466. [PMID: 33058305 DOI: 10.1002/hed.26496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We aimed to compare unstimulated saliva flow using 3-minute modified Schirmer test (MST) following bilateral vs unilateral radiotherapy (RT) in oropharyngeal carcinoma (OPC). METHODS We reviewed OPC patients treated with definitive intensity-modulated radiation therapy (IMRT) between 2011 and 2017. MST was measured at baseline, 1-/6-/12-/24-month post-RT. MST values were compared between bilateral-RT vs unilateral-RT groups. Multivariable logistic regression analysis (MVA) identified predictors of hyposalivation (MST < 25 mm). RESULTS Total 498 bilateral-RT and 36 unilateral-RT patients were eligible. The MST values at 1-/6-/12-/24-month post-RT were all significantly reduced from baseline for the entire cohort. Baseline unilateral-RT and bilateral-RT MST values (in mm) were similar (P = .2), but much higher for unilateral-RT 1-month (mean: 19.1 vs 13.0, P = .03), 6-month (20.5 vs 9.3, P < .001), 12-month (20.1 vs 11.9, P < .01), and 24-month post-RT (22.2 vs 13.9, P = .04). MVA confirmed that unilateral RT reduced the likelihood of hyposalivation vs bilateral RT (OR 2.36, P = .006). CONCLUSION Unilateral RT reduces unstimulated salivary flow in OPC patients.
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Affiliation(s)
- Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Erin Watson
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Michael Glogauer
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Department of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Tong Li
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
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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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10
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Zalewska A, Szarmach I, Żendzian-Piotrowska M, Maciejczyk M. The Effect of N-Acetylcysteine on Respiratory Enzymes, ADP/ATP Ratio, Glutathione Metabolism, and Nitrosative Stress in the Salivary Gland Mitochondria of Insulin Resistant Rats. Nutrients 2020; 12:nu12020458. [PMID: 32059375 PMCID: PMC7071150 DOI: 10.3390/nu12020458] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 12/18/2022] Open
Abstract
This is the first study to assess the effect of N-acetylcysteine (NAC) on the mitochondrial respiratory system, as well as free radical production, glutathione metabolism, nitrosative stress, and apoptosis in the salivary gland mitochondria of rats with high-fat diet (HFD)-induced insulin resistance (IR). The study was conducted on male Wistar rats divided into four groups of 10 animals each: C (control, rats fed a standard diet containing 10.3% fat), C + NAC (rats fed a standard diet, receiving NAC intragastrically), HFD (rats fed a high-fat diet containing 59.8% fat), and HFD + NAC (rats fed HFD diet, receiving NAC intragastrically). We confirmed that 8 weeks of HFD induces systemic IR as well as disturbances in mitochondrial complexes of the parotid and submandibular glands of rats. NAC supplementation leads to a significant increase in the activity of complex I, II + III and cytochrome c oxidase (COX), and also reduces the ADP/ATP ratio compared to HFD rats. Furthermore, NAC reduces the hydrogen peroxide production/activity of pro-oxidant enzymes, increases the pool of mitochondrial glutathione, and prevents cytokine formation, apoptosis, and nitrosative damage to the mitochondria in both aforementioned salivary glands of HFD rats. To sum up, NAC supplementation enhances energy metabolism in the salivary glands of IR rats, and prevents inflammation, apoptosis, and nitrosative stress.
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Affiliation(s)
- Anna Zalewska
- Experimental Dentistry Laboratory, Medical University, 15-222 Bialystok, Poland
- Correspondence: (A.Z.); (M.M.)
| | - Izabela Szarmach
- Department of Orthodontics, Medical University, 15-222 Bialystok, Poland;
| | | | - Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomics, Medical University, 15-222 Bialystok, Poland;
- Correspondence: (A.Z.); (M.M.)
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11
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Varra V, Ross RB, Juloori A, Campbell S, Tom MC, Joshi NP, Woody NM, Ward MC, Xia P, Koyfman SA, Greskovich JF. Selectively sparing the submandibular gland when level Ib lymph nodes are included in the radiation target volume: An initial safety analysis of a novel planning objective. Oral Oncol 2018; 89:79-83. [PMID: 30732963 DOI: 10.1016/j.oraloncology.2018.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Submandibular gland (SMG) metastases are extremely rare in head and neck cancer, even in the presence of level Ib lymph node (LN) involvement. In recent years, we have contoured the SMG and specifically attempted to limit its dose exposure even in patients in whom the level Ib LN station is targeted. This study reports our preliminary feasibility and safety experience with selective submandibular gland sparing. METHODS Patients with squamous cell cancer (SCC) of the oral cavity or oropharynx with T1-2, N0-3, M0 disease in whom at least a single level Ib lymph node region was included in the target volume were identified. All patients were treated from 2009 to 2014 with definitive or postoperative IMRT with or without chemotherapy. Patients with recurrent disease, previous radiation or treated palliatively were excluded. RESULTS A total of 174 patients met criteria for inclusion. Among the 185 level Ib LN stations that were deliberately targeted in the clinical treatment volume, 32 submandibular glands were contoured, excluded from the target volume and avoided during treatment planning. Mean dose to the spared SMG were reduced by 12% (66.6 Gy vs. 58.9 Gy, p < .001). None of these patients experienced any level 1b LN failures. CONCLUSION Selective sparing of the submandibular gland when targeting the level 1b nodes in oral cavity and oropharynx cancer is feasible, reduces the mean dose to submandibular glands and does not result in increased level 1b nodal failure rates. Additional studies with larger cohorts are needed to validate this preliminary observation.
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Affiliation(s)
- Vamsi Varra
- Cleveland Clinic, Department of Radiation Oncology, Cleveland, OH, United States
| | - Richard B Ross
- Cleveland Clinic, Department of Radiation Oncology, Cleveland, OH, United States
| | - Aditya Juloori
- Cleveland Clinic, Department of Radiation Oncology, Cleveland, OH, United States
| | - Shauna Campbell
- Cleveland Clinic, Department of Radiation Oncology, Cleveland, OH, United States
| | - Martin C Tom
- Cleveland Clinic, Department of Radiation Oncology, Cleveland, OH, United States
| | - Nikhil P Joshi
- Cleveland Clinic, Department of Radiation Oncology, Cleveland, OH, United States
| | - Neil M Woody
- Cleveland Clinic, Department of Radiation Oncology, Cleveland, OH, United States
| | - Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States; Southeast Radiation Oncology Group, Charlotte, NC, United States
| | - Ping Xia
- Cleveland Clinic, Department of Radiation Oncology, Cleveland, OH, United States
| | - Shlomo A Koyfman
- Cleveland Clinic, Department of Radiation Oncology, Cleveland, OH, United States.
| | - John F Greskovich
- Cleveland Clinic, Department of Radiation Oncology, Cleveland, OH, United States
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Sherlock S, Way M, Tabah A. Hyperbaric oxygen treatment for the management of radiation-induced xerostomia. J Med Imaging Radiat Oncol 2018; 62:841-846. [PMID: 30113763 DOI: 10.1111/1754-9485.12789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/14/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hyperbaric oxygen therapy (HBOT) is widely used for the treatment of the late effects of radiation therapy. We report a prospective observational cohort study of 51 patients designed to examine the effectiveness of hyperbaric oxygen treatment (HBOT) for xerostomia following radiotherapy. METHODS Objective (saliva volume) and subjective (quality of life scoring and visual analogue scale (VAS) of discomfort) measurements associated with xerostomia were compared prior to commencement of HBOT, after 30 sessions (over 6 weeks) of HBOT at 243 kPa for 90 minutes daily for five days per week and at 6-week review (12 weeks from commencement). RESULTS One hundred and one courses of treatment in 99 patients were examined. For 53 (53%) courses in 51 patients, data were recorded before and after HBOT and so could be included in the analysis. Thirty-four (34%) of these patients had complete data for all three time points. The unit of study was per treatment course, not per person. There were no major complications to HBOT. There was a statistically significant difference in saliva volume following HBOT (P = 0.016). The mean saliva volume increase was 0.9 mL over a 5-min collection period (95% CI 0.2-1.5). There was also a statistically significant improvement in discomfort after HBOT (P < 0.001) and QOL (P < 0.001). The mean visual analogue scale for discomfort (VAS on a 0-10 scale) score decreased by 1.4 units (95% CI 0.7-2.1), whilst the mean QOL score was 10 points lower after treatment (95% CI 5.9-14.4). CONCLUSION Hyperbaric oxygen therapy may be a safe and effective treatment for symptoms of xerostomia after radiation therapy and should be considered when available.
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Affiliation(s)
- Susannah Sherlock
- Hyperbaric Medicine Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Anaesthesia and Perioperative Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mandy Way
- QIMR Berghofer Institute, Biostatistics, Brisbane, Queensland, Australia
| | - Alexis Tabah
- Hyperbaric Medicine Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
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13
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Strojan P, Hutcheson KA, Eisbruch A, Beitler JJ, Langendijk JA, Lee AWM, Corry J, Mendenhall WM, Smee R, Rinaldo A, Ferlito A. Treatment of late sequelae after radiotherapy for head and neck cancer. Cancer Treat Rev 2017; 59:79-92. [PMID: 28759822 PMCID: PMC5902026 DOI: 10.1016/j.ctrv.2017.07.003] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/05/2017] [Accepted: 07/09/2017] [Indexed: 12/21/2022]
Abstract
Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.
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Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne W M Lee
- Center of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - June Corry
- Radiation Oncology, GenesisCare, St. Vincents's Hospital, Melbourne, Victoria, Australia
| | | | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Italy
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14
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Ravi P, Vaishnavi D, Gnanam A, Krishnakumar Raja VB. The role of hyperbaric oxygen therapy in the prevention and management of radiation-induced complications of the head and neck - a systematic review of literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:359-362. [PMID: 28838774 DOI: 10.1016/j.jormas.2017.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
Radiation therapy for the treatment of head and neck cancer can injure normal tissues and have devastating side effects. Hyperbaric oxygen (HBO) is known to reduce the severity of radiation-induced injury by promoting wound healing. While most of the research in literature has focused on its efficacy in osteonecrosis, HBO has other proven benefits as well. The aim of this review was to identify the various benefits of hyperbaric oxygen therapy in patients who have undergone radiation for head and neck cancer. An electronic database search was carried out to identify relevant articles and selected articles were reviewed in detail. The quality of evidence for each benefit, including preserving salivary gland function, preventing osteonecrosis, dental implant success, and overall quality of life, was evaluated. Evidence showed that HBO was effective in improving subjective symptoms of xerostomia, swallowing, speech and overall quality of life. There was no conclusive evidence to show that HBO improved implant survival, prevented osteonecrosis, or improved salivary gland function. The high costs and accessibility of HBO therapy must be weighed against the potential benefits to each patient.
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Affiliation(s)
- P Ravi
- Department of Oral and Maxillofacial Surgery, SRM Dental College, Ramapuram, 600089 Chennai, India.
| | - D Vaishnavi
- Department of Oral and Maxillofacial Surgery, SRM Dental College, Ramapuram, 600089 Chennai, India
| | - A Gnanam
- Department of Oral and Maxillofacial Surgery, SRM Dental College, Ramapuram, 600089 Chennai, India
| | - V B Krishnakumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College, Ramapuram, 600089 Chennai, India
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15
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Galvão-Moreira LV, Santana T, da Cruz MCFN. A closer look at strategies for preserving salivary gland function after radiotherapy in the head and neck region. Oral Oncol 2016; 60:137-41. [DOI: 10.1016/j.oraloncology.2016.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/30/2016] [Accepted: 07/09/2016] [Indexed: 11/26/2022]
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16
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Gonnelli FAS, Palma LF, Giordani AJ, Deboni ALS, Dias RS, Segreto RA, Segreto HRC. Low-Level Laser for Mitigation of Low Salivary Flow Rate in Head and Neck Cancer Patients Undergoing Radiochemotherapy: A Prospective Longitudinal Study. Photomed Laser Surg 2016; 34:326-30. [DOI: 10.1089/pho.2016.4104] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fernanda Aurora Stabile Gonnelli
- Division of Radiotherapy, Department of Imaging Diagnosis, Universidade Federal de São Paulo/Escola Paulista de Medicina/Hospital São Paulo – UNIFESP/EPM/HSP, São Paulo/SP, Brazil
| | - Luiz Felipe Palma
- Division of Radiotherapy, Department of Imaging Diagnosis, Universidade Federal de São Paulo/Escola Paulista de Medicina/Hospital São Paulo – UNIFESP/EPM/HSP, São Paulo/SP, Brazil
| | - Adelmo José Giordani
- Division of Radiotherapy, Department of Imaging Diagnosis, Universidade Federal de São Paulo/Escola Paulista de Medicina/Hospital São Paulo – UNIFESP/EPM/HSP, São Paulo/SP, Brazil
| | - Aline Lima Silva Deboni
- Division of Radiotherapy, Department of Imaging Diagnosis, Universidade Federal de São Paulo/Escola Paulista de Medicina/Hospital São Paulo – UNIFESP/EPM/HSP, São Paulo/SP, Brazil
| | - Rodrigo Souza Dias
- Division of Radiotherapy, Department of Imaging Diagnosis, Universidade Federal de São Paulo/Escola Paulista de Medicina/Hospital São Paulo – UNIFESP/EPM/HSP, São Paulo/SP, Brazil
| | - Roberto Araújo Segreto
- Division of Radiotherapy, Department of Imaging Diagnosis, Universidade Federal de São Paulo/Escola Paulista de Medicina/Hospital São Paulo – UNIFESP/EPM/HSP, São Paulo/SP, Brazil
| | - Helena Regina Comodo Segreto
- Division of Radiotherapy, Department of Imaging Diagnosis, Universidade Federal de São Paulo/Escola Paulista de Medicina/Hospital São Paulo – UNIFESP/EPM/HSP, São Paulo/SP, Brazil
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Fox NF, Xiao C, Sood AJ, Lovelace TL, Nguyen SA, Sharma A, Day TA. Hyperbaric oxygen therapy for the treatment of radiation-induced xerostomia: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:22-8. [DOI: 10.1016/j.oooo.2015.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/09/2015] [Accepted: 03/11/2015] [Indexed: 01/07/2023]
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18
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Tahir ARM, Westhuyzen J, Dass J, Collins MK, Webb R, Hewitt S, Fon P, McKay M. Hyperbaric oxygen therapy for chronic radiation-induced tissue injuries: Australasia's largest study. Asia Pac J Clin Oncol 2014; 11:68-77. [PMID: 25382755 DOI: 10.1111/ajco.12289] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2014] [Indexed: 12/26/2022]
Abstract
AIM Chronic radiation injuries, although uncommon, are associated with poor quality of life in oncology patients. The present study assesses the efficacy and safety of hyperbaric oxygen therapy in the management of chronic radiation-induced tissue injuries. METHODS A retrospective analysis was performed in 276 consecutive patients treated with hyperbaric oxygen therapy for chronic radiation-induced tissue injuries at the Hyperbaric Medicine Unit, Townsville, Queensland, between March 1995 and March 2008. Of these patients, 189 (68%) had complete follow-up data and were assessed. RESULTS A total of 265 events of chronic radiation tissue injury were experienced by the 189 patients treated with hyperbaric oxygen therapy. Osteoradionecrosis prophylaxis due to radiation-induced dental disease had an overall response rate of 96% (P=0.00003; Wilcoxon matched-pairs signed-rank test). The overall response rates for established osteoradionecrosis of mandible, soft tissue necrosis of head and neck, and xerostomia were 86% (P=0.00001), 85% (P=0.002) and 64% (P=0.0001), respectively. The overall response rates for soft tissue necrosis at other sites, chronic radiation proctitis and hemorrhagic cystitis were 84% (P=0.03), 95% (P=0.0001) and 85% (P=0.03), respectively. The total complication rate after hyperbaric oxygen therapy was 15.9%, comprising reversible ear barotrauma (10.6%), reversible ocular barotrauma (4.2%), dental complications (0.5%) and myocardial infarction (0.5%). CONCLUSION Our study demonstrates that hyperbaric oxygen therapy can be effectively used in a variety of chronic radiation-induced tissue injuries; its favorable risk profile suggests it should be considered for patients with radiation-induced tissue injuries.
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Affiliation(s)
- Abdul Rahim Mohd Tahir
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; North Coast Cancer Institute, Coffs Harbour, Australia
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Spiegelberg L, Swagemakers SMA, Van Ijcken WFJ, Oole E, Wolvius EB, Essers J, Braks JAM. Gene expression analysis reveals inhibition of radiation-induced TGFβ-signaling by hyperbaric oxygen therapy in mouse salivary glands. Mol Med 2014; 20:257-69. [PMID: 24849810 DOI: 10.2119/molmed.2014.00003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/12/2014] [Indexed: 11/06/2022] Open
Abstract
A side effect of radiation therapy in the head and neck region is injury to surrounding healthy tissues such as irreversible impaired function of the salivary glands. Hyperbaric oxygen therapy (HBOT) is clinically used to treat radiation-induced damage but its mechanism of action is largely unknown. In this study, we investigated the molecular pathways that are affected by HBOT in mouse salivary glands two weeks after radiation therapy by microarray analysis. Interestingly, HBOT led to significant attenuation of the radiation-induced expression of a set of genes and upstream regulators that are involved in processes such as fibrosis and tissue regeneration. Our data suggest that the TGFβ-pathway, which is involved in radiation-induced fibrosis and chronic loss of function after radiation therapy, is affected by HBOT. On the longer term, HBOT reduced the expression of the fibrosis-associated factor α-smooth muscle actin in irradiated salivary glands. This study highlights the potential of HBOT to inhibit the TGFβ-pathway in irradiated salivary glands and to restrain consequential radiation induced tissue injury.
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Affiliation(s)
- Linda Spiegelberg
- Department of Oral and Maxillofacial Surgery, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Edwin Oole
- Center for Biomics, Erasmus MC, Rotterdam, the Netherlands
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Jeroen Essers
- Department of Cell Biology and Genetics, Cancer Genomics Center, Erasmus MC, Rotterdam, the Netherlands Department of Radiation Oncology, Erasmus MC, Rotterdam, the Netherlands Department of Vascular Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Joanna A M Braks
- Department of Oral and Maxillofacial Surgery, Erasmus MC, Rotterdam, the Netherlands
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20
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Ohara Y, Yoshida N, Kono Y, Hirano H, Yoshida H, Mataki S, Sugimoto K. Effectiveness of an oral health educational program on community-dwelling older people with xerostomia. Geriatr Gerontol Int 2014; 15:481-9. [PMID: 24796714 DOI: 10.1111/ggi.12301] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2014] [Indexed: 11/29/2022]
Abstract
AIM The purpose of the present study was to evaluate the changes in oral health and function through an oral health educational program for the independent older people with xerostomia. METHODS Community-dwelling older people with xerostomia aged over 65 years who participated in a preliminary comprehensive health survey in 2011 were recruited for the educational program. A total of 47 participants were randomly assigned into two groups, the intervention group (n = 26) and the control group (n = 21). The intervention group attended a 90-min oral health education program every 2 weeks for 3 months. The program consisted of oral hygiene instruction, facial and tongue muscle exercise, and salivary gland massage. The control group was provided only general information about oral health. The assessments of oral function, such as oral diadochokinesis of articulation, swallowing, taste threshold and salivary flow rate, were carried out before and after 3 months with or without intervention. RESULTS A total of 38 participants (21 of intervention group and 17 of control group) completed the study protocol. In the intervention group, resting salivation significantly improved after the program. The second and third cumulated Repetitive Saliva Swallowing Test times significantly improved in the intervention group. The threshold for bitterness significantly lowered in the intervention group, whereas the sour threshold significantly heightened in the control group after 3 months (P < 0.05). CONCLUSIONS The present study suggests that the educational program targeting oral function improvement is effective among the independent older population.
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Affiliation(s)
- Yuki Ohara
- Behavioral Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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21
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Chibly AM, Nguyen T, Limesand KH. Palliative Care for Salivary Gland Dysfunction Highlights the Need for Regenerative Therapies: A Review on Radiation and Salivary Gland Stem Cells. ACTA ACUST UNITED AC 2014; 4. [PMID: 26693098 DOI: 10.4172/2165-7386.1000180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Radiotherapy remains the major course of treatment for Head and Neck cancer patients. A common consequence of radiation treatment is dysfunction of the salivary glands, which leads to a number of oral complications including xerostomia and dysphagia, for which there is no existent cure. Here, we briefly describe the current palliative treatments available for patients undergoing these conditions, such as oral lubricants, saliva substitutes, and saliva stimulants. None of these options achieves restoration of normal quality of life due to their limited effectiveness, and in some cases, adverse side effects of their own. Other therapies under development, such as acupuncture and electrostimulation have also yielded mixed results in clinical trials. Due to the ineffectiveness of palliative care to restore quality of life, it is reasonable to aim for the development of regenerative therapies that allow restoration of function of the salivary epithelium following radiation treatment. Adult stem cells are a necessary component of wound healing, and play important roles in preserving normal function of adult tissues. Thus, the present review mainly focuses on the effects of radiation on adult stem cells in a variety of tissues, which may be at play in the response of salivary glands to radiation treatment. This is of clinical importance because progenitor cells of the salivary glands have shown partial regenerative potential in mouse transplantation assays. Therefore, understanding how these progenitor cells are affected by radiation offers potential for development of new therapies for patients with xerostomia.
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Affiliation(s)
| | - Thao Nguyen
- The University of Arizona Nutritional Sciences Graduate Program, Tucson, AZ 85721, USA
| | - Kirsten H Limesand
- The University of Arizona Nutritional Sciences Graduate Program, Tucson, AZ 85721, USA
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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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Spiegelberg L, Braks JAM, Djasim UM, Farrell E, van der Wal KGH, Wolvius EB. Effects of hyperbaric oxygen therapy on the viability of irradiated soft head and neck tissues in mice. Oral Dis 2013; 20:e111-9. [DOI: 10.1111/odi.12162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/14/2013] [Accepted: 06/25/2013] [Indexed: 12/22/2022]
Affiliation(s)
- L Spiegelberg
- Department of Oral and Maxillofacial Surgery; Erasmus MC; Rotterdam The Netherlands
| | - JAM Braks
- Department of Oral and Maxillofacial Surgery; Erasmus MC; Rotterdam The Netherlands
| | - UM Djasim
- Department of Oral and Maxillofacial Surgery; Erasmus MC; Rotterdam The Netherlands
| | - E Farrell
- Department of Oral and Maxillofacial Surgery; Erasmus MC; Rotterdam The Netherlands
| | - KGH van der Wal
- Department of Oral and Maxillofacial Surgery; Erasmus MC; Rotterdam The Netherlands
| | - EB Wolvius
- Department of Oral and Maxillofacial Surgery; Erasmus MC; Rotterdam The Netherlands
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Hadley T, Song C, Wells L, Lehnhardt J, Rogers MW, Anderson J, Terry M, Novy B, Lo T. Does hyperbaric oxygen therapy have the potential to improve salivary gland function in irradiated head and neck cancer patients? Med Gas Res 2013; 3:15. [PMID: 23816249 PMCID: PMC3700882 DOI: 10.1186/2045-9912-3-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 06/25/2013] [Indexed: 11/18/2022] Open
Abstract
Following radiotherapy, many patients with osteoradionecrosis suffer from xerostomia, thereby decreasing their quality of life. Patients can develop problems with speech, eating, increased dental caries, dysphagia, fractured dentition, chronic refractory osteomyelitis and osteoradionecrosis. Symptoms associated with salivary gland dysfunction can be severe enough that patients terminate the course of their radiotherapy prematurely due to the decrease in their quality of life. Currently, the only treatments available to patients are palliative. A definitive treatment has yet to be discovered. Head and neck cancers, which comprise 5% of overall cancer treatments, rank 8th most expensive to treat in the United States today. Hyperbaric oxygen is being considered for the therapy of radiated salivary glands because it has been shown to stimulate capillary angiogenesis and fibroplasia in radiation treated tissues. It has been hypothesized that salivary acinar cells undergo apoptosis following radiation therapy. The purpose of this paper is to discuss the mechanisms of salivary gland injury and evaluate whether hyperbaric oxygen therapy improves salivary gland function in patients who develop xerostomia and osteoradionecrosis following head and neck radiation.
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Affiliation(s)
- Tiffany Hadley
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Loma Linda University Medical Center, 11234 Anderson St,, Loma Linda, CA 92354, USA.
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