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Kallman TF, Bäckryd E. The effects of opioid tapering on select endocrine measures in men and women with head and neck cancer-a longitudinal 12-month study. Pain Rep 2024; 9:e1183. [PMID: 39285953 PMCID: PMC11404959 DOI: 10.1097/pr9.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/31/2024] [Accepted: 07/06/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Opioid treatment may affect endocrine measures in humans either through centrally or peripherally mediated mechanisms. There is a general lack of longitudinal studies examining endocrine measures in opioid-treated patients. Objectives To longitudinally follow the levels of select endocrine measures in men and women with head and neck cancer for 1 year, who after having completed radiotherapy began tapering opioids. Methods This was a prospective, longitudinal, observational study. Testosterone and estradiol were measured in men and women, respectively. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEAS), and prolactin were measured in both sexes. Women were grouped based on if premenopausal or postmenopausal. Samples were collected when opioid tapering started and at 1, 3, 6, and 12 months after tapering start. Daily opioid doses at the same time points were registered. Results Twenty-five men and 12 women were followed for 12 months. In men, testosterone levels increased significantly during the first month after opioid tapering started (P < 0.001). Levels of testosterone, FSH, DHEAS, and prolactin changed significantly in men during the study period. A moderate correlation between opioid dose reduction and testosterone level increase in men aged ≤60 years was found (r s = -0.577, 95% CI -0.854 to -0.044, P = 0.039). In postmenopausal women (n = 10), levels of FSH and LH changed significantly during the study period. Conclusion Previously known effects of opioids on endocrine measures in humans seem to be reversible as select endocrine measures changed significantly in men and postmenopausal women after opioid tapering was initiated.
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Affiliation(s)
- Thomas F Kallman
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Emmanuel Bäckryd
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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2
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Idrees M, Kujan O. A Curcumin-Based Oral Gel Has Potential Protective Efficacy against Oral Mucositis: In Vitro Study. J Pers Med 2023; 14:1. [PMID: 38276216 PMCID: PMC10820130 DOI: 10.3390/jpm14010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
Oral mucositis is a common distressing complication of cancer therapy, characterised by painful sores within the oral cavity. Current management options offer limited symptomatic relief. Curcumin, a natural polyphenolic compound with recognised anti-inflammatory and antioxidant properties, has emerged as a potential protective agent against oral mucositis. This study explores the therapeutic potential of curcumin in mitigating the impact of oral mucositis by investigating a commercially available curcumin-based oral gel, PerioGold®. Liquid chromatography-tandem mass spectrometry was used to characterise the main constituents of PerioGold®. The cytotoxicity of curcumin constituent was investigated in four cell lines: primary oral keratinocytes (HOKs), immortalised oral keratinocytes (OKF6), dysplastic oral keratinocytes (DOKs), and oral squamous cell carcinoma cells (PE/CA-PJ15). Concentrations of hydrogen peroxide were optimised to develop in vitro models that mimic oral mucositis. The inhibitory effects of PerioGold® against the production of reactive oxygen species were assessed using a designated kit. OKF6 cells were the most sensitive to oxidative stress, while PE/CA-PJ15 cells showed the highest resistance. Pretreatment of the investigated cells for 24 h with PerioGold® demonstrated a significant antioxidative effect in all cells based on a dose-response pattern. PerioGold® exhibits clinical potential for protecting against oxidative stress, warranting further individualised clinical investigations.
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Affiliation(s)
| | - Omar Kujan
- Discipline of Oral Pathology, UWA Dental School, The University of Western Australia, 17 Monash Avenue, Nedlands, WA 6009, Australia;
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3
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Salama V, Geng Y, Rigert J, Fuller CD, Shete S, Moreno AC. Systematic Review of Genetic Polymorphisms Associated with Acute Pain Induced by Radiotherapy for Head and Neck Cancers. Clin Transl Radiat Oncol 2023; 43:100669. [PMID: 37954025 PMCID: PMC10634655 DOI: 10.1016/j.ctro.2023.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/10/2023] [Accepted: 08/13/2023] [Indexed: 11/14/2023] Open
Abstract
Background/objective Pain is the most common acute symptom following radiation therapy (RT) for head and neck cancer (HNC). The multifactorial origin of RT-induced pain makes it highly challenging to manage. Multiple studies were conducted to identify genetic variants associated with cancer pain, however few of them focused on RT-induced acute pain. In this review, we summarize the potential mechanisms of acute pain after RT in HNC and identify genetic variants associated with RT-induced acute pain and relevant acute toxicities. Methods A comprehensive search of Ovid Medline, EMBASE and Web of Science databases using terms including "Variants", "Polymorphisms", "Radiotherapy", "Acute pain", "Acute toxicity" published up to February 28, 2022, was performed by two reviewers. Review articles and citations were reviewed manually. The identified SNPs associated with RT-induced acute pain and toxicities were reported, and the molecular functions of the associated genes were described based on genetic annotation using The Human Gene Database; GeneCards. Results A total of 386 articles were identified electronically and 8 more articles were included after manual search. 21 articles were finally included. 32 variants in 27 genes, of which 25% in inflammatory/immune response, 20% had function in DNA damage response and repair, 20% in cell death or cell cycle, were associated with RT-inflammatory pain and acute oral mucositis or dermatitis. 4 variants in 4 genes were associated with neuropathy and neuropathic pain. 5 variants in 4 genes were associated with RT-induced mixed types of post-RT-throat/neck pain. Conclusion Different types of pain develop after RT in HNC, including inflammatory pain; neuropathic pain; nociceptive pain; and mixed oral pain. Genetic variants involved in DNA damage response and repair, cell death, inflammation and neuropathic pathways may affect pain presentation post-RT. These variants could be used for personalized pain management in HNC patients receiving RT.
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Affiliation(s)
- Vivian Salama
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian Rigert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C. Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Cruz AR, Minicucci EM, Betini M, Almeida-Lopes L, Tieghi Neto V, Cataneo AJM. Efficacy of photobiomodulation in the treatment of oral mucositis in patients undergoing antineoplastic therapy: systematic review and meta-analysis. Support Care Cancer 2023; 31:645. [PMID: 37853254 DOI: 10.1007/s00520-023-08105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To evaluate the effectiveness of photobiomodulation in the treatment of oral mucositis. METHODS Systematic review and meta-analysis encompassing in the electronic databases: LILACS, MEDLINE, EMBASE, COCHRANE, SCOPUS, WEB OF SCIENCE, and CINAHL and in http://clinicaltrials.gov . Eligibility criteria were randomized, non-randomized, and observational studies that used photobiomodulation for the treatment of oral mucositis. The endpoints were reduction in the severity of oral mucositis, duration of lesions, and pain reduction. For data analysis, the Review Manager 5.4 program was used. RESULTS A total of 316 studies were identified, 297 in the electronic databases and 19 in http://clinicaltrials.gov . After removing duplicates, 260 studies were selected for title and abstract reading, of which 223 were excluded. A total of 37 studies were chosen for full reading, of which 6 were included in the review, totaling 299 patients. The treatment used was photobiomodulation. The patients were divided into two groups: the laser group used only photobiomodulation or associated with other therapies, and the control group did not use photobiomodulation. For the endpoint reduction in the severity of oral mucositis (OM), the chance of reduction of the OM was greater in the laser group as compared to the control group. For the endpoints duration of OM lesions and pain reduction, it was not possible to carry out a meta-analysis due to the high heterogeneity between studies. In the interpretation of the meta-analysis, the reduction in the severity of oral mucositis was greater in the group that received photobiomodulation. CONCLUSION Photobiomodulation was effective in the treatment of oral mucositis.
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Affiliation(s)
- Adriana Regina Cruz
- Program of Surgery and Translational Medicine, University Unesp, Medical School, Botucatu, São Paulo, Brazil.
| | - Eliana Maria Minicucci
- Clinical Hospital of São Paulo State University Unesp, Medical School, Botucatu, São Paulo, Brazil
| | - Marluci Betini
- Reference Technical Section, University Unesp, Medical School, Botucatu, São Paulo, Brazil
| | - Luciana Almeida-Lopes
- Institute of Research and Learning in the Area of Health - NUPEN, São Carlos, São Paulo, Brazil
| | - Victor Tieghi Neto
- Department of Dentistry, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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5
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Tsujimoto T, Wasa M, Inohara H, Ito T. L-Glutamine and Survival of Patients with Locally Advanced Head and Neck Cancer Receiving Chemoradiotherapy. Nutrients 2023; 15:4117. [PMID: 37836400 PMCID: PMC10574413 DOI: 10.3390/nu15194117] [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: 08/13/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
We previously reported that L-glutamine reduces the severity of mucositis caused by chemoradiotherapy in patients with head and neck cancer. However, the impact of glutamine on the anti-tumor effect of chemoradiotherapy remains controversial. This study, which included 40 patients, investigated whether L-glutamine influences survival. Radiation therapy (total: 66 or 70 Gy), cisplatin, and docetaxel were co-administered for a period of 6 weeks. Patients were randomly assigned to receive either glutamine (glutamine group, n = 20) or placebo (placebo group, n = 20) during the entire course of chemoradiotherapy. We compared the overall survival and progression-free survival rates between the two groups. At 5-year follow-up, 16 (80%) and 13 (72%) patients in the glutamine and placebo groups, respectively, survived (with no significant difference in overall survival [glutamine group: 55.2 ± 12.7 months vs. placebo group: 48.3 ± 21.3 months]). A total of 14 (70%) and 12 (67%) patients in the glutamine and placebo groups, respectively, did not experience disease progression (with no significant difference in progression-free survival [glutamine group: 46.7 ± 19.5 months vs. placebo group: 43.6 ± 25.2 months]). These findings indicate that L-glutamine does not influence the survival of patients with locally advanced head and neck cancer receiving chemoradiotherapy.
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Affiliation(s)
- Takae Tsujimoto
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University, 1-1-3 Minatojima, Chuo-ku, Kobe 650-8586, Japan
| | - Masafumi Wasa
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Osaka 565-0871, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Osaka 565-0871, Japan
| | - Toshinori Ito
- Osaka Center for Cancer & Cardiovascular Disease Prevention, 1-6-107 Morinomiya, Johtou-ku, Osaka 536-0025, Japan
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6
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Leblanc A, Thomas TV, Bouganim N. Chemoradiation for Locoregionally Advanced Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:285-293. [PMID: 37030941 DOI: 10.1016/j.otc.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
Laryngeal preservation with combined modality therapy involving radiotherapy and chemotherapy is usually the treatment of choice for patients with good performance status and with locoregionally advanced laryngeal cancer with a functional larynx. Surgical management with total laryngectomy with neck dissection, followed by adjuvant radiation or chemoradiation, is recommended for patients not eligible for laryngeal preservation. This article provides an overview of the current therapeutic approaches used to treat locoregionally advanced laryngeal cancer and outlines other currently investigated therapies.
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Affiliation(s)
- Andréanne Leblanc
- Medical Oncology, Royal Victoria Hospital/Cedars Cancer Centre, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada.
| | - Toms Vengaloor Thomas
- Dept of Radiation Oncology, University of Mississippi Medical Center, 2500 North State street, Jackson, MS, 39216, USA
| | - Nathaniel Bouganim
- Medical Oncology, Royal Victoria Hospital/Cedars Cancer Centre, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada
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Dong Y, Zhang J, Lam S, Zhang X, Liu A, Teng X, Han X, Cao J, Li H, Lee FK, Yip CW, Au K, Zhang Y, Cai J. Multimodal Data Integration to Predict Severe Acute Oral Mucositis of Nasopharyngeal Carcinoma Patients Following Radiation Therapy. Cancers (Basel) 2023; 15:cancers15072032. [PMID: 37046693 PMCID: PMC10093711 DOI: 10.3390/cancers15072032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: Acute oral mucositis is the most common side effect for nasopharyngeal carcinoma patients receiving radiotherapy. Improper or delayed intervention to severe AOM could degrade the quality of life or survival for NPC patients. An effective prediction method for severe AOM is needed for the individualized management of NPC patients in the era of personalized medicine. (2) Methods: A total of 242 biopsy-proven NPC patients were retrospectively recruited in this study. Radiomics features were extracted from contrast-enhanced CT (CECT), contrast-enhanced T1-weighted (cT1WI), and T2-weighted (T2WI) images in the primary tumor and tumor-related area. Dosiomics features were extracted from 2D or 3D dose-volume histograms (DVH). Multiple models were established with single and integrated data. The dataset was randomized into training and test sets at a ratio of 7:3 with 10-fold cross-validation. (3) Results: The best-performing model using Gaussian Naive Bayes (GNB) (mean validation AUC = 0.81 ± 0.10) was established with integrated radiomics and dosiomics data. The GNB radiomics and dosiomics models yielded mean validation AUC of 0.6 ± 0.20 and 0.69 ± 0.14, respectively. (4) Conclusions: Integrating radiomics and dosiomics data from the primary tumor area could generate the best-performing model for severe AOM prediction.
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Affiliation(s)
- Yanjing Dong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jiang Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Saikt Lam
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xinyu Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Anran Liu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xinzhi Teng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xinyang Han
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jin Cao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Hongxiang Li
- Department of Radiology, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 350000, China
| | - Francis Karho Lee
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Celia Waiyi Yip
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Kwokhung Au
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Yuanpeng Zhang
- Department of Medical Informatics, Nantong University, Nantong 226000, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518000, China
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8
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Yokota T, Ueno T, Soga Y, Ishiki H, Uezono Y, Mori T, Zenda S, Uchitomi Y. J-SUPPORT research policy for oral mucositis associated with cancer treatment. Cancer Med 2022; 11:4816-4829. [PMID: 35691025 PMCID: PMC9761062 DOI: 10.1002/cam4.4811] [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: 03/10/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Oral mucositis is one of the main areas of research in supportive and palliative care of cancer patients. However, the methodology of prospective clinical trials on oral mucositis has not been established, despite its uniqueness. Here, we propose a novel research policy on oral mucositis, including an implementable set of recommendations for researchers conducting clinical trials. METHODS The first draft was developed by an expert panel of six specialists from the Japanese Supportive, Palliative, and Psychosocial Care Study Group. A provisional draft was developed after review by the following medical societies: the Japanese Association of Supportive Care in Cancer, the Japanese Association of Oral Supportive Care in Cancer, the Japanese Cancer Association, and the receipt of public comments. RESULTS The research policy on oral mucositis mainly consists of the following components: (i) definition of oral mucositis; (ii) characteristics of oral mucositis; (iii) characteristics of oral mucositis research; (iv) target population for oral mucositis research; (v) endpoints and assessment measures in oral mucositis; (vi) eligibility criteria; (vii) research design; (viii) minimally recommended intervention in oral mucositis research as a supplement. The final policy (Ver1.0) was completed on August 16, 2021. CONCLUSIONS This policy may serve as a significant reference for planning and conducting clinical trials for the management of oral mucositis.
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Affiliation(s)
- Tomoya Yokota
- Division of Gastrointestinal OncologyShizuoka Cancer CenterSunto‐gunJapan
| | - Takao Ueno
- Department of General Internal Medicine, Dentistry, Oncologic EmergencyNational Cancer Center HospitalTokyoJapan
| | - Yoshihiko Soga
- Division of Hospital DentistryOkayama University HospitalOkayamaJapan
| | - Hiroto Ishiki
- Department of Palliative MedicineNational Cancer Center HospitalTokyoJapan
| | - Yasuhito Uezono
- Department of Pain Control ResearchThe Jikei University School of MedicineTokyoJapan
- Supportive and Palliative Care Research Support OfficeNational Cancer Center Hospital EastKashiwaJapan
- Project for Supportive Care Research, Exploratory Oncology Research and Clinical Trial CenterNational Cancer CenterKashiwaJapan
| | - Takehiko Mori
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
| | - Sadamoto Zenda
- Supportive and Palliative Care Research Support OfficeNational Cancer Center Hospital EastKashiwaJapan
- Department of Radiation OncologyNational Cancer Center Hospital EastKashiwaJapan
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial CareNational Cancer Center HospitalTokyoJapan
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9
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Ji L, Hao S, Wang J, Zou J, Wang Y. Roles of Toll-Like Receptors in Radiotherapy- and Chemotherapy-Induced Oral Mucositis: A Concise Review. Front Cell Infect Microbiol 2022; 12:831387. [PMID: 35719331 PMCID: PMC9201217 DOI: 10.3389/fcimb.2022.831387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Radiotherapy and/or chemotherapy-induced oral mucositis (RIOM/CIOM) is a common complication in cancer patients, leading to negative clinical manifestations, reduced quality of life, and impacting compliance with anticancer treatment. The composition and metabolic function of the oral microbiome, as well as the innate immune response of the oral mucosa are severely altered during chemotherapy or radiotherapy, promoting the expression of inflammatory mediators by direct and indirect mechanisms. Commensal oral bacteria-mediated innate immune signaling via Toll-like receptors (TLRs) ambiguously shapes radiotherapy- and/or chemotherapy-induced oral damage. To date, there has been no comprehensive overview of the role of TLRs in RIOM/CIOM. This review aims to provide a narrative of the involvement of TLRs, including TLR2, TLR4, TLR5, and TLR9, in RIOM/CIOM, mainly by mediating the interaction between the host and microorganisms. As such, we suggest that these TLR signaling pathways are a novel mechanism of RIOM/CIOM with considerable potential for use in therapeutic interventions. More studies are needed in the future to investigate the role of different TLRs in RIOM/CIOM to provide a reference for the precise control of RIOM/CIOM.
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Affiliation(s)
- Ling Ji
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Siyuan Hao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiantao Wang
- State Key Laboratory of Biotherapy and Department of Lung Cancer Center and Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- *Correspondence: Yan Wang,
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10
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Alsubaie HM, Alsini AY, Alsubaie KM, Abu-Zaid A, Alzahrani FR, Sayed S, Pathak AK, Alqahtani KH. Glutamine for prevention and alleviation of radiation-induced oral mucositis in patients with head and neck squamous cell cancer: Systematic review and meta-analysis of controlled trials. Head Neck 2021; 43:3199-3213. [PMID: 34240498 DOI: 10.1002/hed.26798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/20/2021] [Accepted: 06/28/2021] [Indexed: 01/10/2023] Open
Abstract
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that investigated glutamine efficacy in preventing and alleviating radiation-induced oral mucositis (OM) among patients with head and neck (H&N) cancer. We screened five databases from inception till February 4, 2021 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included 11 RCTs, comprising 922 patients (458 and 464 patients were assigned to glutamine and control group, respectively). The incidence and onset of radiation-induced OM of any grade did not substantially differ between both groups. However, glutamine substantially reduced the severity of radiation-induced OM, as reflected by the reduced incidence of severe OM and reduced mean maximal OM grade score. Additionally, glutamine significantly decreased the rates of analgesic opioid use, nasogastric tube feeding, and therapy interruptions. Oral glutamine supplementation demonstrated various therapeutic benefits in preventing and ameliorating radiation-induced OM among patients with H&N cancer.
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Affiliation(s)
- Hemail M Alsubaie
- Department of Otolaryngology - Head and Neck Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Albaraa Y Alsini
- Department of Otolaryngology - Head and Neck Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Khaled M Alsubaie
- Department of General Surgery, Armed Forces Hospitals, Taif, Saudi Arabia
| | - Ahmed Abu-Zaid
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Faisal R Alzahrani
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Suhail Sayed
- Department of Head and Neck Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alok K Pathak
- Department of Head and Neck Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Khaled H Alqahtani
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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11
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Joshi HA, Patwardhan RS, Sharma D, Sandur SK, Devarajan PV. Pre-clinical evaluation of an innovative oral nano-formulation of baicalein for modulation of radiation responses. Int J Pharm 2020; 595:120181. [PMID: 33359537 DOI: 10.1016/j.ijpharm.2020.120181] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 02/04/2023]
Abstract
There is an unmet medical need for non-toxic and effective radiation countermeasures for prevention of radiation toxicity during planned exposures. We have earlier shown that intraperitoneal administration of baicalein (BCL) offers significant survival benefit in animal model. Safety, tolerability, pharmacokinetics (PK) and pharmacodynamics of baicalein has been reported in pre-clinical model systems and also in healthy human volunteers. However, clinical translation of baicalein is hindered owing to poor bioavailability due to lipophilicity. In view of this, we fabricated and characterized in-situ solid lipid nanoparticles of baicalein (SLNB) with effective drug entrapment and release kinetics. SLNB offered significant protection to murine splenic lymphocytes against 4 Gy ionizing radiation (IR) induced apoptosis. Oral administration of SLNB exhibited ~70% protection to mice against whole body irradiation (WBI 7.5 Gy) induced mortality. Oral relative bioavailability of BCL was enhanced by over ~300% after entrapment in the SLNB as compared to BCL. Oral dosing of SLNB resulted in transient increase in neutrophil abundance in peripheral blood. Interestingly, we observed that treatment of human lung cancer cells (A549) with radioprotective dose of SLNB exhibited radio-sensitization as evinced by decrease in survival and clonogenic potential. Contrary to antioxidant nature of baicalein in normal cells, SLNB treatment induced significant increase in cellular ROS levels in A549 cells probably due to higher uptake and inhibition of TrxR. Thus, a pharmaceutically acceptable SLNB exhibited improved bioavailability, better radioprotection to normal cells and sensitized cancer cells to radiation induced killing as compared to BCL suggesting its possible utility as an adjuvant during cancer radiotherapy.
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Affiliation(s)
- Harsh A Joshi
- Department of Pharmaceutical Sciences & Technology, Institute of Chemical Technology, Matunga, Mumbai 400019, India
| | - Raghavendra S Patwardhan
- Radiation Biology and Health Sciences Division, Modular Laboratories, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India.
| | - Deepak Sharma
- Radiation Biology and Health Sciences Division, Modular Laboratories, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai 400094, India
| | - Santosh K Sandur
- Radiation Biology and Health Sciences Division, Modular Laboratories, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India; Homi Bhabha National Institute, Anushaktinagar, Mumbai 400094, India
| | - Padma V Devarajan
- Department of Pharmaceutical Sciences & Technology, Institute of Chemical Technology, Matunga, Mumbai 400019, India.
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12
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Bojaxhiu B, Shrestha BK, Luterbacher P, Elicin O, Shelan M, Macpherson AJS, Heimgartner B, Giger R, Aebersold DM, Zaugg K. Unplanned hospitalizations in patients with locoregionally advanced head and neck cancer treated with (chemo)radiotherapy with and without prophylactic percutaneous endoscopic gastrostomy. Radiat Oncol 2020; 15:281. [PMID: 33317602 PMCID: PMC7737384 DOI: 10.1186/s13014-020-01727-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Current studies about percutaneous endoscopic gastrostomy (PEG) tube placement report equivalent patient outcomes with prophylactic PEG tubes (pPEGs) versus common nutritional support. Unreported was if omitting a pPEG is associated with an increased risk of complications leading to a treatment-related unplanned hospitalization (TRUH). METHODS TRUHs were retrospectively analyzed in patients with advanced head and neck squamous cell carcinoma (n = 310) undergoing (chemo)radiotherapy with (pPEG) or without PEG (nPEG). RESULTS In 88 patients (28%), TRUH was reported. One of the leading causes of TRUH in nPEG patients was inadequate oral intake (n = 16, 13%), and in pPEG patients, complications after PEG tube insertion (n = 12, 10%). Risk factors for TRUH were poor performance status, tobacco use, and surgical procedures. CONCLUSIONS Omitting pPEG tube placement without increasing the risk of an unplanned hospitalization due to dysphagia, dehydration or malnutrition, is an option in patients being carefully monitored. Patients aged > 60 years with hypopharyngeal carcinoma, tobacco consumption, and poor performance status appear at risk of PEG tube-related complications leading to an unplanned hospitalization.
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Affiliation(s)
- Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Radiation Oncology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Binaya K Shrestha
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Luterbacher
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew J S Macpherson
- Department of Visceral Surgery and Medicine, Division of Gastroenterology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin Heimgartner
- Department of Visceral Surgery and Medicine, Division of Gastroenterology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Department of Radiation Oncology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zurich, Switzerland.
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13
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Roy D, Patel A, Goswami G, Samantaray S, Gupta N, Singh SK. Role of Onco rehabilitation in head and neck cancer. Oral Oncol 2020; 112:105015. [PMID: 33223476 DOI: 10.1016/j.oraloncology.2020.105015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Dibyendu Roy
- Apex Hospital, Varanasi, DLW, Hydil Road, Uttar Pradesh 221004, India.
| | - Ankita Patel
- Apex Hospital, Varanasi, DLW, Hydil Road, Uttar Pradesh 221004, India
| | - Gaurav Goswami
- Apex Hospital, Varanasi, DLW, Hydil Road, Uttar Pradesh 221004, India
| | | | - Neha Gupta
- Apex Hospital, Varanasi, DLW, Hydil Road, Uttar Pradesh 221004, India
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Shirazian S, Keykha E, Pourshahidi S, Ebrahimi H. Effects of 660 nm and 810 nm Low-Power Diode Laser on Proliferation and Invasion of Oral Cancer Cells in Cell Culture Media. Photochem Photobiol 2020; 97:618-626. [PMID: 33119134 DOI: 10.1111/php.13351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022]
Abstract
In the present study, the effects of 660 and 810 nm diode laser on the proliferation and invasion of cancer cells were investigated. Sixteen plates of oral cancer cells originated from tongue SCC were irradiated with diode laser at 660 nm (40 and 80 mW) and 810 nm (100 and 200 mW) with the energy density of 4 J cm-2 . One plate received no irradiation (the control). Irradiation was performed at four times (0, 24, 72 and 168 h). Cell proliferation was measured by MTT assay. The Ki67 and vascular endothelial growth factor (VEGF) markers were examined by real-time polymerase chain reaction (RT-PCR). Cyclin D1, E-cadherin, β-catenin and matrix metalloproteinase-9 (MMP-9; flow cytometry) were also evaluated. Proliferation was lower in the irradiated groups. This result was significant for all groups at 24 h. The percentages of cyclin D1 and MMP-9 were higher in 810 nm groups, β-catenin and E-cadherin were higher in 660 nm groups, VEGF marker was significantly lower in 810 nm/200 mW group, and Ki67 marker has no difference between the groups. According to the results of this study, laser irradiation at 0 and 24 h resulted in a significant inhibitory effect on cell proliferation especially in 660 nm/80 mW and 810 nm/200 mW. Further studies are needed in this respect.
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Affiliation(s)
- Shiva Shirazian
- Department of Oral and Maxillofacial Medicine, Dentistry School, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Keykha
- Department of Oral Medicine, Dentistry School, Qom University of Medical Science and Health Services, Qom, Iran
| | - Sara Pourshahidi
- Department of Oral and Maxillofacial Medicine, Dentistry School, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Ebrahimi
- Laser Research Center, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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15
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Campos TM, do Prado Tavares Silva CA, Sobral APT, Sobral SS, Rodrigues MFSD, Bussadori SK, Fernandes KPS, Mesquita-Ferrari RA, Horliana ACRT, Motta LJ. Photobiomodulation in oral mucositis in patients with head and neck cancer: a systematic review and meta-analysis followed by a cost-effectiveness analysis. Support Care Cancer 2020; 28:5649-5659. [DOI: 10.1007/s00520-020-05613-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
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16
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Kim HJ, Kang SU, Lee YS, Jang JY, Kang H, Kim CH. Protective Effects of N-Acetylcysteine against Radiation-Induced Oral Mucositis In Vitro and In Vivo. Cancer Res Treat 2020; 52:1019-1030. [PMID: 32599978 PMCID: PMC7577823 DOI: 10.4143/crt.2020.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Radiation-induced oral mucositis limits delivery of high-dose radiation to targeted cancers. Therefore, it is necessary to develop a treatment strategy to alleviate radiation-induced oral mucositis during radiation therapy. We previously reported that inhibiting reactive oxygen species (ROS) generation suppresses autophagy. Irradiation induces autophagy, suggesting that antioxidant treatment may be used to inhibit radiation-induced oral mucositis. Materials and Methods We determined whether treatment with N-acetyl cysteine (NAC) could attenuate radiation-induced buccal mucosa damage in vitro and in vivo. The protective effects of NAC against oral mucositis were confirmed by transmission electron microscopy and immunocytochemistry. mRNA and protein levels of DNA damage and autophagy-related genes were measured by quantitative real-time polymerase chain reaction and western blot analysis, respectively. RESULTS Rats manifesting radiation-induced oral mucositis showed decreased oral intake, loss of body weight, and low survival rate. NAC intake slightly increased oral intake, body weight, and the survival rate without statistical significance. However, histopathologic characteristics were markedly restored in NAC-treated irradiated rats. LC3B staining of rat buccal mucosa revealed that NAC treatment significantly decreased the number of radiation-induced autophagic cells. Further, NAC inhibited radiation-induced ROS generation and autophagy signaling. In vitro, NAC treatment significantly reduced the expression of NRF2, LC3B, p62, and Beclin-1 in keratinocytes compared with that after radiation treatment. CONCLUSION NAC treatment significantly inhibited radiation-induced autophagy in keratinocytes and rat buccal mucosa and may be a potentially safe and effective option for the prevention of radiation-induced buccal mucosa damage.
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Affiliation(s)
- Haeng Jun Kim
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Sung Un Kang
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Yun Sang Lee
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Jeon Yeob Jang
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hami Kang
- Program of Public Health Studies, Johns Hopkins University, Baltimore, MD, USA
| | - Chul-Ho Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
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17
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Soltani GM, Hemati S, Sarvizadeh M, Kamalinejad M, Tafazoli V, Latifi SA. Efficacy of the plantago major L. syrup on radiation induced oral mucositis in head and neck cancer patients: A randomized, double blind, placebo-controlled clinical trial. Complement Ther Med 2020; 51:102397. [PMID: 32507421 DOI: 10.1016/j.ctim.2020.102397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/23/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Oral mucositis is a complication of radiation therapy in cancer patients. We designed a trial to evaluate efficacy of plantago major on symptoms of radiation induced mucositis in cancer patients. METHODS In this randomized double blind, placebo-controlled trial 23 patients received plantago major syrup as intervention group and 23 patients received placebo syrup as control group for 7 weeks. Outcome measures were severity of mucositis according to WHO scale and severity of patients' pain assessed by visual analogue scale. RESULTS Severity of mucositis were significantly lower in intervention group compared to placebo group (p value<0.05). Also patients in intervention group experienced significantly less pain compared to placebo group during radiotherapy period (p value<0.05) CONCLUSION: Plantago major L syrup was effective on the reduction of the symptoms of radiation induced mucositis in patients with head and neck cancers.
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Affiliation(s)
- Gholamreza Mohammad Soltani
- Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Arak, Iran.
| | - Simin Hemati
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mostafa Sarvizadeh
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Kamalinejad
- School of Pharmacy, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Vahid Tafazoli
- Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Seied AmirHossein Latifi
- Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Arak, Iran.
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Transcutaneous Electrical Nerve Stimulation Reduces Resting Pain in Head and Neck Cancer Patients: A Randomized and Placebo-Controlled Double-Blind Pilot Study. Cancer Nurs 2020; 42:218-228. [PMID: 29649082 DOI: 10.1097/ncc.0000000000000594] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Individuals receiving radiation for head and neck cancer (HNC) often develop painful oral mucositis that impairs function, possibly leading to feeding tubes, hospitalization, and treatment delays. Although pharmacologic medications provide some relief, many report inadequate analgesia and adverse effects. Transcutaneous electrical nerve stimulation (TENS) is a safe, nonpharmacologic intervention; it decreases pain and analgesics and improves function, yet no studies examined TENS for HNC. OBJECTIVE The aim of this study was to examine the efficacy of TENS for pain and function in HNC patients. METHODS This study used a randomized, double-blinded crossover design; participants received 3 TENS treatments during weeks 4 to 6 of radiation: active, placebo, and no TENS over the temporomandibular joint and upper cervical region. Pain (McGill Pain Questionnaire, visual analog scale [VAS] resting and function), function (mouth opening, tongue movement, speaking), fatigue (VAS), and treatment effectiveness (VAS) were assessed before and after TENS at 3 visits. RESULTS Resting pain (McGill Pain Questionnaire and VAS) decreased significantly more after active TENS than placebo or no TENS; changes in function and pain with function did not differ between conditions. Active TENS decreased fatigue significantly more than no TENS and was rated as more effective than placebo TENS. CONCLUSION Transcutaneous electrical nerve stimulation improves pain in HNC patients receiving radiation but not function or pain with function relative to placebo or no TENS. IMPLICATIONS FOR PRACTICE Transcutaneous electrical nerve stimulation may be a viable tool for radiation-induced HNC pain to complement pharmacologic approaches. This nonpharmacologic intervention could decrease the debilitating effects of radiation and analgesics, and improve quality of life. Clinical trials should examine the effects and safety of repeated, daily TENS in HNC patients receiving radiation.
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19
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Efficacy and safety of local lysozyme treatment in patients with oral mucositis after chemotherapy and radiotherapy. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2019; 69:695-704. [PMID: 31639081 DOI: 10.2478/acph-2019-0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 02/07/2023]
Abstract
This observational clinical study was composed of two substudies: a non-comparative one (n = 166), testing only lysozyme-based compounds (LBCs), and a comparative substudy (n = 275), testing both LBCs and bicarbonate-based local compounds (BBCs) on the healing of oral mucositis during radio- or chemotherapy. The density of ulcerations has decreased significantly after the treatment with lysozyme in both substudies. The density of ulcerations in the radiotherapy group was lower in patients treated with LBCs compared to patients treated with BBCs (p < 0.001). In the chemotherapy group, reduction of ulceration density was similar with both LBCs and BBCs. The LBCs reduced pain intensity during the intake of solid food and speech more than BBCs in both patient cohorts (p < 0.05). In the radiotherapy cohort, pain intensity when consuming liquid foods was reduced more with LBCs than with BBCs (p < 0.05). No adverse events were recorded. This study demonstrates the advantages of treating oral mucositis during radiotherapy or chemo-therapy with LBCs.
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20
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Landauer MR, Harvey AJ, Kaytor MD, Day RM. Mechanism and therapeutic window of a genistein nanosuspension to protect against hematopoietic-acute radiation syndrome. JOURNAL OF RADIATION RESEARCH 2019; 60:308-317. [PMID: 31038675 PMCID: PMC6530628 DOI: 10.1093/jrr/rrz014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/08/2019] [Indexed: 05/17/2023]
Abstract
There are no FDA-approved drugs that can be administered prior to ionizing radiation exposure to prevent hematopoietic-acute radiation syndrome (H-ARS). A suspension of synthetic genistein nanoparticles was previously shown to be an effective radioprotectant against H-ARS when administered prior to exposure to a lethal dose of total body radiation. Here we aimed to determine the time to protection and the duration of protection when the genistein nanosuspension was administered by intramuscular injection, and we also investigated the drug's mechanism of action. A single intramuscular injection of the genistein nanosuspension was an effective radioprotectant when given prophylactically 48 h to 12 h before irradiation, with maximum effectiveness occurring when administered 24 h before. No survival advantage was observed in animals administered only a single dose of drug after irradiation. The dose reduction factor of the genistein nanosuspension was determined by comparing the survival of treated and untreated animals following different doses of total body irradiation. As genistein is a selective estrogen receptor beta agonist, we also explored whether this was a central component of its radioprotective mechanism of action. Mice that received an intramuscular injection of an estrogen receptor antagonist (ICI 182,780) prior to administration of the genistein nanosuspension had significantly lower survival following total body irradiation compared with animals only receiving the nanosuspension (P < 0.01). These data define the time to and duration of radioprotection following a single intramuscular injection of the genistein nanosuspension and identify its likely mechanism of action.
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Affiliation(s)
- Michael R Landauer
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, 4555 South Palmer Road, Building 42, Bethesda, MD, USA
| | - Adam J Harvey
- Humanetics Corporation, 7650 Edinborough Way, Suite 620, Edina, MN, USA
| | - Michael D Kaytor
- Humanetics Corporation, 7650 Edinborough Way, Suite 620, Edina, MN, USA
| | - Regina M Day
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Building C, Roomm 2023, 4301 Jones Bridge Road, Bethesda, MD, USA
- Corresponding author. Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Building C, Room 2023, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA. Tel: +301-295-3236; fax: +301-295-3220;
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21
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Graul-Conroy A, Hoover-Regan M, DeSantes KB, Sondel PM, Callander NS, Longo WL, Fahl WE. Reduction in oral mucositis severity using a topical vasoconstrictor: A case report of three bone marrow transplant patients. ACTA ACUST UNITED AC 2018; 5. [PMID: 31832233 PMCID: PMC6907163 DOI: 10.15761/icst.1000293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Grade 3 oral mucositis (OM) is historically observed in >90% of bone marrow transplant patients who received the cyclophosphamide + total body irradiation (CY+TBI) conditioning regimen. It was previously shown that orotopically applied adrenergic vasoconstrictor prevented up to 100% of radiation-induced oral mucositis in two preclinical animal models. Methods: Adrenergic vasoconstrictor (i.e., phenylephrine in an aqueous-alcohol NG11–1 formulation) was orotopically applied to three patients (ages 24–29) who received the CY+TBI conditioning regimen; they were compared to five matched controls who received no orotopical vasoconstrictor. All patients received the CY+TBI conditioning regimen for acute lymphoblastic leukemia within the University of Wisconsin Adult Bone Marrow Transplant Program. Over the seven-day Cy+TBI conditioning regimen, 20 min before each treatment, either radiation or chemotherapy, vasoconstrictor was applied topically to the oral cavity, and patients then received either 1.5 Gy whole-body radiation or IV cyclophosphamide. Results: OM severity was scored over a three-week period using: i) physican assessments, ii) daily photos of the oral cavity, iii) oral pain and oral function score sheets, and iv) recorded narcotic consumption. Both “Grade 3 OM” duration and “any OM” duration in vasoconstrictor-treated patients were substantially lower than for the five control patients. Though nasogastric tube or total parenteral nutrition were used in 3 out of 5 control patients, there was no use of these supportive care measures in the three vasoconstrictor-treated patients. Conclusion: Orotopically applied NG11–1 vasoconstrictor formulation substantially reduced the incidence and severity of “Grade 3” and “any” oral mucositis when compared to matched control patients, all of whom received the same CY+TBI conditioning regimen. The liquid orotopical formulation was easily tolerated by patients both in its ease of use and lack of side effects.
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Affiliation(s)
- Amanda Graul-Conroy
- Department of Pediatrics, Hematology-Oncology Program, University of Wisconsin-Madison, USA.,Department of Pediatrics, Hematology-Oncology Program, Baylor College of Medicine, USA
| | - Margo Hoover-Regan
- Department of Pediatrics, Hematology-Oncology Program, University of Wisconsin-Madison, USA
| | - Kenneth B DeSantes
- Department of Pediatrics, Hematology-Oncology Program, University of Wisconsin-Madison, USA
| | - Paul M Sondel
- Department of Pediatrics, Hematology-Oncology Program, University of Wisconsin-Madison, USA
| | - Natalie S Callander
- Department of Medicine, Bone Marrow Transplant Program, University of Wisconsin-Madison, USA
| | - Walter L Longo
- Department of Medicine, Bone Marrow Transplant Program, University of Wisconsin-Madison, USA.,Department of Medicine, Medical College of Wisconsin, USA
| | - William E Fahl
- Wisconsin Institutes of Medical Research, University of Wisconsin-Madison, USA
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Sroussi HY, Jessri M, Epstein J. Oral Assessment and Management of the Patient with Head and Neck Cancer. Oral Maxillofac Surg Clin North Am 2018; 30:445-458. [DOI: 10.1016/j.coms.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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23
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Photobiomodulation is associated with a decrease in cell viability and migration in oral squamous cell carcinoma. Lasers Med Sci 2018; 34:629-636. [DOI: 10.1007/s10103-018-2640-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 09/11/2018] [Indexed: 12/20/2022]
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24
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Bockel S, Vallard A, Lévy A, François S, Bourdis M, Le Gallic C, Riccobono D, Annede P, Drouet M, Tao Y, Blanchard P, Deutsch É, Magné N, Chargari C. Pharmacological modulation of radiation-induced oral mucosal complications. Cancer Radiother 2018; 22:429-437. [PMID: 29776830 DOI: 10.1016/j.canrad.2017.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 12/12/2022]
Abstract
Radiation-induced mucositis is a common toxicity, especially in patients with head and neck cancers. Despite recent technological advances in radiation therapy, such as intensity-modulated radiotherapy, radiation-induced mucositis is still causing treatment disruptions, negatively affecting patients' long and short term quality of life, and impacting medical resources use with economic consequences. The objective of this article was to review the latest updates in the management of radiation-induced mucositis, with a focus on pharmaceutical strategies for the prevention or treatment of mucositis. Although numerous studies analysing the prevention and management of oral radiation-induced mucositis have been conducted, there are still few reliable data to guide daily clinical practice. Furthermore, most of the tested drugs have shown no (anti-inflammatory cytokine, growth factors) or limited (palifermin) effect. Therapies for acute oral mucositis are predominantly focused on improving oral hygiene and providing symptoms control. Although low-level laser therapy proved efficient in preventing radiation-induced oral mucositis in patients with head and neck cancer, this intervention requires equipment and trained medical staff, and is therefore insufficiently developed in clinical routine. New effective pharmacological agents able to prevent or reverse radio-induced mucositis are required.
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Affiliation(s)
- S Bockel
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - A Vallard
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - A Lévy
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - S François
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - M Bourdis
- Département interdisciplinaire des soins de support pour le patient en oncologie, institut de cancérologie Lucien-Neuwirth, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - C Le Gallic
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - D Riccobono
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - P Annede
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - M Drouet
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - Y Tao
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - P Blanchard
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - É Deutsch
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Inserm U1030, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - N Magné
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - C Chargari
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Inserm U1030, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France; Service de santé des armées, école du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France.
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25
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González-Arriagada WA, Ramos LMA, Andrade MAC, Lopes MA. Efficacy of low-level laser therapy as an auxiliary tool for management of acute side effects of head and neck radiotherapy. J COSMET LASER THER 2017; 20:117-122. [DOI: 10.1080/14764172.2017.1376097] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Lara Maria Alencar Ramos
- Department of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Brasil
| | | | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Semiology and Oral Pathology, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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Chitapanarux I, Tungkasamit T, Petsuksiri J, Kannarunimit D, Katanyoo K, Chakkabat C, Setakornnukul J, Wongsrita S, Jirawatwarakul N, Lertbusayanukul C, Sripan P, Traisathit P. Randomized control trial of benzydamine HCl versus sodium bicarbonate for prophylaxis of concurrent chemoradiation-induced oral mucositis. Support Care Cancer 2017; 26:879-886. [PMID: 28942587 DOI: 10.1007/s00520-017-3904-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/18/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of the study is to compare the efficacy of benzydamine HCl with sodium bicarbonate in the prevention of concurrent chemoradiation-induced oral mucositis in head and neck cancer patients. METHODS Sixty locally advanced head and neck cancer patients treated with high-dose radiotherapy concurrently with platinum-based chemotherapy were randomly assigned to receive either benzydamine HCl or sodium bicarbonate from the first day of treatment to 2 weeks after the completion of treatment. The total score for mucositis, based on the Oral Mucositis Assessment Scale (OMAS), was used for the assessment, conducted weekly during the treatment period and at the fourth week of the follow-up. Pain score, all prescribed medications, and tube feeding needs were also recorded and compared. RESULTS The median of total OMAS score was statistically significant lower in patients who received benzydamine HCl during concurrent chemo-radiotherapy (CCRT) than in those who received sodium bicarbonate, (p value < 0.001). There was no difference in median pain score, (p value = 0.52). Nineteen percent of patients in sodium bicarbonate arm needed oral antifungal agents whereas none in the benzydamine HCl arm required such medications, (p value = 0.06). Tube feeding needs and the compliance of CCRT were not different between the two study arms. CONCLUSIONS For patients undergoing high-dose radiotherapy concurrently with platinum-based chemotherapy, using benzydamine HCl mouthwash as a preventive approach was superior to basic oral care using sodium bicarbonate mouthwash in terms of reducing the severity of oral mucositis and encouraging trend for the less need of oral antifungal drugs.
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Affiliation(s)
- Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. .,Northern Thai Research Group of Therapeutic Radiology and Oncology (NTRG-TRO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. .,Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | | | - Janjira Petsuksiri
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Danita Kannarunimit
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Kanyarat Katanyoo
- Radiation Oncology Unit, Department of Radiology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chakkapong Chakkabat
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Jiraporn Setakornnukul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somying Wongsrita
- Division of Radiation Oncology, Maharaj Nakornratchasima Hospital, Nakornratchasima, Thailand
| | | | - Chawalit Lertbusayanukul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Patumrat Sripan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Therapeutic Radiology and Oncology (NTRG-TRO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Center of Excellence in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Chiang Mai, Thailand
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Sanz R, Calpena AC, Mallandrich M, Gimeno Á, Halbaut L, Clares B. Development of a buccal doxepin platform for pain in oral mucositis derived from head and neck cancer treatment. Eur J Pharm Biopharm 2017; 117:203-211. [DOI: 10.1016/j.ejpb.2017.04.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/02/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
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Chaitanya B, Pai KM, Yathiraj PH, Fernandes D, Chhaparwal Y. Rebamipide gargle in preventive management of chemo-radiotherapy induced oral mucositis. Oral Oncol 2017; 72:179-182. [PMID: 28797456 DOI: 10.1016/j.oraloncology.2017.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/08/2017] [Accepted: 07/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND & OBJECTIVES Oral mucositis is inflammation of mucosa of oral cavity which is an inevitable and acute side effect in patients undergoing chemoradiotherapy for head & neck cancer. Though many agents have been tried in prevention & treatment of oral mucositis, until date no single agent exists that is universally established to be effective. METHODS 60 Patients diagnosed with Head & Neck cancer recruited for concurrent chemo-radiotherapy were assigned in a double blind fashion into 2 groups using computer based 1:1 ratio randomization. Subjects in Group 1 were given Rebamipide gargle while subjects in Group 2 were given Placebo gargle in similar colour coded bottles to gargle 6 times/day. Subjective assessment of oral mucositis was done by Numeric Rating Scale (NRS) and objective scoring according to RTOG system. RESULTS All subjects in the Group 1 reported good treatment compliance but 4 subjects in Group 2 developed burning sensation to gargle and were excluded. Onset of oral mucositis was 3.5days earlier in Group 2 (mean=11.17) as compared to Group 1 (mean=14.63). At the end of chemo-radiotherapy, severity of oral mucositis was significantly lower in Group 1 (mean=1.97) than in Group 2 (mean=2.81). INTERPRETATION & CONCLUSION Findings of this study revealed that Rebamipide gargle may be an effective means to prolong the onset of oral mucositis and may reduce the severity of oral mucositis in undergoing chemo-radiotherapy.
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Affiliation(s)
- B Chaitanya
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka 576104, India.
| | - Keerthilatha M Pai
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka 576104, India
| | - Prahlad H Yathiraj
- Dept. of Radiotherapy and Oncology, Kasturba Medical College and Hospital, Manipal University, Manipal, Karnataka 576104, India
| | - Donald Fernandes
- Dept. of Radiotherapy and Oncology, Kasturba Medical College and Hospital, Manipal University, Manipal, Karnataka 576104, India
| | - Yogesh Chhaparwal
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka 576104, India
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Demir Doğan M, Can G, Meral R. Effectiveness of Black Mulberry Molasses in Prevention of Radiotherapy-Induced Oral Mucositis: A Randomized Controlled Study in Head and Neck Cancer Patients. J Altern Complement Med 2017; 23:971-979. [PMID: 28677999 DOI: 10.1089/acm.2016.0425] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Radiation-induced oral mucositis is one of the problems experienced by 70%-80% of patients receiving radiation therapy (RT). This randomized controlled trial assessed the effectiveness of black mulberry molasses in the prevention of oral mucositis in head and neck cancer patients receiving RT. INTERVENTIONS AND OUTCOME MEASURES Eighty head and neck cancer patients scheduled to undergo RT to the oropharyngeal mucosa were randomly assigned to receive RT (42) or RT plus mulberry molasses (38). The research data were collected with a Patient Description Form, Common Terminology Criteria for Adverse Events, version 4.0, an Oral Assessment Guide, and the University of Washington Quality of Life Assessment Questionnaire. RESULTS The incidence and severity of oral mucositis were lower in the black mulberry molasses group. However, black mulberry molasses usage was an only independent and significant factor in prevention of mucositis [HR 0.63 (%95 GI 0.40-0.98)]. There were no differences between the quality of life scores of experimental and control groups. CONCLUSIONS This randomized controlled study showed that black mulberry molasses usage is an effective intervention in the prevention of the radiation-induced mucositis of head and neck cancer patients. However, to confirm these results, further studies are needed.
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Affiliation(s)
| | - Gulbeyaz Can
- 2 Nursing Faculty, Istanbul University , Istanbul, Turkey
| | - Rasim Meral
- 3 Institute of Oncology, Istanbul University , Istanbul, Turkey
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Porceddu SV, Haddad RI. Management of elderly patients with locoregionally confined head and neck cancer. Lancet Oncol 2017; 18:e274-e283. [DOI: 10.1016/s1470-2045(17)30229-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/01/2016] [Accepted: 12/13/2016] [Indexed: 12/13/2022]
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Toshkov IA, Gleiberman AS, Mett VL, Hutson AD, Singh AK, Gudkov AV, Burdelya LG. Mitigation of Radiation-Induced Epithelial Damage by the TLR5 Agonist Entolimod in a Mouse Model of Fractionated Head and Neck Irradiation. Radiat Res 2017; 187:570-580. [PMID: 28323577 PMCID: PMC5541767 DOI: 10.1667/rr14514.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Radiation treatment of head and neck cancer frequently causes severe collateral damage to normal tissues including mouth mucosa, salivary glands and skin. This toxicity limits the radiation dose that can be delivered and affects the patient's quality of life. Previous studies in mice and nonhuman primates showed that entolimod, a toll-like receptor 5 (TLR5) agonist derived from bacterial flagellin, effectively reduced radiation damage to hematopoietic and gastrointestinal tissues in both total-body and local irradiation scenarios, with no protection of tumors. Here, using a mouse model, we analyzed the efficacy of entolimod administered before or after irradiation in reducing damage to normal tissues. Animals received local fractionated radiation to the head and neck area, thus modeling radiotherapy of head and neck cancer. Tissue damage was evaluated through histomorphological examination of samples collected at different time points up to four weeks, mice were exposed locally to five daily fractions of 5, 6 or 7 Gy. A semiquantitative scoring system was used to assess the severity of observed pathomorphological changes. In this model, radiation damage was most severe in the lips, tongue and skin, moderate in the upper esophagus and minor in salivary glands. The kinetics of injury appearance and recovery of normal morphology varied among tissues, with maximal damage to the tongue, esophagus and salivary glands developing at earlier times (days 8-11 postirradiation) relative to that of lip and skin mucosa (days 11-15 postirradiation). While both tested regimens of entolimod significantly reduced the extent of radiation damage and accelerated restoration of normal structure in all tissues analyzed, administration of entolimod 1 h after each irradiation was more effective than treatment 30 min before irradiation. These results support the potential clinical use of entolimod as an adjuvant for improving the therapeutic index of head and neck cancer radiotherapy by reducing the radiation toxicity in normal tissues.
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Affiliation(s)
| | | | | | - Alan D. Hutson
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Andrei V. Gudkov
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, New York
- Cleveland BioLabs, Inc., Buffalo, New York
| | - Lyudmila G. Burdelya
- Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, New York
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Current Status of Targeted Radioprotection and Radiation Injury Mitigation and Treatment Agents: A Critical Review of the Literature. Int J Radiat Oncol Biol Phys 2017; 98:662-682. [PMID: 28581409 DOI: 10.1016/j.ijrobp.2017.02.211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 01/17/2023]
Abstract
As more cancer patients survive their disease, concerns about radiation therapy-induced side effects have increased. The concept of radioprotection and radiation injury mitigation and treatment offers the possibility to enhance the therapeutic ratio of radiation therapy by limiting radiation therapy-induced normal tissue injury without compromising its antitumor effect. Advances in the understanding of the underlying mechanisms of radiation toxicity have stimulated radiation oncologists to target these pathways across different organ systems. These generalized radiation injury mechanisms include production of free radicals such as superoxides, activation of inflammatory pathways, and vascular endothelial dysfunction leading to tissue hypoxia. There is a significant body of literature evaluating the effectiveness of various treatments in preventing, mitigating, or treating radiation-induced normal tissue injury. Whereas some reviews have focused on a specific disease site or agent, this critical review focuses on a mechanistic classification of activity and assesses multiple agents across different disease sites. The classification of agents used herein further offers a useful framework to organize the multitude of treatments that have been studied. Many commonly available treatments have demonstrated benefit in prevention, mitigation, and/or treatment of radiation toxicity and warrant further investigation. These drug-based approaches to radioprotection and radiation injury mitigation and treatment represent an important method of making radiation therapy safer.
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Kooshyar MM, Mozafari PM, Amirchaghmaghi M, Pakfetrat A, Karoos P, Mohasel MR, Orafai H, Azarian AA. A Randomized Placebo- Controlled Double Blind Clinical Trial of Quercetin in the Prevention and Treatment of Chemotherapy-Induced Oral Mucositis. J Clin Diagn Res 2017; 11:ZC46-ZC50. [PMID: 28511508 DOI: 10.7860/jcdr/2017/23975.9571] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/04/2016] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Oral Mucositis (OM) is a serious complication of chemotherapy that results in painful debilitating inflammation that sometimes ends in interruption of treatment. AIM The study evaluated the effect of quercetin (a natural flavonoid) on preventing and treating chemotherapy induced OM in patients with blood malignancies. Materials and Methods: This double-blind, placebo controlled randomized trial was carried out on 20 adult patients who underwent high dose chemotherapy for blood malignancies. Patients were divided into two groups (10 patients in the intervention group and 10 patients in the control group). Patients in the intervention group were administered 250 mg quercetin capsules twice daily for four weeks. RESULTS Nine out of 20 patients developed OM (three in the intervention group and six in the control group). The incidence of OM was lower in the intervention group although it was not statistically significant (p=0.189). The mean severity of OM was higher in the intervention group (2.6 vs 2). Healing time, age, gender, type of malignancy, drug type and duration of OM were not different in two groups. CONCLUSION The incidence of mucositis was lower in the quercetin group, but mucositis was more severe in the intervention group, which may be due to lower oral health status in the intervention group.
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Affiliation(s)
- Mohammad Mahdi Kooshyar
- Associate Professor, Department of Hematology and Oncology, Imam Reza Hospital, Mashhad University of Medicals, Mashhad, Khorasan Razavi, Iran
| | - Pegah Mosannen Mozafari
- Associate Professor, Department of Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Amirchaghmaghi
- Associate Professor, Department of Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atessa Pakfetrat
- Professor, Department of Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parisa Karoos
- General Dentist, Hojjati Dentistry Clinic, Mashhad, Khorasan Razavi, Iran
| | - Mahdokht Rashed Mohasel
- Oral and Maxillofacial Medicine Specialist, Department of Pedodontics and Oral Medicine, North Khorasan University of Medical Sciences, Mashhad, Iran
| | - Hosein Orafai
- Professor, Department of Industrial Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Khorasan Razavi, Iran
| | - Amir Abbas Azarian
- PhD Candidate of Statistics, Statistics Office, Mashhad University of Statistics, Mashhad, Iran
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Elyasi S, Hosseini S, Niazi Moghadam MR, Aledavood SA, Karimi G. Effect of Oral Silymarin Administration on Prevention of Radiotherapy Induced Mucositis: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. Phytother Res 2016; 30:1879-1885. [PMID: 27555604 DOI: 10.1002/ptr.5704] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/25/2016] [Accepted: 07/31/2016] [Indexed: 12/16/2023]
Abstract
Mucositis is a frequent severe complication of radiation therapy in patient with head and neck cancer. Silymarin is a polyphenolic flavonoid extracted from the milk thistle that exhibits strong antioxidant and antiinflammatory activities. In this study, we evaluate silymarin efficacy in prevention of radiotherapy induced mucositis in patients with head and neck cancer, as the first human study. During this pilot, randomized, double-blinded, placebo-controlled clinical trial, the effect of oral silymarin 420 mg daily in three divided doses starting at the first day of radiotherapy for 6 weeks, on oral mucositis occurrence was assessed. Twenty-seven patients fulfilled the inclusion criteria assigned to the silymarin or placebo group. World Health Organization and National Cancer Institute-Common Terminology Criteria oral mucositis grading scale scores were recorded at baseline and weekly during these 6 weeks. The median World Health Organization and National Cancer Institute Common Terminology Criteria scores were significantly lower in silymarin group at the end of the first to sixth week (p < 0.05). The scores increased significantly in both placebo and silymarin groups during radiotherapy, but there was a delay for mucositis development and progression in silymarin group. Prophylactic administration of conventional form of silymarin tablets could significantly reduce the severity of radiotherapy induced mucositis and delay its occurrence in patients with head and neck cancer. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sepideh Elyasi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sare Hosseini
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | | | - Gholamreza Karimi
- Pharmaceutical Research Center, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Gonnelli FAS, Palma LF, Giordani AJ, Deboni ALS, Dias RS, Segreto RA, Segreto HRC. Low-level laser therapy for the prevention of low salivary flow rate after radiotherapy and chemotherapy in patients with head and neck cancer. Radiol Bras 2016; 49:86-91. [PMID: 27141130 PMCID: PMC4851476 DOI: 10.1590/0100-3984.2014.0144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To determine whether low-level laser therapy can prevent salivary
hypofunction after radiotherapy and chemotherapy in head and neck cancer
patients. Materials and Methods We evaluated 23 head and neck cancer patients, of whom 13 received laser
therapy and 10 received clinical care only. An InGaAlP laser was used
intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm2
and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7
J/cm2, three times per week, on alternate days. Stimulated
and unstimulated sialometry tests were performed before the first
radiotherapy and chemotherapy sessions (N0) and at 30 days after the end of
treatment (N30). Results At N30, the mean salivary flow rates were significantly higher among the
laser therapy patients than among the patients who received clinical care
only, in the stimulated and unstimulated sialometry tests
(p = 0.0131 and p = 0.0143,
respectively). Conclusion Low-level laser therapy, administered concomitantly with radiotherapy and
chemotherapy, appears to mitigate treatment-induced salivary hypofunction in
patients with head and neck cancer.
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Affiliation(s)
| | - Luiz Felipe Palma
- Masters Student in Clinical Radiology, Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Adelmo José Giordani
- PhD, Physicist in Charge of the Medical Physics Sector, Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Rodrigo Souza Dias
- PhD, Interim Head of the Radiotherapy Sector, Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Roberto Araújo Segreto
- Tenured Associate Professor in the Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Helena Regina Comodo Segreto
- PhD, Associate Professor in the Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Multicenter phase II study of an oral care program for patients with head and neck cancer receiving chemoradiotherapy. Support Care Cancer 2016; 24:3029-36. [PMID: 26887378 DOI: 10.1007/s00520-016-3122-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This multicenter phase II trial assessed the clinical benefit of a multidisciplinary oral care program in reducing the incidence of severe chemoradiotherapy-induced oral mucositis (OM). METHODS Patients with head and neck cancer (HNC) who were scheduled to receive definitive or postoperative chemoradiotherapy were enrolled. The oral care program included routine oral screening by dentists and a leaflet containing instructions regarding oral care, nutrition, and lifestyle. Oral hygiene and oral care were evaluated continuously during and after the course of chemoradiotherapy. The primary endpoint was the incidence of grade ≥3 OM assessed by certified medical staff according to the Common Terminology Criteria of Adverse Events version 3.0. RESULTS From April 2012 to December 2013, 120 patients with HNC were enrolled. Sixty-four patients (53.3 %) developed grade ≥3 OM (i.e., functional/symptomatic). The incidence of grade ≤1 OM at 2 and 4 weeks after radiotherapy completion was 34.2 and 67.6 %, respectively. Clinical examination revealed that 51 patients (42.5 %) developed grade ≥3 OM during chemoradiotherapy. The incidence of grade ≤1 OM at 2 and 4 weeks after radiotherapy completion was 54.7 and 89.2 %, respectively. The incidences of grade 3 infection and pneumonitis throughout chemoradiotherapy were <5 %. Only 6.7 % of patients had unplanned breaks in radiotherapy, and 99.2 % completed treatment. CONCLUSIONS A systematic oral care program alone is insufficient to decrease the incidence of severe OM in patients with HNC being treated with chemoradiotherapy. However, systematic oral care programs may indirectly improve treatment compliance by decreasing infection risk. TRIAL REGISTRATION NUMBER UMIN000006660.
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Health advisor facilitated mouth care regime for patients with head and neck cancers undergoing intensity-modulated radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAimTo develop a regime of care for patients with head and neck cancers undergoing intensity-modulated radiotherapy (IMRT), with the support of a health advisor (HA) and temporary access to the mouth care product Caphosol™.Materials and methodsA HA was temporarily employed to assess, monitor and refer patients as appropriate and ensure patients received and utilised supplies of Caphosol™. A retrospective audit was undertaken to provide a gap analysis of current service. The data were used to develop a pro forma for documenting assessments and monitoring lifestyle factors for IMRT patients. Assessments referrals and compliance, plus hospital admissions owing to treatment-related issues, were documented during the baseline audit and the temporary HA service and provision of Caphosol™.ResultsThe presence of a HA facilitated 100% compliance with appropriate assessments, referrals and adherence to treatment. The data suggests that the additional provision of Caphosol™ may have reduced levels of mucositis and associated pain.ConclusionIt is recommended that a HA role be established within radiotherapy departments to facilitate lifestyle assessments, referrals and compliance with positive behaviour changes (e.g., stopping smoking). The use of Caphosol™ as a routine part of mouth care regime for IMRT patients also warrants further investigation.
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Becker-Schiebe M, Sperling M, Pinkert U, Hoffmann W. Impact of p16 Alterations and Pretreatment Anemia on Toxicity in Head and Neck Cancer Patients Undergoing Definitive Radiochemotherapy. Oncol Res Treat 2015; 38:570-6. [PMID: 26599270 DOI: 10.1159/000441344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/16/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Human papilloma virus (HPV) infection, p16 expression and hypoxia may play important roles in the carcinogenesis, treatment response and toxicities of head and neck squamous cell carcinoma (HNSCC). The aim of this analysis was to assess whether there is any correlation between pre-radiotherapy (RT) anemia, p16 expression and toxicities and local control for patients undergoing definitive therapy. METHODS 79 HNSCC patients who had undergone radiochemotherapy (RCT) or RT-antibody therapy were retrospectively analyzed. p16 (INK4A) expression was detected by immunohistochemical analysis. Factors predisposing for acute side effects were examined by uni- and multivariate analysis. RESULTS p16 overexpression was detected in 32 cases. Pretreatment anemia was present in one third of patients. Only 5% of patients were characterized by both pre-RT anemia and p16 overexpression. p16 expression was significantly associated with acute grade 3 toxicity. 47% of p16-positive patients developed grade ≥ 3 radiodermatitis compared to 26% of p16-negative patients (p = 0.04). A reduced risk of severe skin toxicities was noted for patients with hypoxic blood values before RT. p16 expression was significantly correlated with local control (p = 0.002). CONCLUSIONS p16 expression is associated with better response to definitive combined treatment (RCT, RT + cetuximab), but also significantly related to acute high-grade toxicity.
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Abstract
Oral mucositis induced by conventional cytotoxic cancer therapies is a common and significant clinical problem in oncology. Mucositis symptoms, which include severe pain, may lead to dose reductions and unplanned interruptions of chemotherapy and/or radiotherapy, and often affect patients' quality of life. In addition, ulcerative mucositis represents a risk factor for local or systemic infectious complications that may be life-threatening in immunosuppressed patients. The development of biologically based targeted cancer therapies, which aim to block the growth, spread, and survival of tumors by interfering with specific molecular targets, may have reduced mucosal injury, but did not eliminate it. This article will review the epidemiology, pathobiology, and management of oral mucositis associated with conventional cytotoxic therapies for malignant diseases and will briefly summarize emerging information on oral mucosal injury associated with targeted therapies. Considerations for future research aimed at the development of more efficient and effective supportive care approaches will be presented, with emphasis on the contribution of dental researchers and clinicians in these efforts.
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Bonomi M, Batt K. Supportive Management of Mucositis and Metabolic Derangements in Head and Neck Cancer Patients. Cancers (Basel) 2015; 7:1743-57. [PMID: 26404378 PMCID: PMC4586795 DOI: 10.3390/cancers7030862] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 12/17/2022] Open
Abstract
Oral mucositis (OM) is among the most undesirable, painful, and expensive toxicities of cytotoxic cancer therapy, and is disheartening for patients and frustrating for caregivers. Accurate assessment of the incidence of OM has been elusive, but accumulating data suggests that reported OM frequency is significantly less than its actual occurrence. It has been suggested that over 90% of head and neck cancer (HNC) patients receiving radiotherapy (RT) with concurrent cisplatin experience severe OM with symptoms of extreme pain, mucosal ulceration and consequent limitations in swallowing and achieving adequate nutritional intake. This panoply of symptoms inevitably impacts a patients' quality of life and their willingness to continue treatment. In spite of all the advances made in understanding the pathophysiology of OM, there is still no prophylactic therapy with proven efficacy. Strategies to limit the extent of OM and to manage its symptomatology include basic oral care, supportive medications, nutritional support and targeting aggressive treatments to high-risk patients. This review focuses on OM recognition, preventive measurements, and symptom-management strategies.
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Affiliation(s)
- Marcelo Bonomi
- Section of Hematology and Medical Oncology, Wake Forest School of Medicine, Medical CenterBoulevard, Winston-Salem, NC 27157, USA.
| | - Katharine Batt
- Section of Hematology and Medical Oncology, Wake Forest School of Medicine, Medical CenterBoulevard, Winston-Salem, NC 27157, USA.
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Aghamohamamdi A, Hosseinimehr SJ. Natural Products for Management of Oral Mucositis Induced by Radiotherapy and Chemotherapy. Integr Cancer Ther 2015; 15:60-8. [PMID: 26306626 DOI: 10.1177/1534735415596570] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Oral mucositis is a common side effect of systemic chemotherapy and radiotherapy of head and neck in patients with cancer. Severe oral mucositis is painful and affects oral functions, including intake of food and medications and speech. Prevention of oral mucositis affects the life quality of patients. Recent studies have been focused on natural products to improve or reduce this complication. Many clinical trials have been performed to assess natural products for treatment of mucositis and their results are promising. The authors reviewed the evidence for natural products in the prevention and treatment of oral mucositis induced by radiation therapy and chemotherapy.
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Affiliation(s)
- Azar Aghamohamamdi
- Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran Department of Radiopharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran Department of Midwifery, Sari Branch, Islamic Azad University, Sari, Iran
| | - Seyed Jalal Hosseinimehr
- Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran Department of Radiopharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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Jehmlich N, Stegmaier P, Golatowski C, Salazar MG, Rischke C, Henke M, Völker U. Differences in the whole saliva baseline proteome profile associated with development of oral mucositis in head and neck cancer patients undergoing radiotherapy. J Proteomics 2015; 125:98-103. [PMID: 25997676 DOI: 10.1016/j.jprot.2015.04.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/15/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
Oral mucositis (OM) is a common, painful and often treatment-limiting side effect of radiotherapy (RT) for head and neck cancer (HNC) patients. Unstimulated saliva was collected before the first radiotherapy application in 50 HNC patients. 41 out of 50 patients developed OM (grade III) during radiotherapy, of which 14 patients even displayed an early OM (grade III) at a low radiation dose of 30Gy. Nine patients did not develop OM (grade III). Using an LC-MS/MS approach 5323 tryptic peptides were assigned to 487 distinct proteins (≥2 peptides) in the data set. The levels of 48 proteins differed significantly (p<0.05) between patients developing OM or not. 17 proteins displayed increased levels (≥1.3-fold) and 31 proteins decreased in level in OM, respectively. Furthermore, using partial least square analysis protein patterns could be used to distinguish subjects which did not develop grade III OM even after 70Gy total dose (n=9) and those displaying early OM (grade III at <30Gy total dose, n=14). Using leave one out cross validation 37 of 41 patients (90%) developing OM could be correctly assigned indicating that prognostic proteome signatures may help identify patients that should be specifically monitored to increase overall effectiveness of RT treatment.
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Affiliation(s)
- Nico Jehmlich
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Germany
| | - Petra Stegmaier
- Department of Radiation Oncology, University Medical Center Freiburg, Germany
| | - Claas Golatowski
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Germany
| | - Manuela Gesell Salazar
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Germany
| | - Christian Rischke
- Department of Radiation Oncology, University Medical Center Freiburg, Germany
| | - Michael Henke
- Department of Radiation Oncology, University Medical Center Freiburg, Germany
| | - Uwe Völker
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Germany.
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Jayakrishnan R, Chang K, Ugurluer G, Miller RC, Sio TT. Doxepin for Radiation Therapy-Induced Mucositis Pain in the Treatment of Oral Cancers. Oncol Rev 2015; 9:290. [PMID: 26779314 PMCID: PMC4698596 DOI: 10.4081/oncol.2015.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022] Open
Abstract
Radiotherapy (RT), an integral part of the oncologic treatment for patients with head and neck cancer, can cause adverse side effects such as oral mucositis (OM). Pain from OM can impact a patient’s quality of life and interrupt RT treatment schedules, which decreases the probability for achieving cancer cure. Conventionally, RT-induced OM pain is treated with analgesics and/or mouthwash rinses. Doxepin, a traditional tricyclic antidepressant with analgesic and anesthetic properties when applied topically to the mucosa, has been shown to lower OM pain in multiple single-arm trials (Epstein et al.) and more recently, in a placebo-controlled crossover study (Leenstra and Miller et al.). Currently, a placebo-controlled study (Sio and Miller et al.) using doxepin for esophagitis pain caused by RT to the thorax is underway. Doxepin will also be further compared with magic mouthwash and a placebo solution in a three-arm trial (Miller and Sio et al.) with head and neck cancer patients with OM pain caused by RT. Doxepin may represent a new standard for treating RT-induced OM pain in the future.
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Affiliation(s)
| | - Kenneth Chang
- Department of Radiation Oncology, Mayo Clinic , Rochester, MN, USA
| | - Gamze Ugurluer
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA; Department of Radiation Oncology, Acibadem Adana Hospital, Acibadem University, Adana, Turkey
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic , Jacksonville, FL, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA; Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
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Molecular signatures in the prevention of radiation damage by the synergistic effect of N-acetyl cysteine and qingre liyan decoction, a traditional chinese medicine, using a 3-dimensional cell culture model of oral mucositis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:425760. [PMID: 25705238 PMCID: PMC4326035 DOI: 10.1155/2015/425760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/24/2014] [Indexed: 02/03/2023]
Abstract
Qingre Liyan decoction (QYD), a Traditional Chinese medicine, and N-acetyl cysteine (NAC) have been used to prevent radiation induced mucositis. This work evaluates the protective mechanisms of QYD, NAC, and their combination (NAC-QYD) at the cellular and transcriptional level. A validated organotypic model of oral mucosal consisting of a three-dimensional (3D) cell tissue-culture of primary human keratinocytes exposed to X-ray irradiation was used. Six hours after the irradiation, the tissues were evaluated by hematoxylin and eosin (H and E) and a TUNEL assay to assess histopathology and apoptosis, respectively. Total RNA was extracted and used for microarray gene expression profiling. The tissue-cultures treated with NAC-QYD preserved their integrity and showed no apoptosis. Microarray results revealed that the NAC-QYD caused the upregulation of genes encoding metallothioneins, HMOX1, and other components of the Nrf2 pathway, which protects against oxidative stress. DNA repair genes (XCP, GADD45G, RAD9, and XRCC1), protective genes (EGFR and PPARD), and genes of the NFκB pathway were upregulated. Finally, tissue-cultures treated prophylactically with NAC-QYD showed significant downregulation of apoptosis, cytokines and chemokines genes, and constrained damage-associated molecular patterns (DAMPs). NAC-QYD treatment involves the protective effect of Nrf2, NFκB, and DNA repair factors.
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45
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The effect of royal jelly on oral mucositis in patients undergoing radiotherapy and chemotherapy. Holist Nurs Pract 2015; 28:242-6. [PMID: 24919094 DOI: 10.1097/hnp.0000000000000033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was conducted to evaluate the effect of royal jelly on oral mucositis in patients undergoing radiotherapy and chemotherapy. The study population consisted of 103 patients undergoing radiotherapy and chemotherapy. Oral mucositis was graded according to the World Health Organization criteria, and patients were divided into 2 groups. All patients received mouthwash therapy with benzydamine hydrochloride and nystatin rinses. In addition, patients in the experimental group received royal jelly. The mean resolution time of oral mucositis in the royal jelly group was significantly shorter than that of the control group. As a result, the study results demonstrate that royal jelly administrated by a certain procedure improved the signs and symptoms of oral mucositis and markedly shortened its healing time.
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Sheibani KM, Mafi AR, Moghaddam S, Taslimi F, Amiran A, Ameri A. Efficacy of benzydamine oral rinse in prevention and management of radiation-induced oral mucositis: A double-blind placebo-controlled randomized clinical trial. Asia Pac J Clin Oncol 2014; 11:22-7. [DOI: 10.1111/ajco.12288] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Khosro M Sheibani
- Imam Hossein Hospital; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Ahmad R Mafi
- Imam Hossein Hospital; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Shiva Moghaddam
- Imam Hossein Hospital; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Farnaz Taslimi
- Imam Hossein Hospital; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Ahmadreza Amiran
- Imam Hossein Hospital; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Ahmad Ameri
- Imam Hossein Hospital; Shahid Beheshti University of Medical Sciences; Tehran Iran
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8-prenylnaringenin and tamoxifen inhibit the shedding of irradiated epithelial cells and increase the latency period of radiation-induced oral mucositis. Strahlenther Onkol 2014; 191:429-36. [DOI: 10.1007/s00066-014-0782-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
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48
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Gruber S, Schmidt M, Bozsaky E, Wolfram K, Haagen J, Habelt B, Puttrich M, Dörr W. Modulation of radiation-induced oral mucositis by pentoxifylline: Preclinical studies. Strahlenther Onkol 2014; 191:242-7. [DOI: 10.1007/s00066-014-0775-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 02/07/2023]
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Tsujimoto T, Yamamoto Y, Wasa M, Takenaka Y, Nakahara S, Takagi T, Tsugane M, Hayashi N, Maeda K, Inohara H, Uejima E, Ito T. L-glutamine decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: a double-blind, randomized, placebo-controlled trial. Oncol Rep 2014; 33:33-9. [PMID: 25351453 PMCID: PMC4254677 DOI: 10.3892/or.2014.3564] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/06/2014] [Indexed: 11/09/2022] Open
Abstract
The incidence of severe mucositis in the oral cavity, pharynx and larynx is high among patients with head and neck cancer (HNC) receiving chemoradiotherapy (CRT), resulting in significant pain and impairment of quality of life. The present study investigated whether L-glutamine (glutamine) decreases the severity of mucositis in the oral cavity, pharynx and larynx induced by CRT. This double-blind, randomized, placebo-controlled trial included 40 untreated patients with squamous cell carcinoma of the nasopharynx, oropharynx, hypopharynx or larynx. Patients received 66 or 70 Gy of total radiation at the rate of 2 Gy/fraction daily and 5 fractions/week. Cisplatin (20 mg/m2) and docetaxel (10 mg/m2) were intravenously co-administered once a week for 6 weeks. Patients were randomized to orally receive either glutamine (group G) or placebo (group P) at a dose of 10 g 3 times a day throughout the CRT course. Mucositis was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. The primary end point was mucositis severity. Mucositis developed in all patients. A maximal mucositis grade of G4 was observed in 0 and 25% group G and P patients, respectively, while that of G2 was observed in 10 and 0% group G and P patients, respectively (p=0.023). Glutamine significantly decreased the maximal mucositis grade (group G, 2.9±0.3; group P, 3.3±0.4; p=0.005) and pain score at weeks 4, 5 and 6. Glutamine significantly decreased mucositis severity in the oral cavity, pharynx and larynx induced by CRT in patients with HNC.
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Affiliation(s)
- Takae Tsujimoto
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshifumi Yamamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masafumi Wasa
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Susumu Nakahara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tastuya Takagi
- Department of Pharmainformatics and Pharmacometrics, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Osaka, Japan
| | - Mamiko Tsugane
- Department of Clinical Pharmacy Research and Education, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Osaka, Japan
| | - Noriyuki Hayashi
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuhisa Maeda
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Etsuko Uejima
- Department of Clinical Pharmacy Research and Education, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Osaka, Japan
| | - Toshinori Ito
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Kalogirou EM, Tosios KI, Piperi EP, Sklavounou A. mTOR inhibitor-associated stomatitis (mIAS) in three patients with cancer treated with everolimus. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:e13-9. [PMID: 25442249 DOI: 10.1016/j.oooo.2014.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/10/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Abstract
Mammalian targets of rapamycin inhibitors (mTOR inhibitors, mTORI) are indicated for the management of several cancer types, including hormone receptor--positive or HER2-negative breast cancer, advanced renal cell carcinoma, advanced neuroendocrine tumors of pancreatic origin, and tuberous sclerosis complex-related tumors. Among the most common adverse events of mTORI medication are discrete, large, solitary or multiple, superficial ulcers, almost exclusively situated on nonkeratinized oral mucosa, described as mTORI-associated stomatitis (mIAS). We describe the clinical presentation, course, and management of mIAS in three patients receiving the mTORI everolimus (Afinitor, Novartis, East Hanover, NJ). In two patients, mIAS manifested 9 and 30 days after first using everolimus, respectively, whereas in the third patient, it recurred 3 months after re-introduction of everolimus. Oral rinses with a "magic mouthwash" solution (dexamethasone oral drops solution 2 mg/mL × 10 mL, lidocaine gel 2% × 30 g, doxycycline suspension 50 mg/5 mL × 60 mL, and sucralfate oral suspension 1000 mg/5 mL × 150 mL, dissolved in sodium chloride 0.9% × 2000 mL) four times daily proved helpful in alleviating the symptoms, and the ulcers healed in 4 to 15 days. No side effects were recorded, and dose reduction or discontinuation of everolimus was not necessitated in two cases.
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Affiliation(s)
- Eleni-Marina Kalogirou
- Postgraduate Student, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- Assistant Professor, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece.
| | - Evangelia P Piperi
- Lecturer, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- Professor, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece
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