A prospective study of salivary gland function in patients undergoing radiotherapy for squamous cell carcinoma of the oropharynx

Radiation-associated changes in saliva composition of head and neck cancer patients: A systematic review

Xerostomia is a common radiation-associated toxicity in patients with head and neck cancer. Although several studies examined the decrease in saliva production due to radiotherapy (RT) and investigated the factors associated with this side effect, little is known about the change in radiation-associated saliva composition. This systematic review is the first to summarize existing data and give an overview of the change in pH/buffer capacity, electrolytes, proteins, enzymes, and mucins due to radiation to the salivary glands. Literature search was performed in PubMed and Embase with 47 articles finally eligible for the review, analyzing the saliva composition at several time points before, during and/or after RT, or comparing findings in irradiated patients to a healthy control group. Overall, RT leads to a substantial decrease in salivary pH and buffer capacity. For sodium, chloride and calcium ion, as well as amylase, an increased concentration or activity during RT was reported in most of the studies, followed by a subsequent decrease either already during RT or after the end of treatment. Different trends have been described for the total protein concentration during and after RT. Lactoferrin, however, increased considerably, especially in the first phase of RT. Mucin 5B (MUC5B) concentrations showed a slight increase during RT and concentrations around baseline values again six months post-radiotherapy.

Oral Sequelae after Head and Neck Radiotherapy: RCT Comparing 3D-Printed Tissue Retraction Devices with Conventional Dental Splints

OBJECTIVES

To evaluate oral sequelae after head and neck radiotherapy (RT) when using two different types of intraoral appliances. Thermoplastic dental splints (active control) protect against backscattered radiation from dental structures. Semi-individualized, 3D-printed tissue retraction devices (TRDs, study group) additionally spare healthy tissue from irradiation.

MATERIALS AND METHODS

A total of 29 patients with head and neck cancer were enrolled in a randomized controlled pilot trial and allocated to receive TRDs (n = 15) or conventional splints (n = 14). Saliva quality and quantity (Saliva-Check, GC), taste perception (Taste strips, Burghart-Messtechnik), and oral disability (JFLS-8, OHIP-14, maximum mouth opening) were recorded before and 3 months after RT start. Radiotherapy target volume, modality, total dose, fractionation, and imaging guidance were case-dependent. To evaluate intra-group developments between baseline and follow-up, nonparametric Wilcoxon tests were performed. Mann-Whitney-U tests were applied for inter-group comparisons.

RESULTS

At follow-up, taste perception was unimpaired (median difference in the total score; TRDs: 0, control: 0). No significant changes were found regarding oral disability. Saliva quantity (stimulated flow) was significantly reduced with conventional splints (median -4 mL, p = 0.016), while it decreased insignificantly with TRDs (median -2 mL, p = 0.07). Follow-up was attended by 9/15 study group participants (control 13/14). Inter-group comparisons showed no significant differences but a tendency towards a better outcome for disability and saliva quality in the intervention group.

CONCLUSION

Due to the small cohort size and the heterogeneity of the sample, the results must be interpreted with reservation. Further research must confirm the positive trends of TRD application. Negative side-effects of TRD application seem improbable.

Evaluation of halitosis parameters in patients undergoing head and neck radiotherapy

OBJECTIVES

To assess halitosis parameters using OralChromaTM and the correlation with salivary flow, oral hygiene index, radiation dose, and tongue-coating index among irradiated head-and-neck cancer patients compared to patients without cancer.

MATERIALS AND METHODS

This cross-sectional study enrolled irradiated and non-irradiated patients divided into two groups. Hydrogen sulphide, methyl mercaptan, and dimethy sulphide (DMS) levels were measured using a gas chromatograph, and sialometry was performed. The tongue-coating index and simplified oral hygiene index were also assessed.

RESULTS

Thirty-eight patients were allocated to each group. Volatile sulphur compound levels were above the thresholds in both groups. Non-irradiated individuals showed higher levels of hydrogen sulphide and dimethyl sulphide. Patients with asialia had an inexpressive tongue-coating index and increased dimethyl sulphide levels. A decrease in salivary flow rate was followed by a significant increase in volatile sulphur compound levels. Higher doses of radiation to the submandibular salivary glands were associated with higher concentrations of sulphide and methyl mercaptan.

CONCLUSIONS

Head and neck radiotherapy may be important in the development of halitosis. Irradiated patients with asialia presented insignificant lingual biofilm. Consequently, lower levels of volatile sulphur compounds were detected in this group. Asialia, a severe radiation-induced hyposalivation, impacted the levels of DMS (extraoral origin).

Assessment of hyperbaric oxygenation treatment response in parotid glands by T 2 mapping following radiotherapy for head and neck tumours

Background

The study was designed to evaluate the influence of hyperbaric oxygenation therapy (HBOT) on the parotid gland in patients following radiotherapy for head and neck tumours.

Patients and methods

HBOT response was monitored by 3T magnetic resonance imaging (MRI) using T₂ mapping and subsequent measurement of mean T₂ and T₂ variability as well as by salivary tests (salivary flow, buffer capacity, and pH). Eighteen patients previously treated with irradiation doses between 50 and 80 Gy as well as 18 healthy gender and age matched controls were enrolled. MRI was performed prior to HBOT (40.2 ± 20 months after radiotherapy) and after 20 daily HBOT at 2.5 ATA (absolute atmosphere). Each HBOT consisted of breathing 100% oxygen for 90 minutes.

Results

Significant differences in mean T₂ prior to HBOT were observed between the ipsilateral irradiated (121 ± 20 ms), contralateral parotids (107 ± 21) and control group (96 ± 12 ms). A positive correlation in patients between T₂ variability and irradiation dose was detected in contralateral parotids before HBOT (R = 0.489, p = 0.0287). In addition, negative correlations were observed between mean T₂ in the ipsilateral as well as the contralateral gland and salivary flow before and after HBOT. Negative correlations between mean T₂, T₂ variability and pH of unstimulated saliva were also observed in the sides of parotid before and after HBOT.

Conclusions

The study confirmed that T₂ mapping had a potential for monitoring the differences between irradiated and normal parotid glands. It could also be useful in the assessment of the glandular tissue response to HBOT.

Identifying Patient-Reported Outcome Measures (PROMs) for Routine Surveillance of Physical and Emotional Symptoms in Head and Neck Cancer Populations: A Systematic Review

The aims of this review were to identify symptoms experienced by head and neck cancer (HNC) patients and their prevalence, as well as to compare symptom coverage identified in HNC specific patient-reported outcome measures (PROMs). Searches of Ovid Medline, Embase, PsychInfo, and CINAHL were conducted to identify studies. The search revealed 4569 unique articles and identified 115 eligible studies. The prevalence of reported symptoms was highly variable among included studies. Variability in sample size, timing of the assessments, and the use of different measures was noted across studies. Content mapping of commonly used PROMs showed variability and poor capture of prevalent symptoms, even though validation studies confirmed satisfactory reliability and validity. This suggests limitations of some of the tools in providing an accurate and comprehensive picture of the patient's symptoms and problems.

Head and neck cancer therapy-related oral manifestation management in the COVID-19 pandemic: a critical review

With the onset of the new coronavirus disease (COVID-19) pandemic, the dental treatment of patients at risk of infection has become quite challenging. In view of this, patients with head and neck cancer may present with oral complications due to anticancer therapy, making dental assistance necessary. Thus, the objective of the study was to review the literature and critically discuss important concerns about the treatment of patients with head and neck cancer during the COVID-19 pandemic. Because dental professionals are in close contact with the main viral transmission routes, this study presents recommendations for management and protection during clinical dental care. The main characteristics and transmission routes of COVID-19 are also discussed. Dental professionals should control pain and the side effects of antineoplastic treatment and use preventive measures for infection control. During this pandemic, patients with head and neck cancer should not undergo elective procedures, even if they do not have symptoms or a history of COVID-19; therefore, in asymptomatic or painless cases, only preventive actions are recommended. In symptomatic or painful cases, precautions for safe interventional treatments must be implemented by following the hygiene measures recommended by health agencies and using personal protective equipment. During health crises, new protocols emerge for cancer treatment, and professionals must act with greater attention toward biosafety and updated knowledge. It is important to offer adequate individualized treatment based on the recommendations of preventative and interventional treatments so that patients can face this difficult period with optimized quality of life.

Potential Therapeutic Effects of Gut Hormones, Ghrelin and Obestatin in Oral Mucositis

Chemotherapy and/or head and neck radiotherapy are frequently associated with oral mucositis. Oral pain, odynophagia and dysphagia, opioid use, weight loss, dehydration, systemic infection, hospitalization and introduction of a feeding tube should be mentioned as the main determinated effect of oral mucositis. Oral mucositis leads to a decreased quality of life and an increase in treatment costs. Moreover, oral mucositis is a life-threatening disease. In addition to its own direct life-threatening consequences, it can also lead to a reduced survival due to the discontinuation or dose reduction of anti-neoplasm therapy. There are numerous strategies for the prevention or treatment of oral mucositis; however, their effectiveness is limited and does not correspond to expectations. This review is focused on the ghrelin and obestatin as potentially useful candidates for the prevention and treatment of chemo- or/and radiotherapy-induced oral mucositis.

Submandibular Gland Invasion by Oral Cavity Cancers: A Systematic Review

OBJECTIVE

The submandibular gland (SMG) is typically included in level I neck dissection specimens despite limited data demonstrating SMG invasion. The main objective of this article is to determine the rate and pathways of SMG invasion by squamous cell carcinoma of the oral cavity and oropharynx.

DATA SOURCES

A systematic review of relevant studies was performed, evaluating articles identified via the PubMed, Cochrane, and Medline databases.

REVIEW METHODS

Descriptive features of primary tumors, primary treatment modalities, the rate and pathway of SMG invasion, and survival outcomes, if present, were reported following the PRISMA guidelines.

RESULTS

The initial literature search yielded 273 articles, of which 17 met inclusion criteria. A total of 2306 patients with 2792 SMG resections were analyzed. Fifty-eight resections (2.0%) were revealed to have tumor involvement. Among patients with SMG tumor involvement, the most common invasion pathway was direct SMG invasion by primary tumor (43 of 58, 74.1%). The second-most common mode of SMG invasion was from involved adjacent lymph nodes (10 of 58, 17.2%). Only 3 SMG resections out of 2792 (0.1%) had isolated metastatic parenchyma without evidence of direct tumor invasion or invasion by involved lymph nodes.

CONCLUSION

Given this rarity of SMG involvement, preservation of SMG might be feasible in selected patient population. However, additional studies need to examine the functionality of preserved SMGs among patients who receive postoperative adjuvant radiation therapy.

Salivary miR-93 and miR-200a as post-radiotherapy biomarkers in head and neck squamous cell carcinoma

Head and neck squamous cell carcinoma is the 6th most malignant tumor entity worldwide and has exhibited a 5-year mortality of approximately 50% for the last fifty years. For the therapy monitoring and successful management of this tumor entity new and easily accessible biomarkers are greatly needed. The aim of the study was to determine whether and to what extent microRNAs, a class of small regulatory RNAs, are detectable in saliva post-radiation therapy. The expression and feasibility as therapy monitoring marker of the microRNAs were analyzed by RT-qPCR in 83 saliva samples from 33 patients collected at several time points pre-, during and post-radiotherapy treatment. Ten head and neck squamous cell carcinoma- or radiation-associated microRNAs (miR-93, miR-125a, miR-142-3p, miR-200a, miR-203, miR-213, let-7a, let-7b, let-7g and let-7i) were analyzed. All were detectable to a different extent in the saliva of the patients. miR-93 and miR-200a were significantly higher expressed 12 months post-radiotherapy than at baseline (p=0.047 and p=0.036). These results point towards miR-93 and miR-200a as biomarkers for the treatment monitoring post-radiation of head and neck squamous cell carcinoma.

Orthodontic Therapy for Paediatric Cancer Survivors: A Review

The paper aims at reviewing the possibilities of orthodontic therapy for paediatric cancer survivors. It is important to understand the fundamental disease, it's treatment protocols, effects on growing skeleton, dental development, oral cavity and oral mucosa, dental caries, bone, orthodontic tooth movement.

Head and neck intensity modulated radiation therapy leads to an increase of opportunistic oral pathogens

OBJECTIVES

The introduction of intensity modulated radiation therapy (IMRT) has led to new possibilities in the treatment of head and neck cancer (HNC). Limited information is available on how this more advanced radiation technique affects the oral microflora. In a prospective study we assessed the effects of various advanced treatments for HNC on the oral microflora, as well as the effects of elimination of oral foci of infection.

MATERIALS AND METHODS

All consecutive dentate patients >18years, diagnosed with a primary oral or oropharynx carcinoma and seen for a pre-treatment dental screening (May 2011-May 2013) were included. Patients were grouped by oncologic treatment: surgery (SURG), IMRT (IMRT) or IMRT+chemotherapy (CHIMRT). Dental screening data, demographic data, subgingival biofilm samples, oral lavages and whole saliva samples were obtained to microbiologically analyze the effects of cancer treatments (1-year follow-up).

RESULTS

This study included 82 patients (29 SURG, 26 IMRT and 27 CHIMRT). The trends in changes in prevalence and proportions of microorganisms were comparable in the IMRT and CHIMRT group. However, relative to the SURG group, increased prevalence of enteric rods, staphylococci and Candida species was observed in the IMRT and CHIMRT groups. In these groups, elimination of oral foci decreased the frequency of detection of pathogens such as Porphyromonas gingivalis, Tannerella forsythia and Streptococcus mutans.

CONCLUSION

Different treatments in HNC patients result in different changes in the oral microflora. Opportunistic pathogens such as staphylococci, enteric rods and Candida sp. tend to increase in prevalence after IMRT with or without chemotherapy, but not after surgical intervention.

Effect of electromagnetic radiations from mobile phone base stations on general health and salivary function

Objective:

Cell phones use electromagnetic, nonionizing radiations in the microwave range, which some believe may be harmful to human health. The present study aimed to determine the effect of electromagnetic radiations (EMRs) on unstimulated/stimulated salivary flow rate and other health-related problems between the general populations residing in proximity to and far away from mobile phone base stations.

Materials and Methods:

A total of four mobile base stations were randomly selected from four zones of Jaipur, Rajasthan, India. Twenty individuals who were residing in proximity to the selected mobile phone towers were taken as the case group and the other 20 individuals (control group) who were living nearly 1 km away in the periphery were selected for salivary analysis. Questions related to sleep disturbances were measured using Pittsburgh Sleep Quality Index (PSQI) and other health problems were included in the questionnaire. Chi-square test was used for statistical analysis.

Results:

It was unveiled that a majority of the subjects who were residing near the mobile base station complained of sleep disturbances, headache, dizziness, irritability, concentration difficulties, and hypertension. A majority of the study subjects had significantly lesser stimulated salivary secretion (P < 0.01) as compared to the control subjects.

Conclusions:

The effects of prolonged exposure to EMRs from mobile phone base stations on the health and well-being of the general population cannot be ruled out. Further studies are warranted to evaluate the effect of electromagnetic fields (EMFs) on general health and more specifically on oral health.

The Effects of Ionizing Radiation on the Oral Cavity

AIM

The aim of this study is to present a literature review on the effects of the ionizing radiation from radiotherapy treatment on dental tissues.

BACKGROUND

Among the effects of increasing global life expectancy and longevity of the teeth in the oral cavity, increasing rates of neoplastic diseases have been observed. One of the important treatment modalities for head and neck neoplastic diseases is radiotherapy, which uses ionizing radiation as the main mechanism of action. Therefore, it is essential for dentists to be aware of the changes in oral and dental tissues caused by ionizing radiation, and to develop treatment and prevention strategies.

RESULTS

In general, there is still controversy about the effects of ionizing radiation on dental structures. However, qualitative and quantitative changes in saliva and oral microbiota, presence of oral mucositis and radiation-related caries are expected, as they represent the well-known side effects of treatment with ionizing radiation. Points that still remain unclear are the effects of radiotherapy on enamel and dentin, and on their mechanisms of bonding to contemporary adhesive materials.

CONCLUSION

Ionizing radiation has shown important interaction with organic tissues, since more deleterious effects have been shown on the oral mucosa, salivary glands and dentin, than on enamel.

CLINICAL SIGNIFICANCE

With the increasing number of patients with cancer seeking dental treatment before and after head and neck radiotherapy, it is important for dentists to be aware of the effects of ionizing radiation on the oral cavity.

Oral adverse effects of head and neck radiotherapy: literature review and suggestion of a clinical oral care guideline for irradiated patients

Radiotherapy, alone or associated with surgery or chemotherapy, produces a significant increase in cure rates for many malignancies of the head and neck region. However, high doses of radiation in large areas, including the oral mucosa, may result in several undesired reactions that manifest during or after the completion of therapy. The multidisciplinary management is the best alternative to minimize or even prevent such reactions, and the dentist has a fundamental role in this context. This paper reviews the literature related to the main oral sequelae from head and neck radiotherapy and establishes clinical oral management protocol for these irradiated patients.

Recovery of salivary epidermal growth factor in parotid saliva following parotid sparing radiation therapy: a proof-of-principle study

BACKGROUND

Although radiation therapy (RT) causes permanent xerostomia, parotid-sparing radiation therapy (PSRT) ensures recovery of saliva quantity over time. Salivary epidermal growth factor (EGF) is produced primarily by parotid glands.

OBJECTIVES

The aim of this study was to determine whether salivary EGF can be detected in parotid saliva after PSRT and whether protein secretion is time dependent.

STUDY DESIGN

Salivary EGF concentration (pg/mL) was determined by enzyme-linked immunosorbent assay in stimulated parotid saliva before RT and at 3, 6, and 12 months after RT from 22 patients with head and neck cancer treated with PSRT.

RESULTS

Saliva samples were from 17 men and 5 women (age ranges 23-70 years and 46-71 years, respectively). At 6 months after RT, EGF concentration was 407 pg/mL lower than at baseline (P = .045). Twelve months after PSRT, parotid glands produce substantial amounts of EGF and other proteins, eventually approximating pre-RT levels, with recovery of salivary function.

CONCLUSIONS

This proof-of-principle study shows that even proteins in picogram quantities, such as EGF, can be detected in saliva after PSRT.

The effect of hyperbaric oxygenation on postradiation xerostomia and saliva in patients with head and neck tumours

The study was designed to evaluate the influence of hyperbaric oxygenation (HBO) therapy on salivary gland function and the growth of salivary Streptococcus mutans, Lactobacillus and Candida albicans in patients with head and neck tumours who had undergone radiation therapy. Sixteen patients were included, with radiation doses from 58 to 70 Gy. The first examination was performed at baseline before the first HBO therapy (33.7 ± 9 months after radiation therapy), and the second after 20 daily HBO therapies in a hyperbaric chamber at 2.5 ATA (absolute atmospheres), where patients breathed 100% oxygen for 90 min each day. Measurements of salivary flow, buffer capacity, saliva pH and colony density of S. mutans, Lactobacillus and C. albicans in stimulated saliva were conducted, and xerostomia grade was assessed. Salivary flow increased from 0.20 ± 0.1 to 0.39 ± 0.2 ml/min at the end of HBO therapy (p < 0.001). Salivary pH also increased from 6.0 ± 0.2 to 6.5 ± 0.1 (p < 0.05). The colony density decreased from the time at baseline to the end of HBO therapy for S. mutans (p < 0.001), Lactobacillus (p < 0.05) and the fungus C. albicans (p < 0.05). The xerostomia grade decreased from 2.63 ± 0.2 to 1.94 ± 0.2 after HBO (p < 0.001). There was no significant change in buffer capacity. The increased salivary secretion rate and salivary pH, and decreased S. mutans and Lactobacillus colony density that were observed after HBO therapy may reduce caries progression in those patients.

Osteoradionecrosis of the jaws--a current overview--Part 2: dental management and therapeutic options for treatment

PURPOSE

The aim of this paper is to explore the current theories about pretreatment assessment and dental management of patients receiving head and neck radiotherapy, and the therapeutic options to treat osteoradionecrosis of the jaws, based on the literature review.

DISCUSSION

Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. Osteoradionecrosis is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal. Osteoradionecrosis either stabilizes or gradually worsens and is notoriously difficult to manage. Because most cases occur in patients who were dentulous in the mandible at tumor onset, proper dental management is the single most important factor in prevention.

CONCLUSIONS

Complete dental clearance before treatment is no longer necessary. Controversy exists regarding the management of osteoradionecrosis of the maxillofacial skeleton because of the variability of this condition. The treatment of osteoradionecrosis has included local wound care, antibiotic therapy, surgical procedures, and the administration of hyperbaric oxygenation. Recently, new methods of treatment were introduced, according to the new theory about its pathophysiology.

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life

PURPOSE

This systematic review aimed to assess the literature for prevalence, severity, and impact on quality of life of salivary gland hypofunction and xerostomia induced by cancer therapies.

METHODS

The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. Two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results and conclusions for each article.

RESULTS

The inclusion criteria were met by 184 articles covering salivary gland hypofunction and xerostomia induced by conventional, 3D conformal radiotherapy or intensity-modulated radiotherapy in head and neck cancer patients, cancer chemotherapy, total body irradiation/hematopoietic stem cell transplantation, radioactive iodine treatment, and immunotherapy.

CONCLUSIONS

Salivary gland hypofunction and xerostomia are induced by radiotherapy in the head and neck region depending on the cumulative radiation dose to the gland tissue. Treatment focus should be on optimized/new approaches to further reduce the dose to the parotids, and particularly submandibular and minor salivary glands, as these glands are major contributors to moistening of oral tissues. Other cancer treatments also induce salivary gland hypofunction, although to a lesser severity, and in the case of chemotherapy and immunotherapy, the adverse effect is temporary. Fields of sparse literature included pediatric cancer populations, cancer chemotherapy, radioactive iodine treatment, total body irradiation/hematopoietic stem cell transplantation, and immunotherapy.

Evaluation of Radiation-induced Class V Dental Caries in Patients with Head and Neck Cancers Undergoing Radiotherapy

Background and aims

Salivary glands are very susceptible to radiation and any disturbances in their function are detrimental to the hard tissues in the oral cavity. The aim of this study was to evaluate posterior class V dental caries in patients with head and neck cancers undergoing radiotherapy.

Materials and methods

In this study, twenty seven patients undergoing conventional radiotherapy were included. Class V dental caries of posterior teeth in these patients were evaluated in three intervals: before treatment, 3 weeks after the initiation of the treatment, and at the end of the treatment. Differences of mean caries activity between intervals were evaluated using paired sample t-test.

Results

There were no class V decays prior to radiotherapy. Mean percentage of class V caries three weeks after radiotherapy and at the end of radiotherapy were 28.42% ± 14.41 and 67.05% ± 19.02, respectively. There were statistically signifi-cant differences in mean values among three stages (P = 0.00025).

Conclusion

The results of the present study re-vealed that radiotherapy in patients with head and neck cancers causes class V dental caries on posteri-or teeth.

Evaluation of Radiation-induced Xerostomia in Patients with Nasopharyngeal Carcinomas

BACKGROUND AND AIMS

Salivary glands are extremely susceptible to radiation injuries. The aim of this study was to evaluate radiation-induced xerostomia in patients with nasopharyngeal carcinomas, referring to Tabriz Imam Khomeini Hospital in 2005-2006.

MATERIALS AND METHODS

Thirty patients with nasopharyngeal carcinomas, who received conventional radiotherapy, were included in the present study. The patients' unstimulated saliva samples were collected at three intervals, i.e. before treatment, 3 weeks after the initiation of treatment and at the end of treatment by spitting, and measured with a graduated pipette.

RESULTS

The differences in the mean values of the patients' salivary flow rates at three afore-mentioned intervals were statistically significant (p<0.001). Two-by-two comparison of the mean values of salivary flow rates of all the patients and of males and females, carried out separately, demonstrated statistically significant differences (p<0.0025). However, there were no statistically significant differences between males and females before treatment (p = 0.723), 3 weeks after the initiation of treatment (p = 0.724) and at the end of treatment (p = 0.595). There were no statistically significant relationships between age and a decrease in salivary flow rate in the total sample (p = 0.76, r = -0.057), in males (p = 0.96, r = 0.011) and in females (p = 0.539, r = -0.208).

CONCLUSION

Conventional radiotherapy results in severe xerostomia in 3 weeks in patients with nasopharyngeal carcinomas. Age and sex do not influence radiotherapy-induced xerostomia.

Evaluation of some oral postradiotherapy sequelae in patients treated for head and neck tumors

The aim of this study was to evaluate the oral sequelae of radiotherapy in patients treated between 1999 and 2003 for head and neck tumors. One-hundred patients (24 women, 76 men) ranging in age from 30 to 83 years (mean 59.2 years) were examined. Time since radiotherapy ranged from 1 to 72 months (mean 28 months). The total mean radiation dose received by the patients was 5,955 cGy. The evaluation protocol included anamnesis, intraoral and extraoral examination, measurement of stimulated salivary flow and salivary pH. Symptoms reported by the patients included dry mouth (68%), dysphagia (38%), and dysgeusia (30%). In 64% of the patients, the mean stimulated salivary flow rate was less than 0.7 ml/min. The mean salivary pH was 6.97 (± 0.714). Stimulated salivary flow increased with increasing postradiotherapy time (p < 0.05). The prevalence of mucositis was associated with higher radiation doses (p < 0.05), and the prevalence of atrophic candidiasis was related to a longer post-treatment period (p < 0.05). Two cases of recurrence of the primary tumor were detected during the study. The main effect of radiotheraphy in the head and neck region was a reduction of the salivary flow rate, even though our study demonstrated that there was a modest late improvement of the salivary flow.

A randomized phase III prospective trial of bethanechol to prevent radiotherapy-induced salivary gland damage in patients with head and neck cancer

The aim of this study was to verify whether the use of bethanechol during radiotherapy (RT) for head and neck cancer (HNC) prevents radiation-induced xerostomia and salivary flow reduction. Patients that would begin RT were randomly allocated into bethanechol (group 1) or artificial saliva (group 2). Whole resting saliva (WRS) and whole stimulated saliva (WSS) were collected from all the patients at the following four stages: baseline, during, immediately after, and at least two months after the end of RT. Xerostomia was assessed by a subjective visual analogue scale (VAS), and by asking patients whether they felt dry mouth. Forty-three patients were randomized into this trial. The use of bethanechol during RT for HNC cancer was associated with significantly higher WRS immediately after RT (p=0.03) in comparison to a similar cohort of patients who had not received bethanechol.

Complicações bucais da radioterapia em cabeça e pescoço

A radioterapia é uma forma terapêutica amplamente utilizada para o tratamento das neoplasias malignas da cabeça e pescoço. Porém, altas doses de radiação em extensos campos que irão incluir a cavidade bucal, maxila, mandíbula e glândulas salivares freqüentemente resultam em diversas reações indesejadas. Dentre as complicações da radioterapia estão a mucosite, candidose, disgeusia, cárie por radiação, osteorradionecrose, necrose do tecido mole e xerostomia. OBJETIVO: O objetivo deste artigo é fazer uma breve revisão das reações adversas que podem ser detectadas durante o tratamento radioterápico em região de cabeça e pescoço. MÉTODO: A literatura pertinente que trata do assunto foi revisada. FORMA DE ESTUDO: Revisão de literatura. RESULTADOS: A radioterapia ainda está associada a diversas reações adversas, que afetam de forma significativa a qualidade de vida dos pacientes. CONCLUSÕES: O tratamento multidisciplinar, incluindo a equipe médica, o cirurgião-dentista, o fonoaudiólogo, o nutricionista e o psicólogo é a melhor alternativa para minimizar ou mesmo prevenir tais complicações.

Oral complications of radiotherapy in the head and neck

Radiotherapy is a treatment modality largely used for head and neck malignancies. However, high doses of radiation in large areas, including the oral cavity, maxilla, mandible and salivary glands may result in several undesired reactions. Mucositis, candidosis, disgeusia, radiation caries, osteoradionecrosis, soft tissue necrosis and xerostomia are some of radiotherapy's complications.

Aim

The aim of this study is to briefly review the side effects that may be seen in the oral cavity during or after radiotherapy treatment in the head and neck region.

Basic method used

Review of relevant literature.

Study design

Literature review.

Results

Radiotherapy is still associated with several side effects, significantly affecting patients’ quality of life.

Conclusions

A multidisciplinary treatment, including physicians, dentists, speech therapits, nutritionists, and psychologists, is the best alternative to minimize, or even prevent such reactions.

Effect of postoperative radiotherapy on the functional result of implants placed during ablative surgery for oral cancer

The purpose of this retrospective study was to evaluate the survival of dental implants placed during ablative surgery in the interforaminal region of the original edentulous mandible in patients with squamous cell carcinoma of the oral cavity in relation to postoperative radiotherapy. Forty-eight patients treated in 1996-2003 with surgery alone or in combination with postoperative radiotherapy were analysed. In all patients, 2 to 4 Brånemark Mk II/III 2-phase implants were placed during tumour resection. A total of 139 implants were placed of which 61 (21 patients) received postoperative radiotherapy: 60-68 Gy as a boost dose on the primary tumour site and 10-68 Gy on the symphyseal area. No difference was found in percentage of functional dentures on implants between the radiated and non-radiated groups. The success rate of osseointegration was 97% in the postoperative irradiated group and 100% in the non-irradiated group. The prosthetic success rate (75%) was lower because in 12 of the 48 patients (34 implants) a functional denture could not be fitted due to tumour recurrence or metastasis (7 patients, 22 implants) or for psychological reasons (4 patients, 12 implants), independent of whether radiotherapy was administered. Postoperative radiotherapy does not affect the osseointegration of dental implants placed during tumour ablation and the ultimate number of functional dentures. Primary implant placement in edentulous mandibles may have advantages over secondary implant placement in patients with oral squamous cell carcinoma.

Lead levels in blood and saliva in a low-income population of Detroit, Michigan

The relationships between blood lead (PbB) and saliva lead (PbSa) concentrations and the determinants of PbB and PbSa status in 970 low-income adults in the city of Detroit, Michigan were explored. Average PbB and PbSa values in the sample population were found to be 2.7+/-0.1 microg/dl and 2.4+/-0.13 microg/l (equivalent to 0.24+/-0.13 microg/dl), respectively, and a weak but statistically significant association was found between the lead levels in the two types of body fluid samples. The average PbB level for men (4.0+/-0.56 microg/dl) was higher than that for women (2.7+/-0.11 microg/dl); other significant predictors of PbB included age, level of education, being employed, income level, the presence of peeling paint on the wall at home and smoking. There was no gender- or age-dependent difference in blood saliva values but statistically significant correlations were found between PbSa and level of education, employment, income level and smoking. Dental caries was severe in this population. Only 0.5% of the participants had no clinical signs of caries, over 80% had cavitated carious lesions (i.e., lesions that had progressed into dentin), and the number of lost teeth and carious lesions averaged 3.4 and 30, respectively. Weak but significant associations were found between PbB as well as PbSa and measures of dental caries in the study population. The positive associations are believed to be a reflection of the fact that the risk factors for dental caries, especially in low-income populations of the US, overlap extensively with those of lead poisoning and may not have a causal significance.

The use of intensity-modulated radiation therapy in the treatment of oropharyngeal carcinoma

PURPOSE OF REVIEW

The management of oropharyngeal cancers continues to evolve. Due to the functional consequences of surgery, organ preservation strategies with radiation combined with chemotherapy have been developed. Newer strategies to diminish the acute and late toxicities and improve the functional outcome of organ preservation strategies are being developed. Intensity-modulated radiation therapy is a relatively new, advanced form of radiation therapy that is being studied in an effort to improve local control rates and minimize the late effects of treatment.

RECENT FINDINGS

Several recent studies have further supported the role for radiation therapy and chemotherapy as part of organ preservation strategies for cancers of the oropharynx. With the intensification of treatment, however, toxicities and functional impairment occur and have not been well documented in the past. Several recent studies report on the toxicities of traditional treatment methods. In addition, data show that intensity-modulated radiation therapy may be superior in terms of limiting toxicity compared with standard radiation therapy techniques. The integration of intensity-modulated radiation therapy with chemotherapeutic and radioprotective agents to further improve the therapeutic window for radiation therapy is being actively pursued.

SUMMARY

This paper reviews recent advances in radiotherapy for oropharynx cancer and the use of intensity-modulated radiation therapy.