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Pereira CH, Martins AFL, Morais MO, de Sousa-Neto SS, da Silva ACG, Arantes DAC, De Oliveira Moreira VHL, Valadares MC, Freitas NMA, Leles CR, Mendonça EF. Oral mucositis management with photobiomodulation, Bidens pilosa L. (Asteraceae) and Curcuma longa L. (Zingiberaceae), the FITOPROT herbal medicine, and its influence on inflammatory cytokine levels: a randomized clinical trial. Support Care Cancer 2024; 32:628. [PMID: 39223301 DOI: 10.1007/s00520-024-08842-3] [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: 08/10/2023] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This randomized clinical trial aimed to compare the effects of a mucoadhesive formula, containing curcuminoids from Curcuma longa L. and glycerinated extract of Bidens pilosa L. (FITOPROT), associated with photobiomodulation (PBM), and of PBM exclusively, on the incidence of oral mucositis (OM)-induced by radiotherapy (RT) in the head and neck region, and the salivary expression of inflammatory cytokines, in patients with head neck cancer. METHODS Patients were randomly assigned into two intervention groups-FITOPROT + PBM (n = 25) or PBM (n = 27). PBM protocol comprised a wavelength of 660 nm, 25 mW, 0.25 J/point, and daily irradiation from the first until the last day of RT. FITOPROT was gargled twice a day. All patients underwent a preventive oral care program throughout the study. OM degree, salivary concentration of nitrite, and inflammatory (IL-1, TNFα, IL-6, IL-8, and IL-12p70), and anti-inflammatory (IL-10) cytokines were assessed at baseline, and at the 7th, 14th, 21st, and 30th RT sessions. RESULTS There were no differences in the OM degree between groups, but the RT dose significantly affected the OM. The RT significantly affected the salivary nitrite, TNFα, IL-1β, and IL-10 concentrations. CONCLUSION FITOPROT associated with PBM showed limited effects on preventing the incidence of severe OM compared to PBM alone. However, FITOPROT + PBM may be associated with nitrite and cytokine balance, which may contribute to the occurrence of fewer cases of severe OM. TRIAL REGISTRATION Brazilian Clinical Trials database (ReBEC; RBR-9vddmr), registered UTN code: U1111-1193-2066, registered in August 8th, 2017.
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Affiliation(s)
- Carlos Henrique Pereira
- Araujo Jorge Cancer Hospital, R. 239, 206 - Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Allisson Filipe Lopes Martins
- Department of Oral Diagnosis, School of Dentistry, Universidade Evangélica de Goiás, Dentistry School, Anápolis, Goiás, CEP 75083-515, Brazil
| | - Marília Oliveira Morais
- Araujo Jorge Cancer Hospital, R. 239, 206 - Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Sebastião Silvério de Sousa-Neto
- Laboratory of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina Com 1ª Avenida, S/N. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Artur Christian Garcia da Silva
- Laboratory of Education and Research in In Vitro Toxicology, Tox In, Faculty of Pharmacy, Universidade Federal de Goiás, Rodovia R2, N. 3.061, Campus Samambaia, Goiânia, Goiás, CEP 74605.170, Brazil
| | - Diego Antonio Costa Arantes
- Laboratory of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina Com 1ª Avenida, S/N. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Victor Hugo Lopes De Oliveira Moreira
- Laboratory of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina Com 1ª Avenida, S/N. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Marize Campos Valadares
- Laboratory of Education and Research in In Vitro Toxicology, Tox In, Faculty of Pharmacy, Universidade Federal de Goiás, Rodovia R2, N. 3.061, Campus Samambaia, Goiânia, Goiás, CEP 74605.170, Brazil
| | - Nilceana Maya Aires Freitas
- Department of Radiotherapy, Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Cláudio Rodrigues Leles
- Department of Prevention and Oral Rehabilitation, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina Com 1ª Avenida, S/N. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Elismauro Francisco Mendonça
- Laboratory of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina Com 1ª Avenida, S/N. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil.
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Mohammed AI, Fedoruk L, Fisher N, Liu AX, Khanna S, Naylor K, Gong Z, Celentano A, Alrashdan MS, Cirillo N. Systemic Anti-Inflammatory Agents in the Prevention of Chemoradiation-Induced Mucositis: A Review of Randomised Controlled Trials. Biomolecules 2024; 14:560. [PMID: 38785967 PMCID: PMC11117894 DOI: 10.3390/biom14050560] [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: 03/13/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
Mucositis is a pathological condition characterised by inflammation and ulceration of the mucous membranes lining the alimentary canal, particularly in the mouth (oral mucositis) and the gastrointestinal tract. It is a common side effect of cancer treatments, including chemotherapy and radiotherapy, and it is sometimes responsible for treatment interruptions. Preventing mucositis throughout the alimentary tract is therefore crucial. However, current interventions mainly target either oral or gastrointestinal side effects. This review aimed to investigate the use of systemically administered anti-inflammatory agents to prevent mucositis in cancer patients undergoing cancer treatment. PubMed, Ovid, Scopus, Web of Science, WHO ICTRP and ClinicalTrials.gov were screened to identify eligible randomised controlled trials (RCTs). The published literature on anti-inflammatory agents provides mixed evidence regarding the degree of efficacy in preventing/reducing the severity of mucositis in most anticancer treatments; however, sample size continued to be a significant limitation, alongside others discussed. Our review yielded a list of several anti-inflammatory agents that exhibit potential mucositis-preventive effects in cancer patients undergoing cancer treatment, which can be used to inform clinical practice.
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Affiliation(s)
- Ali I. Mohammed
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Carlton, VIC 3053, Australia; (A.I.M.); (L.F.); (N.F.); (A.X.L.); (S.K.); (K.N.); (Z.G.); (A.C.)
| | - Lexi Fedoruk
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Carlton, VIC 3053, Australia; (A.I.M.); (L.F.); (N.F.); (A.X.L.); (S.K.); (K.N.); (Z.G.); (A.C.)
| | - Nicholas Fisher
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Carlton, VIC 3053, Australia; (A.I.M.); (L.F.); (N.F.); (A.X.L.); (S.K.); (K.N.); (Z.G.); (A.C.)
| | - Andy Xiaoqian Liu
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Carlton, VIC 3053, Australia; (A.I.M.); (L.F.); (N.F.); (A.X.L.); (S.K.); (K.N.); (Z.G.); (A.C.)
| | - Samar Khanna
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Carlton, VIC 3053, Australia; (A.I.M.); (L.F.); (N.F.); (A.X.L.); (S.K.); (K.N.); (Z.G.); (A.C.)
| | - Kaelan Naylor
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Carlton, VIC 3053, Australia; (A.I.M.); (L.F.); (N.F.); (A.X.L.); (S.K.); (K.N.); (Z.G.); (A.C.)
| | - Ziyi Gong
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Carlton, VIC 3053, Australia; (A.I.M.); (L.F.); (N.F.); (A.X.L.); (S.K.); (K.N.); (Z.G.); (A.C.)
| | - Antonio Celentano
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Carlton, VIC 3053, Australia; (A.I.M.); (L.F.); (N.F.); (A.X.L.); (S.K.); (K.N.); (Z.G.); (A.C.)
| | - Mohammad S. Alrashdan
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Nicola Cirillo
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Carlton, VIC 3053, Australia; (A.I.M.); (L.F.); (N.F.); (A.X.L.); (S.K.); (K.N.); (Z.G.); (A.C.)
- School of Dentistry, University of Jordan, Amman 11942, Jordan
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Martins AFL, Pereira CH, Morais MO, de Sousa-Neto SS, Valadares MC, Freitas NMA, Leles CR, de Mendonça EF. Effects of a mucoadhesive phytomedicine (Curcuma longa L. and Bidens pilosa L.) on radiotherapy-induced oral mucositis and quality of life of patients undergoing head and neck cancer treatment: randomized clinical trial. Support Care Cancer 2023; 31:517. [PMID: 37566179 DOI: 10.1007/s00520-023-07971-5] [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: 12/29/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE To assess the effect of a mucoadhesive herbal medicine containing curcuminoids and a glycerinated extract of Bidens pilosa L. (FITOPROT) in association with photobiomodulation (PBM) therapy and a Preventive Oral Care Program (POCP) compared to PBM and POCP in the treatment of radiotherapy (RT)-induced oral mucositis (ROM) and in the quality of life of these patients. METHODS A double-blind clinical trial was performed with head and neck cancer patients undergoing RT or chemoradiotherapy. Participants were randomized into two groups: Group 1 (n=27): PBM and POCP; and Group 2 (n=25): PBM, POCP and FITOPROT. The PBM protocol was daily irradiation, 660 nm, 25mW, 0.25 J/point from the first until the last day of RT. The FITOPROT was used as mouthwash twice a day. ROM was evaluated based on the scales of the World Health Organization and National Cancer Institute. The quality of life was evaluated using the University of Washington Questionnaire, OHIP-14 and Patient-Reported Oral Mucositis Symptom Scale. The MMAS-8 questionnaire was used to evaluated the adherence to POCP and FITOPROT. Data were collected at baseline, 7th, 14th, 21st, and 30th RT sessions. RESULTS No statistical differences were found between the groups for the ROM evaluation. Both groups experienced worsening of the quality of life during the RT. No statistically significant differences between groups were observed for any of the instruments evaluated. CONCLUSION The results suggest that PBM associated with FITOPROT and POCP control the severity of ROM and stabilize the QoL of patients with head and neck cancer. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC-RBR-9vddmr; UTN code: U1111-1193-2066), registered in August 8th, 2017.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Universidade Evangélica de Goiás, Dentistry School, Av. Universitária, s/n-Cidade Universitária, Goiás, Anápolis, CEP 75083-515, Brazil
| | - Carlos Henrique Pereira
- Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Marília Oliveira Morais
- Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Sebastião Silvério de Sousa-Neto
- Laboratory of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiás, Goiânia, CEP 74605-220, Brazil
| | - Marize Campos Valadares
- Laboratory of Pharmacology and Cellular Toxicology, Pharmacy Faculty, Universidade Federal de Goiás 5ª Avenida Esquina com Rua 240, s/n-Setor Universitário, Goiás, Goiânia, CEP 74605-170, Brazil
| | - Nilceana Maya Aires Freitas
- Department of Radiotherapy, Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Cláudio Rodrigues Leles
- Department of Prevention and Oral Rehabilitation, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n-Setor Universitário, Goiás, Goiânia, CEP 74605-220, Brazil
| | - Elismauro Francisco de Mendonça
- Department of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil.
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Effects of Photobiomodulation on Oral Mucositis: Visualization and Analysis of Knowledge. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111940. [PMID: 36431074 PMCID: PMC9694968 DOI: 10.3390/life12111940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022]
Abstract
This review article mapped and analyzed the most cited articles on the association of photobiomodulation (PBM) with oral mucositis (OM) and the evolution of clinical protocols in the area. A comprehensive search was performed on the Web of Science Core Collection (WoS-CC) database, leading to the extraction of information such as title, authors, abstract, journal name, number, average of citations, study design, year of publication, institutions, continents, countries, type of laser used, irradiated anatomical points, primary anti-cancer therapy, and laser parameters. Among those, clinical trials and literature reviews were the most common study designs. The main type of laser used was the InGaAlP diode, with a wavelength ranging from 630-660 nm, power going in 40-100 mW, and energy density ranging from 0.375-22 J/cm2. As for the anatomical sites irradiated by PBM, the cheek mucosa, upper and lower lips, lateral tongue, and bottom of the mouth stood out. This analysis highlights an increasing interest in PBM as a supportive treatment in cases of OM, as well as the evolution of the technique, types of laser devices, and protocols used.
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Pranitha V, Meghana C, Dwijendra KS, Ravindra SV, Mounika PBN, Ramana PU. Oral health condition and complications in pediatric cancer patients undergoing chemotherapy – A cross-sectional study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2022. [DOI: 10.4103/jiaomr.jiaomr_271_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ji J, Jiang DD, Xu Z, Yang YQ, Qian KY, Zhang MX. Continuous quality improvement of nutrition management during radiotherapy in patients with nasopharyngeal carcinoma. Nurs Open 2021; 8:3261-3270. [PMID: 34405584 PMCID: PMC8510779 DOI: 10.1002/nop2.1039] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/02/2021] [Accepted: 07/19/2021] [Indexed: 01/29/2023] Open
Abstract
Aim To investigate the effect of implementing a model for continuous quality improvement in the nutritional management of patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy. Design methods In the intervention group (n = 77), a model for the continuous quality improvement of efforts at nutrition management was implemented. These efforts included the development of a new process for nutrition management, a system to provide nutritional support and the use of targeted intervention plans to improve nutrition. The time from diagnosis to the administration of radiation therapy, the severity of oral mucositis and dietary factors were recorded and considered in the development of targeted nutrition intervention and nutrition education. The control group (n = 71) followed the original procedures for nutrition management. Results The study found that the CQI model can decrease the severity of oral mucositis caused by radiation and improve nutritional status in affected patients.
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Affiliation(s)
- Juan Ji
- Department of Radiotherapy, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dan-Dan Jiang
- Department of Radiotherapy, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhe Xu
- Department of Radiotherapy, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi-Qun Yang
- Department of Nursing, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ke-Yan Qian
- Department of Radiotherapy, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mu-Xing Zhang
- Department of Nutrition, First Affiliated Hospital of Soochow University, Suzhou, China
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Minhas S, Sajjad A, Chaudhry RM, Zahid H, Shahid A, Kashif M. Assessment and prevalence of concomitant chemo-radiotherapy-induced oral mucositis in patients with oral squamous cell carcinoma. Turk J Med Sci 2021; 51:675-684. [PMID: 33155791 PMCID: PMC8203133 DOI: 10.3906/sag-2007-131] [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: 07/12/2020] [Accepted: 11/05/2020] [Indexed: 11/06/2022] Open
Abstract
Background/aim Quantification of oral mucositis that progresses during concomitant chemo-radiotherapy (CCRT) is essential for its management. It is important to determine the methods that are simple, reliable and beneficial in foreseeing mucositis at earlier stages of treatment. Materials and methods A prospective study was conducted on 100 oral cancer patients receiving CCRT following the inclusion criteria. Patients were evaluated for mucositis i.e. erythema and ulcers by using the World Health Organization (WHO) scale and the oral mucositis assessment scale (OMAS), whereas mature and immature cells were identified by exfoliative cytology. Clinical examination and procedure of oral cavity were performed before, on days 5, 17, and at the end of treatment. Results Oral mucositis was observed in all oral squamous cell carcinoma (OSCC) patients receiving CCRT on different days with noteworthy increase from day 5 of CCRT to the end of treatment. For OMAS grading related to ulceration and erythema, Grade 1 (7.2%; 34%) was most commonly seen on the 5th day of CCRT, Grade 2 (29%; 19%) and Grade 3 (19%) were most frequently seen at the 17th day and end of CCRT, accordingly. With respect to WHO scale grades 1 and 2 (18.3%; 21.5%) was most frequently observed at the 17th day of CCRT, whereas grades 3 and 4 (12.5%; 2%) was noted at the end of CCRT. There was statistically significant increase in the percentage of immature cells at the end of CCRT (99%). A significant association (P < 0.0000) was observed among the days of smear and maturation stages of epithelial cells as well as among WHO mucositis grading, OMAS and types of epithelial cells, respectively. Conclusion According to the findings of the study, oral mucositis grade is directly proportional to the progressing days of CCRT. Oral mucositis is frequently related to adverse clinical outcomes, affecting the patient’s quality of life. It is essential to develop methods that can be employed for the assessment of CCRT associated oral mucositis.
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Affiliation(s)
- Sadia Minhas
- Department of Oral Pathology, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Aneequa Sajjad
- Department of Oral Pathology, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | | | - Hamza Zahid
- Department of Oral Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Azfar Shahid
- Department of Oral Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Muhammad Kashif
- Department of Oral Pathology, Bakhtawar Amin Medical and Dental College, Multan, Pakistan
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Rodrigues-Oliveira L, Kowalski LP, Santos M, Marta GN, Bensadoun RJ, Martins MD, Lopes MA, Castro GD, William WN, Chaves ALF, Migliorati CA, Salloum RG, Rodrigues-Fernandes CI, Kauark-Fontes E, Brandão TB, Santos-Silva AR, Prado-Ribeiro AC. Direct costs associated with the management of mucositis: A systematic review. Oral Oncol 2021; 118:105296. [PMID: 33933777 DOI: 10.1016/j.oraloncology.2021.105296] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/26/2021] [Accepted: 04/04/2021] [Indexed: 11/26/2022]
Abstract
Mucositis is one of the more frequent and costly adverse events following cancer treatment. To evaluate and report the direct economic outcomes associated with the management of mucositis across several cancer treatments we conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Scopus, MEDLINE/PubMed, and Embase were searched electronically and a total of 37 relevant studies were included. The costs attributable to mucositis in the hematopoietic stem cell transplantation setting ranged from 1124,47 US dollars (USD) to 299 214,14 USD per patient. The radiotherapy/chemoradiotherapy/radiotherapy plus molecular targeted therapy accounted for mucositis costs that ranged from 51,23 USD to 33 560,58 USD per patient. Costs for mucositis in the chemotherapy setting ranged from 4,18 USD to 31 963,64 USD per patient. When the cancer treatment was not specified, costs of mucositis ranged from 565,85 USD to as high as 20 279, 12 USD per patient. Mucositis costs from multimodal therapy ranged from 12,42 USD to 5670,46 USD per patient. The molecular targeted therapy setting included only one study and depending on the healthcare providers' perspective of each country evaluated, mucositis' costs ranged from 45,78 USD to 3484,91 USD per patient. Mucositis is associated with increased resource use, consultations, hospitalizations and extended hospitalizations, leading to a substantial incremental cost that exacerbates the economic burden on the patient, health plan and health system across several cancer treatments and diagnosis. More studies with a prospective evaluation of the economic costs associated with mucositis management are needed.
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Affiliation(s)
- Leticia Rodrigues-Oliveira
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455, Cerqueira César, 01246-903 São Paulo, São Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Rua Tamandaré, 753, Liberdade, 01525-001 São Paulo, São Paulo, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil.
| | - Marcos Santos
- ISPOR - International Society for Pharmacoeconomics and Outcomes Research, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil
| | - Gustavo Nader Marta
- Division of Radiation Oncology, São Paulo State Cancer Institute (ICESP-FMUSP), Av. Dr. Arnaldo, 251, Cerqueira César, 01246-000 São Paulo, São Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 115, Bela Vista, 01308-050 São Paulo, São Paulo, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil.
| | - René-Jean Bensadoun
- Centre de Haute Energie (CHE), 10, Boulevard Pasteur, 06000 Nice, Nice, France.
| | - Manoela Domingues Martins
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil; Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Santa Cecilia, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil
| | - Gilberto de Castro
- Department of Medical Oncology, São Paulo State Cancer Institute (ICESP-FMUSP), Av. Dr. Arnaldo, 251, Cerqueira César, 01246-000 São Paulo, São Paulo, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil.
| | - William Nassib William
- Centro Oncológico BP, Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769, Bela Vista, 01323-001 São Paulo, São Paulo, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil
| | - Aline Lauda Freitas Chaves
- DOM Oncology Group, Av. Antônio Olímpio de Morais, 1990, Santa Clara, 35500-071 Divinópolis, Minas Gerais, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil
| | | | - Ramzi G Salloum
- College of Medicine, University of Florida, 600 SW Archer Rd, Gainesville, FL 32610, USA.
| | - Carla Isabelly Rodrigues-Fernandes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil
| | - Elisa Kauark-Fontes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil
| | - Thaís Bianca Brandão
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), Av. Dr. Arnaldo, 251, Cerqueira César, 01246-000 São Paulo, São Paulo, Brazil.
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil.
| | - Ana Carolina Prado-Ribeiro
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil; Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), Av. Dr. Arnaldo, 251, Cerqueira César, 01246-000 São Paulo, São Paulo, Brazil.
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Trebing CT, Sen S, Rues S, Herpel C, Schöllhorn M, Lux CJ, Rammelsberg P, Schwindling FS. Non-invasive three-dimensional thickness analysis of oral epithelium based on optical coherence tomography-development and diagnostic performance. Heliyon 2021; 7:e06645. [PMID: 33898808 PMCID: PMC8055558 DOI: 10.1016/j.heliyon.2021.e06645] [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: 10/05/2020] [Revised: 02/12/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives Evaluating structural changes in oral epithelium can assist with the diagnosis of cancerous lesions. Two-dimensional (2D) non-invasive optical coherence tomography (OCT) is an established technique for this purpose. The objective of this study was to develop and test the diagnostic accuracy of a three-dimensional (3D) evaluation method. Methods The oral lip mucosa of 10 healthy volunteers was scanned using an 870-nm spectral-domain OCT device (SD-OCT) with enhanced depth imaging (EDI). Four raters semi-automatically segmented the epithelial layer twice. Thus, eighty 3D datasets were created and analyzed for epithelial thickness. To provide a reference standard for comparison, the raters took cross-sectional 2D measurements at representative sites. The correlation between the 2D and 3D measurements, as well as intra- and inter-rater reliability, were analyzed using intraclass correlation coefficients (ICC). Results Mean epithelial thickness was 280 ± 64μm (range 178–500 μm) and 268 ± 49μm (range 163–425 μm) for the 2D and 3D analysis, respectively. The inter-modality correlation of the thickness values was good (ICC: 0.76 [0.626–0.846]), indicating that 3D analysis of epithelial thickness provides valid results. Intra-rater and inter-rater reliability were good (3D analysis) and excellent (2D analysis), suggesting high reproducibility. Conclusions Diagnostic accuracy was high for the developed 3D analysis of oral epithelia using non-invasive, radiation-free OCT imaging. Clinical significance This new 3D technique could potentially be used to improve time-efficiency and quality in the diagnosis of epithelial lesions compared with the 2D reference standard.
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Affiliation(s)
| | - Sinan Sen
- Department of Orthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Rues
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Herpel
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Maria Schöllhorn
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher J Lux
- Department of Orthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
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10
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Lai CC, Chen SY, Tu YK, Ding YW, Lin JJ. Effectiveness of low level laser therapy versus cryotherapy in cancer patients with oral mucositis: Systematic review and network meta-analysis. Crit Rev Oncol Hematol 2021; 160:103276. [PMID: 33716203 DOI: 10.1016/j.critrevonc.2021.103276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/01/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this network meta-analysis was to analyze the relative effects of low level laser therapy (LLLT) and/or cryotherapy in cancer patients with oral mucositis (OM). METHODS This literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) up to 2020. Only randomized control trials which involved comparisons of groups receiving the interventions of combined cryotherapy and LLLT, LLLT, cryotherapy and usual care (the control group) in patients with cancer were eligible for inclusion. The effect sizes are presented as odds ratios for the occurrence of severe, moderate and none/mild OM. The mixed treatment comparison was conducted using generalized linear mixed models to analyze the direct and indirect comparisons of interventions. The critical appraisal was assessed using Cochrane Collaboration's tool. Heterogeneity between studies was assessed using I2 statistics, and publication bias was evaluated by constructing a funnel plot. RESULTS Twenty-six randomized controlled trials with a total enrollment of 1830 cancer patients with OM were included. The outcome of none/mild OM is desirable, and odds ratios of more than 1 favor the intervention group. Moderate and severe OM are defined as adverse outcomes, and ORs less than 1 favor the intervention group. The treatment effects of the combined cryotherapy and LLLT were better than those of usual care for none/mild and severe OM (ORs = 106.23 [95% CI = 12.15 to 929.17] and 0.01 [95% CI = 0 to 0.57], respectively). Treatment effects with cryotherapy alone and LLLT alone were better than those with usual care for none/mild and severe OM (ORs = 3.13 [95%CI = 1.56 to 6.27]; ORs = 7.56 [95%CI = 3.84 to 14.88] and 0.25 [95%CI = 0.11 to 0.54]; ORs = 0.13 [95%CI = 0.07 to 0.24], respectively). Nevertheless, for patients with none/mild OM, treatment effects with combined use of cryotherapy and LLLT were better than those with only LLT or cryotherapy (ORs = 14.06 [95%CI = 1.79 to 110.30] and 33.95 [95%CI = 3.50 to 329.65], respectively). For patients with moderate OM, treatment effect did not reach statistical significance among comparisons. The limitations include the wide variability in treatment protocols and the non-uniform outcome measurements across the studies examined. CONCLUSION Compared with no intervention, the treatment effects of combined cryotherapy and LLLT, laser alone, and cryotherapy alone are beneficial for the reduction of severe OM. There is no difference in treatment effects among cryotherapy and/or LLLT intervention in cancer patients with moderate OM. Results of this study provide an implicative basis for LLLT and cryotherapy as viable interventions that can significantly improve severe OM.
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Affiliation(s)
- Chih-Chin Lai
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Shiau-Yee Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Wei Ding
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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11
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Leuci S, Coppola N, Adamo N, Bizzoca ME, Russo D, Spagnuolo G, Lo Muzio L, Mignogna MD. Clinico-Pathological Profile and Outcomes of 45 Cases of Plasma Cell Gingivitis. J Clin Med 2021; 10:jcm10040830. [PMID: 33670562 PMCID: PMC7922699 DOI: 10.3390/jcm10040830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/21/2022] Open
Abstract
Plasma cell gingivitis (PCG) is an infrequent inflammatory disease of the gingiva of unknown etiology, characterized by a dense polyclonal proliferation of plasma cells in the connective tissue. The aim of this study was to present a case series of patients affected by PCG, analyzing demographic, clinical, histopathological, and therapeutic data. A group of 36 females and 9 males with a mean age of 60.3 years was evaluated. Clinically, 25 cases were bullous, a clinical phenotype never reported to date, 4 erythematous, 4 keratotic, 4 verruciform, and 3 ulcerative. On histological examination, pure polyclonal plasma cell infiltrate was detected in 20 specimens, while in 25 specimens it was associated with a mixed infiltrate. The first-line therapy consisted of oral hygiene and topical corticosteroids in all patients. In 25 patients, doxycycline and sulfasalazine were added; in 10 of these patients, the disease persisted, and it was necessary to resort to systemic steroids. This study presented the clinico-pathological profile and outcomes of a case series of PCG. This could be an aid for clinicians to be aware of the heterogeneous clinical phenotype and of the possible pure bullous phenotype of PCG. Further studies are needed to improve the knowledge about this disorder.
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Affiliation(s)
- Stefania Leuci
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, 80131 Naples, Italy; (S.L.); (N.A.); (G.S.); (M.D.M.)
| | - Noemi Coppola
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, 80131 Naples, Italy; (S.L.); (N.A.); (G.S.); (M.D.M.)
- Correspondence: ; Tel.: +39-3392-602-615 (ext. 80131)
| | - Nicola Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, 80131 Naples, Italy; (S.L.); (N.A.); (G.S.); (M.D.M.)
| | - Maria Eleonora Bizzoca
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.E.B.); (L.L.M.)
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples Federico II, 80131 Naples, Italy;
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, 80131 Naples, Italy; (S.L.); (N.A.); (G.S.); (M.D.M.)
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.E.B.); (L.L.M.)
| | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, 80131 Naples, Italy; (S.L.); (N.A.); (G.S.); (M.D.M.)
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Martins AFL, Morais MO, de Sousa-Neto SS, de Jesus APG, Nogueira TE, Valadares MC, Freitas NMA, Batista AC, Leles CR, Mendonça EF. Photobiomodulation reduces the impact of radiotherapy on oral health-related quality of life due to mucositis-related symptoms in head and neck cancer patients. Lasers Med Sci 2020; 36:903-912. [PMID: 33113075 DOI: 10.1007/s10103-020-03167-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
To assess the effectiveness of photobiomodulation therapy (PBMT) in the oral health-related quality of life (OHRQoL) of patients with head and neck cancer undergoing radiotherapy (RT), using the Oral Health Impact Profile-14 (OHIP-14) and the Patient-Reported Oral Mucositis (OM) Symptoms Scale (PROMS), and to correlate OM degree with the PROMS and OHIP-14 scores. Forty-eight patients undergoing RT for head and neck cancer were randomly assigned into two groups: PBMT group (n = 25)-daily PBMT associated with a preventive oral care program (POCP); and control group (n = 23)-receiving POCP exclusively. OHRQoL was assessed using the PROMS and OHIP-14 questionnaires. OM degrees were classified according to the World Health Organization and the National Cancer Institute scales. Assessments were performed at the 1st, 7th, 14th, 21st, and 30th RT sessions. PBMT was effective in preventing and treating severe OM. Both groups showed increased OHRQoL impacts throughout the RT sessions; however, higher impacts were observed in the control group, mainly at the final stage of treatment (21st and 30th RT sessions). Significant correlations were found between the severity of OM and PROMS scores in the total sample and the control group at all RT periods. PROMS and OM scores were positive correlated at 14th, 21st, and 30th RT sessions in the control group, suggesting that this instrument is useful in classifying OM. PBMT was effective in treating and preventing severe OM and OM-related symptoms, and with consequent positive impacts in OHRQoL in head and neck patients undergoing RT. The PROMS scale was helpful instrument for assessment of the severity of OM. Brazilian Clinical Trials database (ReBEC - RBR-5h4y4n), registered in Aug, 24th 2017.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Marília Oliveira Morais
- Hospital de Câncer Araújo Jorge, R. 239, 206 - Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Sebastião Silvério de Sousa-Neto
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Ana Paula Gonçalves de Jesus
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Tulio Eduardo Nogueira
- Departamento de Prevenção e Reabilitação Oral da Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Marize Campos Valadares
- Laboratório de Farmacologia e Toxicologia Celuular, Faculdade de Farmácia, Universidade Federal de Goiás, 5ª Avenida Esquina com Rua 240, s/n, Setor Universitário, Goiânia, Goiás, 74605-170, Brazil
| | - Nilceana Maya Aires Freitas
- Departamento de Radioterapia, Hospital de Câncer Araújo Jorge, R. 239, 206-Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Aline Carvalho Batista
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Cláudio Rodrigues Leles
- Departamento de Prevenção e Reabilitação Oral da Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Elismauro Francisco Mendonça
- Laboratório de Patologia Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.
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13
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Martins AFL, Morais MO, Sousa-Neto SS, Oton-Leite AF, Pereira CH, Valadares MC, Freitas NMA, Batista AC, Leles CR, Mendonça EF. The Effect of Photobiomodulation on Nitrite and Inflammatory Activity in Radiotherapy-Induced Oral Mucositis: A Randomized Clinical Trial. Lasers Surg Med 2020; 53:671-683. [PMID: 32997817 DOI: 10.1002/lsm.23328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/29/2020] [Accepted: 09/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate pro- and anti-inflammatory cytokines and nitrite salivary levels in patients with head and neck cancer receiving photobiomodulation therapy (PBMT) associated with a Preventive Oral Care Program (POCP), for prevention and control of oral mucositis (OM) during radiotherapy (RT) associated or not with chemotherapy protocol. STUDY DESIGN/MATERIALS AND METHODS In this randomized double-blinded clinical trial, 48 patients were randomly assigned to two groups: PBMT (n = 25) and Control (n = 23). In the PBMT group, patients were submitted to PBMT associated with the POCP. In the Control group, patients were submitted only to the POCP. Saliva samples were collected in the 1st (baseline), 7th, 14th, 21st, and 30th sessions of RT, and the levels of interleukin-6 (IL-6), IL-8, IL-10, IL-12p70, IL-1β, and tumoral necrosis factor-α (TNF-α) were measured using the cytometric bead array. Nitrite levels were measured by colorimetric method. OM was assessed using the World Health Organization and the National Cancer Institute scales. RESULTS Patients in the PBMT group presented less severe OM. PBMT tended to stabilize nitrite concentration levels during the RT regimen. The IL-1β concentration was associated with higher OM scores. PBMT promoted an increase in IL-12p70, TNF-α, and IL-10 concentration. CONCLUSION PBMT was effective in the prevention and control of severe OM, and its mechanism of action may be related to a better balance of inflammatory response that may favor injury control. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Allisson F L Martins
- Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Marília O Morais
- Setor de Odontologia do Hospital de Câncer Araújo Jorge. R. 239, 206-Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Sebastião S Sousa-Neto
- Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Angélica F Oton-Leite
- Setor de Odontologia do Hospital de Câncer Araújo Jorge. R. 239, 206-Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Carlos H Pereira
- Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Marize C Valadares
- Laboratório de Farmacologia e Toxicologia Celular da, Faculdade de Farmácia da, Universidade Federal de Goiás, 5ª Avenida Esquina com Rua 240, s/n. Setor Universitário, Goiânia, Goiás, 74605-170, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Nilceana M A Freitas
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Aline C Batista
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Departamento de Prevenção e Reabilitação Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Cláudio R Leles
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Elismauro F Mendonça
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
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14
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Cost-effectiveness randomized clinical trial on the effect of photobiomodulation therapy for prevention of radiotherapy-induced severe oral mucositis in a Brazilian cancer hospital setting. Support Care Cancer 2020; 29:1245-1256. [PMID: 32621262 DOI: 10.1007/s00520-020-05607-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study aimed to assess the cost-effectiveness of photobiomodulation therapy (PBMT) in association with a Preventive Oral Care Program (POCP) compared with POCP alone in the treatment of radiotherapy (RT)-induced oral mucositis (OM). METHODS The cost-effectiveness was evaluated from the health provider perspective and conducted alongside a randomized, double-blind clinical trial. Participants were randomly assigned to either PBMT (n = 25) or control (n = 23) group. The PBMT group participants received PBMT associated with POCP. In the control group, patients were submitted to POCP alone. Costs were identified, quantified, and valued through observation and consultation of the hospital's financial sector database and estimated in Brazilian real and converted to international dollars using the purchasing power parity exchange rate. The incremental cost-effectiveness ratio (ICER) was estimated by considering the prevention of severe OM, interruption of RT, and oral health-related quality of life (OHRQoL) scores, measured by the OHIP-14 and patient-reported OM symptoms scale (PROMS). RESULTS The incremental cost of PBMT was $857.35, and the cost per session was $25.69. The ICER was $ 2867.39 to avoid one case of severe OM and $ 2756.75 to prevent one interruption in RT due to OM. ICER to reduce 1 point in OHIP-14 and PROMS scores were $170.79 and $31.75, respectively. CONCLUSION PBMT is more cost-effective than POCP alone in preventing severe OM, worsening of the OHRQoL, and RT interruptions. PBMT is a promising therapy, especially to avoid interruptions in oncological treatment. TRIAL REGISTRATION ReBEC-RBR-5h4y4n.
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15
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Lavaee F, Amanati A, Ramzi M, Naseri S, Shakiba Sefat H. Evaluation of the effect of photodynamic therapy on chemotherapy induced oral mucositis. Photodiagnosis Photodyn Ther 2020; 30:101653. [PMID: 31923632 DOI: 10.1016/j.pdpdt.2020.101653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/27/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND In this study the effect of photodynamic therapy on chemotherapy induced mucositis was evaluated. METHODS This randomized single blind clinical pilot evaluation evaluated the effect of PDT with methylene blue on 15 patients with chemotherapy induced bilateral oral mucositis. They were divided into 2 groups (control side and intervention side). Methylene blue was applied on the lesions of both sides, after 10 min the lesion of intervention side was irradiated by a 660 nm diode laser InGaAlP(Azor-2 K) for 10 min (power: 25 mW, dose:19.23 J/CM2, probe diameter: 0.78 cm2) for three sessions (day1,3,5) and followed on day 12. In control side only sham laser was used. Data were analyzed by Wilcoxon and Mann-Whitney test using SPSS version 22. RESULTS Comparing the WCCNR and NCI difference in different sessions between intervention and control group, represented significant improvement in oral mucositis in photodynamic therapy group for sessions 1-0, 2-0, 3-0 (P.value<0.05). CONCLUSION Photodynamic therapy can improve chemotherapy induced oral mucositis.
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Affiliation(s)
- Fatemeh Lavaee
- Oral and Dental Disease Research Center, Assistant Professor of Oral and Maxillofacial Disease Department, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali Amanati
- Professor Alborzi Clinical Microbiology Research Center, Shiraz, Iran.
| | - Mani Ramzi
- Hematology Research Center, Department of Hematology, Oncology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Setareh Naseri
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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Palmieri M, Sarmento DJS, Falcão AP, Martins VAO, Brandão TB, Morais-Faria K, Ribeiro ACP, Hasséus B, Giglio D, Braz-Silva PH. Frequency and Evolution of Acute Oral Complications in Patients Undergoing Radiochemotherapy Treatment for Head and Neck Squamous Cell Carcinoma. EAR, NOSE & THROAT JOURNAL 2019; 100:449S-455S. [PMID: 31619067 DOI: 10.1177/0145561319879245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Despite its effectiveness, radiochemotherapy treatment in the head and neck region is accompanied by acute oral complications such as oral mucositis, dysphagia, xerostomia, and dysgeusia. The aim of this study was to analyze and prospectively assess the frequency and evolution of acute oral complications during radiochemotherapy in patients diagnosed with squamous cell carcinoma in the head and neck region. We have analyzed oral complications of 20 patients during 6 weeks of radiochemotherapy treatment for squamous cell carcinoma. Oral mucositis was evaluated according to the World Health Organization criteria, dysphagia, and dysgeusia according to the National Cancer Institute Common Toxicity Criteria, and xerostomia according to parameters set by the Seminars in Radiation Oncology. Mucositis was first observed in the second week and all patients presented some degree of mucositis in the fourth week of radiotherapy. Xerostomia and dysphagia were initially reported already in the first week of radiotherapy. All patients presented xerostomia in the fourth week; however, dysphagia was observed in all patients, only in the sixth week. Dysgeusia was first observed in the second week, becoming more severe in the third week. Acute oral complications can be observed throughout the treatment, but the third week of radiotherapy seems to represent a critical week, regardless of the grade of the complication. The sixth week presents the worst grades of these complications. Knowledge about the natural course of oral complications during radiotherapy is important to develop better strategies for treatment and improve the patients' quality of life.
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Affiliation(s)
- Michelle Palmieri
- Department of Stomatology, School of Dentistry, 67786University of Sao Paulo, São Paulo, Brazil
| | - Dmitry J S Sarmento
- Department of Stomatology, School of Dentistry, 67786University of Sao Paulo, São Paulo, Brazil
| | - André P Falcão
- Department of Stomatology, School of Dentistry, 67786University of Sao Paulo, São Paulo, Brazil
| | - Victor A O Martins
- Department of Stomatology, School of Dentistry, 67786University of Sao Paulo, São Paulo, Brazil
| | - Thais B Brandão
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil
| | - Karina Morais-Faria
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil
| | - Ana C P Ribeiro
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil
| | - Bengt Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Giglio
- Department of Oncology, Institute of Clinical Sciences, 70712The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Paulo H Braz-Silva
- Department of Stomatology, School of Dentistry, 67786University of Sao Paulo, São Paulo, Brazil.,Laboratory of Virology, Institute of Tropical Medicine of Sao Paulo, 67786University of Sao Paulo, São Paulo, Brazil
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Pakravan F, Ghalayani P, Emami H, Isfahani MN, Noorshargh P. A novel formulation for radiotherapy-induced oral mucositis: Triamcinolone acetonide mucoadhesive film. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:63. [PMID: 31523249 PMCID: PMC6669991 DOI: 10.4103/jrms.jrms_456_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/29/2018] [Accepted: 04/29/2019] [Indexed: 11/04/2022]
Abstract
Background The main purpose of this study was to evaluate the effectiveness of triamcinolone acetonide (TA) mucoadhesive films versus placebo as a preventive and therapeutic intervention of oral mucositis (OM) induced by radiotherapy for head-and-neck cancer (HNC) patients. Materials and Methods In this double-blind, randomized case-controlled clinical trial, 60 HNC patients were randomized to receive TA mucoadhesive films (n = 30) or placebo mucoadhesive films (n = 30) taken four times daily. Mucositis severity was assessed during the course of radiation therapy using the World Health Organization scales, and pain scores were assessed using visual analog scale. Repeated measures ANOVA was used for data analysis. Results Mean ± standard deviation age of the TA group was 58.53 ± 8.89 years and 60% were male, whereas in the placebo group, it was 56.46 ± 9.36 years and 56.7% were male (P > 0.05). The mean value of pain score was significantly reduced in the TA group (5.36 ± 1.29 vs. 2.20 ± 2.02) compared with the placebo group (5.34 ± 0.78 vs. 4.69 ± 0.77) during 4 weeks (P < 0.001); repeated measures ANOVA analysis showed that the mean value of grade mucositis was significantly reduced in the TA group (2.40 ± 0.49 vs. 0.96 ± 0.81) compared with the placebo group (2.36 ± 0.80 vs. 1.86 ± 0.93) during 4 weeks (P < 0.001). Conclusion TA film could be considered as an effective approach for reducing the mucositis grading and pain score in the patients with OM.
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Affiliation(s)
- Fahimeh Pakravan
- Dental Implants Research Center, Department of Oral Medicine, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parichehr Ghalayani
- Dental Implants Research Center, Department of Oral Medicine, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Emami
- Department of Radiotherapy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Nasr Isfahani
- Emergency Medicine Research Center, Department of Emergency Medicine, Al Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pegah Noorshargh
- Young Researchers and Elite Club, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
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Development and internal validation of a model for predicting 60-day risk of invasive mould disease in patients with haematological malignancies. J Infect 2019; 78:484-490. [PMID: 30974130 DOI: 10.1016/j.jinf.2019.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 04/04/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Our objective was to develop a model that predicts a patient's risk of developing invasive mould disease (IMD) within 60 days of admission for treatment of a haematological malignancy. METHODS We analysed 19 risk factors for IMD in a cohort of 1944 adult patients with haematological malignancies over 4127 admissions at a haematology referral centre in Northern Italy (2007-2016). We used a multivariable logistic regression to estimate the 60-day probability of developing probable or proven IMD. The model was internally validated using a bootstrap resampling procedure. RESULTS The prevalence of IMD was 3.3% (90 probable cases, 43 proven cases). Seven risk factors were retained in the final risk model: (1) uncontrolled malignancy, (2) high-risk chemotherapy regimen, (3) high-dose corticosteroids, (4) severe lymphopenia, (5) CMV reactivation or disease, (6) prolonged neutropenia, and (7) a history of previous IMD within 90 days. The model displayed good calibration and discrimination in both the derivation (aROC 0.85, 95% CI 0.84-0.86) and validation (aROC 0.83 95% CI 0.79-0.89) populations. CONCLUSIONS Our model differentiated with 85% accuracy whether or not patients developed IMD within 60-days of admission. Individualized risk assessment, aided by validated prognostic models, could assist IMD management and improve antifungal stewardship.
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Howlader D, Singh V, Mohammad S, Gupta S, Pal US, Pal M. Effect of Topical Application of Pure Honey in Chemo-radiation-Induced Mucositis and Its Clinical Benefits in Improving Quality of Life in Patients of Oral Squamous Cell Carcinoma. J Maxillofac Oral Surg 2019; 18:73-79. [PMID: 30728696 DOI: 10.1007/s12663-017-1077-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022] Open
Abstract
Oral cancer is a major health problem in India, and in certain parts, it represents more than 50% of all cancers. Since almost all of these patients receive chemo-radiotherapy with or without surgery for treatment, a vast majority of them also develop oral mucositis, a debilitating adverse effect of chemo-radiation. There have been various reports in the literature regarding the beneficial role of honey in the management of oral mucositis. The objective of this study was to investigate whether the application of honey in mucositis confers any significant improvement in lesions of mucositis and more specifically whether application of honey brings about any improvement in the quality of life of patients suffering from chemo-radiation-induced oral mucositis. If found to be beneficial, honey could provide a simple, elegant and cost-effective solution to a troublesome health problem, thus benefiting a large number of patients.
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Affiliation(s)
- Debraj Howlader
- 1Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, King George's Medical University, Lucknow, India
| | - Vibha Singh
- 1Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, King George's Medical University, Lucknow, India
| | - Shadab Mohammad
- 1Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, King George's Medical University, Lucknow, India
| | - Seema Gupta
- 2Department of Radiation Oncology, King George's Medical University, Lucknow, India
| | - U S Pal
- 1Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, King George's Medical University, Lucknow, India
| | - Mahesh Pal
- 3Department of Phytochemistry, National Botanical Research Institute, Lucknow, India
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Martins AFL, Nogueira TE, Morais MO, Oton-Leite AF, Valadares MC, Batista AC, Freitas NMA, Leles CR, Mendonça EF. Effect of photobiomodulation on the severity of oral mucositis and molecular changes in head and neck cancer patients undergoing radiotherapy: a study protocol for a cost-effectiveness randomized clinical trial. Trials 2019; 20:97. [PMID: 30709370 PMCID: PMC6359861 DOI: 10.1186/s13063-019-3196-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/14/2019] [Indexed: 01/28/2023] Open
Abstract
Background Oral mucositis (OM) is the most frequent and debilitating acute side effect associated with head and neck cancer (HNC) treatment. When present, severe OM negatively impacts the quality of life of patients undergoing HNC treatment. Photobiomodulation is a well-consolidated and effective therapy for the treatment and prevention of severe OM, and is associated with a cost reduction of the cancer treatment. Although an increase in the quality of life and a reduction in the severity of OM are well described, there is no study on cost-effectiveness for this approach considering the quality of life as a primary outcome. In addition, little is known about the photobiomodulation effects on salivary inflammatory mediators. Thus, this study aimed to assess the cost-effectiveness of the photobiomodulation therapy for the prevention and control of severe OM and its influence on the salivary inflammatory mediators. Methods/design This randomized, double-blind clinical trial will include 50 HNC patients undergoing radiotherapy or chemoradiotherapy. The participants will be randomized into two groups: intervention group (photobiomodulation) and control group (preventive oral care protocol). OM (clinical assessment), saliva (assessment of collected samples) and quality of life (Oral Health Impact Profile-14 and Patient-Reported Oral Mucositis Symptoms questionnaires) will be assessed at the 1st, 7th, 14th, 21st and 30th radiotherapy sessions. Oxidative stress and inflammatory cytokine levels will be measured in the saliva samples of all participants. The costs are identified, measured and evaluated considering the radiotherapy time interval. The incremental cost-effectiveness ratio will be estimated. The study will be conducted according to the Brazilian public health system perspective. Discussion Photobiomodulation is an effective therapy that reduces the cost associated with OM treatment. However, little is known about its cost-effectiveness, mainly when quality of life is the effectiveness measure. Additionally, this therapy is not supported by the Brazilian public health system. Therefore, this study widens the knowledge about the safety of and strengthens evidence for the use of photobiomodulation therapy, providing information for public policy-makers and also for dental care professionals. This study is strongly encouraged due to its clinical relevance and the possibility of incorporating new technology into public health systems. Trial registration Brazilian Registry of Clinical Trials—ReBEC, RBR-5h4y4n. Registered on 13 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3196-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Department of Oral Pathology, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Túlio Eduardo Nogueira
- Department of Prevention and Oral Rehabilitation, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Marília Oliveira Morais
- Department of Stomatology, Araujo Jorge Cancer Hospital , R. 239, 206-Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Angélica Ferreira Oton-Leite
- Department of Stomatology, Araujo Jorge Cancer Hospital , R. 239, 206-Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Marize Campos Valadares
- Department of Pharmacology and Cellular Toxicology, Pharmacy Faculty, Federal University of Goiás, 5ª Avenida Esquina com Rua 240, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-170, Brazil
| | - Aline Carvalho Batista
- Department of Oral Pathology, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Nilceana Maya Aires Freitas
- Department of Radiotherapy, Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiânia, Goiás, CEP 74175-120, Brazil
| | - Cláudio Rodrigues Leles
- Department of Prevention and Oral Rehabilitation, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil
| | - Elismauro Francisco Mendonça
- Department of Oral Pathology, Dentistry Faculty, Federal University of Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil.
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Campos JC, Cunha JD, Ferreira DC, Reis S, Costa PJ. Challenges in the local delivery of peptides and proteins for oral mucositis management. Eur J Pharm Biopharm 2018; 128:131-146. [PMID: 29702221 DOI: 10.1016/j.ejpb.2018.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/20/2022]
Abstract
Oral mucositis, a common inflammatory side effect of oncological treatments, is a disorder of the oral mucosa that can cause painful ulcerations, local motor disabilities, and an increased risk of infections. Due to the discomfort it produces and the associated health risks, it can lead to cancer treatment restrains, such as the need for dose reduction, cycle delays or abandonment. Current mucositis management has low efficiency in prevention and treatment. A topical drug application for a local action can be a more effective approach than systemic routes when addressing oral cavity pathologies. Local delivery of growth factors, antibodies, and anti-inflammatory cytokines have shown promising results. However, due to the peptide and protein nature of these novel agents, and the several anatomic, physiological and environmental challenges of the oral cavity, their local action might be limited when using traditional delivering systems. This review is an awareness of the issues and strategies in the local delivery of macromolecules for the management of oral mucositis.
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Affiliation(s)
- João C Campos
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1).
| | - João D Cunha
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
| | - Domingos C Ferreira
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
| | - Salette Reis
- LAQV, REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
| | - Paulo J Costa
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
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Etiz D, Orhan B, Demirüstü C, Ozdamar K, Cakmak A. Comparison of Radiation-Induced Oral Mucositis Scoring Systems. TUMORI JOURNAL 2018; 88:379-84. [PMID: 12487555 DOI: 10.1177/030089160208800506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background A number of oral toxicity scoring systems have been described, but their direct comparison has rarely been undertaken and little data exists. An impediment to mucositis research has been the lack of an accepted, validated scoring system. The objective of this study was to design a test and validation of scoring systems. Materials and methods Forty-three patients with head and neck malignancies who had been irradiated were evaluated. Five different mucositis scoring systems (World Health Organization, Radiation Therapy Oncology Group, “Hickey”, “Van der Schueren” and “Makkonen”) were compared with each other. Results Daily mucositis scores demonstrated a high correlation among scoring systems (P <0.05 and coefficient of correlation κ and r = 0.5 - 0.95). Objective mucositis scores demonstrated a strong correlation with symptoms. Conclusions All scoring systems were equally valid. The exact grading of mucositis is achieved by combining clinical information about pain and nutritional status with oral mucosal reactions.
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Affiliation(s)
- Durmuş Etiz
- Osmangazi University Faculty of Medicine, Department of Radiation Oncology, Eskişehir, Turkey.
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Gandhi K, Datta G, Ahuja S, Saxena T, G Datta A. Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy. Int J Clin Pediatr Dent 2017; 10:166-171. [PMID: 28890617 PMCID: PMC5571386 DOI: 10.5005/id-iournals-10005-1428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/29/2016] [Indexed: 11/23/2022] Open
Abstract
Multiagent chemotherapy, radiotherapy, or a combination of both are the contemporary methods of cancer treatment. With medical advancements, though cure rates have increased considerably, focus is now shifted to the potential early and late complications of the same. The aim of this study was to assess the early oral complications in pediatric patients receiving chemotherapy. Sixty-two children with cancer undergoing chemotherapy with the mean age of 7.42 ± 3.6 years were included in the study. The various types of malignancies and oral problems during chemotherapy were recorded in the subjects. The most commonly encountered malignancy was acute lymphoblastic leukemia at 35.5%. Various oral and associated complications like mucosal inflammation with ulcerations, oral pain, xerostomia, and secondary infections were commonly seen, with mucositis being the most commonly observed complication in 58.1% of the subjects undergoing chemotherapy. Clinical importance of timely medical and dental interventions by a multidisciplinary team involving a pediatric dentist at different stages of anticancer treatment is also emphasized to minimize discomfort, increase treatment compliance, and improve the quality of life of pediatric patients.
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Affiliation(s)
- Kapil Gandhi
- Professor, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Geetika Datta
- Reader, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Shilpa Ahuja
- Senior Lecturer, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Tanvi Saxena
- Senior Lecturer, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Ankush G Datta
- Ex-Senior Lecturer, Department of Orthodontics and Dentofacial Orthopedics Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
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Variability of high-dose melphalan exposure on oral mucositis in patients undergoing prophylactic low-level laser therapy. Lasers Med Sci 2017; 32:1089-1095. [PMID: 28512727 DOI: 10.1007/s10103-017-2211-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
The present study outlines the clinical impact and risk factors of oral mucositis in 79 patients with multiple myeloma following high-dose melphalan for autologous transplant. All patients underwent daily prophylactic low-level indium gallium aluminum phosphate diode laser therapy (660 nm, 15 mW, 3.75 J/cm2, 10 s per point) from the beginning of the conditioning regimen up to day +2. Oral mucositis assessments were made daily until hospital discharge. For analysis, oral mucositis was divided into two groups according to severity: group 1, patients with oral mucositis grade <III (n = 71) and group 2, patients with oral mucositis grade ≥III (n = 8). Univariate logistic models were used to determine the risk factors. Patients in group 1 were found to have statistically fewer days of oral pain than those in group 2 (3.94 and 6.25 days, respectively, p = 0.014). Morphine was required in 75% of patients in group 2, versus 42.25% in group 1 (p = 0.06). Risk of severe oral mucositis was associated with higher serum creatinine levels (OR = 6.10; 95% CI 1.25-31.60; p = 0.02) and older age (OR = 1.21; 95% CI 1.05-1.47; p = 0.027). Severe oral mucositis was associated with worse clinical outcomes. Older patients and those with renal dysfunction previous autologous transplant had the greatest risk for severe oral mucositis despite prophylactic laser treatment. Our results highlight the importance of further research to define the dose, application time, and number of prophylactic laser sessions in those patients with the greatest risk for severe oral mucositis.
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Short article: Small intestinal mucosal injury in patients taking chemotherapeutic agents for solid cancers. Eur J Gastroenterol Hepatol 2017; 29:568-571. [PMID: 28350747 DOI: 10.1097/meg.0000000000000828] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Chemotherapy for cancer is a systemic treatment often associated with side effects than can be debilitating and, in some cases, life-threatening. Few data are available on intestinal enterotoxicity. Wireless video capsule endoscopy (VCE) is a noninvasive method of imaging the small intestine. This study presents the results of VCE in patients with solid tumors undergoing antineoplastic regimens with agents, notably for toxicity for the gastrointestinal mucosa (i.e. carboplatin, cyclophosphamide, 5-fluorouracil, methotrexate, and cisplatin). MATERIALS AND METHODS The capsule endoscopy procedure was performed 4-13 days after the end of the antineoplastic course. Each patient received a polyethylene-glycol solution (1000 mg×2 in 2 l of water) for bowel preparation and fasted for 10 h before ingestion of the capsule. Videos were evaluated by one operator, supervised by a second operator, and conclusions were drawn by an expert reader. RESULTS Twenty (age range: 38-77 years) patients were evaluated. The cecum was reached in 70% before exhaustion of the battery. The video capsule showed small widespread intestinal ulcerations in 25% and erosions in only one patient. The villus architecture appeared normal in all. VCE detected metastases in one patient with a melanoma. Few patients had more than one lesion. All capsules were passed in the stool. CONCLUSION Our results suggest that chemotherapy in patients with solid cancers is associated with minimal visual small bowel injury. Factors other than damage of the intestinal mucosa causing loss of epithelium are likely involved in gastrointestinal toxicity and related symptoms.
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Al Jaouni SK, Al Muhayawi MS, Hussein A, Elfiki I, Al-Raddadi R, Al Muhayawi SM, Almasaudi S, Kamal MA, Harakeh S. Effects of Honey on Oral Mucositis among Pediatric Cancer Patients Undergoing Chemo/Radiotherapy Treatment at King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:5861024. [PMID: 28270852 PMCID: PMC5320070 DOI: 10.1155/2017/5861024] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/03/2016] [Indexed: 12/17/2022]
Abstract
One of the most common complications of cancer chemotherapy is oral mucositis. This study evaluates the therapeutic effects of honey with the focus on grade III and IV oral mucositis, reduction of bacterial and fungal infections, duration of episodes of oral mucositis, and body weight in pediatric leukemic patients undergoing chemo/radiotherapy. This is an open labeled randomized controlled study conducted at our hospital on 40 pediatric cancer patients undergoing chemo/radiotherapy. All the 40 patients included in this study experienced a sum total of 390 episodes of fever and neutropenia associated with oral mucositis. A significant reduction of oral mucositis, associated Candida, and aerobic pathogenic bacterial infections was noted in patients in the honey treatment group. Also, there is a significant decrease in the duration of hospitalization for all those in the treatment group combined with a significant increase of body weight, delayed onset, and decreased severity of pain related to oral mucositis. Complications of oral mucositis can be tremendously reduced by the topical application of local Saudi honey and honey should be used as an integrative approach in prophylaxis and treatment of chemo/radiotherapy-induced oral mucositis in pediatric cancer patients. Further research is needed to elucidate and better understand the underlying mechanism.
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Affiliation(s)
- Soad K. Al Jaouni
- Department of Pediatric Hematology/Oncology, King Abdulaziz University Hospital (KAUH), Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
- Yousef Abdullatif Jameel Chair of Prophetic Medicine Application (YAJCPMA), King Abdulaziz University Hospital (KAUH), Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Mohammad S. Al Muhayawi
- Department of Pediatric Hematology/Oncology, King Abdulaziz University Hospital (KAUH), Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Abear Hussein
- Department of Pediatric Hematology/Oncology, King Abdulaziz University Hospital (KAUH), Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Iman Elfiki
- Department of Pediatric Hematology/Oncology, King Abdulaziz University Hospital (KAUH), Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | | | - Saad M. Al Muhayawi
- Department of Head & Neck Surgical Oncology, KAUH, Faculty of Medicine, KAU, Jeddah, Saudi Arabia
| | - Saad Almasaudi
- Biology Department, KAU, Jeddah, Saudi Arabia
- King Fahd Medical Research Center (KFMRC), KAU, Jeddah, Saudi Arabia
| | - Mohammad Amjad Kamal
- Yousef Abdullatif Jameel Chair of Prophetic Medicine Application (YAJCPMA), King Abdulaziz University Hospital (KAUH), Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
- King Fahd Medical Research Center (KFMRC), KAU, Jeddah, Saudi Arabia
- Enzymoics, 7 Peterlee Place, Hebersham, NSW 2770, Australia
- Novel Global Community Educational Foundation, Hebersham, NSW 2770, Australia
| | - Steve Harakeh
- Yousef Abdullatif Jameel Chair of Prophetic Medicine Application (YAJCPMA), King Abdulaziz University Hospital (KAUH), Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
- Special Infectious Agents Unit, KFMRC, KAU, Jeddah, Saudi Arabia
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Datta G, Saxena T, Datta AG. Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy. Int J Clin Pediatr Dent 2017. [DOI: 10.5005/jp-journals-10005-1428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
ABSTRACT
Multiagent chemotherapy, radiotherapy, or a combination of both are the contemporary methods of cancer treatment. With medical advancements, though cure rates have increased considerably, focus is now shifted to the potential early and late complications of the same. The aim of this study was to assess the early oral complications in pediatric patients receiving chemotherapy. Sixty-two children with cancer undergoing chemotherapy with the mean age of 7.42 ± 3.6 years were included in the study. The various types of malignancies and oral problems during chemotherapy were recorded in the subjects. The most commonly encountered malignancy was acute lymphoblastic leukemia at 35.5%. Various oral and associated complications like mucosal inflammation with ulcerations, oral pain, xerostomia, and secondary infections were commonly seen, with mucositis being the most commonly observed complication in 58.1% of the subjects undergoing chemotherapy. Clinical importance of timely medical and dental interventions by a multidisciplinary team involving a pediatric dentist at different stages of anticancer treatment is also emphasized to minimize discomfort, increase treatment compliance, and improve the quality of life of pediatric patients.
How to cite this article:
Gandhi K, Datta G, Ahuja S, Saxena T, Datta AG. Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy. Int Int J Clin Pediatr Dent 2017;10(2):166-171.
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A novel lozenge containing bupivacaine as topical alleviation of oral mucositis pain in patients with head and neck cancer: a pilot study. Pain Rep 2016; 1:e571. [PMID: 29392194 PMCID: PMC5741316 DOI: 10.1097/pr9.0000000000000571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/09/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction: Oral mucositis induces severe oral pain in head and neck cancer patients. There is at this point no effective pain treatment without considerable side effects. Objective: The aim of this pilot study was to investigate pain reduction in oral cavity and pharynx in patients with head and neck cancer (HNC) with oral mucositis, the location of anesthetic effect, and duration of pain relief, after a single-dose administration of a 25 mg bupivacaine lozenge. Methods: Ten patients with HNC suffering from oral mucositis pain were included. The patients assessed pain in the oral cavity and pharynx on a visual analogue scale (from 0 to 100 mm) at baseline and up to 3 hours after the lozenge was dissolved. Possible adverse events were registered. Results: The baseline pain was 51 mm (range: 30–73 mm) in the oral cavity and 58 mm (range: 35–70 mm) in the pharynx. When the lozenge was dissolved, both oral (−27 mm; range: −3 to −52 mm; P = 0.0003) and pharynx pain (−20 mm; range: −3 to −45 mm; P = 0.008) were significantly reduced. After 180 minutes, the mean reduction in pain was significant in the oral cavity (−18 mm; range: −8 to −30 mm; P < 0.0001) but not in the pharynx (−8 mm; range: +4 to −23 mm; P = 0.12). No adverse events were observed. Conclusion: The results indicate that the bupivacaine lozenge has a clinically significant and long-lasting pain-relieving effect on pain because of oral mucositis in patients with HNC.
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Guo Y, Hainley S, Palmer JL, Bruera E. Azotemia in Cancer Patients During Inpatient Rehabilitation. Am J Hosp Palliat Care 2016; 24:264-9. [PMID: 17601836 DOI: 10.1177/1049909107302298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This paper presents a study of the relationship between prerenal azotemia and rehabilitation outcomes of cancer patients. A retrospective chart review of 70 patients who underwent inpatient rehabilitation in a tertiary cancer center was undertaken. Eight patients with creatinine values >1.5 were excluded. The remaining 62 patients were divided into 2 groups according to the blood urea nitrogen/creatinine (BUN/Cr) ratio: 27 (44%) in the prerenal azotemia group (BUN/Cr ≥ 20) and 35 (56%) in the non-azotemic group (BUN/Cr < 20). Age, gender, <10 g/dL of hemoglobin, co-morbidity (diabetes mellitus and/or hypertension), discharge destiny and median rehabilitation length of stay were not significantly different in these 2 groups. Prerenal azotemia was present in a significant number of cancer patients, but it did not impact the length of rehabilitation stay or discharge destiny.
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Affiliation(s)
- Ying Guo
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, 1515 Holcombeboulevard, Houston, TX 77030, USA.
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Mutluay Yayla E, Izgu N, Ozdemir L, Aslan Erdem S, Kartal M. Sage tea–thyme–peppermint hydrosol oral rinse reduces chemotherapy-induced oral mucositis: A randomized controlled pilot study. Complement Ther Med 2016; 27:58-64. [DOI: 10.1016/j.ctim.2016.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 05/04/2016] [Accepted: 05/24/2016] [Indexed: 02/02/2023] Open
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Effect of Kangfuxin Solution on Chemo/Radiotherapy-Induced Mucositis in Nasopharyngeal Carcinoma Patients: A Multicenter, Prospective Randomized Phase III Clinical Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:8692343. [PMID: 27375766 PMCID: PMC4914730 DOI: 10.1155/2016/8692343] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/29/2015] [Indexed: 01/27/2023]
Abstract
Objective. To evaluate the efficacy and safety of Kangfuxin Solution, a pure Chinese herbal medicine, on mucositis induced by chemoradiotherapy in nasopharyngeal carcinoma patients. Methods. A randomized, parallel-group, multicenter clinical study was performed. A total of 240 patients were randomized to receive either Kangfuxin Solution (test group) or compound borax gargle (control group) during chemoradiotherapy. Oral mucositis, upper gastrointestinal mucositis, and oral pain were evaluated by Common Terminology Criteria for Adverse Events (CTCAE) v3.0 and the Verbal Rating Scale (VRS). Results. Of 240 patients enrolled, 215 were eligible for efficacy analysis. Compared with the control group, the incidence and severity of oral mucositis in the test group were significantly reduced (P = 0.01). The time to different grade of oral mucositis occurrence (grade 1, 2, or 3) was longer in test group (P < 0.01), and the accumulated radiation dose was also higher in test group comparing to the control group (P < 0.05). The test group showed lower incidence of oral pain and gastrointestinal mucositis than the control group (P < 0.01). No significant adverse events were observed. Conclusion. Kangfuxin Solution demonstrated its superiority to compound borax gargle on mucositis induced by chemoradiotherapy. Its safety is acceptable for clinical application.
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Lucchese A, Matarese G, Ghislanzoni LH, Gastaldi G, Manuelli M, Gherlone E. Efficacy and effects of palifermin for the treatment of oral mucositis in patients affected by acute lymphoblastic leukemia. Leuk Lymphoma 2015; 57:820-7. [DOI: 10.3109/10428194.2015.1081192] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Caira M, Candoni A, Verga L, Busca A, Delia M, Nosari A, Caramatti C, Castagnola C, Cattaneo C, Fanci R, Chierichini A, Melillo L, Mitra ME, Picardi M, Potenza L, Salutari P, Vianelli N, Facchini L, Cesarini M, De Paolis MR, Di Blasi R, Farina F, Venditti A, Ferrari A, Garzia M, Gasbarrino C, Invernizzi R, Lessi F, Manna A, Martino B, Nadali G, Offidani M, Paris L, Pavone V, Rossi G, Spadea A, Specchia G, Trecarichi EM, Vacca A, Cesaro S, Perriello V, Aversa F, Tumbarello M, Pagano L. Pre-chemotherapy risk factors for invasive fungal diseases: prospective analysis of 1,192 patients with newly diagnosed acute myeloid leukemia (SEIFEM 2010-a multicenter study). Haematologica 2015; 100:284-92. [PMID: 25638805 DOI: 10.3324/haematol.2014.113399] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Correct definition of the level of risk of invasive fungal infections is the first step in improving the targeting of preventive strategies. We investigated the potential relationship between pre-hospitalization exposure to sources of fungi and the development of invasive fungal infections in adult patients with newly diagnosed acute myeloid leukemia after their first course of chemotherapy. From January 2010 to April 2012, all consecutive acute myeloid leukemia patients in 33 Italian centers were prospectively registered. Upon first admission, information about possible pre-chemotherapy risk factors and environmental exposure was collected. We recorded data regarding comorbid conditions, employment, hygienic habits, working and living environment, personal habits, hobbies, and pets. All invasive fungal infections occurring within 30 days after the first course of chemotherapy were recorded. Of the 1,192 patients enrolled in this study, 881 received intensive chemotherapy and were included in the present analysis. Of these, 214 developed an invasive fungal infection, including 77 proven/probable cases (8.7%). Of these 77 cases, 54 were proven/probable invasive mold infections (6.1%) and 23 were proven yeast infections (2.6%). Upon univariate analysis, a significant association was found between invasive mold infections and age, performance status, diabetes, chronic obstructive pulmonary disease, smoking, cocaine use, job, hobbies, and a recent house renovation. Higher body weight resulted in a reduced risk of invasive mold infections. Multivariate analysis confirmed the role of performance status, job, body weight, chronic obstructive pulmonary disease, and house renovation. In conclusion, several hospital-independent variables could potentially influence the onset of invasive mold infections in patients with acute myeloid leukemia. Investigation of these factors upon first admission may help to define a patient's risk category and improve targeted prophylactic strategies. (Clinicaltrial.gov: NCT01315925)
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Affiliation(s)
- Morena Caira
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma
| | - Anna Candoni
- Clinica Ematologica, Azienda Ospedaliero Universitaria di Udine
| | - Luisa Verga
- Unità di Ematologia, Università Milano Bicocca, Ospedale S.Gerardo, Monza
| | | | - Mario Delia
- Hematology and BMT Unit, Department of Emergency and Organ Transplantation, University of Bari, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari
| | - Annamaria Nosari
- Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milan
| | | | - Carlo Castagnola
- Dipartimento Onco-Ematologico Fondazione ICRRS Policlinico San Matteo, Pavia
| | | | - Rosa Fanci
- Unità Funzionale di Ematologia, Azienda Ospedaliero-Universitaria Careggi e Università di Firenze
| | | | - Lorella Melillo
- Unità di Ematologia, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | | | - Marco Picardi
- Azienda Ospedaliera Universitaria Federico II Napoli, Dipartimento di Medicina Clinica e Chirurgia
| | - Leonardo Potenza
- Sezione di Ematologia, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università di Modena e Reggio Emilia
| | | | - Nicola Vianelli
- Istituto di Ematologia ed Oncologia Clinica "Lorenzo e Ariosto Serágnoli", Ospedale S.Orsola-Malpighi, Università di Bologna
| | - Luca Facchini
- Divisione di Ematologia, Arciospedale S.Maria Nuova, Reggio Emilia
| | - Monica Cesarini
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma
| | | | - Roberta Di Blasi
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma
| | - Francesca Farina
- Unità di Ematologia, Università Milano Bicocca, Ospedale S.Gerardo, Monza
| | - Adriano Venditti
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma
| | | | | | | | - Rosangela Invernizzi
- Dipartimento di Medicina Interna, Università di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Federica Lessi
- Ematologia ed Immunologia Clinica, Dipartimento di Medicina, Universita' di Padova
| | | | - Bruno Martino
- Divisione di Ematologia, Azienda Ospedaliera "Bianchi Melacrino Morelli", Reggio Calabria
| | - Gianpaolo Nadali
- UOC Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona
| | | | - Laura Paris
- Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milan
| | | | | | - Antonio Spadea
- Unità di Ematologia, Istituti Fisioterapici Ospitalieri, Roma
| | - Giorgina Specchia
- Hematology and BMT Unit, Department of Emergency and Organ Transplantation, University of Bari, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari
| | | | | | - Simone Cesaro
- Emato-Oncologia Pediatrica, Azienda Ospedaliera Universitaria Integrata, Verona
| | - Vincenzo Perriello
- Istituto di Ematologia, Ospedale S. Maria della Misericordia, Università di Perugia, Italy
| | | | - Mario Tumbarello
- Istituto di Malattie Infettive, Università Cattolica del Sacro Cuore, Roma
| | - Livio Pagano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma
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Chethana, Rao PS, Madathil LP, Rao S, Shetty P, Patidar M. Quantitative Analysis of Acute Phase Proteins in Post Chemo-Radiation Mucositis. J Clin Diagn Res 2015; 9:ZC28-31. [PMID: 26557611 DOI: 10.7860/jcdr/2015/13732.6591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/26/2015] [Indexed: 11/24/2022]
Abstract
AIM Oral mucositis induced by radiation is an inevitable but transient side-effect of radiotherapy. Acute phase proteins are a class of proteins whose phase concentrations fluctuate in response to inflammation. The best known of the acute phase proteins is C-reactive protein, a protein that rises in the blood with inflammation. MATERIALS AND METHODS 30 patients undergoing chemo - radiotherapy for head and neck cancer were clinically evaluated for mucositis on day 0, 7, 14, 28 and 42. Blood investigations like C-reactive protein, erythrocyte sedimentation rate and total leukocyte count were also conducted. RESULTS There was a significant increase in the severity of mucositis during the course of treatment followed by a gradual decrease in severity towards the end of radiotherapy. Comparison of C-reactive protein levels from day 0 to day 42 in the study group showed a significant increase towards the end of radiotherapy. There was a significant increase in erythrocyte sedimentation rate levels till day 14 followed by a decrease towards the end of radiotherapy whereas total leukocyte count showed a significant decrease from day 0 to day 7 followed by an increase towards the end of radiotherapy. CONCLUSION The oral mucosa bears only a small clinical spectrum of the side-effect conveyed by chemo-radiation. Both widespread and late effects do occur, and tissues may never return to normal completely. Inflammatory serum markers like C-reactive protein, erythrocyte sedimentation rate and total leukocyte count can thus be used as an objective measure to study the complexities of radiation mucositis which is documented as one of the worst side effects of head and neck cancer therapy.
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Affiliation(s)
- Chethana
- Lecturer, Department of Oral Pathology and Microbiology, A. B. Shetty Memorial Institute of Dental Sciences , Deralakatte, Mangalore, India
| | - Pratima S Rao
- Professor, Department of Oral Pathology and Microbiology, Century International Institute of Dental sciences and Research Centre, Kerala University of Health Sciences , Poinachi, Thekkil (Via), Kasaragod, Kerala, India
| | - Lal P Madathil
- Professor, Department of Oral Pathology and Microbiology, Century International Institute of Dental sciences and Research Centre, Kerala University of Health Sciences , Poinachi, Thekkil (Via), Kasaragod, Kerala, India
| | - Suresh Rao
- Head, Radiation Oncology Division, Mangalore Institute of Oncology , Pumpwell, Mangalore, Karnataka, India
| | - Pushparaja Shetty
- Professor & Head, Department of Oral Pathology and Microbiology, A. B. Shetty Memorial Institute of Dental Sciences , Deralakatte, Mangalore, India
| | - Madhvika Patidar
- Senior Lecturer, Department of Oral Pathology and Microbiology, Babu Banarasi Das College of Dental Sciences , Lucknow, India
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Nagarajan K. Chemo-radiotherapy induced oral mucositis during IMRT for head and neck cancer - An assessment. Med Oral Patol Oral Cir Bucal 2015; 20:e273-7. [PMID: 25662542 PMCID: PMC4464913 DOI: 10.4317/medoral.20126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 11/23/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study is conducted mainly to evaluate the changes in quality and quantity of oral epithelial cells during the course of IMRT. MATERIAL AND METHODS 30 Patients undergoing chemo-radiotherapy were followed through course of treatment. They were compared with a group of age- and sex-matched healthy individuals. The procedure involved WHO clinical scoring, collection of oral washings and preparation of buccal smears from both study group and control group. The changes occurred were recorded as a way of assessing the severity of oral mucositis. RESULTS revealed a significant occurrence of oral mucositis in almost all patients during weekly follow up. There was a significant increase in percentage of viable buccal epithelial cells in study group when compared to normal controls (P<0.005) during and at the end of chemo-radiotherapy. CONCLUSIONS quantification of oral mucositis can be done at cellular level by determining the oral mucosal cell viability and their maturation during IMRT.
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Affiliation(s)
- Karthika Nagarajan
- Unit 40/71, Cherwood Lodge, Olsen Avenue, Labrador, Gold Coast, QLD, 4215, Australia,
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Barrach RH, Souza MPD, Silva DPCD, Lopez PS, Montovani JC. Oral changes in individuals undergoing hematopoietic stem cell transplantation. Braz J Otorhinolaryngol 2015; 81:141-7. [PMID: 25458262 PMCID: PMC9449003 DOI: 10.1016/j.bjorl.2014.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 04/27/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Patients undergoing hematopoietic stem cell transplantation receive high doses of chemotherapy and radiotherapy, which cause severe immunosuppression. OBJECTIVE To report an oral disease management protocol before and after hematopoietic stem cell transplantation. METHODS A prospective study was carried out with 65 patients aged>18 years, with hematological diseases, who were allocated into two groups: A (allogeneic transplant, 34 patients); B (autologous transplant, 31 patients). A total of three dental status assessments were performed: in the pre-transplantation period (moment 1), one week after stem cell infusion (moment 2), and 100 days after transplantation (moment 3). In each moment, oral changes were assigned scores and classified as mild, moderate, and severe risks. RESULTS The most frequent pathological conditions were gingivitis, pericoronitis in the third molar region, and ulcers at the third moment assessments. However, at moments 2 and 3, the most common disease was mucositis associated with toxicity from the drugs used in the immunosuppression. CONCLUSION Mucositis accounted for the increased score and potential risk of clinical complications. Gingivitis, ulcers, and pericoronitis were other changes identified as potential risk factors for clinical complications.
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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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Elad S, Raber-Durlacher JE, Brennan MT, Saunders DP, Mank AP, Zadik Y, Quinn B, Epstein JB, Blijlevens NMA, Waltimo T, Passweg JR, Correa MEP, Dahllöf G, Garming-Legert KUE, Logan RM, Potting CMJ, Shapira MY, Soga Y, Stringer J, Stokman MA, Vokurka S, Wallhult E, Yarom N, Jensen SB. Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer 2015; 23:223-36. [PMID: 25189149 PMCID: PMC4328129 DOI: 10.1007/s00520-014-2378-x] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/30/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Hematology-oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications which may cause significant morbidity and a potential risk of mortality. This emphasizes the importance of basic oral care prior to, during and following chemotherapy/HSCT. While scientific evidence is available to support some of the clinical practices used to manage the oral complications, expert opinion is needed to shape the current optimal protocols. METHODS This position paper was developed by members of the Oral Care Study Group, Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT) in attempt to provide guidance to the health care providers managing these patient populations. RESULTS The protocol on basic oral care outlined in this position paper is presented based on the following principles: prevention of infections, pain control, maintaining oral function, the interplay with managing oral complications of cancer treatment and improving quality of life. CONCLUSION Using these fundamental elements, we developed a protocol to assist the health care provider and present a practical approach for basic oral care. Research is warranted to provide robust scientific evidence and to enhance this clinical protocol.
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Affiliation(s)
- Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave., Rochester, NY, 14620, USA,
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Ghalayani P, Emami H, Pakravan F, Nasr Isfahani M. Comparison of triamcinolone acetonide mucoadhesive film with licorice mucoadhesive film on radiotherapy-induced oral mucositis: A randomized double-blinded clinical trial. Asia Pac J Clin Oncol 2014; 13:e48-e56. [DOI: 10.1111/ajco.12295] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Parichehr Ghalayani
- Department of Oral Medicine; Isfahan University of Medical Sciences; Isfahan Iran
| | - Hamid Emami
- Department of Radiotherapy; Isfahan University of Medical Sciences; Isfahan Iran
| | - Fahimeh Pakravan
- Department of Oral Medicine; Isfahan University of Medical Sciences; Isfahan Iran
| | - Mehdi Nasr Isfahani
- Department of Emergency Medicine; Isfahan University of Medical Sciences; Isfahan Iran
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Stanzani M, Lewis RE, Fiacchini M, Ricci P, Tumietto F, Viale P, Ambretti S, Baccarani M, Cavo M, Vianelli N. A risk prediction score for invasive mold disease in patients with hematological malignancies. PLoS One 2013; 8:e75531. [PMID: 24086555 PMCID: PMC3784450 DOI: 10.1371/journal.pone.0075531] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/14/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A risk score for invasive mold disease (IMD) in patients with hematological malignancies could facilitate patient screening and improve the targeted use of antifungal prophylaxis. METHODS We retrospectively analyzed 1,709 hospital admissions of 840 patients with hematological malignancies (2005-2008) to collect data on 17 epidemiological and treatment-related risk factors for IMD. Multivariate regression was used to develop a weighted risk score based on independent risk factors associated with proven or probable IMD, which was prospectively validated during 1,746 hospital admissions of 855 patients from 2009-2012. RESULTS Of the 17 candidate variables analyzed, 11 correlated with IMD by univariate analysis, but only 4 risk factors (neutropenia, lymphocytopenia or lymphocyte dysfunction in allogeneic hematopoietic stem cell transplant recipients, malignancy status, and prior IMD) were retained in the final multivariate model, resulting in a weighted risk score 0-13. A risk score of < 6 discriminated patients with low (< 1%) versus higher incidence rates (> 5%) of IMD, with a negative predictive value (NPV) of 0.99, (95% CI 0.98-0.99). During 2009-2012, patients with a calculated risk score at admission of < 6 had significantly lower 90-day incidence rates of IMD compared to patients with scores > 6 (0.9% vs. 10.6%, P <0.001). CONCLUSION An objective, weighted risk score for IMD can accurately discriminate patients with hematological malignancies at low risk for developing mold disease, and could possibly facilitate "screening-out" of low risk patients less likely to benefit from intensive diagnostic monitoring or mold-directed antifungal prophylaxis.
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Affiliation(s)
- Marta Stanzani
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- * E-mail:
| | - Russell E. Lewis
- Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Fiacchini
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Ricci
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabio Tumietto
- Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pierluigi Viale
- Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simone Ambretti
- Operative Unit of Microbiology, Department of Hematology, Oncology and Laboratory Medicine, S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Michele Baccarani
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Michele Cavo
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicola Vianelli
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Development and initial evaluation of electronic Children's International Mucositis Evaluation Scale (eChIMES) for children with cancer. Support Care Cancer 2013; 22:115-9. [PMID: 24000043 DOI: 10.1007/s00520-013-1953-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We previously developed a pediatric-specific measure of oral mucositis named the Children's International Mucositis Evaluation Scale (ChIMES). Availability as an electronic version may improve self-report response rates. The objectives were to develop an electronic version of ChIMES (eChIMES) and to determine whether the instrument is easy to use, understandable, and suitable for measuring mucositis among children and adolescents with cancer. METHODS Development of eChIMES was on an iPad; the initial version was piloted with ten children to refine instructions for use and presentation. A crosssectional study then was conducted and included English-speaking children and adolescents 8-18 years of age receiving active treatment for cancer. Participants were shown eCHIMES and were asked to complete it. Questions elicited whether they found eChIMES easy or difficult to use, easy or difficult to understand, and suitable (a good way) for children with cancer to monitor mucositis. Outcomes were rated using five-point ordinal scales. RESULTS Following the development and initial refinement of eChIMES, 40 children were enrolled. Median age was 12.4 (range, 8.0 to 17.8) years. The instrument was found to be easy or very easy to use and understood by 40 (100 %) and 38 (95 %) participants, respectively. The application was considered suitable or very suitable for measuring mucositis by 37 (92 %). CONCLUSIONS We found that eChIMES was easy to use, understandable, and suitable for monitoring mucositis among children with cancer. Incorporation into clinical trials may improve the ability to compare and evaluate interventions for mucositis.
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Shadad AK, Sullivan FJ, Martin JD, Egan LJ. Gastrointestinal radiation injury: Symptoms, risk factors and mechanisms. World J Gastroenterol 2013; 19:185-98. [PMID: 23345941 PMCID: PMC3547560 DOI: 10.3748/wjg.v19.i2.185] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 03/31/2012] [Accepted: 12/15/2012] [Indexed: 02/06/2023] Open
Abstract
Ionising radiation therapy is a common treatment modality for different types of cancer and its use is expected to increase with advances in screening and early detection of cancer. Radiation injury to the gastrointestinal tract is important factor working against better utility of this important therapeutic modality. Cancer survivors can suffer a wide variety of acute and chronic symptoms following radiotherapy, which significantly reduces their quality of life as well as adding an extra burden to the cost of health care. The accurate diagnosis and treatment of intestinal radiation injury often represents a clinical challenge to practicing physicians in both gastroenterology and oncology. Despite the growing recognition of the problem and some advances in understanding the cellular and molecular mechanisms of radiation injury, relatively little is known about the pathophysiology of gastrointestinal radiation injury or any possible susceptibility factors that could aggravate its severity. The aims of this review are to examine the various clinical manifestations of post-radiation gastrointestinal symptoms, to discuss possible patient and treatment factors implicated in normal gastrointestinal tissue radiosensitivity and to outline different mechanisms of intestinal tissue injury.
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Oton-Leite AF, Elias LSA, Morais MO, Pinezi JCD, Leles CR, Silva MAGS, Mendonça EF. Effect of low level laser therapy in the reduction of oral complications in patients with cancer of the head and neck submitted to radiotherapy. SPECIAL CARE IN DENTISTRY 2012; 33:294-300. [DOI: 10.1111/j.1754-4505.2012.00303.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Khurana H, Pandey RK, Saksena AK, Kumar A. An evaluation of Vitamin E and Pycnogenol in children suffering from oral mucositis during cancer chemotherapy. Oral Dis 2012; 19:456-64. [PMID: 23078515 DOI: 10.1111/odi.12024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/22/2012] [Accepted: 08/27/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the present study was to evaluate and compare the effectiveness of Vitamin E (E) and Pycnogenol (P) in treatment of Chemotherapy-Related Oral Mucositis (ChROM) in children. MATERIALS AND METHODS A total of 72 children, aged between 6 and 15 years, with ChROM were selected and randomly divided into three groups after assessment of oral mucositis (OM) by WHO grading system. Glycerine (control), E, and P were topically applied in group I, II, and III, respectively, and the prognosis of OM was assessed by functional, objective, and subjective parameters. RESULTS Patients of group II and III showed significant improvement when ChROM was analyzed through scoring systems - WHO grading, Oral Mucositis Assessment Scale (OMAS), and Children's International Mucositis Evaluation Scale (ChIMES) as compared to group I (P < 0.001); however, there was no significant difference between groups II and III. CONCLUSION Both the drugs E and P per se are effective for treatment of OM with P being not effective for the treatment of severe mucositis (grade 4). Combination of E and P and additional agents may be tried for better results.
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Affiliation(s)
- H Khurana
- Department of Pedodontics and Preventive Dentistry, Faculty of Dental Sciences, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India
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Yavas C, Yavas G, Acar H, Toy H, Yuce D, Akyurek S, Ata O. Amelioration of radiation-induced acute inflammation and mucosal atrophy by beta-hydroxy-beta-methylbutyrate, L-glutamıne, and L-argınıne: results of an experimental study. Support Care Cancer 2012; 21:883-8. [PMID: 22993027 DOI: 10.1007/s00520-012-1601-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 09/10/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE We aimed to evaluate the effects of β-hydroxy-β-methylbutyrate, L-glutamine, and L-arginine (HMB/Glu/Arg) on radiation-induced acute inflammation and mucosal atrophy in the oral mucosa. METHODS Twenty-eight rats were divided into four groups. group (G) 1 was defined as control group, and G2 was the radiation therapy (RT) group. G3 and G4 were HMB/Glu/Arg control and 17 Gy RT plus HMB/Glu/Arg groups, respectively. A single dose of 17 Gy RT was given to the head and neck area, and the active supplement consisting of 5.2 g of HMB, 29.6 g arginine, and 29.6 g of glutamine which was equivalent to 60 kg adult dose was calculated for each rat and administrated orally. HMB/Glu/Arg started from the day of RT and continued until the animals were sacrificed 7 days after the RT. The extent of acute inflammation and mucosal atrophy for each rat was quantified with image analysis of histological sections of the oral mucosa. RESULTS There were significant differences in terms of epithelial thickness, subepithelial edema, inflammation, and congestion between all groups (p values were <0.001, 0.003, <0.001, and 0.001 for each parameter, respectively). Using HMB/Glu/Arg alone led to hypertrophic changes in the epithelial layer. Moreover, when used with RT, HMB/Glu/Arg reversed radiation-induced epithelial atrophy (p, 0.006) and decreased radiation-induced inflammation at a significant level (p, 0.007). CONCLUSION Concomitant use of HMB/Glu/Arg appears to ameliorate the radiation-induced acute inflammation and mucosal atrophy which represent the early phase of acute oral mucositis; however, this finding should be clarified with further clinical studies.
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Affiliation(s)
- Cagdas Yavas
- Department of Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey
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Better Outcome of Patients Undergoing Enteral Tube Feeding After Myeloablative Conditioning for Allogeneic Stem Cell Transplantation. Transplantation 2012; 94:287-94. [DOI: 10.1097/tp.0b013e3182558f60] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Javed F, Utreja A, Bello Correa FO, Al-Askar M, Hudieb M, Qayyum F, Al-Rasheed A, Almas K, Al-Hezaimi K. Oral health status in children with acute lymphoblastic leukemia. Crit Rev Oncol Hematol 2011; 83:303-9. [PMID: 22137828 DOI: 10.1016/j.critrevonc.2011.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/02/2011] [Accepted: 11/09/2011] [Indexed: 02/08/2023] Open
Abstract
UNLABELLED Leukemia is a malignancy of the bone marrow. Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy and accounts for nearly 75% of all newly diagnosed leukemias and 25% of all malignancies in childhood. The aim of the present study was to review the oral health status in children with ALL. Databases were explored using various combinations of the following keywords: "acute lymphoblastic leukemia", "children", "inflammation", "pediatric", "periodontal disease" and "periodontitis". Oral inflammatory conditions including chelitis, gingivitis, herpetic gingivostomatitis, mucositis, oral candidiasis, periodontitis and ulcerations are common manifestations in children with ALL. RESULTS Periodontal inflammatory conditions and oral mucositis were reported to be significantly higher in children with ALL as compared to healthy controls. Tooth morphological disorders including agenesis, microdontia, short roots and developmental defects in the enamel and dentin were more often observed in children with ALL as compared to healthy controls. Children with ALL have a reduced salivary flow rate, which makes them more susceptible to dental caries as compared to healthy children. Malocclusion due to microdontia may also trigger temporomandibular joint disorders in children with ALL; however, this relationship needs further investigations. CONCLUSION Oral inflammatory conditions including mucositis and gingivitis are common in children with ALL as compared to healthy children. Tooth morphological disorders including microdontia and enamel and dentin are common manifestations in children with ALL.
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Affiliation(s)
- Fawad Javed
- Eng. A.B. Research Chair for Growth Factors and Bone Regeneration, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh, Saudi Arabia.
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Carvalho PAG, Jaguar GC, Pellizzon AC, Prado JD, Lopes RN, Alves FA. Evaluation of low-level laser therapy in the prevention and treatment of radiation-induced mucositis: a double-blind randomized study in head and neck cancer patients. Oral Oncol 2011; 47:1176-81. [PMID: 21911312 DOI: 10.1016/j.oraloncology.2011.08.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 08/23/2011] [Accepted: 08/24/2011] [Indexed: 12/22/2022]
Abstract
The purpose of this prospective study was to determine the effect of the low-level laser in the prevention and treatment of mucositis in head and neck cancer patients. A total of 70 patients with malignant neoplasms in the oral cavity or oropharynx were evaluated. The patients were randomized into two low-level laser therapy groups: Group 1 (660nm/15mW/3.8J/cm(2)/spot size 4mm(2)) or Group 2 (660nm/5mW/1.3J/cm(2)/spot size 4mm(2)) starting on the first day of radiotherapy. Oral mucositis was assessed daily and weekly using the NCI and WHO scales. Oral pain was scored daily with a visual analogue scale before laser application. The patients in Group 1 had a mean time of 13.5days (range 6-26days) to present mucositis grade II, while the patients in Group 2 had a mean time of 9.8days (range 4-14days) (both WHO and NCI p=0.005). In addition, Group 2 also presented a higher mucositis grade than Group 1 with significant differences found in weeks 2 (p=0.019), 3 (p=0.005) and 4 (p=0.003) for WHO scale and weeks 2 (p=0.009) and 4 (p=0.013) for NCI scale. The patients in Group 1 reported lower pain levels (p=0.004). Low-level laser therapy during radiotherapy was found to be effective in controlling the intensity of mucositis and pain.
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Affiliation(s)
- P A G Carvalho
- Stomatology Department - Hospital A.C. Camargo, São Paulo, Brazil
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Oton-Leite AF, Corrêa de Castro AC, Morais MO, Pinezi JCD, Leles CR, Mendonça EF. Effect of intraoral low-level laser therapy on quality of life of patients with head and neck cancer undergoing radiotherapy. Head Neck 2011; 34:398-404. [PMID: 21472883 DOI: 10.1002/hed.21737] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/10/2010] [Accepted: 01/04/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Low-level laser therapy has been used to reduce complications of head and neck cancer treatment. The aim was to assess the impact of laser in the quality of life (QOL) of patients receiving radiotherapy. METHODS Sixty outpatients were randomly assigned into 2 groups. The laser group received applications and the placebo group received sham laser. QOL was assessed using the University of Washington QOL questionnaire. A repeated-measures analysis of variance (ANOVA) was used for comparisons of overall QOL scores and Mann-Whitney test compared changes in domain scores. RESULTS A decrease in QOL scores was observed in both groups and the reduction in the laser group was significantly lower (p < .01). Changes in QOL scores regarding pain, chewing, and saliva domains were evident in the placebo group. Both health-related QOL and overall QOL were rated higher by patients who received laser therapy. CONCLUSION Laser therapy reduces the impact of radiotherapy on the QOL of patients with head and neck cancer.
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A randomized controlled trial of visible-light therapy for the prevention of oral mucositis. Oral Oncol 2011; 47:125-30. [DOI: 10.1016/j.oraloncology.2010.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/16/2010] [Accepted: 11/22/2010] [Indexed: 01/01/2023]
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