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Nathan CAO, Asarkar AA, Entezami P, Corry J, Strojan P, Poorten VV, Makitie A, Eisbruch A, Robbins KT, Smee R, St John M, Chiesa-Estomba C, Winter SC, Beitler JJ, Ferlito A. Current management of xerostomia in head and neck cancer patients. Am J Otolaryngol 2023; 44:103867. [PMID: 36996514 DOI: 10.1016/j.amjoto.2023.103867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Radiotherapy (RT) continues to play a key role in the management of head and neck cancer (HNC). Xerostomia remains a principal detriment to the quality of life (QoL) for 80 % of surviving patients receiving head and neck radiation. Radiation-induced injury to the salivary glands is dose-dependent, and thus efforts have been focused on decreasing radiation to the salivary glands. Decreased saliva production reduces both short-term and long-term quality of life in head and neck survivors by impacting on taste and contributing to dysphagia. Several radioprotective agents to the salivary gland have been investigated. Although not widely practiced, surgical transfer of the submandibular gland prior to RT is the mainstay of surgical options in preventing xerostomia. This review focuses on the strategies to improve xerostomia following radiation therapy in head and neck cancers.
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Affiliation(s)
- Cherie-Ann O Nathan
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, LA, USA; Otolaryngology Section, Surgical Service, Overton Brooks VA Medical Center, Shreveport, LA, USA.
| | - Ameya A Asarkar
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, LA, USA
| | - Payam Entezami
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, LA, USA; Otolaryngology Section, Surgical Service, Overton Brooks VA Medical Center, Shreveport, LA, USA
| | - June Corry
- Department of Radiation Oncology, Genesiscare St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Antti Makitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - K T Robbins
- Department of Otolaryngology/Head and Neck Surgery, Southern Illinois University, School of Medicine, Springfield, IL, USA
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | - Maie St John
- Department of Otolaryngology/Head and Neck Surgery, UCLA, CA, USA
| | - Carlos Chiesa-Estomba
- Otorhinolaryngology - Head & Neck Department - Donostia University Hospital, Biodonostia Research Institute, Deusto University, Spain
| | - Stuart C Winter
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Kutuk T, McAllister NC, Rzepczynski AE, Williams A, Young G, Crawley MB, Rabinowits G, Kaiser A, Contreras JA, Kalman NS. Submandibular gland transfer for the prevention of radiation-induced xerostomia in oropharyngeal cancer: Dosimetric impact in the intensity modulated radiotherapy era. Head Neck 2022; 44:1213-1222. [PMID: 35243719 DOI: 10.1002/hed.27021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Submandibular gland (SMG) transfer decreased radiation-associated xerostomia in the 2/3-dimensional radiotherapy era. We evaluated the dosimetric implications of SMG transfer on modern intensity modulated radiotherapy (IMRT) plans. METHODS Eighteen oropharynx cancer patients underwent SMG transfer followed by IMRT; reoptimized plans using the baseline SMG location were generated. Mean salivary gland, oral cavity, and larynx doses were compared between clinical plans and reoptimized plans. RESULTS No statistically significant difference in mean SMG dose (27.53 Gy vs. 29.61 Gy) or total salivary gland dose (26.12 Gy vs. 26.41 Gy) was observed with or without SMG transfer (all p > 0.05). Mean oral cavity and larynx doses were not statistically different. Neither tumor site, target volume crossing midline, stage, nor salivary gland volumes were associated with mean doses. CONCLUSIONS Salivary gland doses were similar with or without SMG transfer. IMRT likely decreases the benefit of SMG transfer on the risk of radiation-associated xerostomia.
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Affiliation(s)
- Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Nicole C McAllister
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Amy E Rzepczynski
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Andre Williams
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Geoffrey Young
- Department of Surgical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Meghan B Crawley
- Department of Surgical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Guilherme Rabinowits
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Department of Hematology/Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Jessika A Contreras
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Noah S Kalman
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
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Chen G, Han Y, Zhang H, Tu W, Zhang S. Radiotherapy-Induced Digestive Injury: Diagnosis, Treatment and Mechanisms. Front Oncol 2021; 11:757973. [PMID: 34804953 PMCID: PMC8604098 DOI: 10.3389/fonc.2021.757973] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Radiotherapy is one of the main therapeutic methods for treating cancer. The digestive system consists of the gastrointestinal tract and the accessory organs of digestion (the tongue, salivary glands, pancreas, liver and gallbladder). The digestive system is easily impaired during radiotherapy, especially in thoracic and abdominal radiotherapy. In this review, we introduce the physical classification, basic pathogenesis, clinical characteristics, predictive/diagnostic factors, and possible treatment targets of radiotherapy-induced digestive injury. Radiotherapy-induced digestive injury complies with the dose-volume effect and has a radiation-based organ correlation. Computed tomography (CT), MRI (magnetic resonance imaging), ultrasound (US) and endoscopy can help diagnose and evaluate the radiation-induced lesion level. The latest treatment approaches include improvement in radiotherapy (such as shielding, hydrogel spacers and dose distribution), stem cell transplantation and drug administration. Gut microbiota modulation may become a novel approach to relieving radiogenic gastrointestinal syndrome. Finally, we summarized the possible mechanisms involved in treatment, but they remain varied. Radionuclide-labeled targeting molecules (RLTMs) are promising for more precise radiotherapy. These advances contribute to our understanding of the assessment and treatment of radiation-induced digestive injury.
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Affiliation(s)
- Guangxia Chen
- Department of Gastroenterology, The First People's Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Yi Han
- Department of Gastroenterology, The First People's Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Haihan Zhang
- Department of Gastroenterology, The First People's Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Wenling Tu
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Shuyu Zhang
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China.,West China Second University Hospital, Sichuan University, Chengdu, China
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Jensen SB, Vissink A, Limesand KH, Reyland ME. Salivary Gland Hypofunction and Xerostomia in Head and Neck Radiation Patients. J Natl Cancer Inst Monogr 2020; 2019:5551361. [PMID: 31425600 DOI: 10.1093/jncimonographs/lgz016] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The most manifest long-term consequences of radiation therapy in the head and neck cancer patient are salivary gland hypofunction and a sensation of oral dryness (xerostomia). METHODS This critical review addresses the consequences of radiation injury to salivary gland tissue, the clinical management of salivary gland hypofunction and xerostomia, and current and potential strategies to prevent or reduce radiation injury to salivary gland tissue or restore the function of radiation-injured salivary gland tissue. RESULTS Salivary gland hypofunction and xerostomia have severe implications for oral functioning, maintenance of oral and general health, and quality of life. Significant progress has been made to spare salivary gland function chiefly due to advances in radiation techniques. Other strategies have also been developed, e.g., radioprotectors, identification and preservation/expansion of salivary stem cells by stimulation with cholinergic muscarinic agonists, and application of new lubricating or stimulatory agents, surgical transfer of submandibular glands, and acupuncture. CONCLUSION Many advances to manage salivary gland hypofunction and xerostomia induced by radiation therapy still only offer partial protection since they are often of short duration, lack the protective effects of saliva, or potentially have significant adverse effects. Intensity-modulated radiation therapy (IMRT), and its next step, proton therapy, have the greatest potential as a management strategy for permanently preserving salivary gland function in head and neck cancer patients.Presently, gene transfer to supplement fluid formation and stem cell transfer to increase the regenerative potential in radiation-damaged salivary glands are promising approaches for regaining function and/or regeneration of radiation-damaged salivary gland tissue.
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Affiliation(s)
- Siri Beier Jensen
- Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center, Groningen, The Netherlands
| | | | - Mary E Reyland
- Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
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Chen D, Chen X, Chen X, Jiang N, Jiang L. The efficacy of positioning stents in preventing Oral complications after head and neck radiotherapy: a systematic literature review. Radiat Oncol 2020; 15:90. [PMID: 32345309 PMCID: PMC7189514 DOI: 10.1186/s13014-020-01536-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/14/2020] [Indexed: 02/08/2023] Open
Abstract
Background Positioning stent in head and neck radiotherapy seems to have benefit to prevent oral complications but it hasn’t been summarized by an evidence-based method. Objectives This review aims to evaluate the efficacy of positioning stents in preventing oral complications after radiotherapy. Methods We conducted an electronic search in MEDLINE, EMBASE, Cochrane CDSR, and Cochrane CENTRAL database for randomized-controlled clinical trials, controlled clinical trials and cohort studies that assessed oral complications after head and neck radiotherapy with positioning stents. Two reviewers extracted information on radiotherapy, follow-up period, oral complications and assessments independently. Results Three RCTs and two cohort studies were included in this review. Oral complications such as mucositis, xerostomia, taste alteration, trismus, salivary changes, dysphagia and pain on swallowing were assessed by different methods in these studies. Conclusions Oral complications were common in patients after head and neck radiotherapy. There is insufficient evidence that positioning stents have a preventive effect against xerostomia, and it needs more high-quality and prospective trials with long-term follow-up to support it.
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Affiliation(s)
- Dong Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China.,Department of Endodontic Dentistry, Sichuan University West China Hospital of Stomatology, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China
| | - Xiaoju Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China.,Department of Endodontic Dentistry, Sichuan University West China Hospital of Stomatology, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China
| | - Xinmei Chen
- Department of Endodontic Dentistry, Sichuan University West China Hospital of Stomatology, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China
| | - Nanchuan Jiang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.
| | - Li Jiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China. .,Department of Endodontic Dentistry, Sichuan University West China Hospital of Stomatology, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China.
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Murray S, Chung J, Zhang H, Baker S, Jha N, Scrimger R, Debenham B, Biron V, Harris J, O'Connell D, Seikaly H. Functional outcomes of the modified submandibular gland transfer procedure. Laryngoscope 2020; 130:925-929. [DOI: 10.1002/lary.28039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/26/2019] [Accepted: 04/15/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Scott Murray
- Divisions of Otolaryngology ‐ Head and Neck Surgery, Departments of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Jeffson Chung
- West Virginia University Morgantown West Virginia U.S.A
| | - Han Zhang
- McMaster University Hamilton Ontario Canada
| | - Sarah Baker
- Division of Radiation Oncology, Department of OncologyUniversity of Alberta Edmonton Alberta Canada
| | - Naresh Jha
- Division of Radiation Oncology, Department of OncologyUniversity of Alberta Edmonton Alberta Canada
| | - Rufus Scrimger
- Division of Radiation Oncology, Department of OncologyUniversity of Alberta Edmonton Alberta Canada
| | - Brock Debenham
- Division of Radiation Oncology, Department of OncologyUniversity of Alberta Edmonton Alberta Canada
| | - Vincent Biron
- Divisions of Otolaryngology ‐ Head and Neck Surgery, Departments of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Jeffery Harris
- Divisions of Otolaryngology ‐ Head and Neck Surgery, Departments of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Daniel O'Connell
- Divisions of Otolaryngology ‐ Head and Neck Surgery, Departments of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Hadi Seikaly
- Divisions of Otolaryngology ‐ Head and Neck Surgery, Departments of SurgeryUniversity of Alberta Edmonton Alberta Canada
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8
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Yi J, Li M, Li Y, Li X, Zhao Z. Root resorption during orthodontic treatment with self-ligating or conventional brackets: a systematic review and meta-analysis. BMC Oral Health 2016; 16:125. [PMID: 27871255 PMCID: PMC5117561 DOI: 10.1186/s12903-016-0320-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 11/10/2016] [Indexed: 02/05/2023] Open
Abstract
Background The aim of this study was to compare the external apical root resorption (EARR) in patients receiving fixed orthodontic treatment with self-ligating or conventional brackets. Methods Studies comparing the EARR between orthodontic patients using self-ligating or conventional brackets were identified through electronic search in databases including CENTRAL, PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and SIGLE, and manual search in relevant journals and reference lists of the included studies until Apr 2016. The extraction of data and risk of bias evaluation were conducted by two investigators independently. The original outcome underwent statistical pooling by using Review Manager 5. Results Seven studies were included in the systematic review, out of which, five studies were statistically pooled in meta-analysis. The value of EARR of maxillary central incisors in the self-ligating bracket group was significantly lower than that in the conventional bracket group (SMD −0.31; 95% CI: −0.60–−0.01). No significant differences in other incisors were observed between self−ligating and conventional brackets. Conclusions Current evidences suggest self-ligating brackets do not outperform conventional brackets in reducing the EARR in maxillary lateral incisors, mandible central incisors and mandible lateral incisors. However, self-ligating brackets appear to have an advantage in protecting maxillary central incisor from EARR, which still needs to be confirmed by more high-quality studies.
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Affiliation(s)
- Jianru Yi
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, #14, 3rd Section, South Renmin Road, Chengdu, 610041, People's Republic of China
| | - Meile Li
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, #14, 3rd Section, South Renmin Road, Chengdu, 610041, People's Republic of China
| | - Yu Li
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, #14, 3rd Section, South Renmin Road, Chengdu, 610041, People's Republic of China
| | - Xiaobing Li
- Department of Pediatric Dentistry, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhihe Zhao
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, #14, 3rd Section, South Renmin Road, Chengdu, 610041, People's Republic of China.
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