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Tanna RD, Pattanshetty RB, Ahmed I. Efficacy of matrix rhythm therapy (MaRhyThe©) over conventional therapy on radiation induced trismus-A pilot randomised control trial. J Cancer Res Ther 2024; 20:118-125. [PMID: 38554308 DOI: 10.4103/jcrt.jcrt_1198_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/05/2022] [Indexed: 04/01/2024]
Abstract
BACKGROUND AND OBJECTIVES Prevalence of radiation induced trismus in head and neck cancer (HNC) is 38% to 42% globally. Radiation induced trismus depends on the dosage of the radiation therapy and the surgical procedure. Myofascial release (MFR) and Matrix rhythm therapy (MaRhyThe©) are techniques used to treat the myofascial pain and muscular restriction. The present study aimed to compare the effect of MFR and MaRhyThe© on pain, mouth opening, TMJ disability index (TDI), Gothenburg Trismuus Questionnaire (GTQ), Functional Intraoral Glasgow Scale (FIGS) and quality of life in participants with Radiation induced trismus. MATERIALS AND METHODOLOGY About 30 participants in age group of 18 to 65 years diagnosed with radiation induced trismus were included in the study. All the participants were randomly allocated in 2 groups MFR group and MaRhyThe© group. Both the group received structured exercise program. Primary outcomes were Visual Analogue Scale (VAS), Vernier Caliper reading for maximum mouth opening. Secondary outcome measure viz. GTQ, TDI, FIGS and Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) all obtained values were analyzed at the end of 4th week. RESULTS The present study demonstrated significant improvement in terms of reduction in pain, improvement in maximum mouth opening and in GTQ, TMD, FIGS, and FACT-HN scores in all the participants in both group (p ≤ 0.05). However, the groups showed equal effectiveness in the treatment of radiation induced trismus.
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Affiliation(s)
- Rushil Deepak Tanna
- Departments of Oncology Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India
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Gill G, Lane C, Myers C, Kerr ED, Lambert P, Cooke A, Kerr PD. Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study. J Otolaryngol Head Neck Surg 2022; 51:41. [PMID: 36348384 PMCID: PMC9641961 DOI: 10.1186/s40463-022-00593-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study objectives were: provide longitudinal data on upper aerodigestive tract function and late complications following IMRT for nasopharyngeal carcinoma, and elucidate factors that might predict a worse outcome. The hypotheses were: (1) Despite advances such as IMRT, radiation will cause significant functional decline and late complications that often progress or arise years after treatment. (2) Larger radiation volume will be associated with poorer outcomes. METHODS Longitudinal, observational cohort study of nasopharyngeal carcinoma patients with retrospective analysis of prospectively collected, population-based data. Late sequelae and validated measures of overall performance, speech, and swallowing were documented pre-treatment and 3,6,12, 24, 36 and ≥ 60-months post-treatment. RESULTS Forty-two patients treated curatively with radiation (N = 9) or chemoradiation (N = 33) were followed for a median 74 months. Functional outcomes showed an initial nadir at 3 months associated with acute effects of treatment, followed by initial recovery. There was subsequent functional decline years post-treatment with advancing dysphagia/aspiration, trismus, muscle spasm, and hypoglossal nerve palsy. Univariable regression analysis revealed that increasing high-dose radiation volumes (PTV 70 Gy) were associated with increased likelihood of less than solid diet (Performance Status Scale (PSS)-Normalcy of Diet score < 50; p = 0.04), and reduced PSS-Understandability of Speech (p = 0.005). The probability of poor outcome increased with time. Eleven percent of patients were tube feed dependent at ≥ 5 years. CONCLUSIONS Despite improvements in radiation delivery, late effects of radiation remain common. Higher radiation volumes are associated with poorer outcomes that worsen over time.
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Affiliation(s)
- Gia Gill
- Department of Otolaryngology-Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
| | - Ciaran Lane
- Department of Otolaryngology-Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Candace Myers
- Speech Language Pathology, Department of Psychosocial Oncology, CancerCare Manitoba, Room ON1018, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Evan D Kerr
- Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada
| | - Pascal Lambert
- Department of Epidemiology, CancerCare Manitoba, Room ON-2114, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
- CancerCare Research Institute, CancerCare Manitoba, CancerCare Manitoba Research Institute Office, 675 McDermot Ave, Winnipeg, MB, R4E 0V9, Canada
| | - Andrew Cooke
- Section of Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba, Room GA216, 820 Sherbrook Street, Winnipeg, MB, R3T 2N2, Canada
- Radiation Oncology, CancerCare Manitoba, 820 Sherbrook Street GA216, Winnipeg, MB, R3T 2N2, Canada
| | - Paul D Kerr
- Department of Otolaryngology-Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
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Raj R, Nair AH, Krishnan NA, Balasubramanian D, Iyer S, Thankappan K. Advances and Controversies in the Management of Osteoradionecrosis After Head and Neck Cancer Treatment: A Narrative Review. J Maxillofac Oral Surg 2022; 21:836-844. [PMID: 36274865 PMCID: PMC9475005 DOI: 10.1007/s12663-021-01680-4] [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: 07/17/2021] [Accepted: 12/08/2021] [Indexed: 01/09/2023] Open
Abstract
Osteoradionecrosis (ORN) is a painful and debilitating serious late complication following treatment for head and neck cancer (HNC) often requiring surgical resection of the jaw and complex multidisciplinary management. An important aggravating factor for mandibular ORN is surgical trauma, commonly dental extractions or implant placement following head and neck radiotherapy. The evidence on the treatment protocols ranges from conservative management to more radical surgical strategies including the use of hyperbaric oxygen therapy. The available evidence on the preventive approaches for ORN includes prophylactic dental care prior to radiotherapy, the use of hyperbaric oxygen (HBO) treatment and prophylactic antibiotics for post-radiotherapy extractions. However, the efficacy of hyperbaric oxygen therapy has been questioned recently signifying poor understanding of the pathophysiology of the condition and therapies targeting the fibroatrophic process have become a focus of ORN treatment. Implementing recent IMRT radiation techniques has also shown evidence to reduce the incidence of ORN. This review provides an insight into the variations in definition and classification of the ORN, the controversies in its pathophysiology and the advances in the prevention and management.
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Affiliation(s)
- Radhu Raj
- Department of Prosthodontics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Aarya Haridasan Nair
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041 Kerala India
| | - Nitin Anand Krishnan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041 Kerala India
| | - Deepak Balasubramanian
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041 Kerala India
| | - Subramania Iyer
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041 Kerala India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041 Kerala India
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Shao CH, Chiang CC, Huang TW. Exercise therapy for cancer treatment-induced trismus in patients with head and neck cancer: A systematic review and meta-analysis of randomized controlled trials. Radiother Oncol 2020; 151:249-255. [DOI: 10.1016/j.radonc.2020.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 01/25/2023]
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Raj R, Thankappan K, Janakiram C, Iyer S, Mathew A. Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review. Craniomaxillofac Trauma Reconstr 2020; 13:219-225. [PMID: 33456691 DOI: 10.1177/1943387520917518] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Trismus refers to a person's inability to normally open his or her mouth. Trismus can occur as a symptom due to tumor ingrowth or it can occur postsurgical following the treatment for head and neck cancer. Radiation-induced trismus is also a relatively common oral complication. This review aimed at reviewing the etiopathogenesis of trismus in patients with head and neck cancer. Of the 16 publications included after final screening, of which one was a nonrandomized control trial, one a randomized control trial, 6 prospective cohort studies, and 8 retrospective cohort studies. Among them, 6 articles addressed the possible mechanism for trismus related to tumor ingrowth, 8 articles suggested the likely reason for trismus in patients who had undergone radiation therapy and 2 articles addressed the postsurgical cause for trismus. This review highlights the possible involvement of infratemporal fossa as a predetermining factor for developing trismus related to tumor extension. The molecular mechanism of radiation-induced fibrosis is well studied in the literature.
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Affiliation(s)
- Radhu Raj
- Department of Prosthodontics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Chandrasekhar Janakiram
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Subramania Iyer
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Anil Mathew
- Department of Prosthodontics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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White JM, Panchal NH, Wehler CJ, Bestgen SC, Colón JE, Desai HG, Hogue CM, Marianne Jurasic M, Maritim BC, Ortega AP, Smith GM, Taylor JY, Gibson G. Department of Veterans Affairs Consensus: Preradiation dental treatment guidelines for patients with head and neck cancer. Head Neck 2019; 41:1153-1160. [DOI: 10.1002/hed.25519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/21/2018] [Accepted: 10/09/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jill M. White
- San Francisco Veterans Affairs Medical Center San Francisco California
| | - Neeraj H. Panchal
- Oral and Maxillofacial SurgeryPhiladelphia Veterans Affairs Medical Center Philadelphia Pennsylvania
- Oral and Maxillofacial SurgeryPenn Presbyterian Medical Center Philadelphia Pennsylvania
- Oral and Maxillofacial SurgeryUniversity of Pennsylvania School of Dental Medicine Philadelphia Pennsylvania
| | - Carolyn J. Wehler
- VA Oral Health Quality GroupEdith Nourse Rogers Memorial Veterans Hospital Bedford Massachusetts
- Boston University Henry M. Goldman School of Dental Medicine Boston Massachusetts
| | | | - José E. Colón
- VHACO Office of Dentistry Washington District of Columbia
| | - Hemal G. Desai
- Corporal Michael J Crescenz VAMC Philadelphia Pennsylvania
| | | | - M. Marianne Jurasic
- Boston University Henry M. Goldman School of Dental Medicine Boston Massachusetts
- Oral Health Quality GroupEdith Nourse Rogers Memorial Veterans Hospital Bedford Massachusetts
| | | | | | | | | | - Gretchen Gibson
- Oral Health Quality GroupVeterans Health Care System of the Ozarks Fayetteville Arkansas
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Ghiam MK, Mannion K, Dietrich MS, Stevens KL, Gilbert J, Murphy BA. Assessment of musculoskeletal impairment in head and neck cancer patients. Support Care Cancer 2017; 25:2085-2092. [DOI: 10.1007/s00520-017-3603-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/23/2017] [Indexed: 11/29/2022]
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van der Geer SJ, Kamstra JI, Roodenburg JL, van Leeuwen M, Reintsema H, Langendijk JA, Dijkstra PU. Predictors for trismus in patients receiving radiotherapy. Acta Oncol 2016; 55:1318-1323. [PMID: 27627138 DOI: 10.1080/0284186x.2016.1223341] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Trismus, a restricted mouth opening in head and neck cancer patients may be caused by tumor infiltration in masticatory muscles, radiation-induced fibrosis or scarring after surgery. It may impede oral functioning severely. The aims of our study were to determine: (1) the incidence of trismus at various time points; and (2) the patient, tumor, and treatment characteristics that predict the development of trismus after radiotherapy in head and neck cancer patients using a large database (n = 641). METHODS Maximal mouth opening was measured prior to and 6, 12, 18, 24, 36, and 48 months after radiotherapy. Patient, tumor, and treatment characteristics were analyzed as potential predictors for trismus using a multivariable logistic regression analysis. RESULTS At six months after radiotherapy, 28.1% of the patients without trismus prior to radiotherapy developed trismus for the first time. At subsequent time points the incidence declined. Over a total period of 48 months after radiotherapy, the incidence of trismus was 3.6 per 10 person years at risk. Patients who had tumors located in the oral cavity, oropharynx or nasopharynx, and the salivary glands or ear, and who had a longer overall treatment time of radiotherapy, were more likely to develop trismus in the first six months after radiotherapy. Maximal mouth opening was a predictor for developing trismus at all time points. CONCLUSION Incidence of trismus is 3.6 per 10 person years at risk. Tumor localization and overall treatment time of radiotherapy are predictors for developing trismus the first six months after radiotherapy. Maximal mouth opening is a significant predictor for developing trismus at all time points. Regular measurements of maximal mouth opening are needed to predict trismus.
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Affiliation(s)
- S. Joyce van der Geer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jolanda I. Kamstra
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan L.N. Roodenburg
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marianne van Leeuwen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry Reintsema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes A. Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter U. Dijkstra
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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9
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Rapidis AD, Dijkstra PU, Roodenburg JLN, Rodrigo JP, Rinaldo A, Strojan P, Takes RP, Ferlito A. Trismus in patients with head and neck cancer: etiopathogenesis, diagnosis and management. Clin Otolaryngol 2016; 40:516-26. [PMID: 26098612 DOI: 10.1111/coa.12488] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Trismus indicates severely restricted mouth opening of any aetiology. A mouth opening of 35 mm or less should be regarded as trismus. Aim of this study was to review the etiopathogenesis, incidence, treatment and prevention of trismus in patients with head and neck cancer. OBJECTIVE OF REVIEW Trismus is frequently seen in patients suffering from malignant tumours of the head and neck. The reported prevalence of trismus in those patients varies considerably in the literature and ranges from 0 to 100% depending on the tumour site and extension. Trismus may worsen or remain the same over time, or the symptoms may reduce, even in the absence of treatment. When a patient presents with trismus after tumour treatment, it is important to determine whether the trismus is the result of the treatment, or is the first sign of a recurrence. Restricted mouth opening may impede inspection of the oral cavity as needed for dental care, and particularly for oncologic follow-up. CONCLUSIONS Mouth opening after radiotherapy (RT) decreases on average by approximately 20% compared to mouth opening prior to RT. The prevalence of trismus increases with increasing doses of RT to mastication structures. The use of intensity-modulated RT seems to lower the percentage and severity of RT-induced trismus. Treatment of trismus can be conservative (with either medical or physical therapy) or surgical. Exercise therapy is the mainstay of treatment and exercise should start as soon as possible after treatment. The prevention of trismus, rather than its treatment, is the most important objective.
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Affiliation(s)
- A D Rapidis
- Department of Head and Neck Surgery, Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece
| | - P U Dijkstra
- Center for Rehabilitation & Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J L N Roodenburg
- Department of Oral and Maxillofacial Surgery, Section of Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - A Rinaldo
- University of Udine School of Medicine, Udine, Italy
| | - P Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - R P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Ferlito
- University of Udine School of Medicine, Udine, Italy
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Wu VWC, Lam YN. Radiation-induced temporo-mandibular joint disorder in post-radiotherapy nasopharyngeal carcinoma patients: assessment and treatment. J Med Radiat Sci 2015; 63:124-32. [PMID: 27350892 PMCID: PMC4914809 DOI: 10.1002/jmrs.145] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 09/24/2015] [Accepted: 10/03/2015] [Indexed: 11/30/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is endemic in southern China, and its incidence in Hong Kong is relatively high. Radiotherapy is the mainstay treatment for NPC due to its relatively high radiosensitivity and deep‐seated anatomical position, which is not readily accessible by surgery. Although the technique of radiotherapy in NPC has been advancing and offers promising treatment outcome, complications around the irradiation areas are inevitable and the quality of life of the post‐radiotherapy patients is often compromised. Trismus, which is defined as the restricted mouth opening or jaw movement due to the disorder of temporo‐mandibular joint (TMJ), is one of the possible late complications for radiotherapy of NPC and is found in 5–17% of the post‐radiotherapy (post‐RT) patients. Trismus at early stage may only affect the speech, but in severe cases nutritional intake and oral hygiene condition may deteriorate seriously. This article reviewed the possible causes of radiation‐induced TMJ damage, the various assessments including imaging modalities and possible treatments. The conclusion is that the availability of simple, yet effective examinations for trismus is essential for delaying the progression and restoring TMJ functions. Although there is no absolutely effective treatment for trismus, many supportive, restorative and palliative management are possible under different clinical situations.
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Affiliation(s)
- Vincent W C Wu
- Department of Health Technology and Informatics Hong Kong Polytechnic University Hung Hom, Kowloon Hong Kong
| | - Ying-Na Lam
- Department of Health Technology and Informatics Hong Kong Polytechnic University Hung Hom, Kowloon Hong Kong
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De Felice F, Musio D, Terenzi V, Valentini V, Cassoni A, Tombolini M, De Vincentiis M, Tombolini V. Treatment improvement and better patient care: which is the most important one in oral cavity cancer? Radiat Oncol 2014; 9:263. [PMID: 25479896 PMCID: PMC4263000 DOI: 10.1186/s13014-014-0263-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/15/2014] [Indexed: 11/10/2022] Open
Abstract
Due to substantial improvement in diagnosis and treatment of oral cavity cancer, a better understanding of the patient care needs to be revised. We reviewed literature related to OCC and discussed current general management approaches and related long-term radiation toxicities to emphasize the multidisciplinary team involvement. New technical modalities and patient quality of life parameters should be an integral and paramount state in the clinical evaluation to significantly contribute to reduce secondary side effects.
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Affiliation(s)
- Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy.
| | - Daniela Musio
- Department of Radiotherapy, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy.
| | - Valentina Terenzi
- Department of Maxillofacial Surgery, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy.
| | - Valentino Valentini
- Department of Maxillofacial Surgery, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy.
| | - Andrea Cassoni
- Department of Maxillofacial Surgery, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy.
| | - Mario Tombolini
- Department Organs of Sense, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy.
| | - Marco De Vincentiis
- Department Organs of Sense, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy.
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy. .,Spencer-Lorillard Foundation, Viale Regina Elena 262, 00161, Rome, Italy.
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Mercado CE, Little SB, Mazewski C, Schwaibold FP, Esiashvili N. Mandibular condyle erosion and sclerosis in pediatric patients treated with radiotherapy to the head and neck region. Pediatr Blood Cancer 2014; 61:1479-80. [PMID: 24443276 DOI: 10.1002/pbc.24941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/19/2013] [Indexed: 11/10/2022]
Abstract
Head and neck radiotherapy in children is associated with significant acute and late morbidities. Temporomandibular joint dysfunction and trismus has been widely reported in patients receiving radiotherapy for sarcomas and nasopharyngeal carcinoma; however, erosion of the mandibular condyle is a rare sequela of modern radiotherapy techniques. In this report, we present three cases of erosion of the temporomandibular joint amongst pediatric patients treated with radiotherapy for distinct head, neck and brain malignancies.
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Affiliation(s)
- Catherine E Mercado
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
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Lindblom U, Gärskog O, Kjellén E, Laurell G, Levring Jäghagen E, Wahlberg P, Zackrisson B, Nilsson P. Radiation-induced trismus in the ARTSCAN head and neck trial. Acta Oncol 2014; 53:620-7. [PMID: 24669774 DOI: 10.3109/0284186x.2014.892209] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Trismus, a well-known sequelae after treatment of head and neck cancer, decreases a patient's oral function and quality of life. The main objectives of this study were to: 1) investigate the long-term prevalence of radiation-induced trismus in patients treated for head and neck cancer according to two different fractionation schedules; and 2) model a dose-response relationship for trismus. MATERIAL AND METHODS Patients were recruited from the Swedish ARTSCAN trial, a prospective randomised multicentre study comparing conventional and accelerated fractionation. A total of 124 patients agreed to a clinical ENT examination 21-127 months (median 66 months) after beginning radiation therapy. Trismus-related scores were assessed using the EORTC H&N35 Quality of Life questionnaire. The TheraBite(®) range of motion scale was used to measure maximal interincisal distance. The dose-response relationship for structures important for mastication and the temporomandibular joints was investigated by normal tissue complication probability modelling. RESULTS No significant differences in patient-reported trismus or maximal interincisal distance were found between the two trial arms. Patient-reported moderate to high scores regarding trismus increased from 3% at the start of radiation therapy to 25% at the long-term follow-up. Maximal interincisal distance correlated significantly with patient-reported scores of trismus. The best dose-response fit to the endpoint data was found for the dose to the ipsilateral masseter. CONCLUSIONS Trismus is a persistent complication after radiotherapy with 3D-conformal radiation therapy. We found no difference between the severity and prevalence of trismus between conventional and accelerated fractionation, but a significant correlation between the absorbed dose to the mastication structures and opening of the mouth. Further prospective studies may determine whether a reduced dose to structures important for mastication using intensity-modulated radiation therapy will reduce problems with trismus.
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Affiliation(s)
- Ulrika Lindblom
- Department of Clinical Sciences, Otorhinolaryngology, Lund University , Lund , Sweden
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Loorents V, Rosell J, Karlsson C, Lidbäck M, Hultman K, Börjeson S. Prophylactic training for the prevention of radiotherapy-induced trismus - a randomised study. Acta Oncol 2014; 53:530-8. [PMID: 24635110 DOI: 10.3109/0284186x.2014.892211] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Radiotherapy-induced trismus (RTIT) is a debilitating condition without any proven effective treatment. This study investigates the effectiveness of prophylactic training to prevent RTIT during and up to 12 months after completed RT in patients with head and neck cancer (HNC), also investigating the incidence of RTIT. METHODS Sixty-six consecutive patients from two RT clinics in Sweden were randomised into one of two groups: training with TheraBite(®) Jaw Motion Rehabilitation System(™) or a control group. Maximum interincisal openings (MIO) were recorded at baseline and once a week during treatment, three, six and 12 months after completed RT. Training frequency was recorded by patients in a log book. RESULTS There were no significant differences in MIO between the intervention and control groups at any of the measurement points. Patients in both groups maintained their normal variation in MIO at 12 months after completed RT. A small group of patients in the control group had a 17% mean decrease in MIO by week 6 compared to baseline and improved their MIO by using the training programme. There was a significant mean difference in MIO from baseline to week 6 (3 mm, p = 0.018), and month 6 (2.7 mm, p = 0.040), for patients receiving 3D conformal radiotherapy. There was a significant difference in MIO between patients treated with RT and concurrent chemotherapy compared to patients with RT only at 12 months (p = 0.033). CONCLUSIONS Patients with HNC undergoing high dose RT do not need to be burdened with an intense prophylactic training programme during RT and up to 12 months after completed RT. MIO measurements during RT and up to 12 months after completed RT are recommended to identify a small risk group who are an exception and may need a training programme.
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Affiliation(s)
- Vera Loorents
- Department of Radiation Oncology, County Council of Östergötland,
Linköping, Sweden
| | - Johan Rosell
- Regional Cancer Centre Southeast, County Council of Östergötland,
Linköping, Sweden
| | - Charlott Karlsson
- Department of Oral and Maxillo-Facial Surgery, Ryhov County Hospital,
Jönköping, Sweden
| | - Maria Lidbäck
- Department of Radiation Oncology, Ryhov County Hospital,
Jönköping, Sweden
| | - Kristina Hultman
- Department of Radiation Oncology, County Council of Östergötland,
Linköping, Sweden
| | - Sussanne Börjeson
- Department of Radiation Oncology, County Council of Östergötland,
Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University,
Linköping, Sweden
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Hsieh CH, Shueng PW, Wang LY, Liao LJ, Lin YC, Kuo YS, Lo WC, Tseng CF, Tien HJ, Chou HL, Hsieh YP, Wu LJ, Chen YJ. Clinical effectiveness, toxicity, and failure patterns of helical tomotherapy for postoperative oral cavity cancer patients. Onco Targets Ther 2014; 7:405-14. [PMID: 24648744 PMCID: PMC3956740 DOI: 10.2147/ott.s59998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The outcome of postoperative high- and intermediate-risk oral cavity cancer (OCC) patients receiving helical tomotherapy (HT) remains limited. Materials and methods Between November 2006 and November 2012, 53 postoperative high- and intermediate-risk OCC patients treated with HT were enrolled. Results The 4-year locoregional, local, and regional control rates were 66%, 76.4%, and 94.3%, respectively. The 4-year locoregional control rates of oral tongue and buccal mucosa cancer were 88.3% and 37.1%, respectively (P=0.012). Eleven (20.8%) patients experienced locoregional failure. In-field failure occurred in six of 53 (11.3%) in the primary area and three of 53 (5.7%) in the regional lymph-node area. No marginal failure was noted. Two of 53 (3.8%) experienced out-of-field failure. The rates of grade 3 dermatitis, mucositis, and dysphagia were 11%, 34%, and 13%, respectively. No grade 3 xerostomia was noted. Grade 2 xerostomia was 33% at month 6 and declined to 0 at month 48. A rate of 56% of grade 2 trismus at month 6 was noted, and declined to around 30% after 2 years. No grade 3 trismus was noted after 2 years. Conclusion HT as a postoperative modality provided satisfying results, especially for xerostomia and trismus, and was impressive in high- and intermediate-risk OCC patients receiving postoperative HT.
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Affiliation(s)
- Chen-Hsi Hsieh
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan ; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Wei Shueng
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan ; Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan
| | - Li-Ying Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology, Oriental Institute of Technology, Taipei, Taiwan
| | - Yu-Chin Lin
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Oriental Institute of Technology, Taipei, Taiwan
| | - Ying-Shiung Kuo
- Department of Dentistry and Oral Surgery, Oriental Institute of Technology, Taipei, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology, Oriental Institute of Technology, Taipei, Taiwan
| | - Chien-Fu Tseng
- Department of Dentistry and Oral Surgery, Oriental Institute of Technology, Taipei, Taiwan
| | - Hui-Ju Tien
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Hsiu-Ling Chou
- Department of Nursing, Far Eastern Memorial Hospital, Oriental Institute of Technology, Taipei, Taiwan ; Department of Nursing, Oriental Institute of Technology, Taipei, Taiwan
| | - Yen-Ping Hsieh
- Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Le-Jung Wu
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Yu-Jen Chen
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan ; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan ; Graduate Institute of Sport Coaching Science, Chinese Culture University, Taipei, Taiwan
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16
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Hsieh LC, Chen JW, Wang LY, Tsang YM, Shueng PW, Liao LJ, Lo WC, Lin YC, Tseng CF, Kuo YS, Jhuang JY, Tien HJ, Juan HF, Hsieh CH. Predicting the severity and prognosis of trismus after intensity-modulated radiation therapy for oral cancer patients by magnetic resonance imaging. PLoS One 2014; 9:e92561. [PMID: 24658376 PMCID: PMC3962418 DOI: 10.1371/journal.pone.0092561] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 02/24/2014] [Indexed: 12/15/2022] Open
Abstract
To develop magnetic resonance imaging (MRI) indicators to predict trismus outcome for post-operative oral cavity cancer patients who received adjuvant intensity-modulated radiation therapy (IMRT), 22 patients with oral cancer treated with IMRT were studied over a two-year period. Signal abnormality scores (SA scores) were computed from Likert-type ratings of the abnormalities of nine masticator structures and compared with the Mann-Whitney U-test and Kruskal-Wallis one-way ANOVA test between groups. Seventeen patients (77.3%) experienced different degrees of trismus during the two-year follow-up period. The SA score correlated with the trismus grade (r = 0.52, p<0.005). Patients having progressive trismus had higher mean doses of radiation to multiple structures, including the masticator and lateral pterygoid muscles, and the parotid gland (p<0.05). In addition, this group also had higher SA-masticator muscle dose product at 6 months and SA scores at 12 months (p<0.05). At the optimum cut-off points of 0.38 for the propensity score, the sensitivity was 100% and the specificity was 93% for predicting the prognosis of the trismus patients. The SA score, as determined using MRI, can reflect the radiation injury and correlate to trismus severity. Together with the radiation dose, it could serve as a useful biomarker to predict the outcome and guide the management of trismus following radiation therapy.
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Affiliation(s)
- Li-Chun Hsieh
- Division of Medical Imaging, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Life Science, Institute of Molecular and Cellular Biology, Center for Systems Biology, National Taiwan University, Taipei, Taiwan
- Medical Imaging Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - John W. Chen
- Center for Systems Biology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Massachusetts, United States of America
| | - Li-Ying Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yuk-Ming Tsang
- Division of Medical Imaging, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Yu-Chin Lin
- Div. Medical Oncology and Hematology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Chien-Fu Tseng
- Department of Dentistry and Oral Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Ying-Shiung Kuo
- Department of Dentistry and Oral Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Jie-Yang Jhuang
- Department of Anatomical Pathology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Hui-Ju Tien
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Hsueh-Fen Juan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Medical Imaging Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chen-Hsi Hsieh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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17
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van der Molen L, van Rossum MA, Rasch CRN, Smeele LE, Hilgers FJM. Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer. Eur Arch Otorhinolaryngol 2013; 271:1257-70. [PMID: 23892729 DOI: 10.1007/s00405-013-2640-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/12/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands,
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18
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Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose–effect relationships for swallowing and mastication structures. Radiother Oncol 2013; 106:364-9. [DOI: 10.1016/j.radonc.2013.03.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 02/18/2013] [Accepted: 03/04/2013] [Indexed: 11/17/2022]
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20
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Chen YY, Zhao C, Wang J, Ma HL, Lai SZ, Liu Y, Han F, Lu LX, Bao Y, Chen M. Intensity-modulated radiation therapy reduces radiation-induced trismus in patients with nasopharyngeal carcinoma. Cancer 2011; 117:2910-6. [DOI: 10.1002/cncr.25773] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 10/08/2010] [Accepted: 10/11/2010] [Indexed: 11/11/2022]
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21
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Tang Y, Shen Q, Wang Y, Lu K, Wang Y, Peng Y. A randomized prospective study of rehabilitation therapy in the treatment of radiation-induced dysphagia and trismus. Strahlenther Onkol 2010; 187:39-44. [PMID: 21136031 DOI: 10.1007/s00066-010-2151-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 08/26/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the therapeutic effect of rehabilitation therapy on radiation-induced dysphagia and trismus in nasopharyngeal carcinoma (NPC) patients after radiotherapy. PATIENTS AND METHODS 43 NPC patients after radiotherapy were included. Patients were randomly assigned to either the rehabilitation group or a control group. Both groups were subjected to routine treatment, while the rehabilitation group also received rehabilitation therapy for 3 months. The severity of dysphagia was assessed using the water swallow test, while trismus was evaluated with the LENT/SOMA score and the interincisor distance (IID). The water swallow test, the LENT/SOMA score, as well as IID for both groups before and after treatment were analyzed and compared. RESULTS After treatment, the rehabilitation group displayed a significant improvement in swallowing function, while the control group did not. The efficacy rate (percentage of patients with excellent or effective results) of rehabilitation group was higher than that of control group (77% vs. 43%), and the difference was statistically significant (ϰ(2) = 5.32, p = 0.02). IID pretreatment and posttreatment did not show much difference in the rehabilitation group, while in the control group IID significantly decreased posttreatment (1.1 ± 0.36 cm vs.1.8 ± 0.56 cm, p = 0.001). Although the mean IID in patients of both groups decreased after the 3 month follow-up, the decrease in the rehabilitation group was less than that of the control group (0.19 ± 0.5 cm vs. 0.69 ± 0.56 cm, p = 0.004 ). The efficacy rate of trismus in the rehabilitation group was significantly higher than that of the control group (64% vs. 28%, ϰ(2) = 5.31, p = 0.02). CONCLUSIONS Rehabilitation training can improve swallow function and slow down the progress of trismus in NPC patients following radiotherapy.
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Affiliation(s)
- Y Tang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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22
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Mou YG, Sai K, Wang ZN, Zhang XH, Lu YC, Wei DN, Yang QY, Chen ZP. Surgical management of radiation-induced temporal lobe necrosis in patients with nasopharyngeal carcinoma: report of 14 cases. Head Neck 2010; 33:1493-500. [PMID: 21928423 DOI: 10.1002/hed.21639] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 07/19/2010] [Accepted: 09/06/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Radiation-induced temporal lobe necrosis is a rare and serious late complication in irradiated patients with nasopharyngeal carcinoma (NPC). Treatment of radiation-induced temporal lobe necrosis with surgery has been seldom thoroughly investigated. METHODS We retrospectively analyzed the clinical data of 14 patients with radiation-induced temporal lobe necrosis treated with surgical intervention. RESULTS Radiation-induced temporal lobe necrosis presented as obvious cystic formation or as heterogeneous enhanced nodule on MRI. Among 3 patients with (18)F-fluorodeoxyglucose ((18)F-FDG) PET-CT scan, increased uptake of (18)F-FDG was observed in 2 cases. Four patients were anesthestized nasotracheally and 1 was through tracheostomy during surgery because of other radiation complications, including trismus and skull base osteoradionecrosis. The temporal approach was applied in all cases, with the removal of bone flap in 11 patients. During follow-up, 1 patient died of exhaustion. CONCLUSIONS Surgery benefits selected patients with NPC with radiation-induced temporal lobe necrosis. The goals of surgery are to relieve the increased intracranial pressure and to establish the accurate diagnosis.
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Affiliation(s)
- Yong-gao Mou
- Department of Neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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23
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Jaw dysfunction related to pterygoid and masseter muscle dosimetry after radiation therapy in children and young adults with head-and-neck sarcomas. Int J Radiat Oncol Biol Phys 2010; 82:355-60. [PMID: 21093167 DOI: 10.1016/j.ijrobp.2010.09.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 06/16/2010] [Accepted: 09/07/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the relationship between jaw function, patient and treatment variables, and radiation dosimetry of the mandibular muscles and joints in children and young adults receiving radiation for soft-tissue and bone sarcomas. METHODS AND MATERIALS Twenty-four pediatric and young adult patients with head-and-neck sarcomas were treated on an institutional review board-approved prospective study of focal radiation therapy for local tumor control. Serial jaw depression measurements were related to radiation dosimetry delivered to the medial and lateral pterygoid muscles, masseter muscles, and temporomandibular joints to generate mathematical models of jaw function. RESULTS Baseline jaw depression was only influenced by the degree of surgical resection. In the first 12 weeks from initiation of radiation, surgical procedures greater than a biopsy, administration of cyclophosphamide containing chemotherapy regimes, and large gross tumor volumes adversely affected jaw depression. Increasing dose to the pterygoid and masseter muscles above 40 Gy predicted loss of jaw function over the full course of follow-up. CONCLUSIONS Clinical and treatment factors are related to initial and subsequent jaw dysfunction. Understanding these complex interactions and the affect of specific radiation doses may help reduce the risk for jaw dysfunction in future children and young adults undergoing radiation therapy for the management of soft-tissue and bone sarcomas.
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Kamstra JI, Jager-Wittenaar H, Dijkstra PU, Huisman PM, van Oort RP, van der Laan BFAM, Roodenburg JLN. Oral symptoms and functional outcome related to oral and oropharyngeal cancer. Support Care Cancer 2010; 19:1327-33. [PMID: 20706851 PMCID: PMC3151373 DOI: 10.1007/s00520-010-0952-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 07/12/2010] [Indexed: 11/28/2022]
Abstract
Purpose This study aimed to assess: (1) oral symptoms of patients treated for oral or oropharyngeal cancer; (2) how patients rank the burden of oral symptoms; (3) the impact of the tumor, the treatment, and oral symptoms on functional outcome. Methods Eighty-nine patients treated for oral or oropharyngeal cancer were asked about their oral symptoms related to mouth opening, dental status, oral sensory function, tongue mobility, salivary function, and pain. They were asked to rank these oral symptoms according to the degree of burden experienced. The Mandibular Function Impairment Questionnaire (MFIQ) was used to assess functional outcome. In a multivariate linear regression analyses, variables related to MFIQ scores (p ≤ 0.10) were entered as predictors with MFIQ score as the outcome. Results Lack of saliva (52%), restricted mouth opening (48%), and restricted tongue mobility (46%) were the most frequently reported oral symptoms. Lack of saliva was most frequently (32%) ranked as the most burdensome oral symptom. For radiated patients, an inability to wear a dental prosthesis, a T3 or T4 stage, and a higher age were predictive of MFIQ scores. For non-radiated patients, a restricted mouth opening, an inability to wear a dental prosthesis, restricted tongue mobility, and surgery of the mandible were predictive of MFIQ scores. Conclusions Lack of saliva was not only the most frequently reported oral symptom after treatment for oral or oropharyngeal cancer, but also the most burdensome. Functional outcome is strongly influenced by an inability to wear a dental prosthesis in both radiated and non-radiated patients.
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Affiliation(s)
- Jolanda I Kamstra
- Department of Oral and Maxillofacial Surgery and Special Dentistry, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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A systematic review of trismus induced by cancer therapies in head and neck cancer patients. Support Care Cancer 2010; 18:1033-8. [DOI: 10.1007/s00520-010-0847-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
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BJR review of the year — 2008. Br J Radiol 2009; 82:180-2. [DOI: 10.1259/bjr/22668077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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