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

The efficacy of positioning stents in preventing Oral complications after head and neck radiotherapy: a systematic literature review

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.

A novel method to evaluate salivary flow rates of head and neck cancer patients after radiotherapy: a pilot study

Introduction

The procedure used to evaluate salivary flow rate is called sialometry. It can be performed through several techniques, but none appears to be really efficient for post-radiotherapy patients.

Objective

To adequate sialometry tests for head and neck cancer patients submitted to radiotherapy.

Methods

22 xerostomic patients post-radiotherapy (total radiation dose ranging from 60 to 70 Gy) were included in this study. Ten patients were evaluated using sialometries originally proposed by the Radiation Therapy Oncology Group and twelve were assessed by our modified methods. Unstimulated and stimulated sialometries were performed and the results were classified according a grading scale and compared between both groups.

Results

There was no statistically significant difference between the salivary evaluations of both groups (p = 0.4487 and p = 0.5615). Also, most of these rates were classified as very low and low.

Conclusion

This novel method seems to be suitable for patients submitted to radiotherapy.

Use of Surrogate Samples to Monitor pH During High dose Methotrexate Therapy

High dose methotrexate (Mtx) therapy is commonly used in hemato-oncological practice. Alkalization of urine is a part of high dose methotrexate therapy for preventing crystallization in urine to avert renal insufficiency. Alkalization is monitored by urine pH at regular intervals. Oral pH has occasionally been used as a surrogate for oral mucositis. To compare and correlate pH of various body secretions (venous blood, oral salivary, lacrimal and urine) among patients undergoing alkalization with intravenous sodium bicarbonate during high dose methotrexate therapy. A prospective single center study in patients with hematological malignancies receiving Mtx > 1.5 g/m² over 4-24 h. Patients were assessed for pH (from all 4 body fluids) at regular time intervals (q8 h) starting 6 h-prior and 48 h-post initiation of Mtx therapy. Mean pH of urine/oral was compared to surrogate samples. The mean oral pH was 6.9 (SD 0.65), the mean urinary pH was 7.59 (SD 0.773) the mean pH by venous blood gas analysis (venous pH) was 7.388 (SD 0.059), the mean lacrimal pH was 7.4536 (SD 0.527). Repeated measures ANOVA suggests that pH of different body fluids differ and cannot be used interchangeably [F (2.417, 309.361) = 54.89, p < 0.0005]. There was no statistically significant correlation between any other pair of assessed body fluids. On paired t test only the means of venous pH and urinary pH did not differ statistically (p 0.056). Venous pH significantly correlated with urinary pH but the strength of correlation was weak (r 0.184; p 0.037). pH of different body fluids is statistically different even when sampled simultaneously thus the pH of one fluid cannot be substituted for other. Based on this study we cannot substitute urinary pH with any other body fluids presently in patients undergoing high dose methotrexate and alkalization except in rare circumstances when venous pH can be used as a poor surrogate for urinary pH in situations where urinary pH cannot be monitored due to any reason. There was no surrogate for oral pH among the studied body fluids.

Low-level laser therapy for the prevention of low salivary flow rate after radiotherapy and chemotherapy in patients with head and neck cancer

Objective

To determine whether low-level laser therapy can prevent salivary hypofunction after radiotherapy and chemotherapy in head and neck cancer patients.

Materials and Methods

We evaluated 23 head and neck cancer patients, of whom 13 received laser therapy and 10 received clinical care only. An InGaAlP laser was used intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm² and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7 J/cm², three times per week, on alternate days. Stimulated and unstimulated sialometry tests were performed before the first radiotherapy and chemotherapy sessions (N0) and at 30 days after the end of treatment (N30).

Results

At N30, the mean salivary flow rates were significantly higher among the laser therapy patients than among the patients who received clinical care only, in the stimulated and unstimulated sialometry tests (p = 0.0131 and p = 0.0143, respectively).

Conclusion

Low-level laser therapy, administered concomitantly with radiotherapy and chemotherapy, appears to mitigate treatment-induced salivary hypofunction in patients with head and neck cancer.

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

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

Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer

BACKGROUND

Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing.

METHODS

Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment. Oral mucosa was rated with the Oral Mucositis Assessment Scale. Stimulated whole-mouth saliva, oral pain rating, percent of oral intake, and 2 subscales of the Performance Status Scale for Head and Neck (PSS-HN) cancer were also collected.

RESULTS

Mucositis scores and pain ratings decreased over time while functional measures of eating improved over time. Reduction in chronic mucositis was correlated with improved oral intake and diet.

CONCLUSION

Lack of association with pain was attributed to the absence of ulcerations. Continued impairment of oral intake during the first year posttreatment may be related to oral mucosal changes and other factors.

Xerostomia in head and neck malignancy

Xerostomia (dry mouth) as a consequence of treatment of head and neck malignancy is almost always due to radiotherapy. The resultant salivary gland dysfunction can adversely affect oral and systemic health as well as lessen quality of life. While the present management of radiotherapy-associated salivary dysfunction is challenging there have been striking advances in preventative strategies and a number of possible treatment options may be over the near horizon.