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Philipsen BB, Korsholm M, Rohde M, Wessel I, Forner L, Johansen J, Godballe C. The effect of hyperbaric oxygen therapy in head and neck cancer patients with radiation induced dysphagia-a systematic review. Clin Transl Oncol 2024; 26:2594-2600. [PMID: 38704813 DOI: 10.1007/s12094-024-03449-w] [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: 01/06/2024] [Accepted: 03/04/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE The aim of this systematic review was to assess the role of hyperbaric oxygen therapy (HBOT) in patients with dysphagia after radiation therapy for head and neck cancer. METHOD A systematic search was conducted in the electronic databases Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials for relevant studies until March 14, 2023. No restriction on language or publication date. The criteria for inclusion: patients with HNC who had received both radiation therapy and HBOT as 1) a preventive treatment against swallowing difficulties, 2) to preserve swallowing function, or 3) to promote swallowing difficulties. RESULTS We identified 1396 records. After removal of 31 duplicates, 1365 records were accessible for title and abstract screening. This yielded 53 studies for full text assessment. Six studies met the eligibility criteria and were included for qualitative analysis. CONCLUSION Evidence of HBOT benefits in patients with dysphagia after radiation therapy for head and neck cancer is inconsistent. Well-designed studies using validated outcome measures and long-term follow-up are warranted.
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Affiliation(s)
- Bahareh Bakhshaie Philipsen
- Department of ORL - Head & Neck Surgery and Audiology, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Malene Korsholm
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Max Rohde
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Irene Wessel
- Department of ORL Head & Neck Surgery and Audiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lone Forner
- Department Of Oral and Maxillofacial Surgery Oral and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Christian Godballe
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
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2
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Paz C, Glassey A, Frick A, Sattar S, Zaorsky NG, Blitzer GC, Kimple RJ. Cancer therapy-related salivary dysfunction. J Clin Invest 2024; 134:e182661. [PMID: 39225092 PMCID: PMC11364403 DOI: 10.1172/jci182661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Salivary gland dysfunction is a common side effect of cancer treatments. Salivary function plays key roles in critical daily activities. Consequently, changes in salivary function can profoundly impair quality of life for cancer patients. We discuss salivary gland anatomy and physiology to understand how anticancer therapies such as chemotherapy, bone marrow transplantation, immunotherapy, and radiation therapy impair salivary function. We discuss approaches to quantify xerostomia in the clinic, including the advantages and limitations of validated quality-of-life instruments and approaches to directly measuring salivary function. Current and emerging approaches to treat cancer therapy-induced dry mouth are presented using radiation-induced salivary dysfunction as a model. Limitations of current sialagogues and salivary analogues are presented. Emerging approaches, including cellular and gene therapy and novel pharmacologic approaches, are described.
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Affiliation(s)
- Cristina Paz
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Annemarie Glassey
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Abigail Frick
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sarah Sattar
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nicholas G. Zaorsky
- University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Grace C. Blitzer
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Randall J. Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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3
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Mehmet T, Murray A, Mackie C, Heffernan A. Top tips for treating patients with a history of head and neck cancer. Br Dent J 2024; 237:438-441. [PMID: 39333801 DOI: 10.1038/s41415-024-7910-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2024]
Affiliation(s)
- T Mehmet
- CT3 OMFS Perth Royal Infirmary, NHS Tayside, Dundee, UK.
| | | | - C Mackie
- CT2 Special Care Dentistry, Dundee Dental Hospital and School, NHS Tayside, Dundee, UK.
| | - A Heffernan
- Consultant in Special Care Dentistry, Dundee Dental Hospital and School, NHS Tayside, Dundee, UK.
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4
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Ebrahim A, Reich C, Wilde K, Salim AM, Hyrcza MD, Willetts L. A comprehensive analysis of the tubarial glands. Anat Rec (Hoboken) 2024. [PMID: 39180150 DOI: 10.1002/ar.25561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/29/2024] [Accepted: 08/08/2024] [Indexed: 08/26/2024]
Abstract
The tubarial glands (TGs) are a collection of salivary glands (SGs) located within the nasopharynx, proximal to the eustachian tube. Currently, there is no quantitative characterization of the TGs. We investigated the histological architecture of the TGs and compared it with the major and minor SGs for categorization. Tubarial, parotid, submandibular, sublingual, buccal, labial, and lingual glands were excised from human donors (8 male and 3 female). Hematoxylin and eosin-stained tissue sections were analyzed to measure the area of the largest lobule, number of ducts, number of mucinous acini, and mean mucinous acini area. Based on our observation, the TGs' histology resembles the minor SGs, while having some unique characteristics that distinguish them from both major and minor SGs. The area of the largest lobule in the TGs and minor SGs was smaller than the major SGs. TGs have a lower number of ducts than the major and minor SGs. TGs contain densely packed clusters of predominantly mucinous acini surrounded by loose connective tissue resembling minor SGs. This density may explain their previously observed high prostate-specific membrane antigen uptake. In our cohort of donors, sex-based differences were observed in the mean mucinous acini area between male and female TGs, submandibular and sublingual glands. Taken together, our findings suggest the histological characteristics of all SGs are better organized on a spectrum rather than discrete groups (major vs. minor) and provide information to open new avenues for research into the TGs' role in head and neck pathologies and sexual dimorphism of the SGs.
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Affiliation(s)
- Alisha Ebrahim
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Caitlan Reich
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kurt Wilde
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Aly Muhammad Salim
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martin D Hyrcza
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lian Willetts
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cell Biology and Anatomy, University of Calgary, Calgary, Alberta, Canada
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5
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Farhadi M, Fadavi P, Mohebbi S, Taghizadeh-Hesary F. A new approach to prevent radiation-induced xerostomia using intraglandular injection of mitochondria-boosting agents. BMC Cancer 2024; 24:832. [PMID: 38992600 PMCID: PMC11241784 DOI: 10.1186/s12885-024-12582-2] [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: 12/03/2023] [Accepted: 06/30/2024] [Indexed: 07/13/2024] Open
Abstract
Radiotherapy in patients with head and neck cancer fairly leads to xerostomia, profoundly affecting their quality of life. With limited effective preventive and therapeutic methods, attention has turned to exploring alternatives. This article outlines how intraglandular injection of mitochondria-boosting agents can serve as a potential strategy to reduce salivary acinar damage. This method can contribute to the thoughtful development of study protocols or medications to reduce radiation-induced salivary glands damage.
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Affiliation(s)
- Mohammad Farhadi
- ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pedram Fadavi
- Department of Radiation Oncology, Iran University of Medical Sciences, Tehran, Iran
- Breast Health Cancer Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saleh Mohebbi
- Skull Base Research Center, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Taghizadeh-Hesary
- ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Department of Radiation Oncology, Iran University of Medical Sciences, Tehran, Iran.
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6
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Gunning JA, Limesand KH. Chronic Phenotypes Underlying Radiation-Induced Salivary Gland Dysfunction. J Dent Res 2024; 103:778-786. [PMID: 38808518 DOI: 10.1177/00220345241252396] [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] [Indexed: 05/30/2024] Open
Abstract
Head and neck cancer (HNC) is the sixth most diagnosed cancer, and treatment typically consists of surgical removal of the tumor followed by ionizing radiation (IR). While excellent at controlling tumor growth, IR often damages salivary glands due to their proximity to common tumor sites. Radiation damage to salivary glands results in loss of secretory function, causing severe and chronic reductions in salivary flow. This leads to the patient-reported sensation of dry mouth, termed xerostomia, which significantly reduces quality of life for HNC patients and survivors. The mechanisms underlying salivary gland damage remain elusive, and therefore, treatment options are scarce. Available therapies provide temporary symptom relief, but there is no standard of care for permanent restoration of function. There is a significant gap in understanding the chronic mechanistic responses to radiation as well as treatments that can be given in the months to years following cessation of treatment. HNC cases are steadily rising; particularly, the number of young patients diagnosed with nonfatal human papillomavirus + HNC continues to increase. The growing number of HNC diagnoses and improved prognoses results in more people living with xerostomia, which highlights the mounting need for restorative treatments. Mechanisms underlying chronic damage include decreases in acinar differentiation markers, increases in acinar cell proliferation, immune and inflammatory dysregulation, and metabolic changes including increases in amino acids and reductions in glycolysis and oxidative phosphorylation, fibrosis, and dysregulated neuronal responses. Currently, promising treatment options include adenoviral gene transfers and stem cell therapy. Thus, this review describes in depth known mechanisms contributing to chronic damage and discusses therapeutic advances in treating chronically damaged glands. Understanding the chronic response to radiation offers potential in development of new therapeutics to reverse salivary gland damage and improve the quality of life of HNC survivors.
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Affiliation(s)
- J A Gunning
- Department of Nutritional Sciences, The University of Arizona, Tucson, AZ, USA
| | - K H Limesand
- Department of Nutritional Sciences, The University of Arizona, Tucson, AZ, USA
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7
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Bhumitrakul J, Lam-Ubol A, Matangkasombut O. Oral Candida in post-radiotherapy patients with xerostomia/hyposalivation: A narrative review. Oral Dis 2024. [PMID: 38946209 DOI: 10.1111/odi.15060] [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: 01/14/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Head and Neck Cancer (HNC) patients receiving radiotherapy (RT) often suffer from xerostomia and/or hyposalivation. As saliva plays an important antimicrobial and cleansing roles, these patients are at higher risks of opportunistic infections. This narrative review aims to provide an overview of current evidence on oral Candida colonisation and infection in these patients. METHODS A literature review of clinical studies on oral Candida colonisation and candidiasis in HNC patients receiving radiotherapy/chemoradiotherapy was conducted. RESULTS Many clinical studies found high levels of Candida colonisation and a substantial proportion of post-RT HNC patients suffering from oropharyngeal candidiasis (OPC). Importantly, oral Candida could be a reservoir for life-threatening systemic infection in immunocompromised patients. The rising prevalence of non-albicans Candida species and drug-resistant infections has made identification of Candida species and antifungal susceptibility more important. Recent advances in oral microbiome and its interactions with Candida are discussed. This review also offers perspectives on limitations of current evidence and suggestions for future research. CONCLUSION Further research to better understand Candida carriage, microbiome, OPC, and xerostomia/hyposalivation post-RT would aid in devising a more comprehensive long-term management plan and novel therapeutic approaches for HNC patients to achieve the full benefits of RT while minimising side effects.
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Affiliation(s)
- Jom Bhumitrakul
- King's College London GKT School of Medical Education, King's College London, London, UK
| | - Aroonwan Lam-Ubol
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
| | - Oranart Matangkasombut
- Department of Microbiology and Center of Excellence on Oral Microbiology and Immunology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Research Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok, Thailand
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8
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Agurto MG, Bozorgi SS, Carpenter G, Ramirez V, Burke M, Felipe Gutierrez M, Cordova C, Banerjee A. Longitudinal study of the role of salivary proteins on radiation-related caries onset in head and neck cancer patients using 5000 ppm fluoride dentifrice up to one-year post-intensity modulated radiotherapy. Clin Oral Investig 2024; 28:379. [PMID: 38886263 DOI: 10.1007/s00784-024-05788-y] [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: 04/01/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Longitudinal assessment of the role of specific proteins on radiotherapy caries (RC) onset in head and neck cancer patients(HNC) up to one-year post-IMRT using a 5000ppm fluoride paste daily. MATERIALS AND METHODS Dental status/salivary protein data were obtained from 40 HNC patients pre-IMRT, six months (T1) and 12 months (T2) post-IMRT (ethical approval/consent). DMFT/salivary parameters were quantified, including flow rate, mucin 5B/7, Immunoglobulin A (IgA), cystatin S and α-amylase. RESULTS 45% patients had at least one carious lesion at T2, a significant reduction in the number of remaining teeth (65% <21), salivary flow rate (< 50%) and, protein secretion (< 0.05) post-IMRT. T1 IgA concentration/secretion rate was associated with RC (p < 0.05). Finally, IgA and total protein concentration obtained at T1 could provide a predictive pattern (AUC 82.3%) for the patients more predisposed to developing RC at T2. CONCLUSIONS This study demonstrated the significant association of RC with salivary proteins in HNC patients treated with IMRT, revealing the potential role of salivary proteins in the early diagnosis of RC. CLINICAL RELEVANCE This research contributes to revealing salivary proteins association with RC, and its role in early diagnosis. Therefore, this could be the first step towards personalized medicine approaches to improve this group quality-of-life.
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Affiliation(s)
- Maria Gonzalez Agurto
- Universidad de los Andes, Santiago, Chile.
- Faculty of Dentistry, Oral & Craniofacial Sciences, King?s College London, London, UK.
| | - Sophie S Bozorgi
- Faculty of Dentistry, Oral & Craniofacial Sciences, King?s College London, London, UK
| | - Guy Carpenter
- Faculty of Dentistry, Oral & Craniofacial Sciences, King?s College London, London, UK
| | | | - Mary Burke
- Faculty of Dentistry, Oral & Craniofacial Sciences, King?s College London, London, UK
| | | | | | - Avijit Banerjee
- Faculty of Dentistry, Oral & Craniofacial Sciences, King?s College London, London, UK
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9
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Chowdhury P, Velalopoulou A, Verginadis II, Morcos G, Loo PE, Kim MM, Motlagh SAO, Shoniyozov K, Diffenderfer ES, Ocampo EA, Putt M, Assenmacher CA, Radaelli E, Lu J, Qin L, Liu H, Leli NM, Girdhani S, Denef N, Vander Stappen F, Cengel KA, Busch TM, Metz JM, Dong L, Lin A, Koumenis C. Proton FLASH Radiotherapy Ameliorates Radiation-induced Salivary Gland Dysfunction and Oral Mucositis and Increases Survival in a Mouse Model of Head and Neck Cancer. Mol Cancer Ther 2024; 23:877-889. [PMID: 38593239 PMCID: PMC11148539 DOI: 10.1158/1535-7163.mct-23-0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/16/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
Head and neck cancer radiotherapy often damages salivary glands and oral mucosa, severely negatively impacting patients' quality of life. The ability of FLASH proton radiotherapy (F-PRT) to decrease normal tissue toxicity while maintaining tumor control compared with standard proton radiotherapy (S-PRT) has been previously demonstrated for several tissues. However, its potential in ameliorating radiation-induced salivary gland dysfunction and oral mucositis and controlling orthotopic head and neck tumor growth has not been reported. The head and neck area of C57BL/6 mice was irradiated with a single dose of radiotherapy (ranging from 14-18 Gy) or a fractionated dose of 8 Gy × 3 of F-PRT (128 Gy/second) or S-PRT (0.95 Gy/second). Following irradiation, the mice were studied for radiation-induced xerostomia by measuring their salivary flow. Oral mucositis was analyzed by histopathologic examination. To determine the ability of F-PRT to control orthotopic head and neck tumors, tongue tumors were generated in the mice and then irradiated with either F-PRT or S-PRT. Mice treated with either a single dose or fractionated dose of F-PRT showed significantly improved survival than those irradiated with S-PRT. F-PRT-treated mice showed improvement in their salivary flow. S-PRT-irradiated mice demonstrated increased fibrosis in their tongue epithelium. F-PRT significantly increased the overall survival of the mice with orthotopic tumors compared with the S-PRT-treated mice. The demonstration that F-PRT decreases radiation-induced normal tissue toxicity without compromising tumor control, suggests that this modality could be useful for the clinical management of patients with head and neck cancer.
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Affiliation(s)
- Priyanka Chowdhury
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anastasia Velalopoulou
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ioannis I Verginadis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - George Morcos
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Phoebe E Loo
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Stanford University, Stanford, California
| | - Michele M Kim
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seyyedeh Azar Oliaei Motlagh
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Khayrullo Shoniyozov
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric S Diffenderfer
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emilio A Ocampo
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- University of California, Los Angeles, California
| | - Mary Putt
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles-Antoine Assenmacher
- Penn Vet comparative Pathology Core, Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Enrico Radaelli
- Penn Vet comparative Pathology Core, Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jiawei Lu
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ling Qin
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hengxi Liu
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nektaria Maria Leli
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Swati Girdhani
- IBA (Ion Beam Applications S.A.), Ottignies-Louvain-la-Neuve, Belgium
| | - Nicolas Denef
- IBA (Ion Beam Applications S.A.), Ottignies-Louvain-la-Neuve, Belgium
| | | | - Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James M Metz
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lei Dong
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Pillai S, Munguia-Lopez JG, Tran SD. Bioengineered Salivary Gland Microtissues─A Review of 3D Cellular Models and their Applications. ACS APPLIED BIO MATERIALS 2024; 7:2620-2636. [PMID: 38591955 DOI: 10.1021/acsabm.4c00028] [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] [Indexed: 04/10/2024]
Abstract
Salivary glands (SGs) play a vital role in maintaining oral health through the production and release of saliva. Injury to SGs can lead to gland hypofunction and a decrease in saliva secretion manifesting as xerostomia. While symptomatic treatments for xerostomia exist, effective permanent solutions are still lacking, emphasizing the need for innovative approaches. Significant progress has been made in the field of three-dimensional (3D) SG bioengineering for applications in gland regeneration. This has been achieved through a major focus on cell culture techniques, including soluble cues and biomaterial components of the 3D niche. Cells derived from both adult and embryonic SGs have highlighted key in vitro characteristics of SG 3D models. While still in its first decade of exploration, SG spheroids and organoids have so far served as crucial tools to study SG pathophysiology. This review, based on a literature search over the past decade, covers the importance of SG cell types in the realm of their isolation, sourcing, and culture conditions that modulate the 3D microenvironment. We discuss different biomaterials employed for SG culture and the current advances made in bioengineering SG models using them. The success of these 3D cellular models are further evaluated in the context of their applications in organ transplantation and in vitro disease modeling.
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Affiliation(s)
- Sangeeth Pillai
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dental Medicine and Oral Health Sciences, McGill University, 3640 Rue University, Montreal, QC H3A 0C7, Canada
| | - Jose G Munguia-Lopez
- Department of Mining and Materials Engineering, McGill University, 3610 University Street, Montreal, QC H3A 0C5, Canada
| | - Simon D Tran
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dental Medicine and Oral Health Sciences, McGill University, 3640 Rue University, Montreal, QC H3A 0C7, Canada
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11
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Jakobsen KK, Carlander ALF, Todsen T, Melchiors J, Paaske N, Østergaard Madsen AK, Kloch Bendtsen S, Mordhorst C, Stampe H, Kastrup J, Ekblond A, Haack-Sørensen M, Farhadi M, Maare C, Friborg J, Lynggaard CD, Werner Hauge A, Christensen R, Grønhøj C, von Buchwald C. Mesenchymal Stem/Stromal Cell Therapy for Radiation-Induced Xerostomia in Previous Head and Neck Cancer Patients: A Phase II Randomized, Placebo-Controlled Trial. Clin Cancer Res 2024; 30:2078-2084. [PMID: 38441659 PMCID: PMC11094414 DOI: 10.1158/1078-0432.ccr-23-3675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/11/2024] [Accepted: 03/01/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE No effective treatment exists for radiation-induced xerostomia. The objective of this study was to compare the effect of adipose-derived mesenchymal stem/stromal cell (ASC) injection, relative to placebo, on salivary gland function in patients with radiation-induced xerostomia. PATIENT AND METHODS In this single-centre, double-blind, placebo-controlled trial, patients with hyposalivation were randomised to receive ultrasound-guided injections of allogeneic ASCs or placebo into the submandibular glands. Patients were followed for 4 months. We evaluated unstimulated whole salivary flow rate (UWS), stimulated salivary flow rate, and patient-reported outcomes. Adverse events were recorded and immune response determined in blood samples. RESULTS We enrolled 120 patients. ASC treatment resulted in a statistically significant UWS increase of 0.04 [95% confidence interval (CI), 0.02-0.06] mL/min (38%) compared with pretreatment baseline whereas placebo treatment did not cause a significant increase [0.01 (95% CI, -0.01 to 0.04) mL/min (21%)]. Both the ASC and placebo treatment yielded notable symptom reductions, with dry mouth decreasing by 13.6 and 7.7 units, sticky saliva decreased by 14.8 and 9.3 units, swallowing difficulties decreased by 7.9 and 8.0 units, and the summary score of the Xerostomia Questionnaire decreased 5.9 and 5.1 units for the ASC and placebo arms, respectively. We found no statistically significant group difference between the ASC and placebo arms for any of the outcomes. CONCLUSIONS We could not confirm superiority of the ASC relative to placebo. ASC therapy significantly improved UWS in previous patients with head and neck cancer, whereas placebo resulted in an insignificant increase.
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Affiliation(s)
- Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark
| | - Amanda-Louise Fenger Carlander
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Jacob Melchiors
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Natasja Paaske
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Anne Kathrine Østergaard Madsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Simone Kloch Bendtsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Christine Mordhorst
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Helene Stampe
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Jens Kastrup
- Cardiology Stem Cell Centre, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Annette Ekblond
- Cardiology Stem Cell Centre, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Mandana Haack-Sørensen
- Cardiology Stem Cell Centre, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Denmark
| | | | - Christian Maare
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Jeppe Friborg
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Charlotte D. Lynggaard
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Anne Werner Hauge
- Department of Clinical Immunology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Denmark
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Nelson DA, Kazanjian I, Melendez JA, Larsen M. Senescence and fibrosis in salivary gland aging and disease. J Oral Biol Craniofac Res 2024; 14:231-237. [PMID: 38516126 PMCID: PMC10951459 DOI: 10.1016/j.jobcr.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/07/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Salivary gland hypofunction is highly prevalent in aged and diseased individuals leading to significant discomfort and morbidity. One factor that contributes to salivary gland hypofunction is cellular aging, or senescence. Senescent cells can impair gland function by secreting paracrine-acting growth factors and cytokines, known as senescence-associated secretory phenotype (SASP) factors. These SASP factors stimulate inflammation, propagate the senescent phenotype through the bystander effect, and stimulate fibrosis. As senotherapeutics that target senescent cells have shown effectiveness in limiting disease manifestations in other conditions, there is interest in the use of these drugs to treat salivary gland hypofunction. In this review, we highlight the contribution of senescence and fibrosis to salivary gland pathologies. We also discuss therapeutic approaches to eliminate or modulate the senescent SASP phenotype for treating age-related salivary gland diseases and extending health span.
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Affiliation(s)
- Deirdre A. Nelson
- Department of Biological Sciences, University at Albany, State University of New York, Albany, NY, USA
- The RNA Institute, University at Albany, State University of New York, Albany, NY, USA
| | - Isabella Kazanjian
- Department of Educational Theory and Practice, University at Albany, State University of New York, Albany, NY, USA
| | - J. Andres Melendez
- College of Nanotechnology, Science, and Engineering, University at Albany, State University of New York, Albany, NY, USA
| | - Melinda Larsen
- Department of Biological Sciences, University at Albany, State University of New York, Albany, NY, USA
- The RNA Institute, University at Albany, State University of New York, Albany, NY, USA
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13
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Lee YH, Won JH, Auh QS, Noh YK, Lee SW. Prediction of xerostomia in elderly based on clinical characteristics and salivary flow rate with machine learning. Sci Rep 2024; 14:3423. [PMID: 38341514 PMCID: PMC10858905 DOI: 10.1038/s41598-024-54120-x] [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: 11/10/2023] [Accepted: 02/08/2024] [Indexed: 02/12/2024] Open
Abstract
Xerostomia may be accompanied by changes in salivary flow rate and the incidence increases in elderly. We aimed to use machine learning algorithms, to identify significant predictors for the presence of xerostomia. This study is the first to predict xerostomia with salivary flow rate in elderly based on artificial intelligence. In a cross-sectional study, 829 patients with oral discomfort were enrolled, and six features (sex, age, unstimulated and stimulated salivary flow rates (UFR and SFR, respectively), number of systemic diseases, and medication usage) were used in four machine learning algorithms to predict the presence of xerostomia. The incidence of xerostomia increased with age. The SFR was significantly higher than the UFR, and the UFR and SFR were significantly correlated. The UFR, but not SFR, decreased with age significantly. In patients more than 60 years of age, the UFR had a significantly higher predictive accuracy for xerostomia than the SFR. Using machine learning algorithms with tenfold cross-validation, the prediction accuracy increased significantly. In particular, the prediction accuracy of the multilayer perceptron (MLP) algorithm that combined UFR and SFR data was significantly better than either UFR or SFR individually. Moreover, when sex, age, number of systemic diseases, and number of medications were added to the MLP model, the prediction accuracy increased from 56 to 68%.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea.
| | - Jong Hyun Won
- Department of Computer Science, Hanyang University, Seoul, 02455, Korea
| | - Q-Schick Auh
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea
| | - Yung-Kyun Noh
- Department of Computer Science, Hanyang University, Seoul, 02455, Korea
- School of Computational Sciences, Korea Institute for Advanced Study (KIAS), Seoul, 02455, Korea
| | - Sung-Woo Lee
- Department of Oral Medicine and Oral Diagnosis, Seoul National University School of Dentistry, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
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14
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Lopez-Garzon M, López-Fernández MD, Ruíz-Martínez AM, Galván-Banqueri P, Lozano-Lozano M, Tovar-Martín I, Postigo-Martin P, Ariza-Vega P, Artacho-Cordón F, Fernández-Lao C, Cantarero-Villanueva I, Fernández-Gualda MÁ, Arroyo-Morales M, Ruíz-Villaverde R, Galiano-Castillo N. Efficacy of photobiomodulation therapy combined with mobile health education in patients with head and neck cancer suffering from chronic xerostomia after radiotherapy: protocol for a three-arm, randomised, placebo-controlled, double-blinded study. BMJ Open 2024; 14:e078068. [PMID: 38267245 PMCID: PMC10824058 DOI: 10.1136/bmjopen-2023-078068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION The role of photobiomodulation (PBM) therapy for oral tissue damage induced by cancer treatment is currently unclear, and there is low-quality to moderate-quality evidence supporting the use of this approach for treating xerostomia and/or hyposalivation. Consequently, patients with head and neck cancer increasingly turn to basic oral hygiene to alleviate salivary gland dysfunction, and their adherence can be improved by mobile health (mHealth) education. The primary objective of this study will be to analyse the effects of different doses of PBM therapy (7.5 J/cm2 vs 3 J/cm2) plus mHealth education on quality of life (QoL), oral health, salivary secretion and salivary gland ultrasound assessment at postintervention and at the 6-month follow-up in patients with head and neck cancer after radiotherapy compared with those in control group. METHODS AND ANALYSIS A prospective, three-arm, randomised, placebo-controlled, double-blinded study will be conducted among patients with head and neck cancer suffering from chronic xerostomia. A total of 20 patients per arm will be included and randomly assigned to receive 7.5 J/cm2 of PBM, 3 J/cm2 of PBM or placebo therapy. PBM therapy will be applied during 24 sessions at 22 points extra and intraorally two times per week for 3 months, combined with a mobile application (https://www.laxer.es). The assessments will be recorded at the beginning of the study, at postintervention and at the 6-month follow-up. The primary outcomes will be QoL, oral health, salivary secretion and salivary gland ultrasound. The pain pressure threshold, functional performance, mood and sleep quality will be secondary indicators. ETHICS AND DISSEMINATION This study received ethics approval from the Andalusian Biomedical Research Ethics Portal (2402-N-21 CEIM/CEI Provincial de Granada) according to the Declaration of Helsinki for Biomedical Research. The results of this study will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT05106608.
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Affiliation(s)
- Maria Lopez-Garzon
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - María Dolores López-Fernández
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
| | - Alba Maria Ruíz-Martínez
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiation Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pilar Galván-Banqueri
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiation Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Mario Lozano-Lozano
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Isabel Tovar-Martín
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiation Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Paula Postigo-Martin
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Patrocinio Ariza-Vega
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Physical Activity for HEaLth Promotion (PA-HELP), Department of Physical and Sport Education, Sports Sciences Faculty, University of Granada, Granada, Spain
| | - Francisco Artacho-Cordón
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiology and Physical Medicine, Medicine Faculty, University of Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Carolina Fernández-Lao
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Irene Cantarero-Villanueva
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Miguel Ángel Fernández-Gualda
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
| | - Manuel Arroyo-Morales
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Ricardo Ruíz-Villaverde
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Medical Surgical Dermatology and Venereology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Noelia Galiano-Castillo
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
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Ribeiro LN, de Vasconcelos Carvalho M, de Oliveira Limirio JPJ, do Egito Vasconcelos BC, Moraes SLD, Pellizzer EP. Impact of low-level laser therapy on the quality of life of patients with xerostomia undergoing head and neck radiotherapy: a systematic review. Support Care Cancer 2024; 32:118. [PMID: 38244087 DOI: 10.1007/s00520-024-08325-5] [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: 10/02/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE To carry out a systematic review to assess whether low-level laser therapy can improve the quality of life of patients with xerostomia undergoing head and neck radiotherapy. METHODS A systematic search was performed through Embase, Medline/PubMed, Cochrane, Scopus, Web of Science, nonpeer-reviewed clinicaltrials.gov and LILACS. The strategy included clinical studies were selected that prospectively followed or evaluated the quality of life by directly comparing the use of low-level laser therapy for xerostomia induced by head and neck radiotherapy with alternative therapies without the use of a laser. The risk of bias in the studies was assessed by RoB 2.0 and Robins I. RESULTS After all application of the predetermined criteria, four studies were included, dated between the years 2014 and 2023. Three studies described as randomized clinical trials were included, one of which was a randomized pilot study and only one was a prospective clinical trial. A total of 126 patients were evaluated, all four studies used the infrared wavelength, with two studies using the combination with the red wavelength. It was observed that low-level laser therapy can change the sensation of dry mouth, improving patients' quality of life. In addition, changes related to increased stimulated and unstimulated salivary flow were also identified. CONCLUSION The use of low-level laser therapy has promising results on xerostomia, consequently improving the quality of life of patients undergoing radiotherapy in the head and neck region.
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Affiliation(s)
- Lucas Nascimento Ribeiro
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Integrated Anatomic Pathology Center, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | - Marianne de Vasconcelos Carvalho
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Integrated Anatomic Pathology Center, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil.
- Department of Oral and Maxillofacial Pathology, School of Dentistry, University of Pernambuco (UPE), Cícero Monteiro Street, s/n - São Cristóvão, Arcoverde, PE, 56503-146, Brazil.
| | - João Pedro Justino de Oliveira Limirio
- Department of Dental Materials and Prosthodontics, Dental School of Araçatuba, São Paulo State University (UNESP), José Bonifácio Street 1193, Araçatuba, São Paulo, 1605000, Brazil
| | - Belmiro Cavalcanti do Egito Vasconcelos
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | - Sandra Lúcia Dantas Moraes
- Department of Prosthodontics, School of Dentistry, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Dental School of Araçatuba, São Paulo State University (UNESP), José Bonifácio Street 1193, Araçatuba, São Paulo, 1605000, Brazil
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16
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Belfiore E, Di Prima G, Angellotti G, Panzarella V, De Caro V. Plant-Derived Polyphenols to Prevent and Treat Oral Mucositis Induced by Chemo- and Radiotherapy in Head and Neck Cancers Management. Cancers (Basel) 2024; 16:260. [PMID: 38254751 PMCID: PMC10813700 DOI: 10.3390/cancers16020260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Oral Mucositis (OM) is the most common side effect due to chemotherapy and radiotherapy, which are the conventional treatment options for head and neck cancers. OM is a severe inflammatory condition characterized by multifactorial etiopathogenesis. It further negatively affects patients' quality of life by severe impairment of normal oral functions. Consequently, it is mandatory to identify new effective therapeutic approaches to both prevent and treat OM while also avoiding any recurrence. Polyphenols recently attracted the interest of the scientific community due to their low toxicity and wide range of biological activities making them ideal candidates for several applications in the odontostomatological field, particularly against OM. This review collects the in vivo studies and the clinical trials conducted over the past 13 years evaluating the preventive and curative effects of several polyphenolic compounds towards chemo- and radiotherapy-induced OM, both when administered alone or as a plant-extracted phytocomplex. The literature fully confirms the usefulness of these molecules, thus opening the possibility of their clinical application. However, polyphenol limitations (e.g., unfavourable physicochemical properties and susceptibility to degradation) have emerged. Consequently, the interest of the scientific community should be focused on developing innovative delivery systems able to stabilize polyphenols, thus facilitating topical administration and maximizing their efficacy.
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Affiliation(s)
- Elena Belfiore
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy; (E.B.); (V.P.)
| | - Giulia Di Prima
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Via Archirafi 32, 90123 Palermo, Italy;
| | - Giuseppe Angellotti
- Institute of Nanostructured Materials, National Research Council, Via U. La Malfa 153, 90146 Palermo, Italy;
| | - Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy; (E.B.); (V.P.)
| | - Viviana De Caro
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Via Archirafi 32, 90123 Palermo, Italy;
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Rupe C, Basco A, Gioco G, Patini R, Lucchese A, Micciché F, Massaccesi M, Lajolo C. Sodium-hyaluronate mouthwash on radiotherapy-induced xerostomia: a randomised clinical trial. Support Care Cancer 2023; 31:644. [PMID: 37851095 PMCID: PMC10584731 DOI: 10.1007/s00520-023-08090-x] [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: 04/28/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Radiotherapy-induced xerostomia (RIX) is one of the most common adverse effects of radiotherapy (RT) in head and neck cancer patients (HNC) and a major determinant of survivors' quality of life. The primary objective was to evaluate the reduction of patients' xerostomia symptoms after the utilisation of a sodium-hyaluronate mouthwash compared to a placebo solution. The secondary objectives were to evaluate the improvement of quality of life and to evaluate the patients' satisfaction. METHODS The protocol was approved by the ethical committee (Ref. 50,053/19) and registered at ClinicalTrials.gov (ID: NCT05103124). The study was a double-blind randomised clinical trial (RCT) with a crossover design and was conducted at the Fondazione Policlinico Universitario A. Gemelli, Rome. RESULTS Thirty-two patients completed the study protocol. Lower values of the modified Xerostomia Questionnaire (XQ) were retrieved when comparing the baseline scores to the ones after the treatment, when compared with placebo (Mann-Whitney U test = 0.01); higher values of patients' satisfaction (Likert scale) and modified XQ were retrieved for the sodium-hyaluronate mouthwash (Mann-Whitney U test = 0.001). CONCLUSIONS This RCT highlights the advantages of treating RIX with the sodium-hyaluronate mouthwash since it seems to be clinically effective in reducing its symptoms, without any reported adverse events. CLINICALTRIALS gov: NCT05103124 in 17/10/2021.
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Affiliation(s)
- Cosimo Rupe
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Alessia Basco
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Gioele Gioco
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Romeo Patini
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Via Luigi de Crecchio 6, 80138, Naples, Italy
| | - Francesco Micciché
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Institute of Radiology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Mariangela Massaccesi
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Institute of Radiology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Carlo Lajolo
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
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18
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Schütte W, Gütz S, Nehls W, Blum TG, Brückl W, Buttmann-Schweiger N, Büttner R, Christopoulos P, Delis S, Deppermann KM, Dickgreber N, Eberhardt W, Eggeling S, Fleckenstein J, Flentje M, Frost N, Griesinger F, Grohé C, Gröschel A, Guckenberger M, Hecker E, Hoffmann H, Huber RM, Junker K, Kauczor HU, Kollmeier J, Kraywinkel K, Krüger M, Kugler C, Möller M, Nestle U, Passlick B, Pfannschmidt J, Reck M, Reinmuth N, Rübe C, Scheubel R, Schumann C, Sebastian M, Serke M, Stoelben E, Stuschke M, Thomas M, Tufman A, Vordermark D, Waller C, Wolf J, Wolf M, Wormanns D. [Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]. Pneumologie 2023; 77:671-813. [PMID: 37884003 DOI: 10.1055/a-2029-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
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Affiliation(s)
- Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)
| | - Sylvia Gütz
- St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig
| | - Wiebke Nehls
- Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring
| | - Torsten Gerriet Blum
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | - Wolfgang Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord
| | | | - Reinhard Büttner
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin
| | | | - Sandra Delis
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Nikolas Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine
| | | | - Stephan Eggeling
- Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin
| | - Jochen Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg
| | - Nikolaj Frost
- Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin
| | - Frank Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg
| | | | - Andreas Gröschel
- Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster
| | | | | | - Hans Hoffmann
- Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München
| | - Rudolf M Huber
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen
| | - Klaus Junker
- Klinikum Oststadt Bremen, Institut für Pathologie, Bremen
| | - Hans-Ulrich Kauczor
- Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Marcus Krüger
- Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau
| | | | - Miriam Möller
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau
| | - Ursula Nestle
- Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach
| | | | - Joachim Pfannschmidt
- Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Martin Reck
- Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf
| | - Niels Reinmuth
- Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg
| | | | | | - Martin Sebastian
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt
| | - Monika Serke
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | | | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Michael Thomas
- Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle
| | - Cornelius Waller
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg
| | | | - Martin Wolf
- Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel
| | - Dag Wormanns
- Evangelische Lungenklinik, Radiologisches Institut, Berlin
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Sardellitti L, Bortone A, Filigheddu E, Serralutzu F, Milia EP. Xerostomia: From Pharmacological Treatments to Traditional Medicine-An Overview on the Possible Clinical Management and Prevention Using Systemic Approaches. Curr Oncol 2023; 30:4412-4426. [PMID: 37232794 DOI: 10.3390/curroncol30050336] [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: 03/06/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023] Open
Abstract
Despite high incidence rates and severe complications, the management of xerostomia lacks clinical guidelines. The aim of this overview was to summarize the clinical experience derived from the last 10 years of treatments and prevention using systemic compounds. Results showed that the cytoprotective drug amifostine, and its antioxidant agents, are the most discussed as preventive agents of xerostomia in head and neck cancer (HNC) patients. In the presence of the disease, the pharmacological treatments have been mainly directed to stimulate secretion of the damaged salivary glands, or to counteract a decreased capacity of the antioxidant system, in view of an increasing of reactive oxygen species (ROS). However, the data demonstrated low ability of the drugs, together with a great number of side effects, which strongly limit their use. Concerning traditional medicine (TM), valid clinical trials are so limited that neither the efficacy nor the absence of interferences to concomitant chemical therapies can be validated. Consequently, the management of xerostomia and its devastating complications remain a very significant void in daily clinical practice.
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Affiliation(s)
- Luigi Sardellitti
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Dental Unit, Head and Neck Department, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Antonella Bortone
- Dental Unit, Head and Neck Department, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Enrica Filigheddu
- Dental Unit, Head and Neck Department, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Francesca Serralutzu
- Institute for Animal Production Systems in the Mediterranean Environment (ISPAAM)-Section of Sassari, 07100 Sassari, Italy
| | - Egle Patrizia Milia
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Dental Unit, Head and Neck Department, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
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Cell-Free Therapies: The Use of Cell Extracts to Mitigate Irradiation-Injured Salivary Glands. BIOLOGY 2023; 12:biology12020305. [PMID: 36829582 PMCID: PMC9953449 DOI: 10.3390/biology12020305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
Radiotherapy is a standard treatment for head and neck cancer patients worldwide. However, millions of patients who received radiotherapy consequently suffer from xerostomia because of irreversible damage to salivary glands (SGs) caused by irradiation (IR). Current treatments for IR-induced SG hypofunction only provide temporary symptom alleviation but do not repair the damaged SG, thus resulting in limited treatment efficacy. Therefore, there has recently been a growing interest in regenerative treatments, such as cell-free therapies. This review aims to summarize cell-free therapies for IR-induced SG, with a particular emphasis on utilizing diverse cell extract (CE) administrations. Cell extract is a group of heterogeneous mixtures containing multifunctional inter-cellular molecules. This review discusses the current knowledge of CE's components and efficacy. We propose optimal approaches to improve cell extract treatment from multiple perspectives (e.g., delivery routes, preparation methods, and other details regarding CE administration). In addition, the advantages and limitations of CE treatment are systematically discussed by comparing it to other cell-free (such as conditioned media and exosomes) and cell-based therapies. Although a comprehensive identification of the bioactive factors within CEs and their mechanisms of action have yet to be fully understood, we propose cell extract therapy as an effective, practical, user-friendly, and safe option to conventional therapies in IR-induced SG.
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Patni T, Lee CT, Li Y, Kaste S, Zhu L, Sun R, Hudson MM, Ness KK, Neumann A, Robison LL. Factors for poor oral health in long-term childhood cancer survivors. BMC Oral Health 2023; 23:73. [PMID: 36739372 PMCID: PMC9899385 DOI: 10.1186/s12903-023-02762-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/23/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Survivors of childhood cancer are at risk for therapy-related dental diseases. The purpose of the study was to investigate the associations between clinical, socioeconomic, and demographic factors and oral diseases in the St. Jude Lifetime Cohort (SJLIFE) participants. METHODS We performed a retrospective medical chart review and evaluated longitudinal self-reported dental outcomes in 4856 childhood cancer survivors and 591 community controls participating in the St. Jude Lifetime Cohort (SJLIFE) study. Univariate and multivariable logistic regression models were used to assess the impact of socioeconomic factors, treatment exposures and patient demographics on dental outcomes. RESULTS Cancer survivors were more likely to report microdontia (odds ratio (OR) = 7.89, 95% confidence interval (CI) [4.64, 14.90]), abnormal root development (OR = 6.19, CI [3.38, 13.00]), hypodontia (OR = 2.75, CI [1.83, 4.33]), enamel hypoplasia (OR = 4.24, CI [2.9, 6.49]), xerostomia (OR = 7.72, CI [3.27, 25.10]), severe gingivitis (OR = 2.04, CI [1.43, 3.03]), and ≥ 6 missing teeth (OR = 3.73, CI [2.46, 6.00]) compared to controls without cancer history. Survivors who received classic alkylating agents (OR = 1.6, CI [1.36, 1.88]), anthracycline antibiotics (OR = 1.22, CI [1.04, 1.42] or radiation therapy potentially exposing the oral cavity (OR = 1.48, CI [1.26, 1.72]) were more likely to report at least one dental health problem after controlling for socioeconomic factors, age at last follow-up and diagnosis, other treatment exposures, and access to dental services. Survivors who had radiation therapy potentially exposing the oral cavity (OR = 1.52, CI [1.25, 1.84]) were also more likely to report at least one soft tissue abnormality after controlling for socioeconomic factors, age at last follow-up and diagnosis, other treatment exposures, and access and utilization of dental services. CONCLUSIONS Childhood cancer survivors have a higher prevalence of oral-dental abnormalities than the controls without a cancer history. Cancer treatment, socioeconomic factors, and access to oral health care contribute to the prevalence of dental abnormalities.
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Affiliation(s)
- Tushar Patni
- grid.240871.80000 0001 0224 711XDepartment of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA.
| | - Yimei Li
- grid.240871.80000 0001 0224 711XDepartment of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Sue Kaste
- grid.240871.80000 0001 0224 711XDepartment of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Liang Zhu
- grid.267308.80000 0000 9206 2401Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Ryan Sun
- grid.240145.60000 0001 2291 4776Department of Biostatistics, MD Anderson Cancer Center, Houston, TX USA
| | - Melissa M. Hudson
- grid.240871.80000 0001 0224 711XDepartment of Oncology, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Kirsten K. Ness
- grid.240871.80000 0001 0224 711XDepartment of Epidemiology, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Ana Neumann
- grid.267308.80000 0000 9206 2401Department of General Practice and Dental Public Health, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX USA
| | - Leslie L. Robison
- grid.240871.80000 0001 0224 711XDepartment of Epidemiology, St. Jude Children’s Research Hospital, Memphis, TN USA
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Pytel A, Zielińska A, Staś J, Chabowski M. Quality of Life, Psychological Distress, and Nutritional Status of Polish Patients with Head and Neck Cancer Treated with Radiotherapy. J Clin Med 2023; 12:jcm12020659. [PMID: 36675586 PMCID: PMC9862327 DOI: 10.3390/jcm12020659] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Head and neck cancer (HNC) is a global epidemiological and clinical problem. In 2020, it was the seventh most common type of cancer worldwide. In 2019, HNC was the fourth most common cause of cancer death among men in Poland. Radiotherapy plays an important role in the treatment of patients with HNC at all clinical stages. However, it is associated with a significant rate of early and late adverse effects. As head and neck cancers are located close to vital anatomical structures, both the local progression of the disease and the treatments used can cause serious problems for patients with HNC, reducing their health-related quality of life (HRQoL) as well as increasing the risk of depressive disorders. Despite this, the current literature lacks research on these aspects of the therapeutic process in the Polish population. The aim of this study was to assess the early impact of radiotherapy on HRQoL outcomes, psychological distress, nutritional status, and overall performance of patients with HNC. METHODS The study was carried out among 85 patients with HNC treated in the Inpatient Radiotherapy Unit of the Radiotherapy Department of the Lower Silesian Oncology Center in Wrocław. The patients were asked to complete a set of questionnaires, including the EORTC QLQ-H&N35, the BDI, the NRS-2002, and the ECOG scale, at two time points: before the initiation of radiotherapy treatment and after a course of radiotherapy. The period between the assessments was 7 to 8 weeks. RESULTS Our findings demonstrated a negative impact of radiotherapy on scores in all the cancer-specific symptom and functioning scales used in the study. As regards functioning scales, the largest differences were observed for senses and swallowing, whereas with symptoms scales, the largest differences were noted for "sticky saliva" and "dry mouth". Over half of the patients included in the study required nutritional support after radiotherapy treatment. We found statistically significant differences in the levels of depressive symptom severity before and after radiotherapy treatment. CONCLUSION The present study showed significant changes in the physical and psychological functioning and nutritional status of the patients with HNC studied after radiotherapy treatment, which may have an impact on the effectiveness of cancer treatment.
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Affiliation(s)
- Aleksandra Pytel
- Department of Nursing and Obstetrics, Division of Internal Medicine Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wroclaw, Poland
| | - Anna Zielińska
- Lower Silesian Oncology Center, 12 Hirszfeld Square, 53-413 Wroclaw, Poland
| | - Jakub Staś
- Student Research Club No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Mariusz Chabowski
- Department of Nursing and Obstetrics, Division of Anaesthesiological and Surgical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wroclaw, Poland
- Department of Surgery, 4th Military Teaching Hospital, 50-981 Wroclaw, Poland
- Correspondence: ; Tel.: +48-261-660-247; Fax: +48-261-660-245
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Intraglandular mesenchymal stem cell treatment induces changes in the salivary proteome of irradiated patients. COMMUNICATIONS MEDICINE 2022; 2:160. [PMID: 36496530 PMCID: PMC9735277 DOI: 10.1038/s43856-022-00223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hyposalivation and xerostomia (dry mouth), are the leading site-effects to treatment of head and neck cancer. Currently, there are no effective therapies to alleviate radiation-induced hyposalivation. Adipose tissue-derived mesenchymal stem/stromal cells (AT-MSCs) have shown potential for restoring salivary gland function. However, the mode of action is unknown. The purpose of the present study was therefore to characterize the effect of AT-MSC therapy on the salivary proteome in previously irradiated head and neck cancer patients. METHODS Whole saliva was collected from patients with radiation-induced salivary gland hypofunction (n = 8) at baseline, and 120 days after AT-MSC treatment, and from healthy controls (n = 10). The salivary proteome was characterized with mass spectrometry based proteomics, and data was compared within the AT-MSC group (baseline versus day 120) and between AT-MSC group and healthy controls. Significance levels between groups were determined by using double-sided t-test, and visualized by means of principal component analysis, volcano plots and cluster analysis. RESULTS Here we show that 140 human proteins are significantly differentially expressed in saliva from patients with radiation-induced hypofunction versus healthy controls. AT-MSC treatment induce a significant impact on the salivary proteome, as 99 proteins are differentially expressed at baseline vs. 120 days after treatment. However, AT-MSC treatment does not restore healthy conditions, as 212 proteins are significantly differentially expressed in saliva 120 days after AT-MSCs treatment, as compared to healthy controls. CONCLUSION The results indicate an increase in proteins related to tissue regeneration in AT-MSCs treated patients. Our study demonstrates the impact of AT-MSCs on the salivary proteome, thereby providing insight into the potential mode of action of this novel treatment approach.
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Vlachtsis K, Tsetsos N, Sotiroudi S, Stavrakas M, Fyrmpas G, Nikolaou A. Quality of Life After Total Laryngectomy: A Retrospective Study. Indian J Otolaryngol Head Neck Surg 2022; 74:4982-4990. [PMID: 36742759 PMCID: PMC9895551 DOI: 10.1007/s12070-021-02575-z] [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: 02/27/2021] [Accepted: 04/17/2021] [Indexed: 02/07/2023] Open
Abstract
Quality of life is severely affected in laryngeal cancer patients, who have undergone total laryngectomy, particularly with regard to cancer diagnosis and the consequences of total laryngectomy. The aim of the present study is to record and evaluate the problems related with the quality of life in laryngectomized patients. A further goal is to investigate, whether a correlation exists between demographics and clinical characteristics of the patients. Fifty male patients, who underwent total laryngectomy, participated in the study. Two questionnaires were used to test various quality of life parameters, the EORTC QLQ C30 version 3.0 and EORTC QLQ H&N35. Specific demographic and clinical data of the patients were also recorded. The overall quality of life index was similar in both studied patients and the reference group of cancer patients provided by the European Organization for Research and Treatment of Cancer (EORTC). However, the following discrepancies were noted: voice, senses, dyspnoea were more problematic in studied patients, whereas the functional status of cognitive, physical, social and emotional function were better. In most recorded symptoms, the intensity was mild. The demographic and clinical data appeared to have interesting correlations with specific functional aspects and symptoms. Although several quality of life aspects are found to be negatively affected in laryngectomized patients, overall quality of life appears to be satisfactory.
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Affiliation(s)
- Konstantinos Vlachtsis
- Department of Otorhinolaryngology-Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology-Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Sotiria Sotiroudi
- Department of Otorhinolaryngology-Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Marios Stavrakas
- Department of Otorhinolaryngology-Head and Neck Surgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Georgios Fyrmpas
- Department of Otorhinolaryngology-Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Angelos Nikolaou
- Department of Otorhinolaryngology-Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
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Ihara Y, Kato H, Tashimo Y, Iizumi Y, Fukunishi Y, Sato H, Shimane T, Takahashi K. Changes in oral function, swallowing function, and quality of life in patients with head and neck cancer: a prospective cohort study. BMC Oral Health 2022; 22:293. [PMID: 35843950 PMCID: PMC9288711 DOI: 10.1186/s12903-022-02329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Head and neck cancer (HNC) treatment can cause oral morbidities, such as oral dryness and dysphagia, affecting the patient’s quality of life (QOL). The relationship between oral functions and QOL in patients with early-stage HNC remains poorly studied. This study aimed to evaluate changes in the QOL of patients with early-stage HNC and identify factors that affect the QOL of these patients. Methods In this prospective cohort study, 37 patients who underwent early-stage (Stage I/Stage II) HNC treatment were evaluated for their oral function, swallowing function, and the QOL score at baseline (BL) and 12 months after surgical treatment (12 M). The participants were divided into two groups: patients who returned to the BL QOL score at 12 M (RE; n = 26) and those who did not (NR; n = 11). Results In total, 29.7% (11/37) patients with early-stage HNC did not return to the BL QOL score at 12 M. There was no significant difference between the RE and NR groups regarding the oral and swallowing function. Moreover, oral and swallowing function of all patients returned to the BL at 12 M. The NR group showed lower QOL scores than the RE group in the global health status, and “sticky saliva” parameters in the questionnaires. Conclusion Restoration of the oral function is insufficient to improve the QOL of patients with early-stage HNC. The treatment of these patients should instead consider several factors that affect their QOL.
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Uchida H, Ingalls MH, Maruyama EO, Johnston CJ, Hernady E, Faustoferri RC, Ovitt CE. Short-term and bystander effects of radiation on murine submandibular glands. Dis Model Mech 2022; 15:dmm049570. [PMID: 36263624 PMCID: PMC9683099 DOI: 10.1242/dmm.049570] [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: 03/21/2022] [Accepted: 10/13/2022] [Indexed: 11/20/2022] Open
Abstract
Many patients treated for head and neck cancers experience salivary gland hypofunction due to radiation damage. Understanding the mechanisms of cellular damage induced by radiation treatment is important in order to design methods of radioprotection. In addition, it is crucial to recognize the indirect effects of irradiation and the systemic responses that may alter saliva secretion. In this study, radiation was delivered to murine submandibular glands (SMGs) bilaterally, using a 137Cs gamma ray irradiator, or unilaterally, using a small-animal radiation research platform (SARRP). Analysis at 3, 24 and 48 h showed dynamic changes in mRNA and protein expression in SMGs irradiated bilaterally. Unilateral irradiation using the SARRP caused similar changes in the irradiated SMGs, as well as significant off-target, bystander effects in the non-irradiated contralateral SMGs.
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Affiliation(s)
- Hitoshi Uchida
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Matthew H. Ingalls
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Eri O. Maruyama
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Carl J. Johnston
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Eric Hernady
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Roberta C. Faustoferri
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Catherine E. Ovitt
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY 14642USA
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Ivkovic N, Martinovic D, Kozina S, Lupi-Ferandin S, Tokic D, Usljebrka M, Kumric M, Bozic J. Quality of Life and Aesthetic Satisfaction in Patients Who Underwent the “Commando Operation” with Pectoralis Major Myocutaneus Flap Reconstruction—A Case Series Study. Healthcare (Basel) 2022; 10:healthcare10091737. [PMID: 36141349 PMCID: PMC9498799 DOI: 10.3390/healthcare10091737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/01/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
The “commando operation” is an extensive surgical procedure used to treat patients with oral squamous carcinoma and metastasis in the cervical lymph nodes. While the procedure can be curative, it is also very mutilating, which consequently has a major impact on the patient’s quality of life. Several studies showed that the procedure is associated with loss of certain functions, such as impairments in speech, chewing, swallowing, and loss of taste and appetite. Furthermore, some of these impairments and their degree depend on the reconstruction method. However, the data regarding the functional impairments and aesthetic results in patients who underwent the “commando operation” along with the pectoralis major myocutaneus flap reconstruction are still inconclusive. This study included 34 patients that underwent partial glossectomy, ipsilateral modified radical neck dissection, pectoralis major myocutaneus flap reconstruction, and adjuvant radiotherapy. A structured questionnaire was used to evaluate aesthetical results and functional impairments as well as to grade the level of satisfaction with the functional and aesthetic outcomes both by the patients and by the operator. Most of the patients stated that their speech (N = 33; 97%) and salivation (N = 32; 94.2%) severely changed after the operation and that they cannot chew (N = 33; 97%) and swallow (N = 33; 97%) the same as before the operation. Moreover, almost half of the patients (N = 16; 47%) reported that they have severe sleep impairments. However, only few of the included patients stated that they sought professional help regarding the speech (N = 4; 11.7%), eating (N = 5; 14.7%), and sleeping (N = 4; 11.7%) disturbances. Additionally, there was a statistically significant difference between the operator and the patients in the subjective assessment of the aesthetic results (p = 0.047), as operators gave significantly better grades. Our results imply that this procedure and reconstructive method possibly cause impairments that have an impact on the patients’ wellbeing. Moreover, our outcomes also suggest that patients should be educated and rehabilitated after the “commando operation” since most of them were reluctant to seek professional help regarding their impairments. Lastly, sleep deficiency, which was observed after the procedure, should be further explored.
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Affiliation(s)
- Natalija Ivkovic
- Department of Otorhinolaryngology, University Hospital of Split, 21000 Split, Croatia
- Sleep Medicine Center, University of Split School of Medicine, 21000 Split, Croatia
| | - Dinko Martinovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Slavica Kozina
- Department of Psychological Medicine, University of Split School of Medicine, 21000 Split, Croatia
| | - Slaven Lupi-Ferandin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia
| | - Mislav Usljebrka
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21-557-871
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The Quantification of Salivary Flow and pH and Stomatognathic System Rehabilitation Interference in Patients with Oral Diseases, Post-Radiotherapy. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12083708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Xerostomia is a common complication post-radiotherapy in patients with oral cancer. The acute and long-term side effects can considerably reduce the patient’s quality of life. The aim of our study was to perform analysis of salivary flow and pH in patients after radiotherapy. Methodology: Clinical and laboratory evaluations were conducted in the 2014–2019 period; out of a total 58 subjects aged between 45 and 84, 28 individuals with oral cancer were selected from St. Spiridon Hospital, Clinic of Maxillo-facial Surgery and Oncology Hospital, Iasi post-radiotherapy. Results: Significant downsized mean values of the hydrogen ion concentration (pH) in saliva (p < 0.001) were recorded in patients after radiotherapy, pH value = 4.580 (±1.051). The mean value of resting salivary flow (MRSF) was significantly lower for the group of patients with radiotherapy (MRSF) = 0.145 mL/min. In 89.29% of cases (25 post-radiotherapy cases), in order to perform oral complex rehabilitation treatment, several endodontic and periodontal treatments were performed. A total of 78.57% of the cases received complex oral rehabilitation as mobile or hybrid prostheses or fixed solutions. Conclusion: Understanding post-radiotherapy salivary biochemic modifications in patients with oral cancer could be of critical importance, in view of related oral disorder prevention.
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Wu D, Chapela PJ, Barrows CML, Harrington DA, Carson DD, Witt RL, Mohyuddin NG, Pradhan-Bhatt S, Farach-Carson MC. MUC1 and Polarity Markers INADL and SCRIB Identify Salivary Ductal Cells. J Dent Res 2022; 101:983-991. [PMID: 35259994 DOI: 10.1177/00220345221076122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Current treatments for xerostomia/dry mouth are palliative and largely ineffective. A permanent clinical resolution is being developed to correct hyposalivation using implanted hydrogel-encapsulated salivary human stem/progenitor cells (hS/PCs) to restore functional salivary components and increase salivary flow. Pluripotent epithelial cell populations derived from hS/PCs, representing a basal stem cell population in tissue, can differentiate along either secretory acinar or fluid-transporting ductal lineages. To develop tissue-engineered salivary gland replacement tissues, it is critical to reliably identify cells in tissue and as they enter these alternative lineages. The secreted protein α-amylase, the transcription factor MIST1, and aquaporin-5 are typical markers for acinar cells, and K19 is the classical ductal marker in salivary tissue. We found that early ductal progenitors derived from hS/PCs do not express K19, and thus earlier markers were needed to distinguish these cells from acinar progenitors. Salivary ductal cells express distinct polarity complex proteins that we hypothesized could serve as lineage biomarkers to distinguish ductal cells from acinar cells in differentiating hS/PC populations. Based on our studies of primary salivary tissue, both parotid and submandibular glands, and differentiating hS/PCs, we conclude that the apical marker MUC1 along with the polarity markers INADL/PATJ and SCRIB reliably can identify ductal cells in salivary glands and in ductal progenitor populations of hS/PCs being used for salivary tissue engineering. Other markers of epithelial maturation, including E-cadherin, ZO-1, and partition complex component PAR3, are present in both ductal and acinar cells, where they can serve as general markers of differentiation but not lineage markers.
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Affiliation(s)
- D Wu
- Department of Diagnostic and Biomedical Sciences, Center for Craniofacial Research, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA.,Department of Bioengineering, Rice University, Houston, TX, USA
| | - P J Chapela
- Department of BioSciences, Rice University, Houston, TX, USA
| | - C M L Barrows
- Department of Diagnostic and Biomedical Sciences, Center for Craniofacial Research, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA
| | - D A Harrington
- Department of Diagnostic and Biomedical Sciences, Center for Craniofacial Research, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA.,Department of Bioengineering, Rice University, Houston, TX, USA.,Department of BioSciences, Rice University, Houston, TX, USA
| | - D D Carson
- Department of BioSciences, Rice University, Houston, TX, USA
| | - R L Witt
- Department of Biological Sciences, Center for Translational Cancer Biology, University of Delaware, Newark, DE, USA.,Helen F. Graham Cancer Center, Christiana Care Health Systems, Newark, DE, USA
| | - N G Mohyuddin
- Department of Clinical Otolaryngology, Houston Methodist Hospital, Houston, TX, USA
| | - S Pradhan-Bhatt
- Department of Biological Sciences, Center for Translational Cancer Biology, University of Delaware, Newark, DE, USA.,Helen F. Graham Cancer Center, Christiana Care Health Systems, Newark, DE, USA
| | - M C Farach-Carson
- Department of Diagnostic and Biomedical Sciences, Center for Craniofacial Research, University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA.,Department of Bioengineering, Rice University, Houston, TX, USA.,Department of BioSciences, Rice University, Houston, TX, USA
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30
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Parke SC, Langelier DM, Cheng JT, Kline-Quiroz C, Stubblefield MD. State of Rehabilitation Research in the Head and Neck Cancer Population: Functional Impact vs. Impairment-Focused Outcomes. Curr Oncol Rep 2022; 24:517-532. [PMID: 35182293 DOI: 10.1007/s11912-022-01227-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Management of head and neck cancer (HNC) typically involves a morbid combination of surgery, radiation, and systemic therapy. As the number of HNC survivors grows, there is growing interest in rehabilitation strategies to manage HNC-related comorbidity. In this review, we summarize the current state of HNC rehabilitation research. RECENT FINDINGS We have organized our review using the World Health Organization's International Classification of Function (ICF) model of impairment, activity, and participation. Specifically, we describe the current research on rehabilitation strategies to prevent and treat impairments including dysphagia, xerostomia, dysgeusia, dysosmia, odynophagia, trismus, first bite syndrome, dysarthria, dysphonia, lymphedema, shoulder syndrome, cervicalgia, cervical dystonia and dropped head syndrome, deconditioning, and fatigue. We also discuss the broader impact of HNC-related impairment by exploring the state of rehabilitation literature on activity, participation, psychosocial distress, and suicidality in HNC survivors. We demonstrate that research in HNC rehabilitation continues to focus primarily on impairment-driven interventions. There remains a dearth of HNC rehabilitation studies directly examining the impact of rehabilitation interventions on outcomes related to activity and participation. More high-quality interventional studies and reviews are needed to guide prevention and treatment of functional loss in HNC survivors.
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Affiliation(s)
- Sara C Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Arizona, Phoenix, USA.
| | - David Michael Langelier
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre Toronto, Ontario, Canada
| | - Jessica Tse Cheng
- Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, TX, Houston, USA
| | - Cristina Kline-Quiroz
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, TN, Nashville, USA
| | - Michael Dean Stubblefield
- Department of Physical Medicine and Rehabilitation - Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, NJ, 07052, West Orange, USA
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Dubey P, Sertorio M, Takiar V. Therapeutic Advancements in Metal and Metal Oxide Nanoparticle-Based Radiosensitization for Head and Neck Cancer Therapy. Cancers (Basel) 2022; 14:514. [PMID: 35158781 PMCID: PMC8833418 DOI: 10.3390/cancers14030514] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/27/2023] Open
Abstract
Although radiation therapy (RT) is one of the mainstays of head and neck cancer (HNC) treatment, innovative approaches are needed to further improve treatment outcomes. A significant challenge has been to design delivery strategies that focus high doses of radiation on the tumor tissue while minimizing damage to surrounding structures. In the last decade, there has been increasing interest in harnessing high atomic number materials (Z-elements) as nanoparticle radiosensitizers that can also be specifically directed to the tumor bed. Metallic nanoparticles typically display chemical inertness in cellular and subcellular systems but serve as significant radioenhancers for synergistic tumor cell killing in the presence of ionizing radiation. In this review, we discuss the current research and therapeutic efficacy of metal nanoparticle (MNP)-based radiosensitizers, specifically in the treatment of HNC with an emphasis on gold- (AuNPs), gadolinium- (AGdIX), and silver- (Ag) based nanoparticles together with the metallic oxide-based hafnium (Hf), zinc (ZnO) and iron (SPION) nanoparticles. Both in vitro and in vivo systems for different ionizing radiations including photons and protons were reviewed. Finally, the current status of preclinical and clinical studies using MNP-enhanced radiation therapy is discussed.
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Affiliation(s)
- Poornima Dubey
- Department of Radiation Oncology, University of Cincinnati Barrett Cancer Center, 234 Goodman Street, ML 0757, Cincinnati, OH 45267, USA; (P.D.); (M.S.)
- Cincinnati Department of Veterans Affairs (VA) Medical Center, 3200 Vine St., Cincinnati, OH 45220, USA
| | - Mathieu Sertorio
- Department of Radiation Oncology, University of Cincinnati Barrett Cancer Center, 234 Goodman Street, ML 0757, Cincinnati, OH 45267, USA; (P.D.); (M.S.)
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati Barrett Cancer Center, 234 Goodman Street, ML 0757, Cincinnati, OH 45267, USA; (P.D.); (M.S.)
- Cincinnati Department of Veterans Affairs (VA) Medical Center, 3200 Vine St., Cincinnati, OH 45220, USA
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Al-Zubidi N, Page JC, Gombos DS, Srivastava A, Appelbaum E, Gidley PW, Chambers MS, Nader ME. Immune-Related Oral, Otologic, and Ocular Adverse Events. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1342:399-416. [PMID: 34972977 DOI: 10.1007/978-3-030-79308-1_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Emerging immunotherapeutic agents, including immune checkpoint inhibitors targeting cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed cell death protein ligand 1 (PD-L1), have revolutionized cancer treatment. The first immune checkpoint inhibitor (ICI) ipilimumab, an anti-CTLA-4, was approved in 2011. Since then, the US Food and Drug Administration (FDA) has approved more than half a dozen immune checkpoint inhibitors to treat various malignancies. These agents are part of a broader class of chemotherapy agents termed immunotherapy, which selectively target different steps in the immune response cascade to upregulate the body's normal response to cancer. While the effects of traditional chemotherapy are well known, the toxicity profile of emerging immune therapies is not fully elucidated. They have been associated with atypical side effects labeled collectively as immune-related adverse events (irAEs).
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Affiliation(s)
- Nagham Al-Zubidi
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Cody Page
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dan S Gombos
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akanksha Srivastava
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric Appelbaum
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul W Gidley
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark S Chambers
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Martins ML, Leite KLDF, Magno MB, Masterson D, Vicente-Gomila JM, Cavalcanti YW, Maia LC, Fonseca-Gonçalves A. The Xylitol Applicability and its Effects in Health Area Worldwide: A Bibliometric Analysis Based on Randomized Controlled Trials. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lynggaard CD, Grønhøj C, Christensen R, Fischer-Nielsen A, Melchiors J, Specht L, Andersen E, Mortensen J, Oturai P, Barfod GH, Haastrup EK, Møller-Hansen M, Haack-Sørensen M, Ekblond A, Kastrup J, Jensen SB, von Buchwald C. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:478-489. [PMID: 35435231 PMCID: PMC9154319 DOI: 10.1093/stcltm/szac011] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
No effective therapy exists for the most common long-term side effect of radiation therapy for head and neck cancer (HNC)—xerostomia. The objective was to evaluate safety and provide proof of concept for efficacy of allogeneic adipose tissue-derived mesenchymal stem/stromal cells (AT-MSCs) injected into the major salivary glands of irradiated patients. This open-label, first-in-human, phase 1b, and single-center trial was conducted with repeated measurements days 0, 1, 5, and 30 and 4 months. Eligible patients with objective and subjective signs of radiation-induced salivary gland damage after treatment of oropharyngeal squamous cell carcinoma stages I-II (UICC 8) were enrolled. Twenty-five million cryopreserved AT-MSCs were injected into each submandibular and 50 million AT-MSCs into each parotid gland. Data were collected on adverse events, unstimulated and stimulated whole saliva (UWS and SWS) flow rates and saliva composition, patient-reported outcomes (EORTC QLQ-H&N35 and Xerostomia Questionnaire [XQ]), blood samples and salivary gland scintigraphy. Data were analyzed using repeated measures linear mixed models. Ten patients (7 men, 3 women, 59.5 years [range: 45-70]) were treated in 4 glands. No treatment-related serious adverse events occurred. During 4 months, UWS flow rate increased from 0.13 mL/minute at baseline to 0.18 mL/minute with a change of 0.06 (P = .0009) mL/minute. SWS flow rate increased from 0.66 mL/minute at baseline to 0.75 mL/minute with a change of 0.09 (P = .017) mL/minute. XQ summary score decreased by 22.6 units (P = .0004), EORTC QLQ-H&N35 dry mouth domains decreased by 26.7 (P = .0013), sticky saliva 23.3 (P = .0015), and swallowing 10.0 (P = .0016). Our trial suggests treatment of the major salivary glands with allogenic AT-MSCs is safe, warranting confirmation in larger trials.
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Affiliation(s)
- Charlotte Duch Lynggaard
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Corresponding author: Charlotte Duch Lynggaard, MD, PhD Student, Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 8, DK-2100 Copenhagen, Denmark. Tel: +45 6178 4460;
| | - Christian Grønhøj
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Anne Fischer-Nielsen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Melchiors
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lena Specht
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Elo Andersen
- Department of Oncology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jann Mortensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Eva Kannik Haastrup
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Møller-Hansen
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mandana Haack-Sørensen
- Cardiology Stem Cell Centre, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annette Ekblond
- Cardiology Stem Cell Centre, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Kastrup
- Cardiology Stem Cell Centre, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Siri Beier Jensen
- Department of Dentistry and Oral Health, Aarhus University, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Lane C, Myers C, Jiang D, Cooke A, Kerr P. Selected functional outcomes in advanced oral cancer: Comparison of surgery alone versus surgery with postoperative radiotherapy. Head Neck 2021; 44:710-721. [PMID: 34939707 DOI: 10.1002/hed.26968] [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: 04/11/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Study objectives were to determine whether the addition of postoperative radiation (PORT) resulted in a decline in oral function relative to surgery alone and to describe the longitudinal course of oral function following treatment of advanced oral cancer. METHODS This was a 36-month retrospectively analyzed observational cohort study of patients with stage III-IV oral cancer. Prospectively collected, oral functional outcomes were acquired pretreatment and 3, 6, 12, 24, and 36 months post-treatment. RESULTS One hundred and eighteen patients were included. Forty-three patients treated with surgery alone were compared to 75 who received surgery with PORT. Mixed model analysis demonstrated the acute effect of PORT was associated with patient-rated xerostomia (p < 0.001) and the late or persistent effect was associated with decreased clinician-rated eating in public (p = 0.008), understandability of speech (p = 0.02), and normalcy of diet (p = 0.005) compared with surgery alone. There were no differences between surgery alone and PORT groups in clinician-rated feeding tube dependence or patient-rated speech handicap. CONCLUSIONS The use of PORT was associated with a demonstrable decline in oral function in four of six outcomes measures relative to surgery alone.
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Affiliation(s)
- Ciaran Lane
- Department of Otolaryngology - Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Candace Myers
- Section of Communication Disorders, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Deping Jiang
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Cooke
- Department of Radiation Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kerr
- Department of Otolaryngology - Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Tamin S, Adham M, Noer A, Supriana N, Bardosono S. Upright epiglottis prevents aspiration in patients with nasopharyngeal carcinoma post-chemoradiation. PLoS One 2021; 16:e0261110. [PMID: 34882745 PMCID: PMC8659317 DOI: 10.1371/journal.pone.0261110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
NPC is the most widely found malignant tumor in the head and neck region in Indonesia. Chemoradiation therapy for NPC can induce swallowing disorders (dysphagia) that adversely affects a patients quality of life. This study aimed to assess the swallowing process by flexible endoscopic evaluation of swallowing in patients with nasopharyngeal carcinoma after chemoradiation. Thirty-nine patients with NPC who had chemoradiation therapy more than one month previously underwent flexible endoscopic evaluation of swallowing and were assessed for oral transport time, sensation, standing-secretion, pre-swallowing leakage, residue, penetration, aspiration, and silent aspiration. The most common structural abnormalities were an upright and swollen epiglottis (89.4%), poor oral hygiene, and velopharyngeal closure defects (56.4%). This examination also revealed a mild degree of standing secretion (38.5%) and aspiration (10.3%). No penetration was observed in 64.1% of the patients, and no silent aspiration was observed in any of the patients. A severe degree of residue (45.7%) was observed when administering oatmeal, while the residue was mild to moderate when administering gastric rice, crackers, and milk. The residue changed to a mild degree (32.3%-51.4%) in all food administrations after the watering maneuver. The highest penetration was noted after oatmeal administration (42.8%), and the highest aspiration was found after milk administration (8.6%). Standing secretion in almost all patients was caused by hyposensitivity of the hypopharynx. Persistent residue and hyposensitivity of the hypopharynx led to aspiration. The low percentage of aspiration and silent aspiration might have been caused by the upright and swollen epiglottis that prevented aspiration. Poor oral hygiene and a dry mouth led to prolonged oral transport. Therefore, most patients had hypopharyngeal abnormalities in the form of a swollen and upright epiglottis. Secretion and food residue were also detected. Drinking helps to expedite the swallowing process by facilitating oral phase transport and reducing residues.
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Affiliation(s)
- Susyana Tamin
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- * E-mail:
| | - Marlinda Adham
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Arfan Noer
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nana Supriana
- Department of Radio Oncology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Saptawati Bardosono
- Department of Nutrition Science, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Naderi E, Crijns APG, Steenbakkers RJHM, van den Hoek JGM, Boezen HM, Alizadeh BZ, Langendijk JA. A two-stage genome-wide association study of radiation-induced acute toxicity in head and neck cancer. J Transl Med 2021; 19:481. [PMID: 34838041 PMCID: PMC8626989 DOI: 10.1186/s12967-021-03145-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Most head and neck cancer (HNC) patients receive radiotherapy (RT) and develop toxicities. This genome-wide association study (GWAS) was designed to identify single nucleotide polymorphisms (SNPs) associated with common acute radiation-induced toxicities (RITs) in an HNC cohort. METHODS A two-stage GWAS was performed in 1279 HNC patients treated with RT and prospectively scored for mucositis, xerostomia, sticky saliva, and dysphagia. The area under the curve (AUC) was used to estimate the average load of toxicity during RT. At the discovery study, multivariate linear regression was used in 957 patients, and the top-ranking SNPs were tested in 322 independent replication cohort. Next, the discovery and the replication studies were meta-analyzed. RESULTS A region on 5q21.3 containing 16 SNPs showed genome-wide (GW) significance association at P-value < 5.0 × 10-8 with patient-rated acute xerostomia in the discovery study. The top signal was rs35542 with an adjusted effect size of 0.17*A (95% CI 0.12 to 0.23; P-value < = 3.78 × 10-9). The genome wide significant SNPs were located within three genes (EFNA5, FBXL17, and FER). In-silico functional analysis showed these genes may be involved in DNA damage response and co-expressed in minor salivary glands. We found 428 suggestive SNPs (P-value < 1.0 × 10-5) for other toxicities, taken to the replication study. Eleven of them showed a nominal association (P-value < 0.05). CONCLUSIONS This GWAS suggested novel SNPs for patient-rated acute xerostomia in HNC patients. If validated, these SNPs and their related functional pathways could lead to a predictive assay to identify sensitive patients to radiation, which may eventually allow a more individualized RT treatment.
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Affiliation(s)
- Elnaz Naderi
- Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, HPC; DA 30, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands.
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands.
| | - Anne Petra Gerarda Crijns
- Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, HPC; DA 30, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands
| | | | - Johanna Geertruida Maria van den Hoek
- Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, HPC; DA 30, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Hendrika Marike Boezen
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Behrooz Ziad Alizadeh
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes Albertus Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, HPC; DA 30, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands.
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Nam K, Dos Santos HT, Maslow F, Trump BG, Lei P, Andreadis ST, Baker OJ. Laminin-1 Peptides Conjugated to Fibrin Hydrogels Promote Salivary Gland Regeneration in Irradiated Mouse Submandibular Glands. Front Bioeng Biotechnol 2021; 9:729180. [PMID: 34631679 PMCID: PMC8498954 DOI: 10.3389/fbioe.2021.729180] [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: 06/22/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Previous studies demonstrated that salivary gland morphogenesis and differentiation are enhanced by modification of fibrin hydrogels chemically conjugated to Laminin-1 peptides. Specifically, Laminin-1 peptides (A99: CGGALRGDN-amide and YIGSR: CGGADPGYIGSRGAA-amide) chemically conjugated to fibrin promoted formation of newly organized salivary epithelium both in vitro (e.g., using organoids) and in vivo (e.g., in a wounded mouse model). While these studies were successful, the model's usefulness for inducing regenerative patterns after radiation therapy remains unknown. Therefore, the goal of the current study was to determine whether transdermal injection with the Laminin-1 peptides A99 and YIGSR chemically conjugated to fibrin hydrogels promotes tissue regeneration in irradiated salivary glands. Results indicate that A99 and YIGSR chemically conjugated to fibrin hydrogels promote formation of functional salivary tissue when transdermally injected to irradiated salivary glands. In contrast, when left untreated, irradiated salivary glands display a loss in structure and functionality. Together, these studies indicate that fibrin hydrogel-based implantable scaffolds containing Laminin-1 peptides promote secretory function of irradiated salivary glands.
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Affiliation(s)
- Kihoon Nam
- Bond Life Sciences Center, University of Missouri, Columbia, MO, United States.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Harim T Dos Santos
- Bond Life Sciences Center, University of Missouri, Columbia, MO, United States.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Frank Maslow
- Bond Life Sciences Center, University of Missouri, Columbia, MO, United States.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Bryan G Trump
- School of Dentistry, University of Utah, Salt Lake City, UT, United States
| | - Pedro Lei
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Stelios T Andreadis
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States.,Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States.,Center of Bioinformatics and Life Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States.,Center of Cell, Gene and Tissue Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Olga J Baker
- Bond Life Sciences Center, University of Missouri, Columbia, MO, United States.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, MO, United States.,Department of Biochemistry, University of Missouri, Columbia, MO, United States
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Villar CC, Dongari-Bagtzoglou A. Fungal diseases: Oral dysbiosis in susceptible hosts. Periodontol 2000 2021; 87:166-180. [PMID: 34463992 DOI: 10.1111/prd.12378] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The oral cavity is colonized by a large number of microorganisms that are referred to collectively as the oral microbiota. These indigenous microorganisms have evolved in symbiotic relationships with the oral mucosal immune system and are involved in maintaining homeostasis in the oral cavity. Although Candida species are commonly found in the healthy oral cavity without causing infection, these fungi can become pathogenic. Recents advances indicate that the development of oral candidiasis is driven both by Candida albicans overgrowth in a dysbiotic microbiome and by disturbances in the host's immune system. Perturbation of the oral microbiota triggered by host-extrinsic (ie, medications), host-intrinsic (ie, host genetics), and microbiome-intrinsic (ie, microbial interactions) factors may increase the risk of oral candidiasis. In this review, we provide an overview of the oral mycobiome, with a particular focus on the interactions of Candida albicans with some of the most common oral bacteria and the oral mucosal immune system. Also, we present a summary of our current knowledge of the host-intrinsic and host-extrinsic factors that can predispose to oral candidiasis.
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Affiliation(s)
- Cristina Cunha Villar
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Anna Dongari-Bagtzoglou
- Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine, Farmington, CT, USA
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Rahul M, Atif M, Tewari N, Mathur V. Cancer-related radiation therapy in early childhood leading to root abnormality in multiple permanent teeth. BMJ Case Rep 2021; 14:e244770. [PMID: 34413047 PMCID: PMC8378346 DOI: 10.1136/bcr-2021-244770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Morankar Rahul
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Mohammad Atif
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Nitesh Tewari
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Vijay Mathur
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
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Abstract
Abstract
Current therapies for Head and Neck cancer treatment are extremely advanced. Though, they cause oral complications which have deleterious effects on basic life functions, affect oral and overall health, may lead to significant morbidity and treatment discontinuation and have an impact on survivorship and quality of life. As new therapies are introduced, a new spectrum of oral complications is rising, compromising the mucosal integrity and the salivary function, that may not be recognized, reported and treated properly. Oral complications, often permanent and extremely painful, may include mucositis, xerostomia, dysgeusia, infections, trismus and fibrosis, risk of dental disease and necrosis of the jaw, neurosensory disorders and when targeted therapies and immunotherapy are involved, aphthoid and lichenoid lesions can also be reported. Increased awareness is required for the prevention and management of these complications, which can be best provided by a multidisciplinary team.
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Tomasik B, Papis-Ubych A, Stawiski K, Fijuth J, Kędzierawski P, Sadowski J, Stando R, Bibik R, Graczyk Ł, Latusek T, Rutkowski T, Fendler W. Serum MicroRNAs as Xerostomia Biomarkers in Patients With Oropharyngeal Cancer Undergoing Radiation Therapy. Int J Radiat Oncol Biol Phys 2021; 111:1237-1249. [PMID: 34280472 DOI: 10.1016/j.ijrobp.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/05/2021] [Accepted: 07/11/2021] [Indexed: 02/09/2023]
Abstract
PURPOSE Severe xerostomia is noted in the majority of patients irradiated for oropharyngeal cancer. Extracellular microRNAs (miRNAs) may serve as effective tools allowing prediction of radiation-related toxicity. The aim of this study was to create an efficient prognostic miRNA-based test for severe, patient-rated xerostomia 3 months after primary treatment. METHODS AND MATERIALS This prospective study enrolled patients with oropharyngeal cancer treated between 2016 and 2018 in 3 centers in Poland. The primary endpoint was severe (grade ≥3) xerostomia as assessed by the European Organisation for Research and Treatment of Cancer H&N-35 questionnaires. Initially, a group of 10 patients with severe xerostomia was randomly selected and matched with a comparative group of 10 patients without severe xerostomia. Samples were collected before radiation therapy, after receiving 20 Gy, and within 24 hours after treatment completion. Quantitative real-time polymerase chain reaction arrays (QIAGEN, Hilden, Germany) were used to quantify expression levels of 752 miRNAs in the serum at all timepoints. The resulting logistic-regression based model was validated in additional 60 patients: 30 with grade >3 xerostomia and 30 without. RESULTS Of 152 eligible patients, we successfully recruited 111 patients. Severe xerostomia 3 months after treatment was reported by 63 patients (56.8%). Mean dose delivered to parotid glands was higher in both the exploratory and validation cohort. The model based on miR-185-5p and miR-425-5p expression levels measured before the start of radiation therapy had an area under the curve of 0.96 (95% confidence interval, 0.88-1.00). The model based on the same miRNAs remained robust when parameters were measured after 20 Gy (area under the curve 0.90; 95% confidence interval, 0.75-1.00). These results were confirmed in the validation group. In the validation group, preradiation therapy model application yielded 73.3% sensitivity and 80.0% specificity. In the samples taken after 20 Gy, the same 2 miRNAs yielded 67.7% sensitivity and 72.4% specificity. The model including pretreatment miR-185-5p and miR-425-5p levels together with mean parotid dose yielded 90.0% sensitivity and 80.0% specificity. In the validation cohort, this model yielded 80.6% sensitivity and 55.2% specificity. The model based on miRNA levels measured after 20 Gy and mean parotid dose had 80.0% sensitivity and 100% specificity in the exploratory group. In the validation cohort its performance fell to 71.0% sensitivity and 58.6% specificity. CONCLUSIONS Serum expression levels of miR-425-5p and miR-185-5p measured before the start of radiation therapy or during therapy (after 20 Gy) had significant prognostic value for the occurrence of severe xerostomia 3 months after treatment completion. The variability explained by miRNAs appears to be, at least partially, independent from that related to the dosimetric data.
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Affiliation(s)
- Bartłomiej Tomasik
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland; Postgraduate School of Molecular Medicine, Medical University of Warsaw, Poland; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Anna Papis-Ubych
- Department of Radiotherapy, N. Copernicus Memorial Regional Specialist Hospital, Lodz, Poland
| | - Konrad Stawiski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Jacek Fijuth
- Department of Radiotherapy, Medical University of Lodz, Lodz, Poland
| | - Piotr Kędzierawski
- Radiotherapy Department, Holycross Cancer Centre, Kielce, Poland; Jan Kochanowski University, Collegium Medicum, Kielce, Poland
| | - Jacek Sadowski
- Radiotherapy Department, Holycross Cancer Centre, Kielce, Poland
| | - Rafał Stando
- Radiotherapy Department, Holycross Cancer Centre, Kielce, Poland
| | - Robert Bibik
- Department of Radiation Oncology, Oncology Center of Radom, Radom, Poland
| | - Łukasz Graczyk
- Department of Radiation Oncology, Oncology Center of Radom, Radom, Poland
| | - Tomasz Latusek
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Gliwice, Poland
| | - Tomasz Rutkowski
- I Radiation and Clinical Oncology Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Gliwice, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
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Prasad A, Carey RM, Brody RM, Bur AM, Cannady SB, Ojerholm E, Newman JG, Ibrahim S, Brant JA, Rajasekaran K. Postoperative Radiation Therapy Refusal in Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2021; 132:339-348. [PMID: 34254672 DOI: 10.1002/lary.29743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/29/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a distinct clinical entity with good prognosis, unique demographics, and a trend toward treatment deintensification. Patients with this disease may opt out of recommended postoperative radiation therapy (PORT) for a variety of reasons. The aim of this paper was to examine factors that predict patient refusal of recommended PORT in HPV-associated OPSCC, and the association of refusal with overall survival. STUDY DESIGN Retrospective population-based cohort study of patients in the National Cancer Database. METHODS We conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with OPSCC between January 2010 and December 2015. We primarily assessed overall survival and the odds of refusing PORT based on demographic, socioeconomic, and clinical factors. Analysis was conducted using multivariable logistic regression and multivariable Cox proportional hazards model. RESULTS A total of 4229 patients were included in the final analysis, with 156 (3.7%) patients opting out of recommended PORT. On multivariable analysis, patient refusal of PORT was independently associated with a variety of socioeconomic factors such as race, insurance status, comorbidity, treatment at a single facility, and margin status. Lastly, PORT refusal was associated with significantly lower overall survival compared to receipt of recommended PORT (hazard ratio 1.69, confidence interval 1.02-2.82). CONCLUSIONS Patient refusal of recommended PORT in HPV-associated OPSCC is rare and associated with variety of disease and socioeconomic factors. PORT refusal may decrease overall survival in this population. Our findings may help clinicians when counseling patients and identifying those who may be more likely to opt out of recommended adjuvant therapy. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Aman Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Andrés M Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Steven B Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Eric Ojerholm
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.,Department of Radiation Oncology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
| | - Jason G Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Said Ibrahim
- Department of Population Health Sciences, Weill Cornell Medicine, New York City, New York, U.S.A
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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44
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Dosimetric Parameters Predicting Tooth Loss after Carbon Ion Radiotherapy for Head and Neck Tumors. RADIATION 2021. [DOI: 10.3390/radiation1030017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Tooth loss reduces quality of life; however, little is known about tooth loss caused by carbon ion radiotherapy (CIRT). Here, we aimed to elucidate the incidence of tooth loss post-CIRT for head and neck tumors and to identify risk-predictive dosimetric parameters. Methods: This study enrolled 14 patients (i.e., 171 teeth in total) with head and neck non-squamous cell carcinoma. All patients received CIRT comprised of 57.6 or 64.0 Gy (relative biological effectiveness, RBE) in 16 fractions. Dose–volume analysis of the teeth was performed using receiver operating characteristic (ROC) curve analysis with VX (i.e., the volume irradiated with X Gy (RBE)). Results: The median follow-up period was 69.1 months. The median time of tooth loss was 38.6 months. The 5 year cumulative incidence of tooth loss was 13.3%. The volume of irradiated teeth was significantly greater for the lost teeth than for the remaining teeth throughout the dose range. Using the cut-offs calculated from ROC curve analysis, V30–V60 showed high accuracy (i.e., >94%) for predicting tooth loss, with V50 being the most accurate (cut-off, 58.1%; accuracy, 0.95). Conclusions: This is the first report to examine the incidence of tooth loss post-CIRT and to identify risk-predictive dosimetric parameters.
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Chiu YH, Tseng WH, Ko JY, Wang TG. Radiation-induced swallowing dysfunction in patients with head and neck cancer: A literature review. J Formos Med Assoc 2021; 121:3-13. [PMID: 34246510 DOI: 10.1016/j.jfma.2021.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/28/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Swallowing dysfunction is a prevailing state following radiotherapy in patients with head and neck cancer. Following the advancement of cancer treatment in recent years, the survival rate of head and neck cancer has gradually increased. Simultaneously, patients with head and neck cancer suffer due to the long-duration and more prominent swallowing dysfunction states. Based on an extensive literature review, we aimed to explore the mechanisms, risk factors, and clinical evaluations of swallowing dysfunction and their related symptoms following radiotherapy. These include functional changes of the muscles, trismus, xerostomia, neuropathy, and lymphedema. When swallowing dysfunction occurs, patients usually seek medical help and are referred for rehabilitation therapy, such as muscle strengthening and tongue resistance exercise. Furthermore, clinicians should discuss with patients how and when to place the feeding tube. Only through detailed evaluation and management can swallowing dysfunction resolve and improve the quality of life of patients with head and neck cancer following radiotherapy.
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Affiliation(s)
- Yi-Hsiang Chiu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Charalambous M, Papakyriacou C, Tsitsi T, Katodritis N, Vomvas D, Charalambous A. The evaluation of the reliability and validity properties of the Greek version of the xerostomia questionnaire (ΧQ). Eur J Oncol Nurs 2021; 52:101971. [PMID: 34022580 DOI: 10.1016/j.ejon.2021.101971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Xerostomia is one of the multidimensional effects of cancer therapy that can impact on patients' quality of life. This study aims to evaluate the reliability and validity properties of the xerostomia questionnaire. METHODS The data were retrieved from a randomized, interventional and longitudinal follow-up study of 72 head and neck cancer patients on active oral radiotherapy. Data were retrieved by the Xerostomia Questionnaire, the EORTC-QLQ C30 and EORT QLQ HN35. Data analyzes included intrinsic credibility of affinity Cronbach alpha factor, which is related to validity and cross-sectional validity. RESULTS The Cronbach's alpha index of the Greek version of the questionnaire was high. Explicitly, the total scale of the questionnaire had an α = 0.97, and the individual dimensions - Degree of dryness and the quality of life had an alpha of 0.97 and 0.98 respectively. The xerostomia dimension of the questionnaire has a high positive correlation with QLQ C30 overall (r = 0.61, p < 0.001), and with the HN35 xerostomia dimension (r = 0.63, p < 0.001) which demonstrate its' concurrent validity. The dimensions of the xerostomia questionnaire were highly correlated with the EORTC-QLQ C30 dimensions which supports its' predictive validity. The level of xerostomia and the quality of life varied according to the level of pain of the patients (p < 0.001) that support the cross-sectional validity of the questionnaire. CONCLUSION The Greek version of the xerostomia questionnaire is a reliable and valid tool for use in head and neck cancer patients on active oral radiotherapy.
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Affiliation(s)
| | | | | | | | | | - Andreas Charalambous
- Cyprus University of Technology, Limassol, Cyprus and University of Turku, Turku, Finland
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Herpel C, Schwindling FS, Held T, Christ L, Lang K, Schwindling M, Moratin J, Zaoui K, Moutsis T, Plinkert P, Herfarth K, Freudlsperger C, Rammelsberg P, Debus J, Adeberg S. Individualized 3D-Printed Tissue Retraction Devices for Head and Neck Radiotherapy. Front Oncol 2021; 11:628743. [PMID: 33833988 PMCID: PMC8021903 DOI: 10.3389/fonc.2021.628743] [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: 11/12/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Radiotherapy for head and neck cancer may cause various oral sequelae, such as radiation-induced mucositis. To protect healthy tissue from irradiation, intraoral devices can be used. Current tissue retraction devices (TRDs) have to be either individually manufactured at considerable cost and time expenditure or they are limited in their variability. In this context, a 3D-printed, tooth-borne TRD might further facilitate clinical use. Methods A novel approach for the manufacturing of TRDs is described and its clinical application is analysed retrospectively. The devices were virtually designed for fabrication by 3D-printing technology, enabling—in only a single printing design—caudal or bi-lateral tongue displacement, as well as stabilization of a tongue-out position. For a total of 10 patients undergoing radiotherapy of head and neck tumors, the devices were individually adapted after pre-fabrication. Technical and clinical feasibility was assessed along with patient adherence. Tissue spacing was calculated by volumetric analysis of tongue retraction. In one exemplary case, radiotherapy treatment plans before and after tissue displacement were generated and compared. The reproducibility of maxillomandibular relation at device re-positioning was quantified by repeated intraoral optical scanning in a voluntary participant. Results 3D-printing was useful for the simplification of TRD manufacture, resulting in a total patient treatment time of less than 30 min. The devices were tolerated well by all tested patients over the entire radiation treatment period. No technical complications occurred with the devices. The TRDs caused an effective spacing of the healthy adjacent tissue, e.g., the tongue. Position changes of maxillomandibular relation were limited to a mean value of 98.1 µm ± 29.4 µm root mean square deviation between initial reference and follow-up positions. Conclusions The presented method allows a resource-efficient fabrication of individualized, tooth-bourne TRDs. A high reproducibility of maxillomandibular relation was found and the first clinical experiences underline the high potential of such devices for radiotherapy in the head and neck area.
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Affiliation(s)
- Christopher Herpel
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Leo Christ
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | | | - Julius Moratin
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Karim Zaoui
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
| | - Tracy Moutsis
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
| | - Peter Plinkert
- Department of Otorhinolaryngology, University of Heidelberg, Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
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48
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Cugini C, Ramasubbu N, Tsiagbe VK, Fine DH. Dysbiosis From a Microbial and Host Perspective Relative to Oral Health and Disease. Front Microbiol 2021; 12:617485. [PMID: 33763040 PMCID: PMC7982844 DOI: 10.3389/fmicb.2021.617485] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
The significance of microbiology and immunology with regard to caries and periodontal disease gained substantial clinical or research consideration in the mid 1960's. This enhanced emphasis related to several simple but elegant experiments illustrating the relevance of bacteria to oral infections. Since that point, the understanding of oral diseases has become increasingly sophisticated and many of the original hypotheses related to disease causality have either been abandoned or amplified. The COVID pandemic has reminded us of the importance of history relative to infectious diseases and in the words of Churchill "those who fail to learn from history are condemned to repeat it." This review is designed to present an overview of broad general directions of research over the last 60 years in oral microbiology and immunology, reviewing significant contributions, indicating emerging foci of interest, and proposing future directions based on technical advances and new understandings. Our goal is to review this rich history (standard microbiology and immunology) and point to potential directions in the future (omics) that can lead to a better understanding of disease. Over the years, research scientists have moved from a position of downplaying the role of bacteria in oral disease to one implicating bacteria as true pathogens that cause disease. More recently it has been proposed that bacteria form the ecological first line of defense against "foreign" invaders and also serve to train the immune system as an acquired host defensive stimulus. While early immunological research was focused on immunological exposure as a modulator of disease, the "hygiene hypothesis," and now the "old friends hypothesis" suggest that the immune response could be trained by bacteria for long-term health. Advanced "omics" technologies are currently being used to address changes that occur in the host and the microbiome in oral disease. The "omics" methodologies have shaped the detection of quantifiable biomarkers to define human physiology and pathologies. In summary, this review will emphasize the role that commensals and pathobionts play in their interaction with the immune status of the host, with a prediction that current "omic" technologies will allow researchers to better understand disease in the future.
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Affiliation(s)
- Carla Cugini
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, United States
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49
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Meeks L, De Oliveira Pessoa D, Martinez JA, Limesand KH, Padi M. Integration of metabolomics and transcriptomics reveals convergent pathways driving radiation-induced salivary gland dysfunction. Physiol Genomics 2021; 53:85-98. [PMID: 33522389 PMCID: PMC7988743 DOI: 10.1152/physiolgenomics.00127.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/04/2021] [Accepted: 01/22/2021] [Indexed: 11/22/2022] Open
Abstract
Radiation therapy for head and neck cancer causes damage to the surrounding salivary glands, resulting in salivary gland hypofunction and xerostomia. Current treatments do not provide lasting restoration of salivary gland function following radiation; therefore, a new mechanistic understanding of the radiation-induced damage response is necessary for identifying therapeutic targets. The purpose of the present study was to investigate the metabolic phenotype of radiation-induced damage in parotid salivary glands by integrating transcriptomic and metabolomic data. Integrated data were then analyzed to identify significant gene-metabolite interactions. Mice received a single 5 Gy dose of targeted head and neck radiation. Parotid tissue samples were collected 5 days following treatment for RNA sequencing and metabolomics analysis. Altered metabolites and transcripts significantly converged on a specific region in the metabolic reaction network. Both integrative pathway enrichment using rank-based statistics and network analysis highlighted significantly coordinated changes in glutathione metabolism, energy metabolism (TCA cycle and thermogenesis), peroxisomal lipid metabolism, and bile acid production with radiation. Integrated changes observed in energy metabolism suggest that radiation induces a mitochondrial dysfunction phenotype. These findings validated previous pathways involved in the radiation-damage response, such as altered energy metabolism, and identified robust signatures in salivary glands, such as reduced glutathione metabolism, that may be driving salivary gland dysfunction.
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Affiliation(s)
- Lauren Meeks
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona
| | | | - Jessica A Martinez
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona
- University of Arizona Cancer Center, Tucson, Arizona
| | - Kirsten H Limesand
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona
- University of Arizona Cancer Center, Tucson, Arizona
| | - Megha Padi
- Bioinformatics Shared Resource, Arizona Cancer Center, University of Arizona, Tucson, Arizona
- University of Arizona Cancer Center, Tucson, Arizona
- Department of Molecular and Cellular Biology, University of Arizona, Tucson, Arizona
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50
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Salimi F, Saavedra F, Andrews B, FitzGerald J, Winter SC. Trans-cutaneous electrical nerve stimulation to treat dry mouth (xerostomia) following radiotherapy for head and neck cancer. A systematic review. Ann Med Surg (Lond) 2021; 63:102146. [PMID: 33664943 PMCID: PMC7903056 DOI: 10.1016/j.amsu.2021.01.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A dry mouth or xerostomia is one of the most common long-term complications following radiotherapy for head and neck cancer and has a negative impact on quality of life in cancer survivors. Transcutaneous electrical nerve stimulation (TENS) is a novel approach to improving saliva flow in these patients. OBJECTIVE To perform a systematic review of studies evaluating TENS in the treatment of radiotherapy induced xerostomia in head and neck cancer patients. DATA COLLECTION AND ANALYSIS A comprehensive electronic search was performed in PubMed/MEDLINE, the Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted in January 2020. Two review authors assessed all studies identified by the search strategy and carried out data extraction. RESULTS Five studies were included in the systematic review which analysed a total of 280 patients with head and neck cancer. Methodological quality and outcomes were evaluated in every study included. The outcome measure was either subjectively assessed or objectively measured. Three studies used conventional TENS therapy to stimulate parotid glands which produced a significant increase in saliva production following therapy. Two studies used acupunctured TENS type to electrically stimulate acupuncture points scattered in the body and they reported improvement in saliva production at the same level as medical treatment. No reported adverse effect of TENS was identified. CONCLUSIONS This systematic review confirms the safety and feasibility of TENS in the treatment of xerostomia. It is established that commencing daily TENS therapy simultaneously with radiotherapy has the most efficacy. Given the nonspecific parameters used in the included studies, further evidence is needed in order to establish optimal settings and parameters of TENS for treatment of xerostomia.
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Affiliation(s)
- Fatemeh Salimi
- Surgical Science Department, University of Oxford, United Kingdom
| | - Francisco Saavedra
- Electrical Engineering Department, Faculty of Engineering, University of Concepcion, Chile
- Nuffield Department of Surgical Science, University of Oxford, United Kingdom
| | - Brain Andrews
- Nuffield Department of Surgical Science, University of Oxford, United Kingdom
| | - James FitzGerald
- Nuffield Department of Surgical Science, University of Oxford, United Kingdom
| | - Stuart C. Winter
- Nuffield Department of Surgical Science, University of Oxford, United Kingdom
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