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Nascimento RB, Neri BP, Moutinho MM, Fortuna T, Martins GB, Carrera M, Lima HR. Might photobiomodulation therapy interfere with the frequency of severe mucositis and oral candidiasis? A retrospective analysis in patients with head and neck carcinoma. Support Care Cancer 2024; 32:508. [PMID: 38992294 DOI: 10.1007/s00520-024-08724-8] [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: 10/11/2023] [Accepted: 07/05/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE Considering the tumor in the oral cavity or the oropharynx and nasopharynx region might be an aggravating factor for oral mucositis (OM) manifestation, the present study aimed to evaluate whether the location of the tumor and the use of photobiomodulation therapy (PBMT) might affect the frequency of oral candidiasis (OC) during radiotherapy (RT) and/or chemotherapy (CT) treatments. METHODS The medial records of seventy-four patients with head and neck cancer treated in a public service from 2016 to 2019 were evaluated. All these patients were submitted to RT in an accumulated dose of 48 to 70 Gy of radiation. Data about OM and OC were collected and presented according to the application of a therapeutic protocol with laser photobiomodulation (PBMT) to control oral mucositis, or not (No-PBM), and the location of tumor (head and neck or oral cavity). In the PBMT group patients, a low-power laser device composed of InGaAlP diode (maximum output power of 86.7 mW, active tip area of 0.1256 cm2, and continuous wavelength of 660 nm), was applied to the lips (three points each), right and left jugal mucosa (three points each), the limit between hard and soft palate (three points), buccal floor/sublingual gland (one point), lateral edge of the tongue (three points on each side), and back of the tongue (six points), three times weekly, for 5 weeks. The dosimetry used in each application was 2 J for 3 s, thus totaling 56 J. The correlation between clinical characteristics such as age, tumor size (T), metastatic lymph node (N), number of RT and CT sessions, candidiasis, and OM were analyzed. RESULTS Mucositis grades 1 and 2 were the most common among all patients, especially before the 12th radiotherapy session, regardless of the treatment with PBM (p > 0.05). Additionally, no difference in the grade of OM and OC was significantly observed when comparing the two laser therapy groups. OC was more frequent after the 12th radiotherapy session in all groups. Nonetheless, OM and OC had a different correlation regarding to tumor location (head and neck and oral cavity) being PBMT a positive therapy to delay OM. It was observed a positive and statistically significant correlation between tumors at oral cavity and OM, regardless PBMT (R = 0.84, p < 0.05 to PBMT and R = 0.13, p < 0.05 to No-PBM). Otherwise, OC was positively correlated to local metastasis in patients with oral tumors undergoing PBMT (R = 0.84, p < 0.05). CONCLUSION Patients with oral cavity tumor presented more OM, especially high grades, then patients with tumors in other regions of the head and neck, which seems to be related to the irradiation parameters of radiotherapy and/or with the limitation of conduction of PBMT in tumor areas. OM and OC were not changed by PBMT, although it helped to reduce the incidence of severe cases of OM.
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Affiliation(s)
| | - Bruna Portela Neri
- Faculty of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Tila Fortuna
- Interactive Processes of Organs and Systems Post Graduation Program, Institute of Health Sciences, Salvador, Bahia, Brazil
| | - Gabriela Botelho Martins
- Interactive Processes of Organs and Systems Post Graduation Program, Institute of Health Sciences, Salvador, Bahia, Brazil
- Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Manoela Carrera
- Faculty of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Life Sciences, State University of Bahia, Salvador, Bahia, Brazil
| | - Hayana Ramos Lima
- Center of Health Sciences, Federal University of Southern Bahia, Teixeira de Freitas, Praça Joana Angélica, No. 250Zip Code: 45988-058, Bahia, Brazil.
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Elsaadany B, Anayb SM, Mashhour K, Yossif M, Zahran F. Rebamipide gargle and benzydamine gargle in prevention and management of chemo-radiotherapy and radiotherapy-induced oral mucositis in head and neck cancer patients (randomized clinical trial). BMC Oral Health 2024; 24:645. [PMID: 38824583 PMCID: PMC11143556 DOI: 10.1186/s12903-024-04379-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/16/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the preventive and therapeutic effects of rebamipide gargle in comparison with benzydamine in head and neck cancer patients undergoing radiotherapy with or without chemotherapy. MATERIALS AND METHODS Phase III randomized clinical trial was conducted from January 2021 till August 2022 on one hundred patients with head and neck cancer receiving high doses of radiotherapy. These patients were equally allocated into either rebamipide group or benzydamine group, The measured outcomes were the incidence of oral mucositis ≥ grade1, according to the WHO mucositis scale, in addition to the duration, and the onset of oral mucositis. RESULTS There was no statistically significant difference between the two groups, regarding the incidence of a severe grade of oral mucositis (WHO grades 3), as well as the onset and duration of oral mucositis. Both gargles succeeded to prevent the development of WHO grade 4 oral mucositis. Side effects reported were mainly burning sensation in benzydamine group and nausea in rebamipide group. CONCLUSION Rebamipide mouthwash was as beneficial as benzydamine mouthwash in minimizing the incidence of severe oral mucositis induced by treatment of head and neck cancer. However, rebamipide gargle proved to be superior to benzydamine in terms of reduction in the severity of the radiation-induced oral mucositis. TRIAL REGISTRATION The trial was registered in the protocol Registration and Result system of Clinical Trials (Registration ID: NCT04685395)0.28-12-2020.
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Affiliation(s)
- Basma Elsaadany
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Samah M Anayb
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Karim Mashhour
- Clinical Oncology, Kasr El Ainy- Cairo University, Cairo, Egypt
| | | | - Fat'heya Zahran
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Najafizade N, Mobini Dehkordi R, Hemati S. Investigating the effect of Aloe vera on the prevention and treatment of radiotherapy-induced oral mucositis in patients with head-and-neck cancer. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:16. [PMID: 38808218 PMCID: PMC11132420 DOI: 10.4103/jrms.jrms_115_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 08/31/2023] [Accepted: 11/14/2023] [Indexed: 05/30/2024]
Abstract
Background Oral mucositis is one of the main complications of radiotherapy (RT) while treating head-and-neck cancers and can affect the patients' treatment process and life. Therefore, this study evaluated the effect of Aloe vera on the prevention and treatment of radiotherapy-induced oral mucositis (RIOM) in patients with head-and-neck cancer. Materials and Methods This was a double-blind clinical trial performed in 2019 on 75 patients with head-and-neck cancer. Patients were randomly assigned to two groups receiving gargles of 5 cc Aloe vera and the same dose of placebo mouthwash three times a day, respectively. Then, the incidence and severity of RIOM were evaluated and compared between the two groups over 6 weeks of RT. Results There was no significant difference between the two groups in terms of the severity of RIOM from the 1st to 3rd weeks of RT (P > 0.05). However, the severity of RIOM in the 4th, 5th, and 6th weeks of RT was significantly lower in the Aloe vera group compared with the placebo group (P < 0.05). Conclusion According to the results of the present study, the long-term use of Aloe vera mouthwash can reduce the severity of RIOM.
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Affiliation(s)
- Nadia Najafizade
- Department of Radiation Oncology, Cancer Prevention Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Mobini Dehkordi
- Department of Radiation Oncology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Simin Hemati
- Department of Radiation Oncology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Harnekar SH, Prakash N, Nagarkar R, Pradeep GL, Mahajan A, Patil RKA. Comparative evaluation of oral mucositis in oral cancer patients undergoing 3-dimensional conformal radiation therapy and intensity modulated radiation therapy with or without chemotherapy. J Oral Maxillofac Pathol 2023; 27:720-726. [PMID: 38304500 PMCID: PMC10829452 DOI: 10.4103/jomfp.jomfp_31_23] [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: 01/22/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 02/03/2024] Open
Abstract
Context Oral cancer is a significant cause of death across the world. A combined multimodal approach integrating surgery and radiation therapy (RT) with or without chemotherapy (CT) is commonly employed in advanced oral cancer to prevent recurrences and locoregional spread. Oral mucositis is a common acute toxicity reported in patients undergoing RT and CT. The delivery of optimal cancer therapy protocols is compromised due to morbidity caused by oral mucositis. Aims To compare the severity of oral mucositis in oral cancer patients undergoing 3-Dimensional Conformal Radiation Therapy (3DCRT) and Intensity Modulated Radiation Therapy (IMRT) with or without concomitant CT. Settings and Design This was a prospective, unicentric and longitudinal study conducted in a cancer centre. Methods and Material One hundred four patients with locally advanced oral cancer were enrolled in this study. Fifty-two patients were treated with IMRT and 52 patients with 3DCRT to a dose of >60 Gy, along with concurrent cisplatin weekly CT. Mucositis was recorded before the start, in the end, 1 month, and 3 months post-chemoradiotherapy treatment. Statistical Analysis Used Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software (v. 21.0, Chicago. 2012). Descriptive and frequency statistics were performed for different parameters assessed in 3DCRT and IMRT group. Results Grade 3 mucositis was the most predominant grade observed in both groups at the end of treatment. Thirty-six patients (69.3%) versus 24 patients (46.1%) developed grade 3 mucositis in 3DCRT and IMRT group, respectively (P = 0.013). Healing was better with IMRT group when compared to 3DCRT group 1 month and 3 months post-RT. Mucositis was severe in patients undergoing concomitant CT. Conclusions IMRT reduced the incidence of severe mucositis and also improved the treatment-compliance compared to 3DCRT in locally advanced head neck cancer patients treated by chemoradiotherapy.
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Affiliation(s)
- Shirin H. Harnekar
- Oral Pathology and Microbiology, MGV’s KBH Dental College and Hospital, Nashik, Maharashtra, India
| | - Nilima Prakash
- Oral Pathology and Microbiology, MGV’s KBH Dental College and Hospital, Nashik, Maharashtra, India
| | - Raj Nagarkar
- Chief Robotic Surgeon and Surgical Oncologist, HCG Manavata Cancer Centre, Nashik, Maharashtra, India
| | - GL Pradeep
- Oral Pathology and Microbiology, MGV’s KBH Dental College and Hospital, Nashik, Maharashtra, India
| | - Aarti Mahajan
- Oral Pathology and Microbiology, MGV’s KBH Dental College and Hospital, Nashik, Maharashtra, India
| | - Roshan Kumar A. Patil
- Consultant Radiation Oncologist, Cancer Centers of America, Nashik, Maharashtra, India
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Fernández Forné Á, García Anaya MJ, Segado Guillot SJ, Plaza Andrade I, de la Peña Fernández L, Lorca Ocón MJ, Lupiáñez Pérez Y, Queipo-Ortuño MI, Gómez-Millán J. Influence of the microbiome on radiotherapy-induced oral mucositis and its management: A comprehensive review. Oral Oncol 2023; 144:106488. [PMID: 37399707 DOI: 10.1016/j.oraloncology.2023.106488] [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: 04/05/2023] [Accepted: 06/29/2023] [Indexed: 07/05/2023]
Abstract
Radiation-induced mucositis is the most common, debilitating and painful acute toxicity associated with active treatment in head and neck cancer area, severely affecting more than 65% of patients. Oral microbiota significantly changes during cancer therapy and appears to be involved on its pathophysiology. This review aims to present a comprehensive update of new etiopathogenic factors and treatments that may decrease the incidence of mucositis, mainly modifications of dietary interventions to modify microbiome. Despite advances in recent years, its management is mainly symptomatic opioid-based with variable results on different substances analyzed for its prevention. Immunonutrition seems to play a significant role, particularly the supplementation of compounds such as fatty acids, polyphenols or selected probiotics have shown to promote commensal bacteria diversity and reduced incidence of ulcerative mucositis. Modification of the microbiome is a promising preventive treatment for mucositis although its evidence is still scarce. Large studies are needed to demonstrate the efficacy of interventions on microbiome and its clinical impact on radiation-induced mucositis.
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Affiliation(s)
- África Fernández Forné
- Department of Radiation Oncology. Punta Europa University Hospital. Algeciras, Cádiz, Spain
| | - María Jesús García Anaya
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | | | - Isaac Plaza Andrade
- Intercenter Clinical Unit of Medical Oncology, Regional and Virgen de la Victoria University Hospitals, Biomedical Research Institute of Malaga (IBIMA)-CIMES-UMA, University of Malaga, 29010 Málaga, Spain
| | | | - María Jesús Lorca Ocón
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | - Yolanda Lupiáñez Pérez
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | - María Isabel Queipo-Ortuño
- Intercenter Clinical Unit of Medical Oncology, Regional and Virgen de la Victoria University Hospitals, Biomedical Research Institute of Malaga (IBIMA)-CIMES-UMA, University of Malaga, 29010 Málaga, Spain; Department of Surgical Specialties, Biochemical and Immunology, Faculty of Medicine, University of Málaga, 29010 Malaga, Spain.
| | - Jaime Gómez-Millán
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
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de Vasconcellos Ferreira PM, Gomes MDCMF, Almeida ACSM, Cornélio JS, Arruda TJ, Mafra A, Nunes MHS, Salera RB, Nogueira RF, Sclauser JMB, Drummond-Lage AP, Rezende BA. Evaluation of oral mucositis, candidiasis, and quality of life in patients with head and neck cancer treated with a hypofractionated or conventional radiotherapy protocol: a longitudinal, prospective, observational study. Head Face Med 2023; 19:7. [PMID: 36890527 PMCID: PMC9992900 DOI: 10.1186/s13005-023-00356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, recently, Radiotherapy (RT) protocols requiring fewer sessions (hypofractionated) have been used to shorten RT treatment and minimize patient exposure to medical centers, and decrease the risk of SARS-CoV-2 infection. METHODS This longitudinal, prospective, observational study aimed to compare the quality of life (QoL) and the incidence of oral mucositis and candidiasis in 66 patients with head and neck cancer (HNC) who undergo a hypofractionated RT protocol (GHipo), total of 55 Gy for 4 weeks, or a conventional RT protocol (GConv), total of 66 - 70 Gy for 6 - 7 weeks. PURPOSE To assess the incidence and severity of oral mucositis, the incidence of candidiasis, and QoL were evaluated using the World Health Organization scale, clinical evaluation, and the QLC-30 and H&N-35 questionnaires, respectively, at the beginning and the end of RT. RESULTS The incidence of candidiasis did not show differences between the two groups. However, at the end of RT, mucositis had a higher incidence (p < 0.01) and severity (p < 0.05) in GHipo. QoL was not markedly different between the two groups. Although mucositis worsened in patients treated with hypofractionated RT, QoL did not worsen for patients on this regimen. CONCLUSIONS Our results open perspectives for the potential use of RT protocols for HNC with fewer sessions in conditions that require faster, cheaper, and more practical treatments.
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Affiliation(s)
| | | | | | - Júlia Soares Cornélio
- School of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias, Belo Horizonte, 27530130-110, Brazil
| | - Thiago Jardim Arruda
- Mario Penna Institute, 901, Joaquim Candido Filho, Belo Horizonte, 30320-420, Brazil
| | - Arnoldo Mafra
- Mario Penna Institute, 901, Joaquim Candido Filho, Belo Horizonte, 30320-420, Brazil
| | | | - Rafael Borges Salera
- Mario Penna Institute, 901, Joaquim Candido Filho, Belo Horizonte, 30320-420, Brazil
| | | | | | - Ana Paula Drummond-Lage
- School of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias, Belo Horizonte, 27530130-110, Brazil
| | - Bruno Almeida Rezende
- School of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias, Belo Horizonte, 27530130-110, Brazil.
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Comparative study of royal jelly, propolis, and photobiomodulation therapies in 5-fluorouracil-related oral mucositis in rats. Support Care Cancer 2021; 30:2723-2734. [PMID: 34822003 DOI: 10.1007/s00520-021-06660-5] [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: 02/17/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to evaluate the effects and mechanisms of action of royal jelly (RJ) and propolis compared to photobiomodulation therapy (PBMT) in an animal model of 5-fluorouracil-related oral mucositis (OM). METHODS Seventy-two male Wistar rats were randomly allocated to four groups (n = 18 each): control (no treatment), PBMT (intraoral laser, 6 J/cm2), RJ, and propolis. On days 0 and 2, the animals received an injection of 5-fluorouracil (5-FU). The buccal mucosa was scratched (days 3 and 4) and the treatments were initiated on day 5. Six animals of each group were euthanized on days 8, 10, and 14. Phytochemical analysis (thin-layer chromatography, TLC) and clinical, histopathological, and immunohistochemical analysis of pS6, pAKT, and NF-κB were performed, and oxidative stress markers were also investigated. RESULTS TLC revealed the presence of large amounts of sucrose (Rf 0.34) in RJ and of flavonoids in propolis. Lower clinical OM scores were observed on day 8, and improved morphological data were observed on day 10 in the PBMT, RJ, and propolis groups (p < 0.05). On day 8, immunoexpression of pS6, pAKT, and NF-κB was increased compared to control. On day 14, reduced glutathione (GSH) antioxidant levels were increased in the propolis group compared to control (p < 0.05). CONCLUSIONS Our results showed that RJ and propolis, as well as PBMT, are effective in the treatment of OM. Considering that some patients who develop OM do not have access to PBMT, the present study demonstrated that topical application of RJ and propolis may be an important alternative for the treatment of OM.
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de Oliveira Faria S, Hurwitz G, Kim J, Liberty J, Orchard K, Liu G, Barbera L, Howell D. Identifying Patient-Reported Outcome Measures (PROMs) for Routine Surveillance of Physical and Emotional Symptoms in Head and Neck Cancer Populations: A Systematic Review. J Clin Med 2021; 10:jcm10184162. [PMID: 34575271 PMCID: PMC8470145 DOI: 10.3390/jcm10184162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
The aims of this review were to identify symptoms experienced by head and neck cancer (HNC) patients and their prevalence, as well as to compare symptom coverage identified in HNC specific patient-reported outcome measures (PROMs). Searches of Ovid Medline, Embase, PsychInfo, and CINAHL were conducted to identify studies. The search revealed 4569 unique articles and identified 115 eligible studies. The prevalence of reported symptoms was highly variable among included studies. Variability in sample size, timing of the assessments, and the use of different measures was noted across studies. Content mapping of commonly used PROMs showed variability and poor capture of prevalent symptoms, even though validation studies confirmed satisfactory reliability and validity. This suggests limitations of some of the tools in providing an accurate and comprehensive picture of the patient's symptoms and problems.
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Affiliation(s)
- Sheilla de Oliveira Faria
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
- Correspondence: ; Tel.: +55-11-3061-8278
| | - Gillian Hurwitz
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Jaemin Kim
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Jacqueline Liberty
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Kimberly Orchard
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada
- Temerty Faculty of Medicine, Toronto, ON M5S 1A8, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Lisa Barbera
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
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Lao Z, Bi F, Fan W, Xu X, Tu W, Shi H. Noncoplanar Versus Coplanar Intensity-Modulated Radiation Therapy (IMRT) for Protection of the Lip and Buccal Mucosa. Technol Cancer Res Treat 2021; 20:15330338211019511. [PMID: 34044671 PMCID: PMC8165526 DOI: 10.1177/15330338211019511] [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] [Indexed: 11/17/2022] Open
Abstract
Objective: In this study, by comparing coplanar and noncoplanar intensity-modulated radiation therapy (IMRT) treatment planning in treating tongue cancer, the significance of noncoplanar fields in the protection of the lip and buccal mucosa was determined, and a reasonable solution was selected. Methods: Forty-eight tongue cancer patients treated from June 2019 to February 2021 were selected and randomly divided into a coplanar field group and a noncoplanar field group. The mucosal dose limit changed from 15 Gy to 45 Gy for comparison of the two treatment plans. The evaluation indicators (conformal index (CI); homogeneity index (HI); D5, D50, and D98 of the target volume; and the dose of normal tissues) were calculated under different mucosal dose limits. The clinical observation of the lip and buccal mucosa of 48 cases was monitored and graded carefully according to NCI-CTCAE V4.0. Statistical analyses were performed. Results: The differences in CI, HI, D98, D50 and D5 between the two groups in the target volume tended to decrease when the mucosal dose limit was less than 30 Gy, with a significant difference (P < 0.05). When the limit exceeded 30 Gy, significant differences in other indicators except CI (P < 0.05) were still noted. In normal tissue, differences in doses between the two groups existed when the mucosal limit was less than 20 Gy, with a significant difference (P < 0.05). When the limit exceeded 20 Gy, no significant difference was noted. Patients in the noncoplanar group showed significantly better results than those in the other group in terms of the radiation-related toxicity of the lip and cheek membrane(P < 0.001). Conclusions: Compared with coplanar field radiotherapy, noncoplanar field radiotherapy can effectively reduce the exposure dose to the lip and buccal mucosa. The application of noncoplanar treatment plans exhibits good clinical significance and deserves to be promoted.
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Affiliation(s)
- Zheng Lao
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
| | - Fan Bi
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
| | - Wenhui Fan
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
| | - Xuanli Xu
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
| | - Wenyong Tu
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
| | - Huifeng Shi
- Department of Oral Maxillofacial Head and Neck Oncology, 56695Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai China.,National Clinical Research Center of Oral Diseases, Shanghai, Shanghai China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, Shanghai China
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Minhas S, Sajjad A, Chaudhry RM, Zahid H, Shahid A, Kashif M. Assessment and prevalence of concomitant chemo-radiotherapy-induced oral mucositis in patients with oral squamous cell carcinoma. Turk J Med Sci 2021; 51:675-684. [PMID: 33155791 PMCID: PMC8203133 DOI: 10.3906/sag-2007-131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/05/2020] [Indexed: 11/06/2022] Open
Abstract
Background/aim Quantification of oral mucositis that progresses during concomitant chemo-radiotherapy (CCRT) is essential for its management. It is important to determine the methods that are simple, reliable and beneficial in foreseeing mucositis at earlier stages of treatment. Materials and methods A prospective study was conducted on 100 oral cancer patients receiving CCRT following the inclusion criteria. Patients were evaluated for mucositis i.e. erythema and ulcers by using the World Health Organization (WHO) scale and the oral mucositis assessment scale (OMAS), whereas mature and immature cells were identified by exfoliative cytology. Clinical examination and procedure of oral cavity were performed before, on days 5, 17, and at the end of treatment. Results Oral mucositis was observed in all oral squamous cell carcinoma (OSCC) patients receiving CCRT on different days with noteworthy increase from day 5 of CCRT to the end of treatment. For OMAS grading related to ulceration and erythema, Grade 1 (7.2%; 34%) was most commonly seen on the 5th day of CCRT, Grade 2 (29%; 19%) and Grade 3 (19%) were most frequently seen at the 17th day and end of CCRT, accordingly. With respect to WHO scale grades 1 and 2 (18.3%; 21.5%) was most frequently observed at the 17th day of CCRT, whereas grades 3 and 4 (12.5%; 2%) was noted at the end of CCRT. There was statistically significant increase in the percentage of immature cells at the end of CCRT (99%). A significant association (P < 0.0000) was observed among the days of smear and maturation stages of epithelial cells as well as among WHO mucositis grading, OMAS and types of epithelial cells, respectively. Conclusion According to the findings of the study, oral mucositis grade is directly proportional to the progressing days of CCRT. Oral mucositis is frequently related to adverse clinical outcomes, affecting the patient’s quality of life. It is essential to develop methods that can be employed for the assessment of CCRT associated oral mucositis.
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Affiliation(s)
- Sadia Minhas
- Department of Oral Pathology, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Aneequa Sajjad
- Department of Oral Pathology, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | | | - Hamza Zahid
- Department of Oral Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Azfar Shahid
- Department of Oral Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Muhammad Kashif
- Department of Oral Pathology, Bakhtawar Amin Medical and Dental College, Multan, Pakistan
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de Souza BM, Silva MS, Braga AS, Bueno PSK, da Silva Santos PS, Buzalaf MAR, Magalhães AC. Protective effect of titanium tetrafluoride and silver diamine fluoride on radiation-induced dentin caries in vitro. Sci Rep 2021; 11:6083. [PMID: 33727650 PMCID: PMC7966395 DOI: 10.1038/s41598-021-85748-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/28/2021] [Indexed: 11/11/2022] Open
Abstract
This in vitro study evaluated the protective effect of titanium tetrafluoride (TiF4) varnish and silver diamine fluoride (SDF) solution on the radiation-induced dentin caries. Bovine root dentin samples were irradiated (70 Gy) and treated as follows: (6 h): 4% TiF4 varnish; 5.42% NaF varnish; 30% SDF solution; placebo varnish; or untreated (negative control). Microcosm biofilm was produced from human dental biofilm (from patients with head-neck cancer) mixed with McBain saliva for the first 8 h. After 16 h and from day 2 to day 5, McBain saliva (0.2% sucrose) was replaced daily (37 °C, 5% CO2) (biological triplicate). Demineralization was quantified by transverse microradiography (TMR), while biofilm was analyzed by using viability, colony-forming units (CFU) counting and lactic acid production assays. The data were statistically analyzed by ANOVA (p < 0.05). TiF4 and SDF were able to reduce mineral loss compared to placebo and the negative control. TiF4 and SDF significantly reduced the biofilm viability compared to negative control. TiF4 significantly reduced the CFU count of total microorganism, while only SDF affected total streptococci and mutans streptococci counts. The varnishes induced a reduction in lactic acid production compared to the negative control. TiF4 and SDF may be good alternatives to control the development of radiation-induced dentin caries.
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Affiliation(s)
- Beatriz Martines de Souza
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-191, Brazil
| | - Mayara Souza Silva
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-191, Brazil
| | - Aline Silva Braga
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-191, Brazil
| | - Patrícia Sanches Kerges Bueno
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-191, Brazil
| | - Paulo Sergio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-191, Brazil
| | - Marília Afonso Rabelo Buzalaf
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-191, Brazil
| | - Ana Carolina Magalhães
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-191, Brazil.
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Cheng Y, Zhou YF, Ding YP, Xing Y, Shan E, Sun H. Cleaning the palate and tongue without nausea: a mixed methods study exploring the appropriate depth and direction of oral care. BMC Oral Health 2021; 21:67. [PMID: 33579247 PMCID: PMC7881663 DOI: 10.1186/s12903-021-01414-5] [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: 07/26/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is advisable to clean the palate and tongue thoroughly during oral care to protect against nosocomial infections. However, improper cleaning may cause nausea. To date, no robust data are available regarding how to implement this procedure properly. Furthermore, traditional cotton balls, forceps and normal saline are still used in clinical in China. This mixed methods study aimed to explore the appropriate depth and direction of cleaning methods for palates and tongues without causing nausea and the factors influencing cleaning depth and discomfort in traditional oral care. METHODS Our study recruited students (n = 276) from a medical university. The first phase was a quantitative study, in which forceps were slowly inserted into their throats until the gag reflex was triggered, and then, the insertion depth was measured. After that, participants were randomly divided into two groups. In group A, palates and tongues were cleaned coronally and then sagittally, with the converse order used for group B. The extent of nausea was measured. Additionally, the qualitative data were types of discomfort other than nausea reported by the participants. RESULTS The tolerable depths (without causing nausea) for cleaning the palate and tongue were 6.75 ± 1.07 cm and 6.92 ± 1.11 cm, respectively. Participants of male sex and with high BMI (overweight/obese) were associated with greater tolerable cleaning depth. The extent of nausea caused by cleaning both the palate and the tongue sagittally was higher than that elicited by coronal cleaning (p = 0.025 and p = 0.003, respectively). Other discomforts included itching, saltiness and coldness. CONCLUSION It is appropriate to increase the cleaning depth of the palate and tongue for adult males and overweight/obese individuals. Moreover, coronal cleaning causes lower levels of nausea, and traditional oral care appliances should be improved.
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Affiliation(s)
- Yang Cheng
- School of Nursing, Nanjing Medical University, 140 Hanzhong Road, Nanjing, 210000, Jiangsu, People's Republic of China
| | - Yu-Feng Zhou
- School of Nursing, Nanjing Medical University, 140 Hanzhong Road, Nanjing, 210000, Jiangsu, People's Republic of China.
| | - Ya-Ping Ding
- School of Nursing, Nanjing Medical University, 140 Hanzhong Road, Nanjing, 210000, Jiangsu, People's Republic of China.
| | - Ying Xing
- School of Nursing, Nanjing Medical University, 140 Hanzhong Road, Nanjing, 210000, Jiangsu, People's Republic of China
| | - Enfang Shan
- School of Nursing, Nanjing Medical University, 140 Hanzhong Road, Nanjing, 210000, Jiangsu, People's Republic of China
| | - Hang Sun
- School of Nursing, Nanjing Medical University, 140 Hanzhong Road, Nanjing, 210000, Jiangsu, People's Republic of China
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Sumatriptan alleviates radiation-induced oral mucositis in rats by inhibition of NF-kB and ERK activation, prevention of TNF-α and ROS release. Arch Oral Biol 2020; 119:104919. [PMID: 32977152 DOI: 10.1016/j.archoralbio.2020.104919] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Oral mucositis caused by radiation therapy is a common problem in cancer patients, especially those with head and neck cancer. Numerous experimental and clinical studies have attempted to find a drug to alleviate oral mucositis. Sumatriptan, is conventionally used to treat migraine attack and cluster headache. Recently, low doses have been shown to have anti-inflammatory properties. In this study we aimed to measure the effect of sumatriptan on experimental radiotherapy-induced oral mucositis. MATERIAL AND METHODS This study evaluates the use of sumatriptan 0.3 and 1 mg/kg in radiation-induced oral mucositis. In order to induce oral mucositis, six rats from each group received 8-Gy of X-ray in a single session. Likewise, three rats from each group received 26-Gy of X-ray. The latter dose of X-ray was used for inducing severe mucositis and apoptosis evaluation by TUNEL assay, while the first dose was used for histopathological and molecular assessments. On 8th day after irradiation, specimens were collected from their tongues for histology, TUNEL and molecular assessments. RESULTS Radiation caused mucosal atrophy, derangement of the tissue and vasodilation. Sumatriptan significantly decreased histopathological score and alleviated mucosal atrophy. As well, there was no evidence of vasodilation in the sumatriptan group. Likewise, sumatriptan decreased the increased level of NF-kB and prevented its activation as well as ERK phosphorylation. In addition, Sumatriptan-treated rats had lower tissue level of TNF-α, reactive oxygen species and fewer apoptotic cells in TUNEL assay. CONCLUSION Based on study results, sumatriptan mitigate radiation-induced oral mucositis by inhibiting NF-kB, ERK and limiting the release of TNF-α, oxidative stress factor and apoptosis.
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Souza E Silva VCD, Oliveira VDC, Sousa ÁFLD, Bim FL, Macedo AP, Andrade DD, Watanabe E. Prevalence and susceptibility profile of Candida spp. isolated from patients in cancer therapy. Arch Oral Biol 2020; 119:104906. [PMID: 32947164 DOI: 10.1016/j.archoralbio.2020.104906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study determined the prevalence of Candida spp. in the saliva of cancer patients. Furthermore, we assessed the antimicrobial activity of mouthwashes against the isolated strains and its susceptibility to amphotericin B and fluconazole. METHODS Thirty-four cancer patients undergoing radiotherapy, chemotherapy alone or combined treatment were investigated for oral Candida spp. colonization and compared in regard to mucositis presence. The maximum inhibitory dilution was used to assess the antimicrobial activity of Periogard®, Cepacol® Cool Ice and 0.12 % Chlorhexidine Digluconate mouthwashes against the isolates. In parallel, susceptibility to amphotericin B and fluconazole was determined by agar-based E-test. Data did not adhere to normal distribution as inferred by the Shapiro-Wilk test and statistical analysis was conducted by non-parametric McNemar test (α0.05). RESULTS Twenty-seven participants (79.4 %) were male, 19 (55.9 %) had mucositis and 9 (26.5 %) were colonized by Candida spp. 12 different strains of Candida spp. were isolated, being Candida albicans the most prevalent strain. Risk of Candida spp. colonization was increased by almost twofold among the participants with mucositis (odds ratio: 1.84; 95 % confidence interval: 0.37-9.07). Mouthwash Cepacol® Cool Ice presented better antimicrobial activity against Candida spp. while 0.12 % Chlorhexidine exhibited the worst activity. All strains were sensitive to amphotericin B, and 2 non-albicans strains were dose-dependent sensitive to fluconazole. CONCLUSION Considering the increased risk of colonization byCandida spp. in patients with mucositis, and the emergence of antifungal drug resistance, the antiseptics use could benefit the maintenance of cancer patient's oral health.
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Affiliation(s)
- Vanessa Castro de Souza E Silva
- Human Exposome and Infectious Diseases Network (HEID), School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Viviane de Cássia Oliveira
- Human Exposome and Infectious Diseases Network (HEID), School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil; Department of Dental Materials and Prostheses, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Álvaro Francisco Lopes de Sousa
- Human Exposome and Infectious Diseases Network (HEID), School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil; Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
| | - Felipe Lazarini Bim
- Human Exposome and Infectious Diseases Network (HEID), School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Ana Paula Macedo
- Department of Dental Materials and Prostheses, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Denise de Andrade
- Human Exposome and Infectious Diseases Network (HEID), School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Evandro Watanabe
- Human Exposome and Infectious Diseases Network (HEID), School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil; Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
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