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Pachler KS, Lauwers I, Verkaik NS, Rovituso M, van der Wal E, Mast H, Jonker BP, Sewnaik A, Hardillo JA, Keereweer S, Monserez D, Kremer B, Koppes S, van den Bosch TPP, Verduijn GM, Petit S, Sørensen BS, van Gent DC, Capala ME. Development of an Ex Vivo Functional Assay for Prediction of Irradiation Related Toxicity in Healthy Oral Mucosa Tissue. Int J Mol Sci 2024; 25:7157. [PMID: 39000262 PMCID: PMC11241643 DOI: 10.3390/ijms25137157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
Radiotherapy in the head-and-neck area is one of the main curative treatment options. However, this comes at the cost of varying levels of normal tissue toxicity, affecting up to 80% of patients. Mucositis can cause pain, weight loss and treatment delays, leading to worse outcomes and a decreased quality of life. Therefore, there is an urgent need for an approach to predicting normal mucosal responses in patients prior to treatment. We here describe an assay to detect irradiation responses in healthy oral mucosa tissue. Mucosa specimens from the oral cavity were obtained after surgical resection, cut into thin slices, irradiated and cultured for three days. Seven samples were irradiated with X-ray, and three additional samples were irradiated with both X-ray and protons. Healthy oral mucosa tissue slices maintained normal morphology and viability for three days. We measured a dose-dependent response to X-ray irradiation and compared X-ray and proton irradiation in the same mucosa sample using standardized automated image analysis. Furthermore, increased levels of inflammation-inducing factors-major drivers of mucositis development-could be detected after irradiation. This model can be utilized for investigating mechanistic aspects of mucositis development and can be developed into an assay to predict radiation-induced toxicity in normal mucosa.
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Affiliation(s)
- Katrin S. Pachler
- Department of Molecular Genetics, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (K.S.P.); (D.C.v.G.)
| | - Iris Lauwers
- Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Nicole S. Verkaik
- Department of Molecular Genetics, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (K.S.P.); (D.C.v.G.)
| | - Marta Rovituso
- Holland Proton Therapy Centre (HPTC), Huismansingel 4, 2629 JH Delft, The Netherlands
| | - Ernst van der Wal
- Holland Proton Therapy Centre (HPTC), Huismansingel 4, 2629 JH Delft, The Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Brend P. Jonker
- Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Jose A. Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Dominiek Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Sjors Koppes
- Department of Pathology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | | | - Gerda M. Verduijn
- Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Steven Petit
- Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Brita S. Sørensen
- Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Experimental Clinical Oncology, Danish Centre for Particle Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Denmark
| | - Dik C. van Gent
- Department of Molecular Genetics, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (K.S.P.); (D.C.v.G.)
| | - Marta E. Capala
- Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
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Schoenberg P, Wulff-Burchfield E, Schlundt D, Bonnet K, Dietrich M, Murphy B. Qualitative Classification of Late Systemic Symptoms in Head and Neck Cancer Survivors. Cancers (Basel) 2024; 16:2106. [PMID: 38893225 PMCID: PMC11172150 DOI: 10.3390/cancers16112106] [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: 05/01/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Improved rates of cancer control have increased the head and neck cancer survivor population. Cancer survivorship clinics are not widely available in the USA, and longitudinal supportive care for patients undergoing multimodal therapy has not advanced at a pace commensurate with improvements in cancer control. Consequently, a large head and neck cancer survivor population whose quality of life may be chronically and/or permanently diminished presently exists. This lack of awareness perpetuates under-recognition and under-investigation, leaving survivors' (mostly detrimental) experiences largely uncharted. We conducted a qualitative exploration of survivors' experiences, aiming to unpack the profound impact of late systemic symptoms on daily life, encompassing work, relationships, and self-identity in the head and neck cancer survivor community. The study included 15 remitted head and neck survivors, ≥12 months from their final treatment, who participated in semi-structured interviews conducted by a medical oncologist. Data analysis comprised qualitative thematic analysis, specifically inductive hierarchical linear modeling, enriched by a deductive approach of anecdotal clinical reporting. Results highlighted that 43.36% of all quotation material discussed in the interviews pertained to chronic emotion disturbance with significant implications for other domains of life. A central symptom cluster comprised impairments in mood/emotions, daily activity, and significant fatigue. Dysfunction in sleep, other medical conditions, and cognitive deficits comprised a secondary cluster. Physical dysfunctionality, encompassing pain, appetite, and eating, and alterations in experienced body temperature, constituted a tertiary cluster, and perhaps were surprisingly the least discussed symptom burden among head and neck cancer survivors. Symptoms causing heightened long-term survivor burden may be considered epiphenomenal to central physical dysfunctionality, albeit being presently the least represented in cancer survivor care programs. Moving forward, the development of targeted and multi-dimensional treatment programs that encompass physical, psychosocial, and spiritual domains are needed to increase clinical specificity and effective holistic long-term solutions that will foster a more compassionate and informed future of care for the cancer survivorship community.
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Affiliation(s)
- Poppy Schoenberg
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | | | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN 37212, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN 37212, USA
| | - Mary Dietrich
- Department of Biostatistics, School of Nursing, Vanderbilt University, Nashville, TN 37240, USA
| | - Barbara Murphy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA
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Hasanah NT, Sufiawati I, Kusumadjati A, Sunardi MA. In Vitro Effect of Low-level Laser Therapy on Candida albicans Colonies Isolated From Patients Undergoing Radiotherapy for Head and Neck Cancer. J Lasers Med Sci 2024; 15:e11. [PMID: 39051003 PMCID: PMC11267099 DOI: 10.34172/jlms.2024.11] [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: 09/14/2023] [Accepted: 02/21/2024] [Indexed: 07/27/2024]
Abstract
Introduction: Studies on head and neck cancer (HNC) patients undergoing radiotherapy have revealed increased numbers of Candida spp., leading to oral candidiasis and oral mucositis. The effects of laser therapy on Candida spp. have been studied with varied results. This study aimed to investigate the effect of low-level laser therapy (LLLT) on C. albicans colonies isolated from HNC patients undergoing radiotherapy. Methods: This study included a treated group, wherein 11 C. albicans isolates were obtained from the saliva of HNC patients undergoing radiotherapy at a dose exceeding 30 Gy. The control groups consisted of an untreated negative control and a positive control treated with nystatin. The treatment groups were subjected to LLLT in continuous mode for 50 seconds at a wavelength of 976 nm, 0.1 W at a dose of 5 J/cm2 for Laser 1 (L1) group and 0.2 W at a dose of 10 J/cm2 for Laser 2 (L2) group. The tests were conducted using C. albicans inoculum equivalent to a 0.5-McFarland suspension on 96-well plates. All test group inoculums were then cultured on Sabouraud dextrose agar (SDA), and the colony count was assessed at 104 CFU/mL. Results: LLLT at 5 and 10 J/ cm2 reduced C. albicans colonies by 7.01% and 10.94%, respectively, but the reductions were not statistically significant (P>0.05). Nystatin eliminated all the colonies. Conclusion: LLLT shows potential for reducing C. albicans colonies in HNC patients undergoing radiotherapy. However, further studies with varied parameters and methods are necessary.
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Affiliation(s)
- Novia Tri Hasanah
- Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Irna Sufiawati
- Department of Oral Medicine, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Adji Kusumadjati
- Department of Radiation Oncology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Mas Adi Sunardi
- Department of Radiation Oncology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Song J, Wen Y, Liang L, Lv Y, Liu T, Wang R, Hu K. Prediction of severe radiation-induced oral mucositis in locally advanced nasopharyngeal carcinoma using the combined systemic immune-inflammatory index and prognostic nutritional index. Eur Arch Otorhinolaryngol 2024; 281:2627-2635. [PMID: 38472492 DOI: 10.1007/s00405-024-08536-w] [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: 12/16/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Severe radiation-induced oral mucositis (sRIOM) can seriously affect patients' quality of life and treatment compliance. This study was to investigate the utility of the systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI) in predicting sRIOM in patients with locally advanced nasopharyngeal carcinoma (LANPC). METHODS 295 patients with LANPC were retrospectively screened. The pre-radiotherapy SII and PNI were calculated based on peripheral blood samples. A receiver operating characteristic (ROC) curve was used to determine the cut-off value. Logistic regression was used for univariate and multivariate analyses. Patients were classified into three groups based on the SII-PNI score: score of 2, high SII (> cut-off value) and low PNI (≤ cut-off value); score of 1, either high SII or low PNI; score of 0, neither high SII nor low PNI. RESULTS The SII-PNI demonstrated significant predictive ability for sRIOM occurrence, as evidenced by an area under the curve (AUC) of 0.738. The incidence rates of sRIOM with SII-PNI score of 2, 1, and 0 were 73.86%, 44.35%, and 18.07%, respectively. Multivariate analysis confirmed that the SII-PNI score was an independent risk factor for sRIOM. CONCLUSION The SII-PNI score is a reliable and convenient indicator for predicting sRIOM in patients with LANPC.
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Affiliation(s)
- JunMei Song
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Nanning, 530021, Guangxi, China
- Oncology Department, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - YaJing Wen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangzhou, China
| | - Lixing Liang
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - YuQing Lv
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Ting Liu
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - RenSheng Wang
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Nanning, 530021, Guangxi, China.
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China.
| | - Kai Hu
- Department of Radiation Oncology, the First Affiliated Hospital of Guangxi Medical University, 22# Shuangyong Road, Nanning, 530021, Guangxi, China.
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China.
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Qamar S, Rozi S, Sawani S, Awan MS, Akhtar S, Siddiqui MI, Abbas SA, Taimoor S, Raza Khan F. Oral health related quality of life in head and neck cancer survivors within the first year following treatment: a cross-sectional study in Karachi, Pakistan. Sci Rep 2024; 14:2560. [PMID: 38297035 PMCID: PMC10830491 DOI: 10.1038/s41598-024-52813-x] [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: 10/08/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
After completing treatment for head and neck cancer (HNC), patients often face oral complications like oral pain, limited mouth opening and dry mouth which significantly reduce their oral health related quality of life (OHRQoL). These issues impact their overall well-being, social activities and long-term survival. The primary objective of this study was to evaluate OHRQoL and its association with sociodemographic characteristics, oral hygiene practices and oral clinical parameters such as oral hygiene status and oral mucositis grade in patients who have completed treatment for head and neck cancer. This cross-sectional study involved 79 HNC-treated patients within first year after completion of cancer treatment attending ENT and dental clinics at outpatient department (OPD) setting in Karachi. Data was collected electronically using structured questionnaire comprising of EORTC QLQ H&N - 35 to measure OHRQoL, patients were also examined for oral hygiene status using oral hygiene index- simplified (OHI-s) and oral mucositis grade using WHO oral mucositis scale. Multiple linear regression was used to test OHRQoL associations with the sociodemographic and different clinical factors. The result showed an overall mean score for oral health related quality of life (OHRQoL) of 25.02 ± 15.86 (95% CI 21.46-28.57), with difficulty in mouth opening 53.16 ± 18.88 and dry mouth 45.14 ± 24.48 being predominant concerns for decline in the OHRQoL in the population. Male predilection was observed among participants n = 60 (75.9%), majority of the participants n = 41 (51.9%) were below 52 years of age. n = 63 (80%) participants received radiotherapy alongside surgery and chemotherapy. Most of participants n = 66 (83.5%) experienced moderate to severe oral mucositis with poor oral hygiene status n = 56 (71%). Significant associations were found between OHRQoL and BMI, OH status, marital status, monthly income, gender and fluoride toothpaste (p < 0.05). These findings suggest that Quality of Life (QoL) among HNC treated patients is negatively impacted by their poor oral health, post cancer treatment. Therefore, it is important to evaluate and modify the current treatment modalities and involve multidisciplinary teams, to improve their OHRQoL thereby enhancing overall QoL.
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Affiliation(s)
- Sana Qamar
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan.
| | - Shafquat Rozi
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Sobia Sawani
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Sohail Awan
- Department of Surgery, Section of Otolaryngology and Head and neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shabbir Akhtar
- Department of Surgery, Section of Otolaryngology and Head and neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Moghira Iqbaluddin Siddiqui
- Department of Surgery, Section of Otolaryngology and Head and neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Akbar Abbas
- Department of Surgery, Section of Otolaryngology and Head and neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shazia Taimoor
- Department of Surgery, Associate of Science of Dental Hygiene, Aga Khan University Hospital, Karachi, Pakistan
| | - Farhan Raza Khan
- Department of Surgery, Section of Dental Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Redwan AS, Kattan FA, Alidrisi MA, Ali GA, Ghaith MM, Arbaeen AF, Almasmoum HA, Almohmadi NH, Alkholy SO, Alhassani WE, Abusudah WF, Babateen AM, Ghabashi MA, Obeidat AA, Al Yacoub AN, Alazzeh AY, Azzeh FS. Predictive Factors for Critical Weight Loss in Saudi Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy. Cancers (Basel) 2024; 16:414. [PMID: 38254902 PMCID: PMC10814742 DOI: 10.3390/cancers16020414] [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: 12/17/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Weight loss is a significant health problem among patients with head and neck cancer (HNC) that is attributable primarily to the tumor or tumor therapy. Critical weight loss (CWL) is defined as the unintentional loss of ≥5% of weight. Therefore, this study's goal was to investigate and determine the possible factors influencing CWL among patients with HNC who have received radiotherapy or concurrent chemoradiotherapy (CCRT). We conducted a retrospective analysis of 175 patients who received radiotherapy or CCRT as either their primary, adjuvant, or combined treatment at the Oncology Center in King Abdullah Medical City. All patients were ≥18 years of age and diagnosed with HNC with no metastasis. The study results showed that 107 patients (61%) had CWL, while 68 (39%) did not. The following factors were significantly predictive of CWL with a multivariate regression analysis: pretreatment BMI (AOR = 1.1, 95% CI = 1.02-1.17), oral cavity cancer (AOR = 10.36, 95% CI = 1.13-94.55), and male sex (AOR = 3.15, 95% CI = 1.39-7.11). In conclusion, weight loss is highly prevalent among HNC patients during treatment. Accordingly, pretreatment BMI, cancer in the oral cavity, and being male can be considered predictive factors for CWL.
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Affiliation(s)
- Alaa S. Redwan
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (A.S.R.); (N.H.A.); (S.O.A.); (W.E.A.); (W.F.A.); (A.M.B.); (M.A.G.)
- Clinical Nutrition Administration, King Abdullah Medical City, P.O. Box 24246, Makkah 21955, Saudi Arabia;
| | - Fayrooz A. Kattan
- Clinical Nutrition Administration, King Abdullah Medical City, P.O. Box 24246, Makkah 21955, Saudi Arabia;
| | - Maha A. Alidrisi
- Radiation Oncology Department, King Abdullah Medical City, P.O. Box 24246, Makkah 21955, Saudi Arabia; (M.A.A.); (G.A.A.)
| | - Gayur A. Ali
- Radiation Oncology Department, King Abdullah Medical City, P.O. Box 24246, Makkah 21955, Saudi Arabia; (M.A.A.); (G.A.A.)
| | - Mazen M. Ghaith
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (M.M.G.); (A.F.A.); (H.A.A.)
| | - Ahmad F. Arbaeen
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (M.M.G.); (A.F.A.); (H.A.A.)
| | - Hussain A. Almasmoum
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (M.M.G.); (A.F.A.); (H.A.A.)
| | - Najlaa H. Almohmadi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (A.S.R.); (N.H.A.); (S.O.A.); (W.E.A.); (W.F.A.); (A.M.B.); (M.A.G.)
| | - Sarah O. Alkholy
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (A.S.R.); (N.H.A.); (S.O.A.); (W.E.A.); (W.F.A.); (A.M.B.); (M.A.G.)
| | - Walaa E. Alhassani
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (A.S.R.); (N.H.A.); (S.O.A.); (W.E.A.); (W.F.A.); (A.M.B.); (M.A.G.)
| | - Wafaa F. Abusudah
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (A.S.R.); (N.H.A.); (S.O.A.); (W.E.A.); (W.F.A.); (A.M.B.); (M.A.G.)
| | - Abrar M. Babateen
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (A.S.R.); (N.H.A.); (S.O.A.); (W.E.A.); (W.F.A.); (A.M.B.); (M.A.G.)
| | - Mai A. Ghabashi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (A.S.R.); (N.H.A.); (S.O.A.); (W.E.A.); (W.F.A.); (A.M.B.); (M.A.G.)
| | - Ahmad A. Obeidat
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan;
| | - Azzam N. Al Yacoub
- Department of Biology, Faculty of Applied Science, Umm Al-Qura University, P.O. Box 715, Makkah 24382, Saudi Arabia;
| | - Awfa Y. Alazzeh
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, University of Ha’il, Ha’il 21955, Saudi Arabia;
| | - Firas S. Azzeh
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia; (A.S.R.); (N.H.A.); (S.O.A.); (W.E.A.); (W.F.A.); (A.M.B.); (M.A.G.)
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Raghunand Sindhe J, Asha V, Arvind M, Shabana S, Sowbhagya Lakshmi A, Tanvi K, Ananta G. A Systematic Review of the Efficacy and Safety of Mulberry Formulations for Chemotherapy- and/or Radiotherapy-Induced Oral Mucositis. Cureus 2024; 16:e52340. [PMID: 38361712 PMCID: PMC10867387 DOI: 10.7759/cureus.52340] [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] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
Oral mucositis (OM) is one of the common side effects of radiotherapy and chemotherapy. It is an extremely painful condition characterized by erythema, edema, and ulceration of the oral mucosa. Many plant-based and chemical formulations are used to prevent OM. The aim of the study is to evaluate the efficacy and safety of different black mulberry formulations in chemotherapy and/or radiotherapy-induced OM. A systematic search was performed using PubMed, Excerpta Medica database (Embase), the Cochrane Library, and Web of Science databases for articles published until March 2023. We have included studies conducted on people undergoing chemotherapy and/or radiotherapy and compared the effect of any mulberry formulation with other interventions. Out of 30 articles retrieved, four articles with a cumulative sample size of (N = 297) were included in the review. Mulberry formulations were compared with no intervention, grape molasses, chlorhexidine, and sodium bicarbonate. Out of the four articles, in three articles, mulberry formulations showed a significant decrease in grade 2 and grade 3 OM and also showed better prevention of OM as compared to the other intervention and control groups, and in one article, the grape molasses was more preventive for the occurrence of OM. Mulberry showed a significant decrease in dry mouth. Mulberry showed more improvement in the pain score and quality of life. The incidence and severity were lower in the mulberry group than in other interventions. One article showed less weight loss, and another article showed gradual weight gain from the use of mulberries. From this, we conclude that mulberry is effective for the treatment of OM. Mulberry also shows improvement in the pain score and quality of life.
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Affiliation(s)
| | - V Asha
- Oral Medicine and Radiology, The Oxford Dental College and Hospital, Bangalore, IND
| | - Muthukrishnan Arvind
- Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Chennai, IND
| | - Shaik Shabana
- Oral Medicine and Radiology, Al Ameen Dental College, Bijapur, IND
| | - A Sowbhagya Lakshmi
- Oral Medicine and Radiology, The Oxford Dental College and Hospital, Bangalore, IND
| | | | - Gimre Ananta
- Evidence Synthesis, coGuide Academy, Bangalore, IND
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8
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Bergamaschi L, Vincini MG, Zaffaroni M, Pepa M, Angelicone I, Astone A, Bergamini C, Buonopane S, Conte M, De Rosa N, Deantoni C, Dell'Oca I, Di Gennaro D, Di Muzio N, Osti MF, Federico M, Ferini G, Franzese C, Gatti M, Grillo A, Iorio V, Manzo R, Marmiroli L, Martin G, Mazzuca F, Molinaro MA, Muto M, Pacelli R, Pepe A, Perillo A, Russo D, Salerno F, Spadaro P, Viola A, Iorio GC, Muto P, Ricardi U, Alterio D. Management of radiation-induced oral mucositis in head and neck cancer patients: a real-life survey among 25 Italian radiation oncology centers. Support Care Cancer 2023; 32:38. [PMID: 38110572 PMCID: PMC10728275 DOI: 10.1007/s00520-023-08185-5] [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: 07/19/2023] [Accepted: 11/12/2023] [Indexed: 12/20/2023]
Abstract
AIM Radiation-induced oral mucositis (RIOM) is the most frequent side effect in head and neck cancer (HNC) patients treated with curative radiotherapy (RT). A standardized strategy for preventing and treating RIOM has not been defined. Aim of this study was to perform a real-life survey on RIOM management among Italian RT centers. METHODS A 40-question survey was administered to 25 radiation oncologists working in 25 different RT centers across Italy. RESULTS A total of 1554 HNC patients have been treated in the participating centers in 2021, the majority (median across the centers 91%) with curative intent. Median treatment time was 41 days, with a mean percentage of interruption due to toxicity of 14.5%. Eighty percent of responders provide written oral cavity hygiene recommendations. Regarding RIOM prevention, sodium bicarbonate mouthwashes, oral mucosa barrier agents, and hyaluronic acid-based mouthwashes were the most frequent topic agents used. Regarding RIOM treatment, 14 (56%) centers relied on literature evidence, while internal guidelines were available in 13 centers (44%). Grade (G)1 mucositis is mostly treated with sodium bicarbonate mouthwashes, oral mucosa barrier agents, and steroids, while hyaluronic acid-based agents, local anesthetics, and benzydamine were the most used in mucositis G2/G3. Steroids, painkillers, and anti-inflammatory drugs were the most frequent systemic agents used independently from the RIOM severity. CONCLUSION Great variety of strategies exist among Italian centers in RIOM management for HNC patients. Whether different strategies could impact patients' compliance and overall treatment time of the radiation course is still unclear and needs further investigation.
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Affiliation(s)
- Luca Bergamaschi
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy.
| | - Mattia Zaffaroni
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Ilaria Angelicone
- Radiotherapy Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Astone
- Division of Medical Oncology, Fatebenefratelli San Pietro Hospital, 00189, Rome, Italy
| | - Cristiana Bergamini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sergio Buonopane
- Radiation Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Mario Conte
- Fondazione Muto Onlus, Casavatore, Naples, Italy
| | - Nicola De Rosa
- Centro Aktis Diagnostica e Terapia, Marano, Naples, Italy
| | - Chiara Deantoni
- Radiotherapy Department, IRCCS San Raffaele Scientific Institute, Vita Salute S. Raffaele University, Milan, Italy
| | - Italo Dell'Oca
- Radiotherapy Department, IRCCS San Raffaele Scientific Institute, Vita Salute S. Raffaele University, Milan, Italy
| | | | - Nadia Di Muzio
- Radiotherapy Department, IRCCS San Raffaele Scientific Institute, Vita Salute S. Raffaele University, Milan, Italy
| | - Mattia Falchetto Osti
- Radiotherapy Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Manuela Federico
- Casa di cura Macchiarella, U.O. Radioterapia Oncologica, Palermo, Italy
| | | | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Gatti
- Radiotherapy Unit, Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy
| | - Antonietta Grillo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | | | - Roberto Manzo
- Radiation Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Luca Marmiroli
- U.O. Radioterapia, Ospedale Fatebenefratelli S. Giovanni Calibita, Isola Tiberina, 00186, Rome, Italy
| | | | - Federica Mazzuca
- Radiotherapy Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Matteo Muto
- Department of Onco-Hematological Diseases, U.O.C. Radiotherapy-Azienda Ospedaliera San Giuseppe Moscati-(AV), 83100, Avellino, Italy
| | - Roberto Pacelli
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | | | - Annarita Perillo
- Centro Aktis Diagnostica e Terapia, Marano, Naples, Italy
- Department of Radiation Oncology, San Pio Hospital, Benevento, Italia
| | | | | | - Pietro Spadaro
- U.O. di Oncologia ed Ematologia, Casa di Cura Villa Salus, Messina, Italy
| | - Anna Viola
- Fondazione IOM, Viagrande, Catania, Italy
| | | | - Paolo Muto
- Radiation Oncology Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
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9
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Ambili R, Ramadas K, Nair LM, Raj D, Nazeer F, George PS, Rejnish Kumar R, Radhakrishna Pillai M. Efficacy of a herbal mouthwash for management of periodontitis and radiation-induced mucositis - A consolidated report of two randomized controlled clinical trials. J Ayurveda Integr Med 2023; 14:100791. [PMID: 37897968 PMCID: PMC10641263 DOI: 10.1016/j.jaim.2023.100791] [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: 09/14/2022] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Oral diseases like periodontitis and mucositis often require home care using topical agents in the form of mouthwashes. Many herbal mouthwashes are found to be beneficial; however lack proper scientific evidence to support their use. OBJECTIVES Study 1 evaluated clinical efficacy of herbal mouthwash in the management of chronic periodontitis in comparison with chlorhexidine mouthwash. Study 2 aimed at assessment of herbal mouthwash in patients of radiation-induced mucosititis. METHODS The novel herbal mouthwash used in the present study wa prepared from extracts of five plants namely Emblica Officinalis, Terminalia chebula, Terminalia bellerica, Glycyrrhiza glabra, and Azadirachta indica. 50 periodontitis patients were randomly allocated to two groups. As per allocation, they were instructed to use either herbal mouthwash or chlorhexidine mouthwash twice daily for two weeks after nonsurgical periodontal therapy. Similarly, patients with radiation-induced mucositis were randomly given herbal mouthwash and soda saline mouthwash. Intergroup and intragroup comparisons of continuous variables were conducted using paired and unpaired t-tests. Categorical variables were compared using the chi-square test. RESULTS Significant reductions in gingival bleeding, plaque accumulation, and pocket depth were noticed in periodontitis patients in both groups. Patients reported acceptable taste, freshness, and satisfaction after the use of herbal mouthwash. The herbal mouthwash group noticed a significant reduction in the severity of radiation-induced mucositis and analgesic requirements. The intensity of pain, dryness of mouth, oral hygiene, and need for the use of antibiotic and antifungal during radiotherapy was not significant among the groups. CONCLUSION The results of this preliminary clinical trial support the use of the tested herbal formulation mouthwash as an adjunct in the treatment of periodontitis as well as radiation-induced mucositis. CLINICAL TRIAL REGISTRATION NUMBER For Study 1: CTRI/2019/10/021574, Study 2: CTRI/2020/04/024851.
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Affiliation(s)
- R Ambili
- Department of Periodontics, PMS College of Dental Science and Research, Thiruvananthapuram, India.
| | - K Ramadas
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - Lekha M Nair
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - Divya Raj
- Division of Dental Care, Regional Cancer Centre, Thiruvananthapuram, India
| | - Farida Nazeer
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - Preethi Sara George
- Division of Cancer Epidemiology, Regional Cancer Centre, Thiruvananthapuram, India
| | - R Rejnish Kumar
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
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10
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Morsy BM, El Domiaty S, Meheissen MAM, Heikal LA, Meheissen MA, Aly NM. Omega-3 nanoemulgel in prevention of radiation-induced oral mucositis and its associated effect on microbiome: a randomized clinical trial. BMC Oral Health 2023; 23:612. [PMID: 37648997 PMCID: PMC10470147 DOI: 10.1186/s12903-023-03276-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Oral mucositis (OM) is recognized as one of the most frequent debilitating sequelae encountered by head and neck cancer (HNC) patients treated by radiotherapy. This results in severe mucosal tissue inflammation and oral ulcerations that interfere with patient's nutrition, quality of life (QoL) and survival. Omega-3 (ω-3) polyunsaturated fatty acids (PUFAs) have recently gained special interest in dealing with oral diseases owing to its anti-inflammatory, anti-oxidant and wound healing properties. Thus, this study aims to assess topical Omega-3 nanoemulgel efficacy in prevention of radiation-induced oral mucositis and regulation of oral microbial dysbiosis. MATERIALS AND METHODS Thirty-four head and neck cancer patients planned to receive radiotherapy were randomly allocated into two groups: Group I: conventional preventive treatment and Group II: topical Omega-3 nanoemulgel. Patients were evaluated at baseline, three and six weeks after treatment using the World Health Organization (WHO) grading system for oral mucositis severity, Visual Analogue Scale (VAS) for perceived pain severity, and MD-Anderson Symptom Inventory for Head and Neck cancer (MDASI-HN) for QoL. Oral swabs were collected to assess oral microbiome changes. RESULTS VAS scores and WHO mucositis grades were significantly lower after six weeks of treatment with topical Omega-3 nanoemulgel when compared to the conventional treatment. The total MDASI score was significantly higher in the control group after three weeks of treatment, and the head and neck subscale differed significantly at both three and six weeks. A significant reduction in Firmicutes/Bacteroidetes ratio was observed after six weeks in the test group indicating less microbial dysbiosis. CONCLUSIONS Topical Omega-3 nanoemulgel demonstrated a beneficial effect in prevention of radiation-induced oral mucositis with a possibility of regulating oral microbial dysbiosis.
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Affiliation(s)
- Basma M Morsy
- Oral Medicine, Periodontology, Oral Diagnosis, and Oral Radiology Department, Faculty of Dentistry, Alexandria University, Champolion St, 21527, Alexandria Governorate, Egypt.
| | - Shahira El Domiaty
- Oral Medicine, Periodontology, Oral Diagnosis, and Oral Radiology Department, Faculty of Dentistry, Alexandria University, Champolion St, 21527, Alexandria Governorate, Egypt
| | - Mohamed A M Meheissen
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Alexandria University, Alexandria Governorate, Egypt
| | - Lamia A Heikal
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria Governorate, Egypt
| | - Marwa A Meheissen
- Medical Microbiology and Immunology Department, Faculty of Medicine, Alexandria University, Alexandria Governorate, Egypt
| | - Nourhan M Aly
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria Governorate, Egypt
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11
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Martins AFL, Pereira CH, Morais MO, de Sousa-Neto SS, Valadares MC, Freitas NMA, Leles CR, de Mendonça EF. Effects of a mucoadhesive phytomedicine (Curcuma longa L. and Bidens pilosa L.) on radiotherapy-induced oral mucositis and quality of life of patients undergoing head and neck cancer treatment: randomized clinical trial. Support Care Cancer 2023; 31:517. [PMID: 37566179 DOI: 10.1007/s00520-023-07971-5] [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: 12/29/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE To assess the effect of a mucoadhesive herbal medicine containing curcuminoids and a glycerinated extract of Bidens pilosa L. (FITOPROT) in association with photobiomodulation (PBM) therapy and a Preventive Oral Care Program (POCP) compared to PBM and POCP in the treatment of radiotherapy (RT)-induced oral mucositis (ROM) and in the quality of life of these patients. METHODS A double-blind clinical trial was performed with head and neck cancer patients undergoing RT or chemoradiotherapy. Participants were randomized into two groups: Group 1 (n=27): PBM and POCP; and Group 2 (n=25): PBM, POCP and FITOPROT. The PBM protocol was daily irradiation, 660 nm, 25mW, 0.25 J/point from the first until the last day of RT. The FITOPROT was used as mouthwash twice a day. ROM was evaluated based on the scales of the World Health Organization and National Cancer Institute. The quality of life was evaluated using the University of Washington Questionnaire, OHIP-14 and Patient-Reported Oral Mucositis Symptom Scale. The MMAS-8 questionnaire was used to evaluated the adherence to POCP and FITOPROT. Data were collected at baseline, 7th, 14th, 21st, and 30th RT sessions. RESULTS No statistical differences were found between the groups for the ROM evaluation. Both groups experienced worsening of the quality of life during the RT. No statistically significant differences between groups were observed for any of the instruments evaluated. CONCLUSION The results suggest that PBM associated with FITOPROT and POCP control the severity of ROM and stabilize the QoL of patients with head and neck cancer. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC-RBR-9vddmr; UTN code: U1111-1193-2066), registered in August 8th, 2017.
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Affiliation(s)
- Allisson Filipe Lopes Martins
- Universidade Evangélica de Goiás, Dentistry School, Av. Universitária, s/n-Cidade Universitária, Goiás, Anápolis, CEP 75083-515, Brazil
| | - Carlos Henrique Pereira
- Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Marília Oliveira Morais
- Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Sebastião Silvério de Sousa-Neto
- Laboratory of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiás, Goiânia, CEP 74605-220, Brazil
| | - Marize Campos Valadares
- Laboratory of Pharmacology and Cellular Toxicology, Pharmacy Faculty, Universidade Federal de Goiás 5ª Avenida Esquina com Rua 240, s/n-Setor Universitário, Goiás, Goiânia, CEP 74605-170, Brazil
| | - Nilceana Maya Aires Freitas
- Department of Radiotherapy, Araujo Jorge Cancer Hospital, R. 239, 206-Setor Universitário, Goiás, Goiânia, CEP 74175-120, Brazil
| | - Cláudio Rodrigues Leles
- Department of Prevention and Oral Rehabilitation, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n-Setor Universitário, Goiás, Goiânia, CEP 74605-220, Brazil
| | - Elismauro Francisco de Mendonça
- Department of Oral Pathology, School of Dentistry, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, CEP 74605-220, Brazil.
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12
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Ameri A, Heydarirad G, Choopani R, Poshtmahi S, Ameri P, Talebi F, Bagheri Pour A, Taghizadeh-Hesary F. Sumac-rose water mouthwash versus benzydamine to prevent radiation-induced oral mucositis in head and neck cancers: a phase II randomized trial. J Cancer Res Clin Oncol 2023; 149:7427-7439. [PMID: 36947237 DOI: 10.1007/s00432-023-04687-1] [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: 02/20/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Radiation-induced oral mucositis (OM) largely impairs the quality of life (QoL) of patients with head and neck cancer (HNC). Few choices with limited efficacy are available to prevent this adverse effect. This randomized trial was conducted to compare the efficacy of benzydamine (standard) and a new combination (sumac and rose water) in preventing radiation-induced OM. METHODS This was a phase II, triple-blind, active-controlled, randomized trial. The primary endpoint was OM, and the secondary endpoints were oral pain and QoL. Besides, the possible variables defining the outcomes were analyzed using the chi-squared test (univariate analysis) and binomial regression model (multivariate analysis). RESULTS Sumac-rose group had fewer high-grade OM (33% vs. 63%, odds ratio [OR] 0.28, 95% confidence interval [CI 95%] 0.08-0.93, P = 0.03) and better QoL (P < 0.05). Multivariate analysis confirmed these findings. Sumac-rose rinsing could also postpone the start of oral pain (hazard ratio [HR] 0.02, CI 95% 0.001-0.32, P = 0.001) and high-grade OM (HR 0.28, P = 0.03) compared with benzydamine. CONCLUSIONS The sumac-rose group had a lower OM rate and grade and higher QoL than the benzydamine group. In addition, the experimental group developed high-grade OM and oral pain later during the radiotherapy course. Further studies need to be conducted to assess the role of sumac and rose water in reducing grade 3-4 mucositis in patients who undergo chemoradiation for head and neck cancer.
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Affiliation(s)
- Ahmad Ameri
- Department of Clinical Oncology, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazaleh Heydarirad
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasoul Choopani
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Traditional Medicine and Materia Medica Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Poshtmahi
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Pooya Ameri
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Talebi
- Department of Clinical Oncology, Imam Hossein Educational Hospital, Shahid Beheshti 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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13
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Ito K, Tokura S, Takazawa I, Yoshida N, Nakanishi T, Akiyama K, Onuma Y, Adachi T, Harada H, Nojima H, Miura M, Yoshimura R, Kabasawa Y. Clinical investigation of use of Episil® oral solution in oral mucositis during radiotherapy for head and neck cancer. Heliyon 2023; 9:e15869. [PMID: 37260888 PMCID: PMC10227342 DOI: 10.1016/j.heliyon.2023.e15869] [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: 07/18/2022] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
Objective Episil® is a bio adhesive barrier-forming oral liquid gel that has been used in recent years to relieve pain of oral mucositis (OM) with radiotherapy (RT) or chemoradiotherapy (CRT) in head and neck cancer (HNC) patients. We conducted a retrospective analysis of the clinical effects of Episil® on OM in these patients. Study design Between June 2018 and May 2020, 65 patients with HNC were treated with RT or CRT at our hospital. Results The median total RT dose was 50 Gy (range, 30-70 Gy) and the completion rate was 63/65 (97%). The median time to OM resolution was 47 (6-90) days and was significantly longer (53 [27-90] days) when the total RT dose was ≥51 Gy (P < 0.001). Episil® was used in 26 patients. Among them, 10 discontinued its use due to ineffective pain relief, usage difficulties, and taste intolerance. The median duration of use was 30 days and was significantly longer (34.5 days) (P < 0.001) when patients experienced pain relief at treatment initiation. Conclusion Although Episil® has been shown to be effective in improving the pain of OM caused by RT for HNC patients, and medical professionals are required to give careful attention to each patient.
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Affiliation(s)
- Kanade Ito
- Department of Oral Care for Systemic Health Support, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Shiori Tokura
- Department of Oral Care for Systemic Health Support, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Itsuki Takazawa
- Department of Oral Health Care Education, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Naomi Yoshida
- Department of Oral Health Care Education, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Tohko Nakanishi
- Department of Dental Hygiene, Tokyo Medical and Dental University Hospital, Japan
| | - Kikue Akiyama
- Department of Dental Hygiene, Tokyo Medical and Dental University Hospital, Japan
| | - Yuki Onuma
- Department of Dental Hygiene, Tokyo Medical and Dental University Hospital, Japan
| | - Toshiko Adachi
- Department of Dental Hygiene, Tokyo Medical and Dental University Hospital, Japan
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgical Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Hitomi Nojima
- Department of Dental Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Masahiko Miura
- Department of Dental Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Yuji Kabasawa
- Department of Oral Care for Systemic Health Support, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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14
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Fahy E, Brooker RC, Fleming JC, Patterson JM. A review of unplanned admissions in head and neck cancer patients undergoing oncological treatment. Support Care Cancer 2023; 31:328. [PMID: 37154829 PMCID: PMC10165288 DOI: 10.1007/s00520-023-07770-y] [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: 01/16/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
AIM Non-surgical treatment for head and neck cancer (HNC) often results in severe toxicities, which are detrimental to a patient's health and quality of life. There is limited published UK data on unplanned hospital admissions and reasons associated with admission. We aim to identify frequencies and reasons for unplanned hospital admissions, highlighting those patient groups who are most vulnerable. METHODS A retrospective study of unplanned hospital admissions of HNC patients receiving non-surgical treatment was completed. An inpatient admission was defined as ≥ 1 night spent in the hospital. To test potential demographic and treatment predictors of inpatient admission, a multiple regression model was constructed using the endpoint measure (unplanned admission), as the dependent variable. RESULTS A cohort of 216 patients was identified over a 7-month period, and 38 of these patients (17%) required an unplanned admission. Treatment type was the only statistically significant predictor of in-patient admission. The majority of admissions were patients receiving chemoradiotherapy (CRT) (58%) with predominant reasons for admission being nausea and vomiting (25.5%) and decreased oral intake/dehydration (30%). Of the patients admitted, 12 had a prophylactic PEG placed pre-treatment, and 18 of 26 admitted without prophylactic PEG required nasogastric tube feeding during their admission. DISCUSSION Almost one-fifth of HNC patients over this time period required hospital admission; the majority of which can be attributed to treatment toxicities when receiving CRT. This is concurrent with other studies which review the impact of radiotherapy versus CRT. Increased support and monitoring, particularly focused on nutrition, are required for patients with HNC who receive CRT. KEY MESSAGE This article describes a retrospective review of a patient undergoing non-surgical treatment for head and neck cancer. These patients frequently require unplanned hospital admission. The results indicate that patients undergoing (chemo)radiotherapy are most vulnerable to deterioration and additional support focused on nutrition for these patients is indicated.
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Affiliation(s)
- Emer Fahy
- Speech and Language Therapy, The Clatterbridge Cancer Centre NHS Foundation Trusts, 65 Pembroke Place, Liverpool, L7 8YA, UK.
| | - Rachel C Brooker
- The Clatterbridge Cancer Centre NHS Foundation Trusts, Liverpool, UK
| | - Jason C Fleming
- Liverpool Head & Neck Centre, Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Liverpool, L9 7AL, UK
| | - Joanne M Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
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15
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Xu J, Yang G, An W, Wang W, Li F, Meng Y, Wang X. Correlations between the severity of radiation-induced oral mucositis and salivary epidermal growth factor as well as inflammatory cytokines in patients with head and neck cancer. Head Neck 2023; 45:1122-1129. [PMID: 36866530 DOI: 10.1002/hed.27313] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/29/2023] [Accepted: 02/08/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND This study aimed to investigate correlations of the severity of radiation-induced oral mucositis (RIOM) with epidermal growth factor (EGF) and inflammatory cytokines in patients with head and neck cancer (HNC). METHODS Levels of inflammatory cytokines and EGF in saliva of HNC patients were measured. Correlations of inflammatory cytokines and EGF levels with RIOM severity and pain degree, and their diagnostic values on RIOM severity were determined. RESULTS Elevated IFN-γ, TNF-α, IL-2, and IL-6 levels, and reduced IL-4, IL-10, and EGF levels were found in patients with severe RIOM. IFN-γ, TNF-α, IL-2, and IL-6 were positively correlated with RIOM severity, while IL-10, IL-4, and EGF were negatively correlated with it. All factors were effective in predicting the severity of RIOM. CONCLUSION IFN-γ, TNF-α, IL-2, and IL-6 in saliva of patients with HNC are positively correlated with the severity of RIOM, and IL-4, IL-10, and EGF were negatively correlated with it.
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Affiliation(s)
- Juan Xu
- Department of Head and Neck Radiotherapy Ward 1, Shandong Cancer Hospital and Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Guang Yang
- Department of Head and Neck Radiotherapy Ward 1, Shandong Cancer Hospital and Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wei An
- Department of Head and Neck Radiotherapy Ward 1, Shandong Cancer Hospital and Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wei Wang
- Department of Head and Neck Radiotherapy Ward 1, Shandong Cancer Hospital and Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Fangfang Li
- Department of Head and Neck Radiotherapy Ward 1, Shandong Cancer Hospital and Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yingtao Meng
- Department of Nursing, Shandong Cancer Hospital and Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shangdong, China
| | - Xingli Wang
- Department of Nursing, Shandong Cancer Hospital and Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shangdong, China
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Gvozdikova EN, Avanesov AM, Khalil EF, Kandakova EY, Avanesov KA. Personalized or unified approach in the prevention and treatment of oral mucositis in patients with malignant neoplasms of the head and neck organs: the choice of the optimal solution. HEAD AND NECK TUMORS (HNT) 2022. [DOI: 10.17650/2222-1468-2022-12-3-44-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction. The prevalence of oncological diseases of the oropharyngeal region continues to grow steadily, but there is an increase for a number of nosologies in the five-year survival rate of this category of patients, which naturally leads to the actualization of accompanying treatment programs and the desire to improve the quality of life of oncological patients. One of the areas of maintenance therapy in oncology is dental support, the choice of approaches and methods of which is not systematically organized.Aim. To determine the optimal method of dental support for patients with malignant neoplasms of the head and neck organs for the prevention and treatment of oral mucositis.Materials and methods. At the Russian Scientific Center of Roentgenoradiology, retrospective analysis of scientific clinical results of oral mycosis treatment in patients with malignant tumors of the head and neck receiving antitumor therapy was performed.Results. Two main approaches have been identified for the prevention and treatment of oral mucositis in patients with malignant neoplasms of the head and neck organs: personalized and unified approach. using personalized approach, maximal mean value of oral mycosis severity during the whole antitumor treatment period per the Radiation therapy Oncology group (RTOg) classification was 2.19 ± 0.13. The quality of life of patients is reduced by 26.1 %. using unified approach, maximal mean value of oral mycosis severity during the whole antitumor treatment period per the RTOg classification was 2.44 ± 0.05. The quality of life of patients is reduced by 51.5 %, but at the same time, absolutely all patients retain the ability to eat independently and take care of the oral cavity.Conclusion. Both personalized and unified approaches for the prevention and treatment of oral mucositis are possible for use in clinical practice.
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Affiliation(s)
- E. N. Gvozdikova
- Рeoples’ Friendship University of Russia; Russian Scientific Center of Roentgenoradiology, Ministry of Health of Russia
| | | | - E. F. Khalil
- Russian Scientific Center of Roentgenoradiology, Ministry of Health of Russia
| | - E. Yu. Kandakova
- Russian Scientific Center of Roentgenoradiology, Ministry of Health of Russia
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17
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Evaluation of the Effect of Grape Seed Extract (GSE) on Oral Mucositis in Patients with Head and Neck Radiotherapy History- A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-130603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Mucositis is one of the most important complications of radiotherapy. Some factors such as type of treatment and degree of patient sensitivity affect mucositis occurrence. Objective: This research was implemented to evaluate the effect of grape seed extract on radiation-induced mucositis. Methods: This research is a double-blinded randomized clinical trial implemented on 78 patients undergoing head and neck radiotherapy in the oncology ward of Imam Reza Hospital of Tabriz. The patients were randomly divided into 2 groups, the intervention, and the control group. Each group included 39 patients. The intervention group used 2% grape seed extract mouthwashes and the control group used placebo mouthwashes. The mouthwashes were used 3 times a day for 2 weeks. For statistical analysis of collected data, SPSS 20 software was applied. Results: The results showed that according to the Friedman test, on the 10th and 14th days, mucositis grade and incidence had a significant difference between the intervention and control groups. Conclusions: The findings indicated that grape seed extract mouthwash in preventing radiation-induced mucositis was more effective than a placebo. Thus, this agent can be recommended as an appropriate medication to eliminate oral mucositis symptoms.
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Kongwattanakul S, Petchann N, Petroch P, Thanthong S, Tungfung S, Chamchod S, Pitiporn S, Nantajit D. Prophylactic management of radiation-induced mucositis using herbal mouthwash in patients with head and neck cancer: an assessor-blinded randomized controlled trial. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2022; 19:771-780. [PMID: 35218685 DOI: 10.1515/jcim-2021-0457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Radiation-induced mucositis (RIOM) is one of the most common side effects from head and neck radiotherapy. Several reagents have been introduced to manage the symptom; however, there is still a limited number of effective reagents. Herbal mouthwashes with payayor (Clinacanthus nutans Lindau) and fingerroot (Boesenbergia rotunda) were tested their efficacies in preventing and reducing severity of RIOM in comparison with normal saline with sodium bicarbonate. METHODS One hundred twenty patients with head and neck cancer undergoing radiotherapy participated in the study and were randomly assigned into three treatment groups using block randomization method. The participants were assigned one of the three mouthwashes for use throughout their radiotherapy course and were assessed for their mucositis scores from week one to six into their radiotherapy course as well as at one-month follow-up. Body mass index was also measured for comparison of nutritional status. RESULTS The two mouthwashes were similarly effective in prophylaxis of RIOM in term of severity. The averaged mucositis scores were less than two for all groups. For the onset of RIOM, both herbal mouthwashes could slightly delay the symptom but not statistically significant. Patients' body mass index across the three treatment groups was also comparable. The patients were largely satisfied with all the mouthwashes with no clear preference on any of them. CONCLUSIONS Prophylactic treatment of RIOM using herbal mouthwashes could substitute the current standard of normal saline with bicarbonate. A different formulation of the two herbs could potentially improve the prophylactic outcome. TRIAL REGISTRATION NO NCT03359187.
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Affiliation(s)
- Sirikorn Kongwattanakul
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Nutjaree Petchann
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Petcharat Petroch
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Saengrawee Thanthong
- Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Sunanta Tungfung
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Sasikarn Chamchod
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Supaporn Pitiporn
- Chaopraya Abhaiphubejhr Hospital, Prachinburi, Thailand
- Chaopraya Abhaiphubejhr Hospital Foundation, Prachinburi, Thailand
| | - Danupon Nantajit
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
- Centre for Host Microbiome Interactions, Faculty of Dentistry and Craniofacial Sciences, King's College London, London, UK
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19
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Krysa K, Kowalczyk E, Borysowski J, Lachota M, Pasierski T. Exclusion of older adults from clinical trials in cancer-related pain. Front Med (Lausanne) 2022; 9:945481. [PMID: 35991635 PMCID: PMC9385985 DOI: 10.3389/fmed.2022.945481] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Pain is one of the most common symptoms in cancer patients including older adults. The objective of this study was to evaluate the enrollment criteria that can limit the inclusion of older adults in clinical trials concerning cancer-related pain (CRP). The study included 356 trials registered with ClinicalTrials.gov. Our primary outcome measures were the proportion of trials that excluded patients based on upper age limits (80 years of age or less), strict organ-specific exclusion criteria, broad and imprecise criteria, and inadequate performance score. One hundred and twenty-six trials (35.4%) had upper age limits. Strict exclusion criteria were used in 95 (26.7%) trials. Broad and imprecise exclusion criteria were listed in 57 (16.2%) trials. Low performance score was used as an exclusion criterion in 4 trials (1.1%). Overall, in 241 trials (67.7%) there was either an upper age limit or at least one strict or broad and imprecise exclusion criterion, or a criterion involving the performance status. The odds of excluding older adults were significantly higher in certain neoplasm types, study objectives, intervention types, and center locations. In conclusion, considerable proportion of recent clinical trials concerning CRP either explicitly exclude older adults or create high risk of such exclusion which substantially limits the evidence base for the treatment of such patients in clinical practice. Sponsors and investigators should consider careful modification of the enrollment criteria to improve the inclusion of older individuals who make up the major proportion of cancer patients population.
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Affiliation(s)
| | - Ewa Kowalczyk
- Clinical Research Development Centre, Medical Research Agency, Warsaw, Poland
| | - Jan Borysowski
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
- Centre for Studies on Research Integrity, Institute of Law Studies, Polish Academy of Sciences, Warsaw, Poland
- *Correspondence: Jan Borysowski
| | - Mieszko Lachota
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Pasierski
- Department of Medical Ethics and Palliative Medicine, Medical University of Warsaw, Warsaw, Poland
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20
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Efficacy of the Nourishing Yin and Clearing Heat Therapy Based on Traditional Chinese Medicine in the Prevention and Treatment of Radiotherapy-Induced Oral Mucositis in Nasopharyngeal Carcinomas: A Systematic Review and Meta-Analysis of Thirty Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4436361. [PMID: 35529930 PMCID: PMC9068295 DOI: 10.1155/2022/4436361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/25/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2022]
Abstract
This study aimed to evaluate the efficacy of nourishing Yin and clearing heat therapy (NYCH therapy) based on traditional Chinese medicine (TCM) in the treatment of radiotherapy-induced oral mucositis (RTOM) in nasopharyngeal carcinomas (NPCs). A total of eight online databases were searched from inception to September 2021 for randomized controlled trials (RCTs). The control group was treated with Western medicine (WM) alone, whereas the experimental group was treated with a combined NYCH and WM therapy. A total of 30 RCTs involving 2562 participants were ultimately included. NYCH therapy combined with conventional WM delayed the onset time (days) of RTOM (MD = 10.80, p < 0.001), and at that time, a higher cumulative radiotherapy dose (Gy) (MD = 5.72, p < 0.001) was completed in the experimental group. The combination regimen also reduced the incidence of severe oral mucositis (Grade III–IV) (RR = 0.25, p < 0.001). In addition, the treatment efficacy of the experimental group was significantly better than that of the control group (RR = 1.31, p < 0.001). Compared with the patients in the control group, the experimental group had lower xerostomia scores (MD = -1.07, p < 0.001) and more saliva (MD = 0.36, p < 0.001). NYCH combined with WM improved the efficacy of treating RTOM in NPC. This study provides a sufficient basis for conducting further large RCTs to prove the efficacy of NYCH.
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21
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Gugnacki P, Sierko E. Is There an Interplay between Oral Microbiome, Head and Neck Carcinoma and Radiation-Induced Oral Mucositis? Cancers (Basel) 2021; 13:5902. [PMID: 34885015 PMCID: PMC8656742 DOI: 10.3390/cancers13235902] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023] Open
Abstract
Head and neck carcinoma is one of the most common human malignancy types and it ranks as the sixth most common cancer worldwide. Nowadays, a great potential of microbiome research is observed in oncology-investigating the effect of oral microbiome in oncogenesis, occurrence of treatment side effects and response to anticancer therapies. The microbiome is a unique collection of microorganisms and their genetic material, interactions and products residing within the mucous membranes. The aim of this paper is to summarize current research on the oral microbiome and its impact on the development of head and neck cancer and radiation-induced oral mucositis. Human microbiome might determine an oncogenic effect by, among other things, inducing chronic inflammatory response, instigating cellular antiapoptotic signals, modulation of anticancer immunity or influencing xenobiotic metabolism. Influence of oral microbiome on radiation-induced oral mucositis is expressed by the production of additional inflammatory cytokines and facilitates progression and aggravation of mucositis. Exacerbated acute radiation reaction and bacterial superinfections lead to the deterioration of the patient's condition and worsening of the quality of life. Simultaneously, positive effects of probiotics on the course of radiation-induced oral mucositis have been observed. Understanding the impact on the emerging acute radiation reaction on the composition of the microflora can be helpful in developing a multifactorial model to forecast the course of radiation-induced oral mucositis. Investigating these processes will allow us to create optimized and personalized preventive measures and treatment aimed at their formation mechanism. Further studies are needed to better establish the structure of the oral microbiome as well as the dynamics of its changes before and after therapy. It will help to expand the understanding of the biological function of commensal and pathogenic oral microbiota in HNC carcinogenesis and the development of radiation-induced oral mucositis.
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Affiliation(s)
| | - Ewa Sierko
- Department of Oncology, Medical University of Bialystok, 15-025 Bialystok, Poland;
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22
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Mast1 mediates radiation-induced gastric injury via the P38 MAPK pathway. Exp Cell Res 2021; 409:112913. [PMID: 34774870 DOI: 10.1016/j.yexcr.2021.112913] [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: 06/14/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/20/2022]
Abstract
Radiation-induced gastric injury is a serious adverse effect and reduces the efficacy of radiotherapy treatment. However, the mechanisms underlying radiation-induced stomach injury remain unclear. Here, mouse stomach and gastric epithelial cells were irradiated with different doses of X-ray radiation. The results showed that radiation induced gastric injury in vivo and in vitro. Differentially expressed functional mRNAs in irradiation-induced gastric tissues were screened from the Gene Expression Omnibus (GEO) database. We found that the expression of microtubule-associated serine/threonine kinase 1 (Mast1) was downregulated in mouse gastric tissues and gastric epithelial cells after irradiation. Furthermore, functional assays showed that knockdown of Mast1 inhibited growth and promoted apoptosis in gastric epithelial cells, while overexpression of Mast1 protected gastric epithelial cells from radiation damage. Mechanistically, Mast1 negatively regulated radiation-induced injury in gastric epithelial cells by inhibiting the activation of P38. The apoptosis caused by knockdown of Mast1 in gastric epithelial cells could be partially reversed by the P38 inhibitor SB203580. Moreover, data from several gastric cancer cell lines and online databases revealed that Mast1 was not involved in the development of gastric cancer. Collectively, our findings demonstrated that Mast1 is essential for radiation-induced gastric injury, providing a promising prognostic and therapeutic target.
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Oral Mucositis in Cancer and Potential Use of Omega-3 Free Fatty Acids in Its Management: A Review. Biomedicines 2021; 9:biomedicines9111531. [PMID: 34829760 PMCID: PMC8615276 DOI: 10.3390/biomedicines9111531] [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: 08/15/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/01/2022] Open
Abstract
Oral mucositis (OM) is a painful condition caused by chemotherapeutic or radiotherapeutic cancer treatments, occurring in patients with different tumour characteristics and locations. OM greatly impacts a patient’s quality of life and cancer recovery. Current OM management strategies are not providing sufficient prevention and treatment; new approaches to injury management are needed. Studies on the benefit of omega-3 free fatty acids (FFA) in human health have increased significantly in recent years. FFA properties have been studied extensively, including their potential therapeutic use in inflammatory conditions. However, omega-3 FFA’s use as a supplementary treatment for OM has not been clinically tested. Preliminary evidence suggests that utilising FFA to manage OM could be a useful strategy for lesion management, assisting with healthy oral mucosa recovery. This review will describe the incidence, risk factors, biology of OM and the current treatment strategies, leading to a discussion of the utility of omega-3 FFA as a novel therapeutic agent for OM.
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Latest Innovations and Nanotechnologies with Curcumin as a Nature-Inspired Photosensitizer Applied in the Photodynamic Therapy of Cancer. Pharmaceutics 2021; 13:pharmaceutics13101562. [PMID: 34683855 PMCID: PMC8539945 DOI: 10.3390/pharmaceutics13101562] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 12/27/2022] Open
Abstract
In the context of the high incidence of cancer worldwide, state-of-the-art photodynamic therapy (PDT) has entered as a usual protocol of attempting to eradicate cancer as a minimally invasive procedure, along with pharmacological resources and radiation therapy. The photosensitizer (PS) excited at certain wavelengths of the applied light source, in the presence of oxygen releases several free radicals and various oxidation products with high cytotoxic potential, which will lead to cell death in irradiated cancerous tissues. Current research focuses on the potential of natural products as a superior generation of photosensitizers, which through the latest nanotechnologies target tumors better, are less toxic to neighboring tissues, but at the same time, have improved light absorption for the more aggressive and widespread forms of cancer. Curcumin incorporated into nanotechnologies has a higher intracellular absorption, a higher targeting rate, increased toxicity to tumor cells, accelerates the activity of caspases and DNA cleavage, decreases the mitochondrial activity of cancer cells, decreases their viability and proliferation, decreases angiogenesis, and finally induces apoptosis. It reduces the size of the primary tumor, reverses multidrug resistance in chemotherapy and decreases resistance to radiation therapy in neoplasms. Current research has shown that the use of PDT and nanoformulations of curcumin has a modulating effect on ROS generation, so light or laser irradiation will lead to excessive ROS growth, while nanocurcumin will reduce the activation of ROS-producing enzymes or will determine the quick removal of ROS, seemingly opposite but synergistic phenomena by inducing neoplasm apoptosis, but at the same time, accelerating the repair of nearby tissue. The latest curcumin nanoformulations have a huge potential to optimize PDT, to overcome major side effects, resistance to chemotherapy, relapses and metastases. All the studies reviewed and presented revealed great potential for the applicability of nanoformulations of curcumin and PDT in cancer therapy.
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