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Negro M, Crisafulli O, D'Antona G. Effects of essential amino acid (EAA) and glutamine supplementation on skeletal muscle wasting in acute, subacute, and postacute conditions. Clin Nutr ESPEN 2024; 62:224-233. [PMID: 38843393 DOI: 10.1016/j.clnesp.2024.05.023] [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: 12/04/2023] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/22/2024]
Abstract
Under optimal physiological conditions, muscle mass maintenance is ensured by dietary protein, which balances the amino acid loss during the post-absorption period and preserves the body's protein homeostasis. Conversely, in critical clinical conditions (acute, subacute or postacute), particularly those related to hypomobility or immobility, combined with malnutrition, and local/systemic inflammation, the loss of muscle mass and strength can be quantitatively significant. A decline of more than 1% in muscle mass and of more than 3% in muscle strength has been registered in subjects with aged 20-37 yr after just five days of bed rest, similarly to those observed during one year of age-related decline in individuals over the age of 50. Loss of muscle mass and strength can have a dramatic effect on subjects' functional capacities, on their systemic metabolic control and on the amino acid reserve function, all of which are fundamental for the maintenance of other organs' and tissues' cell processes. References available indicate that the average 1%-2% reduction per day of muscle mass in patients in the intensive care unit (ICU) could represent an independent predictor of hospital mortality and physical disability in the five years following hospitalization. After just a few days or weeks of administration, supplementation with EAAs and glutamine has shown significant effects in maintaining muscle size and strength, which are typically negatively affected by some acute/subacute or postacute critical conditions (muscle recovery after surgery, oncology patients, ICU treatments), especially in the elderly or in those with pre-existing degenerative diseases. In this review, we focused on the theoretical bases and the most relevant clinical studies of EAA and glutamine supplementation as a single compound, with the aim of clarifying whether their combined use in a blend (EAAs-glutamine) could be potentially synergistic to prevent disease-related muscle wasting and its impact on the duration and quality of patients' clinical course.
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Affiliation(s)
- Massimo Negro
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS) - Sport Medicine Centre, University of Pavia, Voghera, Italy
| | - Oscar Crisafulli
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS) - Sport Medicine Centre, University of Pavia, Voghera, Italy
| | - Giuseppe D'Antona
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS) - Sport Medicine Centre, University of Pavia, Voghera, Italy; Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
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Ibrahim SS, Hassanein FEA, Zaky HW, Gamal H. Clinical and biochemical assessment of the effect of glutamine in management of radiation induced oral mucositis in patients with head and neck cancer: Randomized controlled clinical trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101827. [PMID: 38493953 DOI: 10.1016/j.jormas.2024.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/01/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND This study aimed to evaluate the effect of oral glutamine suspension on salivary levels of transforming growth factor beta 1 (TGF-β1), a cytokine involved in inflammation and Tumor progression, and the severity of radiation-induced oral mucositis (RIOM) in head and neck cancer patients. This is the first study to investigate the impact of glutamine on TGF-β1 levels in head and neck cancer patients with radiation induced oral mucositis (RIOM). METHODS In this randomized controlled clinical trial, 50 HNC patients were enrolled and received either glutamine oral suspension or maltodextrin as a placebo from the baseline of RIOM to the end of radiotherapy. Salivary TGF-β1 levels were measured at baseline and after treatment. Also, RIOM was assessed using the World Health Organization (WHO) Oral Toxicity Scale, the Oral Mucositis Assessment Scale (OMAS), the Pain Visual Analog Scale (Pain-VAS), the incidence of opioid use, and body mass index (BMI). RESULTS Glutamine significantly reduced salivary TGF-β1 levels and improved RIOM symptoms, such as pain, opioid use, and weight loss. The reduction of TGF-β1 levels was associated with the improvement of RIOM severity. CONCLUSION Glutamine may modulate the inflammatory response and enhance wound healing in RIOM by decreasing salivary TGF-β1 levels. These findings support the use of glutamine as a potential intervention for RIOM and nutritional support for improving radiation sensitivity. TRIAL REGISTRATION This study was registered on clinicalTrials.gov with identifier no. NCT05856188.
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Affiliation(s)
- Suzan S Ibrahim
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Faculty of Oral and Dental medicine, Nahda university, Beni Suef, Egypt
| | - Fatma E A Hassanein
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Faulty of Dentistry, King Salman International University, El-Tur, Egypt.
| | - Hany W Zaky
- Radiation Oncology, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Hadeel Gamal
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Zhang S, Li J, Zhang Y, Li X, Zhang Y, Li Y, Zhou L, Hu X. Efficacy of nonpharmacological interventions for severe radiation-induced oral mucositis among head and neck cancer patients: A network meta-analysis of randomised controlled trials. J Clin Nurs 2024; 33:2030-2049. [PMID: 38454556 DOI: 10.1111/jocn.17087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 12/08/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
AIMS AND OBJECTIVES To assess the effectiveness of different nonpharmacological treatments for severe radiation-induced oral mucositis in patients with head and neck cancer. BACKGROUND Radiation-induced oral mucositis is highly prevalent in patients with head and neck cancer. Current medications for radiation-induced oral mucositis are limited in effectiveness and susceptible to side effects, and while there is an increasing adoption of nonpharmacological interventions, the optimal one remains unclear. DESIGN Systematic review and network meta-analysis based on the PRISMA-NMA guidelines. METHODS Six databases were searched. Two authors independently performed the literature screening, data extraction and methodological quality assessment of the included studies. Traditional pairwise meta-analysis was performed by R Studio. A network meta-analysis was then conducted to assess the effects of nonpharmacological interventions for severe radiation-induced oral mucositis in patients with head and neck cancer. RESULTS Fifty-two studies involving seven types of nonpharmacological interventions were enrolled. The network meta-analysis indicated that natural plant-based therapies might be the most effective, health education interventions might be the second most effective, and honey might be the third most effective interventions for reducing the incidence of severe radiation-induced oral mucositis. For reducing the incidence of severe oral mucositis-related pain, the pairwise meta-analysis showed that only natural plant-based therapies and health education interventions were effective. CONCLUSIONS Nonpharmacological interventions are effective in the management of severe radiation-induced oral mucositis among patients with head and neck cancer. RELEVANCE TO CLINICAL PRACTICE Nonpharmacological interventions are a category of safe and effective adjunctive therapies that should be encouraged in clinical practice. TRIAL REGISTRATION DETAILS CRD42023400745.
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Affiliation(s)
- Shu Zhang
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Juejin Li
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yun Zhang
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xia Li
- Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yalin Zhang
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yunhuan Li
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Lin Zhou
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu, Sichuan, China
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Fatima K, Andleeb A, Nasreen S, Sofi MA, Najmi AM, Qadri SK, Ryhan R, Roohi S, Afroz F, Khan NA. Oral glutamine: Is there a role in the amelioration of radiation-induced mucositis? A prospective case-control study at a tertiary care centre in North India. J Cancer Res Ther 2024; 20:858-862. [PMID: 38261438 DOI: 10.4103/jcrt.jcrt_2742_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/27/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND The most frequently occurring painful and dose-limiting side effect of radiation therapy (RT) to the head and neck region is oral mucositis (OM). Several studies demonstrated that glutamine may reduce the severity and the duration of OM significantly during RT and chemo-radiotherapy in patients with head and neck cancer (HNC). MATERIALS AND METHODS Between January 2021 and August 2022, a prospective single institutional case-control study compared the efficacy and safety of oral glutamine on radiation-induced mucositis in patients with HNC. Of 60 biopsy-proven patients with HNC, 30 patients in the study arm received oral glutamine suspension (10 g in 500 mL of water) orally once daily, 2 hours before RT, receiving definitive or adjuvant RT and chemo-radiotherapy, while as 30 patients in the control arm received placebo with the same dose and schedule (n = 30 in the study arm and n = 30 in the control arm). RESULTS AND ANALYSIS A total of 27 (90%) in the glutamine arm and 28 (93.33%) patients in the control arm developed mucositis. Grade 3 mucositis (13.33%) and Grade 4 mucositis (6.66%), respectively, were significantly less ( P = .040 and P = .004) in the glutamine arm. The mean duration of grade 3 and grade 4 mucositis was significantly less in the glutamine arm (8.94 days in the study arm vs. 14.54 in the control arm; P = .0001). The mean time of onset of OM was significantly delayed in the glutamine arm in comparison to the control arm with P < .001. CONCLUSION Glutamine delays the onset of OM and decreases the severity of OM in patients of HNC receiving RT with or without chemotherapy.
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Affiliation(s)
- Kaneez Fatima
- Departments of Radiation Oncology, Pathology, Blood Transfusion and Immunohematology, Microbiology Sheri Kashmir Institute of Medical Sciences, SKIMS, Soura, Srinagar, Jammu and Kashmir, India
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Muranaka H, Akinsola R, Billet S, Pandol SJ, Hendifar AE, Bhowmick NA, Gong J. Glutamine Supplementation as an Anticancer Strategy: A Potential Therapeutic Alternative to the Convention. Cancers (Basel) 2024; 16:1057. [PMID: 38473414 PMCID: PMC10930819 DOI: 10.3390/cancers16051057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Glutamine, a multifaceted nonessential/conditionally essential amino acid integral to cellular metabolism and immune function, holds pivotal importance in the landscape of cancer therapy. This review delves into the intricate dynamics surrounding both glutamine antagonism strategies and glutamine supplementation within the context of cancer treatment, emphasizing the critical role of glutamine metabolism in cancer progression and therapy. Glutamine antagonism, aiming to disrupt tumor growth by targeting critical metabolic pathways, is challenged by the adaptive nature of cancer cells and the complex metabolic microenvironment, potentially compromising its therapeutic efficacy. In contrast, glutamine supplementation supports immune function, improves gut integrity, alleviates treatment-related toxicities, and improves patient well-being. Moreover, recent studies highlighted its contributions to epigenetic regulation within cancer cells and its potential to bolster anti-cancer immune functions. However, glutamine implementation necessitates careful consideration of potential interactions with ongoing treatment regimens and the delicate equilibrium between supporting normal cellular function and promoting tumorigenesis. By critically assessing the implications of both glutamine antagonism strategies and glutamine supplementation, this review aims to offer comprehensive insights into potential therapeutic strategies targeting glutamine metabolism for effective cancer management.
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Affiliation(s)
- Hayato Muranaka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rasaq Akinsola
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sandrine Billet
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Stephen J. Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Andrew E. Hendifar
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Neil A. Bhowmick
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Jun Gong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Golomb BA, Berg BK, Han JH. Susceptibility to radiation adverse effects in veterans with Gulf War illness and healthy civilians. Sci Rep 2024; 14:874. [PMID: 38195674 PMCID: PMC10776672 DOI: 10.1038/s41598-023-50083-7] [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: 08/24/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024] Open
Abstract
We evaluated whether veterans with Gulf War illness (VGWI) report greater ionizing radiation adverse effects (RadAEs) than controls; whether radiation-sensitivity is tied to reported chemical-sensitivity; and whether environmental exposures are apparent risk factors for reported RadAEs (rRadAEs). 81 participants (41 VGWI, 40 controls) rated exposure to, and rRadAEs from, four radiation types. The relations of RadAE-propensity (defined as the ratio of rRadAEs to summed radiation exposures) to Gulf War illness (GWI) presence and severity, and to reported chemical-sensitivity were assessed. Ordinal logistic regression evaluated exposure prediction of RadAE-propensity in the full sample, in VGWI, and stratified by age and chemical-sensitivity. RadAE-propensity was increased in VGWI (vs. controls) and related to GWI severity (p < 0.01) and chemical-sensitivity (p < 0.01). Past carbon monoxide (CO) exposure emerged as a strong, robust predictor of RadAE-propensity on univariable and multivariable analyses (p < 0.001 on multivariable assessment, without and with adjustment for VGWI case status), retaining significance in age-stratified and chemical-sensitivity-stratified replication analyses. Thus, RadAE-propensity, a newly-described GWI-feature, relates to chemical-sensitivity, and is predicted by CO exposure-both features reported for nonionizing radiation sensitivity, consistent with shared mitochondrial/oxidative toxicity across radiation frequencies. Greater RadAE vulnerability fits an emerging picture of heightened drug/chemical susceptibility in VGWI.
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Affiliation(s)
- Beatrice Alexandra Golomb
- Department of Medicine, UC San Diego School of Medicine, University of California, San Diego, 9500 Gilman Dr. #0995, La Jolla, CA, 92093-0995, USA.
| | - Brinton Keith Berg
- Department of Medicine, UC San Diego School of Medicine, University of California, San Diego, 9500 Gilman Dr. #0995, La Jolla, CA, 92093-0995, USA
| | - Jun Hee Han
- Department of Medicine, UC San Diego School of Medicine, University of California, San Diego, 9500 Gilman Dr. #0995, La Jolla, CA, 92093-0995, USA
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Tsujimoto T, Wasa M, Inohara H, Ito T. L-Glutamine and Survival of Patients with Locally Advanced Head and Neck Cancer Receiving Chemoradiotherapy. Nutrients 2023; 15:4117. [PMID: 37836400 PMCID: PMC10574413 DOI: 10.3390/nu15194117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
We previously reported that L-glutamine reduces the severity of mucositis caused by chemoradiotherapy in patients with head and neck cancer. However, the impact of glutamine on the anti-tumor effect of chemoradiotherapy remains controversial. This study, which included 40 patients, investigated whether L-glutamine influences survival. Radiation therapy (total: 66 or 70 Gy), cisplatin, and docetaxel were co-administered for a period of 6 weeks. Patients were randomly assigned to receive either glutamine (glutamine group, n = 20) or placebo (placebo group, n = 20) during the entire course of chemoradiotherapy. We compared the overall survival and progression-free survival rates between the two groups. At 5-year follow-up, 16 (80%) and 13 (72%) patients in the glutamine and placebo groups, respectively, survived (with no significant difference in overall survival [glutamine group: 55.2 ± 12.7 months vs. placebo group: 48.3 ± 21.3 months]). A total of 14 (70%) and 12 (67%) patients in the glutamine and placebo groups, respectively, did not experience disease progression (with no significant difference in progression-free survival [glutamine group: 46.7 ± 19.5 months vs. placebo group: 43.6 ± 25.2 months]). These findings indicate that L-glutamine does not influence the survival of patients with locally advanced head and neck cancer receiving chemoradiotherapy.
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Affiliation(s)
- Takae Tsujimoto
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kobe Gakuin University, 1-1-3 Minatojima, Chuo-ku, Kobe 650-8586, Japan
| | - Masafumi Wasa
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Osaka 565-0871, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Osaka 565-0871, Japan
| | - Toshinori Ito
- Osaka Center for Cancer & Cardiovascular Disease Prevention, 1-6-107 Morinomiya, Johtou-ku, Osaka 536-0025, Japan
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Amiri Khosroshahi R, Talebi S, Zeraattalab-Motlagh S, Imani H, Rashidi A, Travica N, Mohammadi H. Nutritional interventions for the prevention and treatment of cancer therapy-induced oral mucositis: an umbrella review of systematic reviews and meta-analysis. Nutr Rev 2023; 81:1200-1212. [PMID: 36763701 DOI: 10.1093/nutrit/nuac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
CONTEXT To date, the efficacy of nutritional interventions on oral mucositis (OM) in patients with cancer, and the quality of this evidence have not been explored. OBJECTIVE The goal of this umbrella review was to provide a comprehensive evaluation of nutritional interventions for patients with cancer with OM, as well as to assess the quality of this evidence. DATA SOURCES Meta-analyses were searched for using PubMed, Scopus, and ISI Web of Science databases until December 2021, with no time restrictions. DATA EXTRACTION Meta-analyses of randomized control trials that evaluated the effects of nutritional interventions on the incidence of OM in patients with cancer had inclusion criteria for this umbrella review. Data extraction, quality assessment of meta-analyses, and primary studies were done independently by 2 authors. The Grading of Recommendations Assessment, Development, and Evaluation technique was used to grade the certainty of evidence. DATA ANALYSIS A total of 26 meta-analyses were included in this umbrella review. The results showed that honey, glutamine, and propolis can reduce the incidence of severe OM, based on moderate evidence quality. In addition, zinc supplementation significantly reduced the incidence of OM, regardless of symptom severity; however, low certainty of the evidence was observed. The effects of vitamin E, curcumin, and probiotics on OM were not statistically significant. CONCLUSION This umbrella review shows that honey, glutamine, and propolis can significantly reduce the incidence of severe OM. These findings need to be confirmed with well-designed, longitudinal randomized controlled trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022301010.
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Affiliation(s)
- Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hossein Imani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirabbas Rashidi
- Hematology-Oncology and BMT Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nikolaj Travica
- Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Namuangchan Y, Chailertwanich O, Susinsamphan S, Supakalin N, Supaadirek C, Krusun S, Pesee M, Thamronganantasakul K. Prophylaxis of Oral Mucositis with Iodine Solution during Concurrent Chemoradiation of Head and Neck Cancer: Preliminary Results of a Double-Blind, Randomized Controlled Trial. Asian Pac J Cancer Prev 2023; 24:2445-2454. [PMID: 37505779 PMCID: PMC10676485 DOI: 10.31557/apjcp.2023.24.7.2445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/09/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the clinical efficacy of an in-house iodine solution (IS) mouthwash for the prophylaxis of concurrent chemoradiation (CCRT) induced oral mucositis (OM) in head & neck cancer (HNC) patients. METHODS This prospective, double-blind, randomized controlled trial was conducted on 20 HNC patients, being treated with definite or postoperative CCRT, at the Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. The patients were randomly assigned (1:1) to the treatment group or the control group. Patients in the treatment group gargled IS three times daily after meals, while patients in the control group gargled normal saline solutions (NSS). Assessment of OM was performed before starting CCRT, once a week during CCRT, and 4 weeks after CCRT was completed. The primary outcome was Oral Mucositis Assessment Scale (OMAS). RESULTS The mean weekly OMAS, pain score, and impact on swallowing score were not statistically significant in patients who rinsed with IS mouthwash compared to those who received NSS (p > 0.999 in every week). There was no difference in the mean onset to OM (all grades) (p = 0.704), and the mean duration of OM (all grades) (p = 0.365). Severe OM (WHO grade 3-4) occurred in three patients [IS=2, NSS=1] with the median onset of 45.50 & 33.00 days (p = NA), and the duration of 8.00 & 57.00 days (p = NA) in the IS and NSS groups, respectively. Oral candidiasis occurred in one patient from the NSS group while no secondary infection of oral mucosa was observed in the patients receiving IS mouthwash. CONCLUSION The study could not reach statistically significance to show that IS mouthwash was effective in of prevention CCRT-induced OM. Further study with a larger number of participants is encouraged.
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Affiliation(s)
- Yotdanai Namuangchan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | | | - Sirinun Susinsamphan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Narudom Supakalin
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Chunsri Supaadirek
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Srichai Krusun
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Montien Pesee
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Komsan Thamronganantasakul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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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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11
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Jiménez-Alonso JJ, López-Lázaro M. Dietary Manipulation of Amino Acids for Cancer Therapy. Nutrients 2023; 15:2879. [PMID: 37447206 DOI: 10.3390/nu15132879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Cancer cells cannot proliferate and survive unless they obtain sufficient levels of the 20 proteinogenic amino acids (AAs). Unlike normal cells, cancer cells have genetic and metabolic alterations that may limit their capacity to obtain adequate levels of the 20 AAs in challenging metabolic environments. However, since normal diets provide all AAs at relatively constant levels and ratios, these potentially lethal genetic and metabolic defects are eventually harmless to cancer cells. If we temporarily replace the normal diet of cancer patients with artificial diets in which the levels of specific AAs are manipulated, cancer cells may be unable to proliferate and survive. This article reviews in vivo studies that have evaluated the antitumor activity of diets restricted in or supplemented with the 20 proteinogenic AAs, individually and in combination. It also reviews our recent studies that show that manipulating the levels of several AAs simultaneously can lead to marked survival improvements in mice with metastatic cancers.
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Affiliation(s)
| | - Miguel López-Lázaro
- Department of Pharmacology, Faculty of Pharmacy, University of Seville, 41012 Sevilla, Spain
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12
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Gong J, Osipov A, Lorber J, Tighiouart M, Kwan AK, Muranaka H, Akinsola R, Billet S, Levi A, Abbas A, Davelaar J, Bhowmick N, Hendifar AE. Combination L-Glutamine with Gemcitabine and Nab-Paclitaxel in Treatment-Naïve Advanced Pancreatic Cancer: The Phase I GlutaPanc Study Protocol. Biomedicines 2023; 11:1392. [PMID: 37239063 PMCID: PMC10216251 DOI: 10.3390/biomedicines11051392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Advanced pancreatic cancer is underscored by progressive therapeutic resistance and a dismal 5-year survival rate of 3%. Preclinical data demonstrated glutamine supplementation, not deprivation, elicited antitumor effects against pancreatic ductal adenocarcinoma (PDAC) alone and in combination with gemcitabine in a dose-dependent manner. The GlutaPanc phase I trial is a single-arm, open-label clinical trial investigating the safety of combination L-glutamine, gemcitabine, and nab-paclitaxel in subjects (n = 16) with untreated, locally advanced unresectable or metastatic pancreatic cancer. Following a 7-day lead-in phase with L-glutamine, the dose-finding phase via Bayesian design begins with treatment cycles lasting 28 days until disease progression, intolerance, or withdrawal. The primary objective is to establish the recommended phase II dose (RP2D) of combination L-glutamine, gemcitabine, and nab-paclitaxel. Secondary objectives include safety of the combination across all dose levels and preliminary evidence of antitumor activity. Exploratory objectives include evaluating changes in plasma metabolites across multiple time points and changes in the stool microbiome pre and post L-glutamine supplementation. If this phase I clinical trial demonstrates the feasibility of L-glutamine in combination with nab-paclitaxel and gemcitabine, we would advance the development of this combination as a first-line systemic option in subjects with metastatic pancreatic cancer, a high-risk subgroup desperately in need of additional therapies.
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Affiliation(s)
- Jun Gong
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Arsen Osipov
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jeremy Lorber
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mourad Tighiouart
- Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Albert K. Kwan
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Hayato Muranaka
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rasaq Akinsola
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sandrine Billet
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Abrahm Levi
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Anser Abbas
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - John Davelaar
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Neil Bhowmick
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Andrew E. Hendifar
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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13
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Pisani C, Mastroleo F, Collo A, Ferrante D, Carabelli G, Franco P, Riso S, Dell’Era V, Garzaro M, Aluffi Valletti P, Krengli M. Variation in Body Mass and Skeletal Muscle Indices in Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy and Nutritional Intervention. Curr Oncol 2022; 30:250-260. [PMID: 36661669 PMCID: PMC9857332 DOI: 10.3390/curroncol30010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to analyze variation in body mass index (BMI) and skeletal muscle index (SMI) in head and neck squamous cell carcinoma (HNSCC) patients who underwent exclusive radiotherapy (RT) or concurrent chemo-radiotherapy (RT-CHT). We enrolled 73 HNSCC pts treated with definitive or post-operative RT (14 pts) or RT-CHT (59 pts). At the time of diagnosis (t0) and 3 months after treatment completion (t3), CT scans were retrieved to measure skeletal muscle at the level of the C3 vertebra. Median follow-up was 16 months. Nine disease progressions with distant metastases and eleven local relapses were observed. Fifty-three pts were free from progression at 1 year. At t0, average BMI was 25.8 (SD 4.1), while at t3 it was 24.5, with no reduction in 54 pts. A BMI decrease of −1.3 (p-value < 0.0001) between t0 and t3 was found with the Wilcoxon signed-rank test. SMI was 57.1 and 59.2 at t0 and t3, respectively (p-value = 0.005). According to our analysis, SMI variation seems to reflect the effect of an appropriate nutritional intervention and may represent a reliable, simple tool for muscle mass analysis.
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Affiliation(s)
- Carla Pisani
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
| | - Alessandro Collo
- Clinical Nutrition and Dietetic Unit, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, University of Piemonte Orientale (UPO) and Cancer Epidemiology, CPO Piemonte, Via Solaroli 17, 28100 Novara, Italy
| | - Greta Carabelli
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Pierfrancesco Franco
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Valeria Dell’Era
- ENT Division, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Massimiliano Garzaro
- ENT Division, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Paolo Aluffi Valletti
- ENT Division, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Marco Krengli
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
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14
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Peng TR, Tsai FP, Wu TW. Effects of various treatments for preventing oral mucositis in cancer patients: A network meta-analysis. PLoS One 2022; 17:e0278102. [PMID: 36480513 PMCID: PMC9731456 DOI: 10.1371/journal.pone.0278102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Oral mucositis (OM) is a common side effect of chemotherapy and radiotherapy in patients with cancers. The prevention or treatment of OM in cancer patients is crucial in the treatment of cancer. METHODS We searched PubMed, Embase, and Cochrane Library for the randomized control trials (RCTs) of interventions for preventing and treating OM. Network meta-analysis (NMA) was performed to estimate odds ratios (ORs) and 95% confidence intervals (CI) from both direct and indirect evidence. The prespecified primary efficacy outcome was the treatment effect of moderate to severe oral mucositis with 12 interventions. The outcome was moderate to a severe grade of OM. RESULTS This study included 55 RCTs with 3,552 participants. The results showed that honey significantly lowered the risk of chemo/radiotherapy-induced moderate to severe oral mucositis than placebo (OR: 0.01, 95%CI 0.00 to 0.45), followed by lignocaine (OR: 0.07, 95%CI 0.00 to 0.95). The surface under cumulative ranking curve (SUCRA) values for honey were 0.95, followed by lignocaine (SUCRA, 0.81) and benzydamine (SUCRA, 0.78). CONCLUSIONS The honey is effective for patients with cancer undergoing chemotherapy or radiotherapy-induced oral mucositis.
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Affiliation(s)
- Tzu-Rong Peng
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Fang-Pei Tsai
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ta-Wei Wu
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- * E-mail:
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15
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Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022; 40:3998-4024. [PMID: 36122322 DOI: 10.1200/jco.22.01357] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra Barton
- University of Michigan School of Nursing, Ann Arbor, MI
| | - Eran Ben-Arye
- Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT
| | | | | | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ana Maria Lopez
- Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jodi MacLeod
- Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA
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16
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Chen YH, Molenaar D, Uyl-de Groot CA, van Vulpen M, Blommestein HM. Medical Resource Use and Medical Costs for Radiotherapy-Related Adverse Effects: A Systematic Review. Cancers (Basel) 2022; 14:2444. [PMID: 35626049 PMCID: PMC9139402 DOI: 10.3390/cancers14102444] [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: 04/18/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite the need for a proper economic evaluation of new radiotherapies, the economic burden of radiotherapy-induced adverse effects remains unclear. A systematic review has been conducted to identify the existing evidence of healthcare resource use and costs related to radiotherapy-induced adverse effects and also to provide recommendations for including this evidence in economic evaluations. METHODS This systematic review of healthcare resource use and/or medical costs related to radiotherapy-induced adverse effects was performed up until 2020, focusing on patients with head and neck cancer, brain cancer, prostate cancer, eye cancer and breast cancer. RESULTS Resource use for treating the same adverse effects varied considerably across studies; for instance, the cost for mucositis ranged from USD 2949 to USD 17,244. This broad range could be related to differences in (1) severity of adverse effects in the study population, (2) study design, (3) cost estimation approach and (4) country and clinical practice. CONCLUSIONS Our findings revealed unignorable differences for the same adverse effects, which implied that the potential for the economic burden of adverse effects was being overestimated or underestimated in economic evaluation for radiotherapy.
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Affiliation(s)
- Yi Hsuan Chen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands; (C.A.U.-d.G.); (H.M.B.)
| | - Dominique Molenaar
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands; (C.A.U.-d.G.); (H.M.B.)
| | | | - Hedwig M. Blommestein
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands; (C.A.U.-d.G.); (H.M.B.)
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17
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Wang CC, Hwang TZ, Yang CC, Lien CF, Wang CC, Shih YC, Yeh SA, Hsieh MC. Impact of Parenteral Glutamine Supplement on Oncologic Outcomes in Patients with Nasopharyngeal Cancer Treated with Concurrent Chemoradiotherapy. Nutrients 2022; 14:997. [PMID: 35267972 PMCID: PMC8912271 DOI: 10.3390/nu14050997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Oral mucositis (OM) is a common toxic side effect in nasopharyngeal carcinoma (NPC) patients receiving concurrent chemoradiotherapy (CCRT) that has a negative impact on treatment outcomes and patients’ survival. Our study aimed to evaluate the impact of parenteral glutamine supplement (dipeptiven) on oncologic outcomes in patients with NPC treated with CCRT. Methods: Patients who were diagnosed with pathologically proved NPC and treated with CCRT were enrolled into our study. Patients were classified as dipeptiven (+) and dipeptiven (−). Oncologic outcomes were measured, and multivariate regression analysis was performed. Grade 3−4 treatment related toxicities were also documented. Results: A total of 144 patients with NPC were recruited in this study to evaluate oncologic outcomes, with 41 dipeptiven (+) and 103 dipeptiven (−). CCRT interruption rate and severe adverse effect (SAE) rate were significant lower in the dipeptiven (+) group than in the dipeptiven (−) group. The median overall survival (OS) was not mature yet in the dipeptiven (+) group and 30 months in the dipeptiven (−) group (p < 0.01). Multivariate analysis demonstrated that dipeptiven supplementation and CCRT interruption were independent predictors associated with better survival. The OS was longest in patients with a dipeptiven supplement and patients who had CCRT interruption had significantly worst OS. As for safety profiles, grade 3 to 4 adverse effects were fewer in dipeptiven (+) than in dipeptiven (−). Conclusion: Dipeptiven supplementation is crucial in NPC patients treated with CCRT, which can ameliorate treatment-related toxicity and augment treatment efficacy. Further prospective clinical trials are warranted to validate our results.
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Affiliation(s)
- Chih-Chun Wang
- Department of Otolaryngology, E-Da Hospital, Kaohsiung 82445, Taiwan; (C.-C.W.); (T.-Z.H.); (C.-C.Y.); (C.-F.L.); (C.-C.W.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (Y.-C.S.); (S.-A.Y.)
| | - Tzer-Zen Hwang
- Department of Otolaryngology, E-Da Hospital, Kaohsiung 82445, Taiwan; (C.-C.W.); (T.-Z.H.); (C.-C.Y.); (C.-F.L.); (C.-C.W.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (Y.-C.S.); (S.-A.Y.)
| | - Chuan-Chien Yang
- Department of Otolaryngology, E-Da Hospital, Kaohsiung 82445, Taiwan; (C.-C.W.); (T.-Z.H.); (C.-C.Y.); (C.-F.L.); (C.-C.W.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (Y.-C.S.); (S.-A.Y.)
| | - Ching-Feng Lien
- Department of Otolaryngology, E-Da Hospital, Kaohsiung 82445, Taiwan; (C.-C.W.); (T.-Z.H.); (C.-C.Y.); (C.-F.L.); (C.-C.W.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (Y.-C.S.); (S.-A.Y.)
| | - Chien-Chung Wang
- Department of Otolaryngology, E-Da Hospital, Kaohsiung 82445, Taiwan; (C.-C.W.); (T.-Z.H.); (C.-C.Y.); (C.-F.L.); (C.-C.W.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (Y.-C.S.); (S.-A.Y.)
| | - Yu-Chen Shih
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (Y.-C.S.); (S.-A.Y.)
- Department of Otolaryngology, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan
| | - Shyh-An Yeh
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (Y.-C.S.); (S.-A.Y.)
- Department of Radiation Oncology, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Meng-Che Hsieh
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (Y.-C.S.); (S.-A.Y.)
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan
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18
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Tan SE, Abdul Satar NF, Majid HA. Effects of Immunonutrition in Head and Neck Cancer Patients Undergoing Cancer Treatment – A Systematic Review. Front Nutr 2022; 9:821924. [PMID: 35360685 PMCID: PMC8961436 DOI: 10.3389/fnut.2022.821924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aims Malnutrition is prevalent among head and neck cancer (HNC) patients and leads to undesirable outcomes such as reduced treatment response and increased treatment-related side effects. This systematic review summarizes the recent evidence regarding the effect of immunonutrition in HNC patients undergoing radiotherapy and chemotherapy. Methods A literature search was conducted of the CENTRAL, ProQuest, MEDLINE, EBSCOhost, Web of Science and CINAHL databases; and further supplemented with internet and manual searches. Studies published between January 2011 and May 2021 were identified, screened, retrieved, and data extraction was performed. Results Twenty studies involving 1535 patients were included, 15 were randomized controlled trials (RCTs), three were retrospective study and two were comparative cohort studies. Five out of seven studies reported improvement or maintenance of nutrition status with continuous supplementation using immunonutrient-enriched formula. Three studies reported functional status as an outcome, with one study reporting significant improvement, one study reporting maintenance, and another study reporting no difference in the functional status of patients supplemented with immunonutrient-enriched formulas. Supplementation with glutamine did not reduce the overall incidence of mucositis but delayed the onset of oral mucositis and had significantly less incidence of severe oral mucositis. Conclusion Supplementation with immunonutrient-enriched formulas in HNC patients during radiotherapy and chemotherapy may improve or maintain nutrition status. Supplementation with glutamine during HNC radiotherapy and chemotherapy may delay the onset of oral mucositis and reduce incidences of severe oral mucositis. Further investigations are required, focusing on the timing, dosage, and duration of immunonutrition. Systematic Review Registration: PROSPERO, identifier CRD42021241817.
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Affiliation(s)
- Sing Ean Tan
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Ministry of Health, Putrajaya, Malaysia
| | | | - Hazreen Abdul Majid
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Nutrition, Faculty of Public Health, Airlangga University, Surabaya, Indonesia
- *Correspondence: Hazreen Abdul Majid
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19
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Papanikolopoulou A, Syrigos N, Vini L, Papasavva M, Lazopoulos G, Kteniadakis S, Spandidos DA, Charpidou A, Drakoulis N. Use of oral glutamine in radiation-induced adverse effects in patients with thoracic and upper aerodigestive malignancies: Results of a prospective observational study. Oncol Lett 2022; 23:19. [PMID: 34858523 PMCID: PMC8617560 DOI: 10.3892/ol.2021.13137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022] Open
Abstract
Cancer growth in host tissues features glutamine (gln) depletion over time, decreasing epithelial cells' optimal functioning. In addition, radiotherapy (RT) and/or chemotherapy (CT) cause damage to normal tissues, probably enhanced by this depletion. The present study prospectively examined the effect of gln supplementation on 72 patients with thoracic and upper aerodigestive malignancies (T&UAM) treated with sequential or concurrent RT-CT or RT alone. All patients received prophylactic gln powder 15 g bid for the full duration of treatment. The severity of acute radiation toxicities was graded according to the RT Oncology Group/European Organization for Research and Treatment of Cancer criteria. Primary endpoints were the incidence of grade >2 toxicities, weight loss and requirement for analgesics, and the secondary endpoint was the association of the length of irradiated esophagus from treatment planning with the use of opioids. The incidence of adverse effects was as follows: Grade >2 stomatitis, 25.0%; esophagitis, 60.5%; dysphagia, 54.2%; pain, 25.4%; mycosis, 40.8%. Stomatitis grade >2 was more frequent in patients with head and neck tumors (P<0.001) and in those with prior surgery (P<0.001). Esophagitis (P=0.020) and dysphagia (P=0.008) grade >2 were more frequent in patients with concurrent RT-CT. Regarding analgesics, 9.9% of patients received no pain treatment, 56.3% received simple analgesic therapy and 33.8% opioids. Patients on opioid therapy had a greater mean length of irradiated esophagus (P=0.024) or length >12 cm (P=0.018). In 54.2% of patients, weight loss was observed, particularly with concurrent RT-CT (P=0.007). Thus, the use of oral gln may have an important role in reducing acute radiation toxicities and weight loss, and in lowering the requirement for analgesics in patients with T&UAM. Further randomized trials are required to identify the appropriate gln dose, duration of treatment and precise radiation dosimetric parameters in this group of patients. The present clinical trial was retrospectively registered in the ClinicalTrials.gov Protocol Registration and Results System (registration no. NCT05054517/22-09-2021).
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Affiliation(s)
| | - Nikolaos Syrigos
- Oncology Unit, 3rd Department of Medicine, Sotiria General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Louisa Vini
- Radiotherapy Department, Athens Medical Center, 15125 Athens, Greece
| | - Maria Papasavva
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Georgios Lazopoulos
- Cardio-Thoracic Surgery Department, University Hospital of Heraklion, 71003 Heraklion, Greece
| | - Stelios Kteniadakis
- Cardio-Thoracic Surgery Department, University Hospital of Heraklion, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Adrianni Charpidou
- Oncology Unit, 3rd Department of Medicine, Sotiria General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Drakoulis
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece
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Sandri LCS, Pontes L, Bonfim CMS, Kusma SZ. Nursing diagnosis after hematopoietic stem cell transplant due to Fanconi anemia. Rev Bras Enferm 2021; 75:e20190864. [PMID: 34852115 DOI: 10.1590/0034-7167-2019-0864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/14/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify nursing diagnoses in patients who underwent hematopoietic stem-cell transplants due to Fanconi anemia, according to the NANDA-I taxonomy. METHODS exploratory study using a retrospective analysis of 85 records from patients who underwent hematopoietic stem-cell transplants due to Fanconi anemia, developed in a specialize transplant center in the South of Brazil. The results were analyzed using descriptive statistics. RESULTS 73 different diagnoses were found in 9 out of the 13 domains from the NANDA-I taxonomy. From these, 22 were in 50% or more of the patients investigated, and most of them are related to the domain Safety/Protection. CONCLUSIONS it was possible to identify the nursing diagnosis in the patients who underwent hematopoietic stem cell transplants due to Fanconi anemia, contributing to design a plan for the care of these patients. The same was true for those with other syndromes of chromosomal instability that need to undergo this transplant.
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Affiliation(s)
| | - Letícia Pontes
- Universidade Federal do Paraná. Curitiba, Paraná, Brazil
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21
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A Narrative Review about Nutritional Management and Prevention of Oral Mucositis in Haematology and Oncology Cancer Patients Undergoing Antineoplastic Treatments. Nutrients 2021; 13:nu13114075. [PMID: 34836330 PMCID: PMC8618139 DOI: 10.3390/nu13114075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/22/2022] Open
Abstract
Cancer is a prevalent disease worldwide, and treatments such as radiotherapy and chemotherapy sometimes lead to adverse events. Oral mucositis is one of the most disabling adverse events, and clinical guidelines do not take into account nutritional interventions. The primary endpoint was to gather the evidence about the efficacy of nutritional interventions in the prevention and/or treatment of antineoplastic-induced oral mucositis in oncological patients. A bibliographic review was carried out in the PubMed data base by combining MeSH terms with Boolean operators. Articles were selected based on inclusion and exclusion criteria; 50 final articles were found. Although further evidence is needed, glutamine, honey, and vitamins appear to be good therapeutic options. The rest of the compounds presented controversial or insufficient results, making it difficult to draw conclusions over their utilization as prevention or treatment options. Little evidence is reported about oral mucositis nutritional interventions in spite of them being attainable and affordable compounds. Scarce evidence is shown in paediatric patients compared with adults. Developing higher quality studies and combinations with the compounds researched is necessary for creating a stronger body of evidence.
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Alsubaie HM, Alsini AY, Alsubaie KM, Abu-Zaid A, Alzahrani FR, Sayed S, Pathak AK, Alqahtani KH. Glutamine for prevention and alleviation of radiation-induced oral mucositis in patients with head and neck squamous cell cancer: Systematic review and meta-analysis of controlled trials. Head Neck 2021; 43:3199-3213. [PMID: 34240498 DOI: 10.1002/hed.26798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/20/2021] [Accepted: 06/28/2021] [Indexed: 01/10/2023] Open
Abstract
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that investigated glutamine efficacy in preventing and alleviating radiation-induced oral mucositis (OM) among patients with head and neck (H&N) cancer. We screened five databases from inception till February 4, 2021 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included 11 RCTs, comprising 922 patients (458 and 464 patients were assigned to glutamine and control group, respectively). The incidence and onset of radiation-induced OM of any grade did not substantially differ between both groups. However, glutamine substantially reduced the severity of radiation-induced OM, as reflected by the reduced incidence of severe OM and reduced mean maximal OM grade score. Additionally, glutamine significantly decreased the rates of analgesic opioid use, nasogastric tube feeding, and therapy interruptions. Oral glutamine supplementation demonstrated various therapeutic benefits in preventing and ameliorating radiation-induced OM among patients with H&N cancer.
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Affiliation(s)
- Hemail M Alsubaie
- Department of Otolaryngology - Head and Neck Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Albaraa Y Alsini
- Department of Otolaryngology - Head and Neck Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Khaled M Alsubaie
- Department of General Surgery, Armed Forces Hospitals, Taif, Saudi Arabia
| | - Ahmed Abu-Zaid
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Faisal R Alzahrani
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Suhail Sayed
- Department of Head and Neck Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alok K Pathak
- Department of Head and Neck Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Khaled H Alqahtani
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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23
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Time-Course of Salivary Metabolomic Profiles during Radiation Therapy for Head and Neck Cancer. J Clin Med 2021; 10:jcm10122631. [PMID: 34203786 PMCID: PMC8232617 DOI: 10.3390/jcm10122631] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/05/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022] Open
Abstract
Oral mucositis (OM) is one of the most frequently observed adverse oral events in radiation therapy for patients with head and neck cancer. Thus, objective evaluation of OM severity is needed for early and timely intervention. Here, we analyzed the time-course of salivary metabolomic profiles during the radiation therapy. The severity of OM (National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events v3.0) of nine patients with head and neck cancer was evaluated. Partial least squares regression-discriminant analysis, using samples collected before radiation therapy, showed that histidine and tyrosine highly discriminated high-grade OM from low-grade OM before the start of radiation therapy (significant difference, p = 0.048 for both metabolites). Further, the pretreatment concentrations of gamma-aminobutyric acid and 2-aminobutyric acids were higher in the high-grade OM group. Although further validations are still necessary, this study showed potentially associated metabolites with worse radiotherapy-related OM among patients with head and neck cancer.
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24
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de Sousa Melo A, de Lima Dantas JB, Medrado ARAP, Lima HR, Martins GB, Carrera M. Nutritional supplements in the management of oral mucositis in patients with head and neck cancer: Narrative literary review. Clin Nutr ESPEN 2021; 43:31-38. [PMID: 34024533 DOI: 10.1016/j.clnesp.2021.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/23/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Oral mucositis is the most common side effect in response to anticancer therapies in the head and neck region. It has a debilitating potential for the health of affected individuals, negatively interfering with nutritional status and quality of life. Due to the great complexity of its pathogenicity, different forms of interventions for prevention and treatment are being studied, including nutritional supplements with vitamin E, zinc and glutamine. This study aimed to review the literature on the influence of nutrients, in supplement form, for prevention and/or treatment of mucositis in patients with head and neck cancer. METHODS A survey of studies related to the definition, treatment and prevention of mucositis with nutrients was carried out between January 2018 and July 2019, using the Pubmed, Cochrane Library and Scielo databases. In the end, 61 relevant scientific publications were selected between the years 2004 and 2019. RESULTS Nutrients such as vitamin E, glutamine and zinc are forms of supplementation that have positive effects on the manifestation and severity of oral mucositis due to their antioxidant and immunomodulatory properties. However, some studies reveal that antioxidant properties may reduce the effectiveness of antineoplastic therapy. CONCLUSIONS This study suggests the effectiveness of vitamin E, zinc and glutamine in preventing and treating oral mucositis. However, the importance of new clinical researches to clarify possible doubts is highlighted, as well as the creation of a protocol that includes the dose, route and time of administration, for greater safety in use.
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Affiliation(s)
| | - Juliana Borges de Lima Dantas
- Federal University of Bahia, Institute of Health Sciences, Salvador, Adventist College of Bahia, Cachoeira, Bahia, Brazil
| | | | - Hayana Ramos Lima
- Center of Health Sciences, Federal University of Southern Bahia, Bahia, Brazil
| | | | - Manoela Carrera
- School of Dentistry, Federal University of Bahia, Department of Life Sciences, Bahia State University, Salvador, Bahia, Brazil.
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Davy C, Heathcote S. A systematic review of interventions to mitigate radiotherapy-induced oral mucositis in head and neck cancer patients. Support Care Cancer 2021; 29:2187-2202. [PMID: 32889582 PMCID: PMC7892691 DOI: 10.1007/s00520-020-05548-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Oral mucositis is a debilitating consequence of radiotherapy in patients with head and neck cancers. Radiation-induced oral mucositis (RIOM) can cause pain and weight loss, reduce quality of life and affect treatment outcomes. METHODS A systematic review was undertaken to identify and examine the efficacy of low-cost interventions to mitigate RIOM and to develop clinical guidelines based on the evidence. RESULTS The author identified three interventions: benzydamine hydrochloride mouth rinse (BHM), honey and oral glutamine (OG). The search identified twenty-four studies in total. Four studies examined BHM; all findings were favourable, although only one had moderate methodological quality, and the rest were low. The product was poorly tolerated by some participants in one study. Twelve studies examined honey. Eleven of these had favourable results; two studies had moderate methodological quality, and the rest were low. Eight studies examined OG. Six of these had favourable results; two studies had moderate methodological quality, and the rest were low. CONCLUSION The author cannot recommend BHM to mitigate RIOM due to the overall low quality of the studies and poor tolerance to the product. The author cannot recommend honey to mitigate RIOM due to weak evidence supporting the intervention. The author can recommend OG to mitigate RIOM. There is a need for high-quality studies with a consensus of the methodology to reduce heterogeneity and examination of the cost-effectiveness of the interventions.
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26
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Karri J, Lachman L, Hanania A, Marathe A, Singh M, Zacharias N, Orhurhu V, Gulati A, Abd-Elsayed A. Radiotherapy-Specific Chronic Pain Syndromes in the Cancer Population: An Evidence-Based Narrative Review. Adv Ther 2021; 38:1425-1446. [PMID: 33570737 DOI: 10.1007/s12325-021-01640-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/27/2021] [Indexed: 12/25/2022]
Abstract
While radiation therapy is increasingly utilized in the treatment paradigm of many solid cancers, the chronic effects of radiation therapies are poorly characterized. Notably, understanding radiation-specific chronic pain syndromes is paramount given that the diagnosis and management of these conditions can serve to prevent long-standing functional impairments, optimize quality of life, and even allow for continued radiotherapy candidacy. These radiation-specific chronic pain phenomena include dermatitis, mucositis, enteritis, connective tissue fibrosis, lymphedema, and neuropathic pain syndromes. It is necessary to maintain a low threshold of suspicion for appropriately diagnosing these conditions as there exists a variance in when these symptoms arise after radiation. However, we present key epidemiological data delineating vulnerable cancer populations for each pain syndrome along with the available evidence for the management for each specific condition.
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Affiliation(s)
- Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Laura Lachman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alex Hanania
- Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Anuj Marathe
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Mani Singh
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Nicholas Zacharias
- Division of Pain Medicine, Department of Anesthesia, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Vwaire Orhurhu
- Division of Pain Medicine, Department of Anesthesia, University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
| | - Amitabh Gulati
- Division of Pain Medicine, Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Alaa Abd-Elsayed
- Division of Pain Medicine, Department of Anesthesia, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
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Tang G, Huang W, Zhang L, Wei Z. Role of Glutamine in the Management of Oral Mucositis in Patients with Cancer: A Meta-Analysis of Randomized Controlled Trials. Nutr Cancer 2021; 74:482-495. [PMID: 33605813 DOI: 10.1080/01635581.2021.1889623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
As the effectiveness of glutamine supplementation for oral mucositis (OM) in patients with cancer remains controversial, a comprehensive summary and analysis of available evidence is necessary. The aim of the present meta-analysis was to evaluate the benefits of glutamine supplementation on OM and OM-related adverse reactions in patients with cancer receiving chemotherapy (CT) and/or radiotherapy (RT), using data from randomized controlled trials (RCTs). The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for RCTs on the use of glutamine for treating OM, published until September 11, 2020. Risk ratios (RRs) or standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated using RevMan 5.3. Fifteen studies with 988 participants were included. Glutamine did not reduce the incidence of OM (RR 0.94), but it reduced the severity of OM (SMD -0.73) and incidence of severe OM (RR 0.41). Additionally, glutamine reduced the incidence of opioid analgesic use (RR 0.84), feeding tube use (RR 0.46), hospitalization (RR 0.39), and treatment interruption (RR 0.49) caused by OM. Glutamine effectively improved OM and reduced OM-related adverse reactions in patients with cancer receiving CT and/or RT.
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Affiliation(s)
- Gang Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wang Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linyu Zhang
- Department of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Zhengqiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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28
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Effectiveness of glutamine in the management of oral mucositis in cancer patients: a meta-analysis of randomized controlled trials. Support Care Cancer 2021; 29:4885-4892. [DOI: 10.1007/s00520-021-06060-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/07/2021] [Indexed: 01/08/2023]
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Lyra MDMF, Meira JECD, Guedes GDS, Bueno NB. Immunonutrition in head and neck cancer: Systematic review and metanalysis of its clinical and nutritional effects. Clin Nutr ESPEN 2021; 41:30-41. [PMID: 33487281 DOI: 10.1016/j.clnesp.2020.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS A systematic review was conducted to assess the effects of glutamine, arginine and omega-3 supplementation on the tolerance to treatment, nutritional status and immune function of head and neck cancer (HNC) patients undergoing chemoradiotherapy. METHODS Randomized clinical trials were searched in MEDLINE, EMBASE, CENTRAL, LILACS, ClinicalTrials.gov, OpenGrey and Proquest. Tolerance to treatment, nutritional status, immune function and mortality rate were the primary outcomes investigated. Secondary outcomes comprised functional status, weight loss and body composition. Risk of bias of individual studies and the overall quality of the evidence were assessed using the Cochrane and the GRADE tools, respectively. RESULTS Nineteen articles met the inclusion criteria and nine were included in the meta-analyses, which assessed mucositis severity, weight loss and handgrip strength. Ten studies were evaluated as high risk of bias. Glutamine supplementation has significantly reduced the risk of grade 2-4 mucositis (RR: 0.76, IC95% [0.63; 0.92], P = 0.006, I2 = 0%; P = 0.792; 4 studies). Omega-3 supplementation did not show statistically significant results on weight loss (SMD: -0.042, 95% CI [-0.322; 0.238], P = 0.769, I2 = 33.4%; P = 0.212; 4 studies). The overall quality of the evidence ranged from low to very low. CONCLUSIONS These results must be interpreted with caution due to differences between supplementations regimen, lack of methodological rigor in most studies and due to the possible role of glutamine in tumor metabolism. Studies focused on elucidating the contribution of each immunonutrient to HNC patients undergoing chemoradiotherapy deserve further investigation.
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Abstract
Complementary and alternative medicine (CAM) approaches are widely used by patients throughout a broad range of medical fields and diseases, and often self-administered by patients without the involvement of physicians or other members of the health care team. CAM use is well documented in cancer and chronic illnesses, and emerging data in radiation oncology show CAM usage of 26% to 97% in radiation therapy patients. No information is, however, available on CAM usage in radiology and in the imaging procedure fields. This article reviews the fundamental principles and the experience with the wide spectrum of CAM in radiation oncology-a field that shares many parallels with radiology, such as prevalence of imaging, procedural requirements, and cooperation demanded from patients.CAM is defined as "approaches and practices that are typically not part of conventional medical care," and includes the use of mind- and body-based practices (eg, meditation, massage, acupuncture), natural products (eg, herbs, vitamins, minerals), and other interventions. Supplements are used frequently to alleviate side effects of therapy and promote overall well-being. Specifically, the mindfulness/meditation approaches of CAM are known to reduce anxiety and enhance physical and emotional wellbeing in patients with chronic diseases, such as cancer or neurologic diseases, through physiological, psychological, and perhaps placebo mechanisms. Such patients often require repetitive and invasive imaging examinations or procedures, such as for cancer treatment, cancer surveillance/follow-up, or monitoring of chronic diseases, for example, surveillance MRI in multiple sclerosis. Such parallels suggest that the vastly understudied area of CAMs deserve further investigation in both the radiation oncology and the imaging fields. Further research on CAM is needed to develop refined recommendations and national/and international guidelines on its use.
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Gkantaifi A, Vardas E, Alongi F, Tsoukalas N, Saraireh HH, Charalampakis N, Lövey J, Hajiioannou J, Kyrodimos E, Tsanadis K, Mauri D, Christopoulos C, Iliadis G, Tolia M. Radiation-Induced Oral Mucositis in Head and Neck Cancer Patients. Five Years Literature Review. Rev Recent Clin Trials 2020; 16:151-165. [PMID: 32735527 DOI: 10.2174/1574887115666200731182708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022]
Abstract
Backround: Radiation-induced oral mucositis consists of a series of relatively frequent side effects after head and neck cancer radiotherapy and has an adverse impact on both regular treatment process and the quality of life of patients. OBJECTIVE The purpose of the present review is to optimize the current management of radiation-induced oral mucositis in head and neck cancer patients. METHODS PubMed database research was performed on articles published since 2015 that demonstrated efficacy in the management of radiation-induced oral mucositis in head and neck cancer patients. The study selection included observational, prospective, comparative, randomized, double- blind, placebo-controlled or uncontrolled, and retrospective studies, as well as systematic reviews and metanalyses. RESULTS From the 931 citations obtained from the search, only 94 articles met the inclusion criteria, including mucosal protectants, anti-inflammatory agents, growth factors, and various miscellaneous and natural agents. Several methods, including both pharmacological and natural agents, have been proposed for the management of oral mucositis. In addition to the already known interventions with strong evidence, according to the Multinational Association of Supportive Care in Cancer and he International Society of Oral Oncology guidelines, further agents have been used. However, a great number of them lack clear evidence, which surely requires the design of more controlled clinical trials for a better assessment of the ideal methods. CONCLUSION The management of oral mucositis constitutes an active area of research. In light of these results, it is aimed to illustrate those treatment strategies that are most effective regarding the treatment approach of oral mucositis.
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Affiliation(s)
- Areti Gkantaifi
- Radiotherapy Department, Interbalkan Medical Center, 10 Asclepioustr, 57001 Pylaia, Thessaloniki, Greece
| | - Emmanouil Vardas
- Clinic of Hospital Dentistry, Dental School, National and Kapodistrian University of Athens, 2 Thivonstr, Goudi, 11527Athens, Greece
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS SacroCuore Don Calabria, Hospital, Negrar, Verona, University of Brescia, Brescia, Italy
| | - Nikolaos Tsoukalas
- Oncology Department, General Military Hospital 401, 138 Avenue Mesogeion & Katechaki, 11525, Athens, Greece
| | - Haytham Hamed Saraireh
- Radiation Oncology Department, Jordanian Royal Medical Services, King Hussein, Medical Center, King Abdullah II St 230, Amman, Jordan
| | | | - Jozsef Lövey
- Department of Oncology, Center of Radiotherapy, National Institute of Oncology, Semmelweis University, Budapest, Hungary
| | - Jiannis Hajiioannou
- Department of Otolaryngology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Biopolis,41110, Larissa, Greece
| | - Efthymios Kyrodimos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocration Hospital, University of Athens, Athens, Greece
| | - Konstantinos Tsanadis
- Department of Radiotherapy, University Hospital of Larisa, Biopolis, 41110, Larisa, Greece
| | - Davide Mauri
- Medical Oncology, University of Ioannina, Ioannina, Greece
| | - Christos Christopoulos
- Radiation Oncology Department, Groupe Hospitalier Intercommunal Le Raincy, Montfermeil, 10 Rue du General Leclerc, 93370 Montfermeil, France
| | - George Iliadis
- Radiotherapy Department, Interbalkan Medical Center, 10 Asclepioustr, 57001 Pylaia, Thessaloniki, Greece
| | - Maria Tolia
- Department of Radiotherapy, University of Thessaly, School of Health Sciences, Faculty of Medicine, Biopolis,41110, Larisa, Greece
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Anderson PM, Lalla RV. Glutamine for Amelioration of Radiation and Chemotherapy Associated Mucositis during Cancer Therapy. Nutrients 2020; 12:nu12061675. [PMID: 32512833 PMCID: PMC7352314 DOI: 10.3390/nu12061675] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023] Open
Abstract
Glutamine is a major dietary amino acid that is both a fuel and nitrogen donor for healing tissues damaged by chemotherapy and radiation. Evidence supports the benefit of oral (enteral) glutamine to reduce symptoms and improve and/or maintain quality of life of cancer patients. Benefits include not only better nutrition, but also decreased mucosal damage (mucositis, stomatitis, pharyngitis, esophagitis, and enteritis). Glutamine supplementation in a high protein diet (10 grams/day) + disaccharides, such as sucrose and/or trehalose, is a combination that increases glutamine uptake by mucosal cells. This increased topical effect can reduce painful mucosal symptoms and ulceration associated with chemotherapy and radiation in the head and neck region, esophagus, stomach and small intestine. Topical and oral glutamine seem to be the preferred routes for this amino acid to promote mucosal healing during and after cancer treatment.
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Affiliation(s)
- Peter M. Anderson
- Cleveland Clinic Pediatric Hematology/Oncology and Bone Marrow Transplant, Pediatric Institute and Taussig Cancer Institute, Cleveland, OH 44195, USA
- Correspondence: ; Tel.: +1-216-308-2706
| | - Rajesh V. Lalla
- UConn Health, School of Dental Medicine, Farmington, CT 06030 USA;
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Başak K, Demir MG, Altıntoprak N, Aydın S. The Effect of Antioxidant Agents on Cisplatin-Induced Laryngeal Histological Alterations in Rats. J Med Food 2020; 24:197-204. [PMID: 32423279 DOI: 10.1089/jmf.2019.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The larynx-related adverse effects that depend on cisplatin decrease patient comfort and many antioxidants have been used to eliminate these side effects. We aimed to identify the laryngeal mucosal changes imposed by cisplatin and investigated whether antioxidants, and their healing effects on these changes, may help reduce laryngeal complications in patients resulting from adverse effects in the larynx. A rat model was designed to evaluate the effects of cisplatin on the larynx and the protective role of antioxidants. Single-dose cisplatin was given both intraperitoneally alone and additionally administered with p-coumaric acid, melatonin, resveratrol, vitamin D, and oleic acid over 5 days. Whole larynges were dissected and evaluated histologically, histochemically, and immunohistochemically. Varying degrees of mucosal changes cisplatin group, but neither erosion nor an ulcer was observed. Numerous variable histological effects of antioxidants were observed on cisplatin exposed laryngeal mucosa. The most obvious effects of cisplatin were edema. The results of the study showed that resveratrol was the most preventive antioxidant agent against cisplatin-dependent mucosal changes. The highest increase in the Ki67 index was in the oleic acid group. Vitamin D increased stromal cyclooxygenase-2 expression that may have an effect on increasing mucosal damage.
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Affiliation(s)
- Kayhan Başak
- Department of Pathology, University of Health Science, Kartal Dr. Lütfi Kırdar Research Hospital, İstanbul, Turkey
| | - Mehmet Gökhan Demir
- Department of Oral and Maxillofacial Surgery, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | | | - Sedat Aydın
- Department of Oral and Maxillofacial Surgery, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
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Shuai T, Tian X, Xu LL, Chen WQ, Pi YP, Zhang L, Wan QQ, Li XE. Oral Glutamine May Have No Clinical Benefits to Prevent Radiation-Induced Oral Mucositis in Adult Patients With Head and Neck Cancer: A Meta-Analysis of Randomized Controlled Trials. Front Nutr 2020; 7:49. [PMID: 32363198 PMCID: PMC7180868 DOI: 10.3389/fnut.2020.00049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/26/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives: The role of oral glutamine for the management of oral mucositis (OM) has not yet been confirmed. The objective of the present study is to further investigate whether oral glutamine is effective in preventing and treating OM among patients with head and neck cancer (HNC) receiving radiotherapy alone or concurrent with chemotherapy. Methods: A systematic search was performed in PubMed, EMBASE, EBSCO, and Cochrane Central Register of Controlled Trials (CENTRAL) to capture all potential citations from the inception to June 2019. Then data extraction and assessment of risk of bias were carried out after selecting the eligible citations. RevMan 5.3 software was used to perform all statistical analyses. Results: Six randomized controlled trials (RCTs) including 441 patients were included in the final analysis. The meta-analysis showed that oral glutamine couldn't significantly decrease the incidence of OM (risk ratio [RR] = 0.98, 95% confidence interval [CI] = 0.94−1.02) and alleviate the development of moderate or severe grade of OM (Moderate-to-severe OM: RR = 0.81, 95% CI = 0.59−1.12; Severe OM: RR = 0.45, 95% CI = 0.13−1.52). But oral glutamine may have the potential to reduce the opioid use (RR = 0.84, 95% CI = 0.71−0.99). The role of oral glutamine in delaying the onset of OM remains uncertain due to conflicting results between quantitative (mean difference [MD] = 4.11 days, 95% CI = 3.49−4.73) and qualitative results. Conclusions: Oral glutamine may have no clinical benefits to prevent or reduce the incidence and severity of radiation-induced OM in patients with HNC receiving radiotherapy alone or concurrent with chemotherapy. It is also uncertain whether oral glutamine can delay the onset of OM. But it may have the potential to relieve the degree of oral pain. Nevertheless, we must cautiously interpret the results because the observed effect size for delay in mucositis start or reduction in opioid use is marginal. Moreover, further RCTs with more rigorous methodology and large-scale are required to enhance the quality of evidence.
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Affiliation(s)
- Ting Shuai
- Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xu Tian
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Ling-Li Xu
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yuan-Ping Pi
- Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China
| | - Lin Zhang
- Department of Nursing, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qiao-Qin Wan
- School of Nursing, Peking University, Beijing, China
| | - Xiu-E Li
- Department of Nursing, Peking University School and Hospital of Stomatology, Beijing, China
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Al-Taie A, Al-Shohani AD, Albasry Z, Altaee A. Current topical trends and novel therapeutic approaches and delivery systems for oral mucositis management. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:94-101. [PMID: 32742107 PMCID: PMC7373116 DOI: 10.4103/jpbs.jpbs_198_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/21/2019] [Accepted: 12/01/2019] [Indexed: 11/12/2022] Open
Abstract
Oral mucositis (OM) is an extremely serious and challenging complication of chemoradiotherapy, which may limit the efficacy of cancer treatment. Complications related to OM include potential nutrition impairment, high economic burden, and negative impacts on patients' quality of life. Current therapeutic options with local traditional pharmaceutical formulations are largely focused on controlling symptoms, and only few agents are available for treatment. Several local supportive and palliative agents are used for the prevention of OM; however, a standard treatment for the disease has not been confirmed yet. The efficacy of treatment could be improved through the introduction of new medical agents with updated dosage forms that can enhance and optimize local drug delivery and create greater therapeutic effects with fewer side effects. The focus of this review was to provide clear and direct information about the currently available topical therapeutic agents in clinical practice used to cure and/or reduce the incidence of ulcerative symptoms of OM, excluding the associated pain and other coexisting complications such as bacterial and fungal infections. The review also provides recent evidences regarding agents that could be used as promising novel therapies in updated local delivering systems. This will support further encouraging options and approaches for the management of OM and will improve compliance that could be translated in better disease control and survival.
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Affiliation(s)
- Anmar Al-Taie
- Pharmacy Department, Faculty of Pharmacy, Girne American University, North Cyprus, Turkey
| | - Athmar D Al-Shohani
- Department of Pharmaceutics, College of Pharmacy, Mustansiriyah University, Baghdad, Iraq
| | - Zahraa Albasry
- Department of Clinical Pharmacy, College of Pharmacy, Mustansiriyah University, Baghdad, Iraq
| | - Ataa Altaee
- Department of Clinical Pharmacy, College of Pharmacy, Mustansiriyah University, Baghdad, Iraq
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Zheng X, Yu K, Wang G, Liu M, Li Y, Yu P, Yang M, Guo N, Ma X, Bu Y, Peng Y, Han C, Yu K, Wang C. Effects of Immunonutrition on Chemoradiotherapy Patients: A Systematic Review and Meta-Analysis. JPEN J Parenter Enteral Nutr 2019; 44:768-778. [PMID: 31709589 DOI: 10.1002/jpen.1735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/26/2019] [Accepted: 10/15/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We conducted a systematic review to assess the effects of immunonutrition on chemoradiotherapy patients. METHODS We searched the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science. We assessed the risk of bias using the Cochrane Risk of Bias tool. Our primary outcomes were the incidence of oral mucositis and diarrhea. The secondary outcomes were the incidence of esophagitis, grade ≥3 oral mucositis, grade ≥3 diarrhea, grade ≥3 esophagitis, and body weight loss. RESULTS A total of 1478 patients and 27 studies were included. There were no significant differences in the incidence of oral mucositis (relative risk [RR] = 0.91; 95% confidence interval [CI], 0.79-1.05), diarrhea (RR = 0.89; 95% CI, 0.76-1.05), or esophagitis (RR = 0.55; 95% CI, 0.11-2.86) between the immunonutrition group and standard nutrition/placebo group. Nevertheless, immunonutrition significantly reduced the incidence of grade ≥3 oral mucositis (RR = 0.45; 95% CI, 0.22-0.92), grade ≥3 diarrhea (RR = 0.56; 95% CI, 0.35-0.88), grade ≥3 esophagitis (RR = 0.15; 95% CI, 0.04-0.54), and losing >5% body weight (RR = 0.34; 95% CI, 0.18-0.64). CONCLUSIONS In this study, immunonutrition failed to reduce the incidence rates of oral mucositis, diarrhea, or esophagitis but was conducive to significantly improving the severity of oral mucositis and diarrhea esophagitis and reducing the rate of body weight loss.
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Affiliation(s)
- Xiaoya Zheng
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Kaili Yu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Guiyue Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Miao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yuhang Li
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Pulin Yu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Mengyuan Yang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Nana Guo
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xiaohui Ma
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yue Bu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yahui Peng
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ci Han
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Changsong Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, China
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Perna S, Alalwan TA, Alaali Z, Alnashaba T, Gasparri C, Infantino V, Hammad L, Riva A, Petrangolini G, Allegrini P, Rondanelli M. The Role of Glutamine in the Complex Interaction between Gut Microbiota and Health: A Narrative Review. Int J Mol Sci 2019; 20:E5232. [PMID: 31652531 PMCID: PMC6834172 DOI: 10.3390/ijms20205232] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/16/2019] [Accepted: 10/20/2019] [Indexed: 02/07/2023] Open
Abstract
The scientific literature has demonstrated that glutamine is one of the main beneficial amino acids. It plays an important role in gut microbiota and immunity. This paper provides a critical overview of experimental studies (in vitro, in vivo, and clinical) investigating the efficacy of glutamine and its effect on gut microbiota. As a result of this review, we have summarized that glutamine could affect gut microbiota via different mechanisms including the reduction in the ratio of Firmicutes to Bacteroidetes, with the activation of NF-κB and PI3K-Akt pathways, reducing the intestinal colonization (Eimeria lesions) and bacterial overgrowth or bacterial translocation, increasing the production of secretory immunoglobulin A (SIgA) and immunoglobulin A+ (IgA+) cells in the intestinal lumen, and decreasing asparagine levels. The potential applications of glutamine on gut microbiota include, but are not limited to, the management of obesity, bacterial translocation and community, cytokines profiles, and the management of side effects during post-chemotherapy and constipation periods. Further studies and reviews are needed regarding the effects of glutamine supplementation on other conditions in humans.
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Affiliation(s)
- Simone Perna
- Department of Biology, College of Science, University of Bahrain, 32038 Sakhir, Bahrain.
| | - Tariq A Alalwan
- Department of Biology, College of Science, University of Bahrain, 32038 Sakhir, Bahrain.
| | - Zahraa Alaali
- Department of Biology, College of Science, University of Bahrain, 32038 Sakhir, Bahrain.
| | - Tahera Alnashaba
- Department of Biology, College of Science, University of Bahrain, 32038 Sakhir, Bahrain.
| | - Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ''Istituto Santa Margherita'', University of Pavia, Pavia 27100, Italy.
| | - Vittoria Infantino
- Department of Biomedical Science and Human Oncology, University of Bari, Bari 70121, Italy.
| | - Layla Hammad
- Department of Biology, College of Science, University of Bahrain, 32038 Sakhir, Bahrain.
| | - Antonella Riva
- Research and Development Department, Indena SpA, 20139 Milan, Italy.
| | | | - Pietro Allegrini
- Research and Development Department, Indena SpA, 20139 Milan, Italy.
| | - Mariangela Rondanelli
- IRCCS Mondino Foundation, Pavia 27100, Italy.
- Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, Pavia 27100, Italy.
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38
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What makes a good new therapeutic l-asparaginase? World J Microbiol Biotechnol 2019; 35:152. [DOI: 10.1007/s11274-019-2731-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022]
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39
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Glutamine Metabolism Is Essential for Stemness of Bone Marrow Mesenchymal Stem Cells and Bone Homeostasis. Stem Cells Int 2019; 2019:8928934. [PMID: 31611919 PMCID: PMC6757285 DOI: 10.1155/2019/8928934] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/23/2019] [Indexed: 02/06/2023] Open
Abstract
Skeleton has emerged as an endocrine organ which is both capable of regulating energy metabolism and being a target for it. Glutamine is the most bountiful and flexible amino acid in the body which provides adenosine 5′-triphosphate (ATP) demands for cells. Emerging evidences support that glutamine which acts as the second metabolic regulator after glucose exerts crucial roles in bone homeostasis at cellular level, including the lineage allocation and proliferation of bone mesenchymal stem cells (BMSCs), the matrix mineralization of osteoblasts, and the biosynthesis in chondrocytes. The integrated mechanism consisting of WNT, mammalian target of rapamycin (mTOR), and reactive oxygen species (ROS) signaling pathway in a glutamine-dependent pattern is responsible to regulate the complex intrinsic biological process, despite more extensive molecules are deserved to be elucidated in glutamine metabolism further. Indeed, dysfunctional glutamine metabolism enhances the development of degenerative bone diseases, such as osteoporosis and osteoarthritis, and glutamine or glutamine progenitor supplementation can partially restore bone defects which may promote treatment of bone diseases, although the mechanisms are not quite clear. In this review, we will summarize and update the latest research findings and clinical trials on the crucial regulatory roles of glutamine metabolism in BMSCs and BMSC-derived bone cells, also followed with the osteoclasts which are important in bone resorption.
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40
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Yarom N, Hovan A, Bossi P, Ariyawardana A, Jensen SB, Gobbo M, Saca-Hazboun H, Kandwal A, Majorana A, Ottaviani G, Pentenero M, Nasr NM, Rouleau T, Lucas AS, Treister NS, Zur E, Ranna V, Vaddi A, Cheng KKF, Barasch A, Lalla RV, Elad S. Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines-part 1: vitamins, minerals, and nutritional supplements. Support Care Cancer 2019; 27:3997-4010. [PMID: 31286229 DOI: 10.1007/s00520-019-04887-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To update the clinical practice guidelines for the use of natural and miscellaneous agents for the prevention and/or treatment of oral mucositis (OM). METHODS A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible. RESULTS A total of 78 papers were identified within the scope of this section, out of which 29 were included in this part, and were analyzed with 27 previously reviewed studies. A new Suggestion was made for oral glutamine for the prevention of OM in head and neck (H&N) cancer patients receiving radiotherapy with concomitant chemotherapy. The previous Recommendation against the use of parenteral glutamine for the prevention of OM in hematopoietic stem cell transplantation (HSCT) patients was re-established. A previous Suggestion for zinc to prevent OM in H&N cancer patients treated with radiotherapy or chemo-radiotherapy was reversed to No Guideline Possible. No guideline was possible for other interventions. CONCLUSIONS Of the vitamins, minerals, and nutritional supplements studied for the management of OM, the evidence supports a Recommendation against parenteral glutamine in HSCT patients and a Suggestion in favor of oral glutamine in H&N cancer patients for the management of OM.
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Affiliation(s)
- Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel. .,School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Allan Hovan
- British Columbia Cancer - Vancouver Centre, Vancouver, Canada
| | - Paolo Bossi
- Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Anura Ariyawardana
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.,Metro South Oral Health, Queensland Health, Brisbane, Australia
| | - Siri Beier Jensen
- Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Margherita Gobbo
- Division of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Abhishek Kandwal
- Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himayalan University, Dehradun, Uttarakhand, India
| | - Alessandra Majorana
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, Dental School University of Brescia, Brescia, Italy
| | - Giulia Ottaviani
- Division of Oral Medicine and Pathology, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Monica Pentenero
- Department of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Turin, Italy
| | - Narmin Mohammed Nasr
- Special Needs Dentistry, Dental Services, Directorate General of Health Services-Muscat Governorate, Ministry of Health, Muscat, Oman
| | - Tanya Rouleau
- Dental Oncology Program, Health Sciences North, North East Cancer Center, Sudbury, ON, Canada
| | - Anna Skripnik Lucas
- Medical Oncology Service, Department of Medicine, NYU Langone Perlmutter Cancer Center, New York, NY, USA
| | - Nathaniel Simon Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Eyal Zur
- Compounding Solutions, Tel-Mond, Israel
| | - Vinisha Ranna
- Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, 10029, USA
| | - Anusha Vaddi
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Karis Kin Fong Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrei Barasch
- Division of Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Rajesh V Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Sharon Elad
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
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41
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de Menêses AG, Normando AGC, Porto de Toledo I, Reis PED, Guerra ENS. Effects of oral supplementation in the management of oral mucositis in cancer patients: A meta-analysis of randomized clinical trials. J Oral Pathol Med 2019; 49:117-125. [PMID: 31172573 DOI: 10.1111/jop.12901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/30/2019] [Accepted: 05/30/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the effects of oral supplementation on the management of oral mucositis in patients with cancer undergoing chemo and/or radiation therapy. METHOD This is a systematic review and meta-analysis. The search was performed at 6 databases, and in the gray literature. Methodology of included studies was evaluated by the Cochrane Collaboration Risk of Bias Tool, and evidence quality was assessed by GRADE instrument. RESULTS Twelve randomized clinical trials were included in this review. The oral supplementation used was an oral elemental diet with amino acids and minerals (elental), glutamine, and zinc. The majority of the studies included in this review showed benefits in delaying the occurrence of OM by using glutamine and zinc, and in reducing the severity of OM with glutamine, zinc, and elental in patients receiving chemoradiotherapy. The meta-analysis showed that the risk of oral mucositis in the zinc group was slightly lower than in the control (RR: 0.71, 95% CI: 0.53-0.96, P = 0.02, n = 982) while the glutamine group presented the same risk as the control (RR: 0.91, 95% CI: 0.78-1.05, P = 0.19, n = 314). The evidence quality suggested low confidence for zinc and glutamine studies in the estimated effect from the outcomes assessed. CONCLUSIONS Zinc is a promising strategy in the management of oral mucositis since it delayed the occurrence and reduced its severity. Glutamine and Elental, on the other hand, had no strong evidence in the prevention and/or treatment of oral mucositis in patients with cancer.
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Affiliation(s)
- Amanda Gomes de Menêses
- Interdisciplinary Laboratory of Oncology Research, School of Health Sciences, University of Brasília, Brasília, Brazil
| | | | - Isabela Porto de Toledo
- Laboratory of Oral Histopathology, School of Health Sciences, University of Brasília, Brasília, Brazil.,Brazilian Centre for Evidence Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Paula Elaine Diniz Reis
- Interdisciplinary Laboratory of Oncology Research, School of Health Sciences, University of Brasília, Brasília, Brazil
| | - Eliete Neves Silva Guerra
- Laboratory of Oral Histopathology, School of Health Sciences, University of Brasília, Brasília, Brazil
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Mucosal Injury during Anti-Cancer Treatment: From Pathobiology to Bedside. Cancers (Basel) 2019; 11:cancers11060857. [PMID: 31226812 PMCID: PMC6627284 DOI: 10.3390/cancers11060857] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
Mucositis is one of the most common debilitating side effects related to chemotherapy (CT), radiation therapy (RT), targeted agents and immunotherapy. It is a complex process potentially involving any portion of the gastrointestinal tract and injuring the mucosa, leading to inflammatory or ulcerative lesions. Mechanisms and clinical presentation can differ according both to the anatomic site involved (oral or gastrointestinal) and the treatment received. Understanding the pathophysiology and management of mucosal injury as a secondary effect of anti-cancer treatment is an important area of clinical research. Prophylaxis, early diagnosis, and adequate management of complications are essential to increase therapeutic success and, thus, improve the survival outcomes of cancer patients. This review focuses on the pathobiology and management guidelines for mucositis, a secondary effect of old and new anti-cancer treatments, highlighting recent advances in prevention and discussing future research options.
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43
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Pathak S, Soni TP, Sharma LM, Patni N, Gupta AK. A Randomized Controlled Trial to Evaluate the Role and Efficacy of Oral Glutamine in the Treatment of Chemo-radiotherapy-induced Oral Mucositis and Dysphagia in Patients with Oropharynx and Larynx Carcinoma. Cureus 2019; 11:e4855. [PMID: 31410338 PMCID: PMC6684294 DOI: 10.7759/cureus.4855] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/03/2019] [Indexed: 11/05/2022] Open
Abstract
AIM To determine the role and efficacy of oral glutamine in the treatment of chemo-radiotherapy-induced oral mucositis and dysphagia in patients with carcinoma of the oropharynx and larynx. The primary objective of this study was to compare the incidence and severity of oral mucositis and dysphagia between the glutamine group (oral glutamine, along with concurrent chemo-radiotherapy) and the control group (concurrent chemo-radiotherapy alone, no glutamine). Secondary objectives were to compare the time to onset of oral mucositis and dysphagia, the incidence of treatment breaks (more than three consecutive radiation fractions missed), and significant weight loss (more than 3 kilograms of weight loss from the baseline) between the two groups. METHOD A total of 60 patients with locally advanced carcinoma of the oropharynx and larynx (Stage III - IV) who were receiving concurrent chemo-radiotherapy were randomised to the glutamine group (study arm, n = 30) and the non-glutamine group (control arm, n = 30). All patients were treated by radiotherapy to a total dose of 70 Gy in 35 fractions, along with concurrent weekly injections of cisplatin (40 mg/m2) chemotherapy. Patients in the study arm received 10 gm of oral glutamine two hours before radiotherapy (five days a week during the seven-week course of radiotherapy). In the control arm, glutamine was not given to patients during the chemo-radiotherapy treatment. All patients were assessed for oral mucositis, dysphagia, weight loss, and compliance/gap in the treatment (greater than three consecutive days of radiation missed) until the completion of chemo-radiotherapy. Grading of oral mucositis and dysphagia was done as per the National Cancer Institute, Common Terminology Criteria for Adverse Events version 4.03. RESULTS Out of 60 patients, 56 patients (93.33%) completed the full course of chemo-radiotherapy treatment. Twenty-seven patients (96.43%) in the control arm developed Grade III oral mucositis compared to only 12 patients (42.83%) in the glutamine arm (p < 0.001). Twenty-six patients (93%) in the control arm developed Grade III dysphagia compared to only 11 patients (39%) in the glutamine arm (p < 0.001). Glutamine significantly decreased the incidence and severity of mucositis and dysphagia. Glutamine delayed the onset of mucositis and dysphagia. As severe dysphagia was more prevalent in the control arm, feeding by Ryle's tube was required in 17 patients (56.67%) in the control arm versus only in eight patients (26.67%) in the glutamine arm (p = 0.03). Significant weight loss during the treatment was seen in all patients of the control arm (100% patients) compared to only 71% of the patients in the glutamine arm (p = 0.004). In the control arm, 46.67% patients had treatment interruption (gap) compared to 16.67% in the glutamine arm (p = 0.025). Sixteen patients (53%) from the control arm required admission (inpatient care) in the hospital to manage the treatment-toxicity (mucositis and dysphagia) compared to seven patients (23%) from the glutamine arm (p = 0.03). CONCLUSION Glutamine significantly decreased the incidence and severity of chemo-radiotherapy-induced oral mucositis and dysphagia. It delayed the onset of oral mucositis and dysphagia, improved the compliance to the chemo-radiotherapy treatment, and reduced the requirement for hospitalization for the management of treatment-induced toxicities in patients with locally advanced carcinoma of the oropharynx and larynx.
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Affiliation(s)
- Shuchita Pathak
- Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, IND
| | - Tej P Soni
- Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, IND
| | - Lalit M Sharma
- Medical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, IND
| | - Nidhi Patni
- Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, IND
| | - Anil K Gupta
- Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, IND
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Huang CJ, Huang MY, Fang PT, Chen F, Wang YT, Chen CH, Yuan SS, Huang CM, Luo KH, Chuang HY, Wang YY, Lee HH. Randomized double-blind, placebo-controlled trial evaluating oral glutamine on radiation-induced oral mucositis and dermatitis in head and neck cancer patients. Am J Clin Nutr 2019; 109:606-614. [PMID: 30753262 PMCID: PMC6408208 DOI: 10.1093/ajcn/nqy329] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/22/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Glutamine is the primary fuel for the gastrointestinal epithelium and maintains the mucosal structure. Oncologists frequently encounter oral mucositis, which can cause unplanned breaks in radiotherapy (RT). OBJECTIVES The aim of this study was to explore the association between oral glutamine and acute toxicities in patients with head and neck cancer undergoing RT. METHODS This was a parallel, double-blind, randomized, placebo-controlled Phase III trial conducted in a university hospital. A central randomization center used computer-generated tables to allocate interventions to 71 patients with stages I-IV head and neck cancers. The patients, care providers, and investigators were blinded to the group assignment. Eligible patients received either oral glutamine (5 g glutamine and 10 g maltodextrin) or placebo (15 g maltodextrin) 3 times daily from 7 d before RT to 14 d after RT. The primary and secondary endpoints were radiation-induced oral mucositis and neck dermatitis, respectively. These were documented in agreement with the National Cancer Institute Common Terminology Criteria for Adverse Events version 3. RESULTS The study included 64 patients (placebo n = 33; glutamine n = 31) who completed RT for the completers' analysis. Based on multivariate analysis, glutamine had no significant effect on the severity of oral mucositis (OR: 0.3; 95% CI: 0.05, 1.67; P = 0.169). Only the change in body mass index (BMI) was significant in both multivariate completers (OR: 0.41; 95% CI: 0.20, 0.84; P = 0.015) and per-protocol analysis (OR: 0.40; 95% CI: 0.20, 0.83; P = 0.014). No difference was found in the incidence and severity of neck dermatitis between the two arms. CONCLUSIONS The decrease in BMI was strongly related to the severity of oral mucositis in the head and neck cancer patients under RT, but not to the use of glutamine. This trial was registered at clinicaltrials.gov as NCT03015077.
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Affiliation(s)
- Chih-Jen Huang
- Division of Radiation Oncology, Department of Radiation Oncology,Faculty of Medicine, College of Medicine
| | - Ming-Yii Huang
- Division of Radiation Oncology, Department of Radiation Oncology,Faculty of Medicine, College of Medicine
| | - Pen-Tzu Fang
- Division of Radiation Oncology, Department of Radiation Oncology
| | - Frank Chen
- Division of Radiation Oncology, Department of Radiation Oncology
| | | | | | | | - Chun-Ming Huang
- Division of Radiation Oncology, Department of Radiation Oncology,Faculty of Medicine, College of Medicine
| | - Kuei-Hau Luo
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Yi Chuang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan,Faculty of Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Hsin-Hua Lee
- Division of Radiation Oncology, Department of Radiation Oncology,PhD Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan,Address correspondence to H-HL (e-mail: )
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45
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Thomsen M, Vitetta L. Adjunctive Treatments for the Prevention of Chemotherapy- and Radiotherapy-Induced Mucositis. Integr Cancer Ther 2018; 17:1027-1047. [PMID: 30136590 PMCID: PMC6247548 DOI: 10.1177/1534735418794885] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Chemoradiotherapy-associated mucositis can manifest as
pain, inflammation, dysphagia, diarrhea, weight loss, rectal bleeding, and
infection. Mucositis is a major dose-limiting side effect of chemotherapy,
affecting nutritional intake and oral and intestinal function. Despite several
interventions being available, there is a need for safe and effective
preventative and treatment options for treatment-induced mucositis. The goals of
this review are to discuss interventions based on foods and natural products and
present the research to date. Methods: A narrative literature
review identified 60 clinical studies examining various nutritional compounds
and 20 examining probiotics. 9 studies on probiotics for the prevention of
diarrhea were also assessed on methodological quality and limitations
identified. Results: Several compounds have been posited as useful
adjuvants for cancer treatment–related mucositis. Probiotics demonstrate
efficacy for the prevention and treatment of chemoradiotherapy-induced
gastrointestinal toxicity without significant side effects. Glutamine and
activated charcoal were reported to reduce chemotherapy-induced diarrhea but not
radiation-induced intestinal mucositis. Honey has been reported to decrease
treatment interruptions, weight loss, and delays the onset of oral mucositis.
Zinc, glutamine, and topical vitamin E were demonstrated efficacy for oral
mucositis. Conclusion: There is plausible clinical evidence for the
administration of several adjunctive treatments for the prevention and treatment
of mucositis. Probiotics were reported to reduce the burden of intestinal
mucositis and treatment-induced diarrhea. Activated charcoal and glutamine are
beneficial for chemotherapy-induced diarrhea, whereas the administration of
honey, zinc, and glutamine reduce the risk of developing oral mucositis during
chemotherapy or radiotherapy.
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Affiliation(s)
| | - Luis Vitetta
- 1 University of Sydney, Sydney, New South Wales, Australia.,2 Medlab Clinical Ltd, Sydney, New South Wales, Australia
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46
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Bockel S, Vallard A, Lévy A, François S, Bourdis M, Le Gallic C, Riccobono D, Annede P, Drouet M, Tao Y, Blanchard P, Deutsch É, Magné N, Chargari C. Pharmacological modulation of radiation-induced oral mucosal complications. Cancer Radiother 2018; 22:429-437. [PMID: 29776830 DOI: 10.1016/j.canrad.2017.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 12/12/2022]
Abstract
Radiation-induced mucositis is a common toxicity, especially in patients with head and neck cancers. Despite recent technological advances in radiation therapy, such as intensity-modulated radiotherapy, radiation-induced mucositis is still causing treatment disruptions, negatively affecting patients' long and short term quality of life, and impacting medical resources use with economic consequences. The objective of this article was to review the latest updates in the management of radiation-induced mucositis, with a focus on pharmaceutical strategies for the prevention or treatment of mucositis. Although numerous studies analysing the prevention and management of oral radiation-induced mucositis have been conducted, there are still few reliable data to guide daily clinical practice. Furthermore, most of the tested drugs have shown no (anti-inflammatory cytokine, growth factors) or limited (palifermin) effect. Therapies for acute oral mucositis are predominantly focused on improving oral hygiene and providing symptoms control. Although low-level laser therapy proved efficient in preventing radiation-induced oral mucositis in patients with head and neck cancer, this intervention requires equipment and trained medical staff, and is therefore insufficiently developed in clinical routine. New effective pharmacological agents able to prevent or reverse radio-induced mucositis are required.
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Affiliation(s)
- S Bockel
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - A Vallard
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - A Lévy
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - S François
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - M Bourdis
- Département interdisciplinaire des soins de support pour le patient en oncologie, institut de cancérologie Lucien-Neuwirth, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - C Le Gallic
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - D Riccobono
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - P Annede
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - M Drouet
- Département effets biologiques des rayonnements, institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - Y Tao
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - P Blanchard
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - É Deutsch
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Inserm U1030, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - N Magné
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - C Chargari
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Inserm U1030, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France; Service de santé des armées, école du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France.
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47
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Lin MC, Shueng PW, Chang WK, Mu-Hsin Chang P, Feng HC, Yang MH, Lou PJ. Consensus and clinical recommendations for nutritional intervention for head and neck cancer patients undergoing chemoradiotherapy in Taiwan. Oral Oncol 2018; 81:16-21. [PMID: 29884409 DOI: 10.1016/j.oraloncology.2018.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 01/10/2023]
Abstract
Because of the anatomical location, patients with head and neck cancer (HNC) frequently experience dysphagia and malnutrition at the time of diagnosis and these conditions are often exacerbated after chemoradiotherapy. There is an emerging medical need to establish a consensus on nutritional intervention for these patients. A panel of 30 senior physicians and experts from multidisciplinary teams drafted clinical recommendations to improve the management of nutritional interventions in Taiwan and to provide updated treatment strategy recommendations in hope of improving the nutritional status of patients with HNC. This clinical review describes the resulting consensus document, including the impact of malnutrition on clinical outcomes, the role of prophylactic tube feeding, the choice of tube feeding, and the benefit of oral nutritional supplements in patients with HNC undergoing chemoradiotherapy. The outcomes of this review will support clinicians in their efforts to improve the nutritional status of patients with HNC.
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Affiliation(s)
- Mei-Chun Lin
- Department of Otolaryngology, National Taiwan University Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Peter Mu-Hsin Chang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Chun Feng
- Department of Dietetics and Nutrition, National Taiwan University Hospital, Taipei, Taiwan
| | - Muh-Hwa Yang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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48
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Abstract
Head and neck cancer (HNC) patients often face multiple nutritional challenges before, during, and after treatment due to the close proximity of the cancer to organs that are vital for normal eating function. Common treatment-related side effects, such as dysphagia, odynophagia, dysgeusia, xerostomia, thick saliva, mucositis, nausea, and vomiting, all further impair the patient's ability to maintain adequate oral intake. Malnutrition and unintentional weight loss in HNC patients during and after treatment are associated with poorer treatment outcomes, increased morbidity and mortality, and poor quality of life, even in overweight and obese patients whose Body Mass Index (BMI) is not suggestive of malnutrition. The main nutrition goal for HNC patients is thus to maximize nutrition intake either orally or through nutrition support therapy in order to prevent or limit weight loss, preserve lean body mass, minimize treatment delays and unplanned hospitalizations, and improve treatment outcomes. This chapter will discuss nutrition interventions to manage common symptoms before, during, and after treatment for HNC. Guidelines will be provided for patients that require enteral nutrition or less commonly, parenteral nutrition.
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Affiliation(s)
- Denise Ackerman
- Department of Surgery, Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Meghan Laszlo
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arlene Provisor
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Adern Yu
- Department of Surgery, Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA, USA
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49
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Arikapudi S, Rashid S, Al Almomani LA, Treece J, Baumrucker SJ. Serum Bovine Immunoglobulin for Chemotherapy-Induced Gastrointestinal Mucositis. Am J Hosp Palliat Care 2017; 35:814-817. [PMID: 29020798 DOI: 10.1177/1049909117735831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cancer treatments including chemotherapy and radiotherapy treat cancer by targeting rapidly dividing cells. Although these forms of treatment damage rapidly dividing cancer cells, they are also toxic to the cells of the gastrointestinal tract, leading to inflammation of the mucosal layer (mucositis) and causing nausea, vomiting, diarrhea, and abdominal pain. Improvement in symptoms may allow patients to have better performance status permitting ongoing treatment and possibly a better prognosis. This article describes the pathophysiology of chemotherapy-induced mucositis and includes 3 case reports of treatment of mucositis with serum bovine immunoglobulin.
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Affiliation(s)
- Sowminya Arikapudi
- 1 Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Saima Rashid
- 1 Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Laith Adel Al Almomani
- 1 Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Jennifer Treece
- 1 Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Steven J Baumrucker
- 2 Department of Hospice and Palliative Medicine, Wellmont Health System, Kingsport, TN, USA
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50
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Nichetti F, Lobefaro R, Pagani F, Randon G, Corti F, de Braud F, Celio L, Platania M. "Systemic strategy at the patient's service": a congress report on supportive care in oncology. TUMORI JOURNAL 2017; 103:0. [PMID: 28777425 DOI: 10.5301/tj.2017.17342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Federico Nichetti
- Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan - Italy
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