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Gül D, Atasoy BM, Ercan E, Başkan Z, Bektaş Kayhan K. Does lower dose pilocarpine have a role in radiation-induced xerostomia in the modern radiotherapy era? A single-center experience based on patient-reported outcome measures. Eur Arch Otorhinolaryngol 2024; 281:3727-3733. [PMID: 38573515 PMCID: PMC11211147 DOI: 10.1007/s00405-024-08616-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE This study aims to investigate the efficacy of lower dose pilocarpine in alleviating late dry mouth symptoms in head and neck cancer patients received radiotherapy. METHODS Eighteen head and neck cancer patients experiencing persistent dry mouth were enrolled in this study. All participants started pilocarpine treatment a median of 6 months post-radiotherapy. Initially, patients received pilocarpine at 5 mg/day, with a gradual increase to the recommended dose of 15 mg/day. A Patient-Reported Outcome Measurement (PROMs) questionnaire assessed symptoms' severity related to hyposalivation. RESULTS All patients reported symptomatic dry mouth above grade 2 before starting the medication. Pilocarpine treatment continued based on patients' self-assessment, with a median duration of 12 months (range, 3-36 months). The median daily maintenance dose was 10 mg (range, 5 to 20 mg). Total PROMs scores significantly decreased following medication, from 13 points (range 7-18 points) to 7 points (range 4-13 points) (p = 0.001). Significant improvements were observed in questions related to dry mouth (p < 0.001), water intake during eating (p = 0.01), carrying water (p = 0.01), taste (p < 0.001), and water intake during speech (p < 0.001). Initial and maintenance doses of pilocarpine were lower, and the duration of pilocarpine usage was shorter in patients treated with intensity-modulated radiation therapy compared to conformal radiotherapy (12 months vs. 25 months, p = 0.04). CONCLUSION Pilocarpine may be considered at doses lower for late-term dry mouth. With modern radiotherapy techniques effectively preserving the parotid gland, short-term use may be recommended in these patients. Future studies may enhance the development of a more robust patient selection criteria model.
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Affiliation(s)
- Dilek Gül
- S.B.-Marmara University Pendik Education and Research Hospital Radiation Oncology Clinic, Istanbul, Turkey
| | - Beste M Atasoy
- Department of Radiation Oncology, School of Medicine, Marmara University, Istanbul, Turkey.
- Marmara Üniversitesi Pendik EAH Radyasyon Onkolojisi Kliniği, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No: 8, 34899, Istanbul, Turkey.
| | - Ece Ercan
- Department of Radiation Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Zilan Başkan
- Department of Radiation Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Kıvanç Bektaş Kayhan
- Department of Oral and Maxillofacial Surgery, İstanbul University Faculty of Dentistry, Istanbul, Turkey
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Weissheimer T, Só BB, Pradebon MC, de Figueiredo JAP, Martins MD, Só MVR. Head and neck radiotherapy effects on the dental pulp vitality and response to sensitivity tests. A systematic review with meta-analysis. Int Endod J 2022; 55:563-578. [PMID: 35298027 DOI: 10.1111/iej.13726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is no consensus whether radiotherapy for head and neck cancer (HNC) could induce pulp necrosis. Therefore, a systematic review of clinical studies is necessary. OBJECTIVES To evaluate the evidences on radiotherapy for HNC and pulp status. METHODS A systematic search of articles published until November 2021 was performed in the MEDLINE/PubMed, Cochrane Library, Web of Science (All Databases), Scopus, EMBASE and Open Grey databases. The eligibility criteria were based on the PICOS strategy, as follows: (P) vital teeth of adult patients with intraoral and/or oropharyngeal cancer; (I) radiotherapy; (C) control group or values of the same tooth before radiotherapy (basal values); (O) pulpal status after radiotherapy; (S) clinical studies. The Cochrane Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool was used to assess the quality of the included studies. Meta-analyses were performed using fixed and random effects. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS Six studies were included for qualitative analysis. Five were classified as serious risk of bias and one as moderate risk of bias. Four studies reported altered pulp responses to cold thermal test after radiotherapy initiation. Meta-analyses were performed using three included studies. From these, all were included in the meta-analysis for pulp response values to cold sensitivity test immediately after radiotherapy initiation (risk ratio: 0.00[CI:0.00, 0.02], P < 0.00001; I2 = 0%); and two in the meta-analysis for pulp response values to cold sensitivity test after 4-5 months of radiotherapy (risk ratio: 0.01[CI: 0.00. 0.06], P < 0.00001; I2 = 0%). Two reported progressively higher readings to pulp response in the electrical test after radiotherapy initiation (mean difference: -11.46[-13.09, -9.84], P < 0.00001; I2 = 68%) and at all periods evaluated. Two studies demonstrated a pulp oxygen saturation (SpO2 ) decrease at the end of radiotherapy; and increase after 4-6 months of radiotherapy beginning. And other demonstrated normal dental pulp SpO2 4 to 6 years after treatment. GRADE analysis presented a moderate certainty of evidence. DISCUSSION This review verified that radiotherapy for HNC causes significant alterations on the dental pulp responses, but does not seem to induce pulp necrosis. Significant limitations regarding controlling for confounding factors, classification of interventions and measurement of outcomes were verified, evidencing the need for well-designed studies. CONCLUSIONS This systematic review demonstrated that radiotherapy for HNC induced significant changes in the pulp response with moderate quality of evidence. Such altered responses cannot determine pulp status accurately.
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Affiliation(s)
- Theodoro Weissheimer
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Bruna Barcelos Só
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Marieli Chitolina Pradebon
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | | | - Manoela Domingues Martins
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Marcus Vinicius Reis Só
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
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Lin GS, Wang WW, Lin H, Lin RS. Bevacizumab Combined with Intensity-Modulated Radiation Therapy on Cognitive and Coagulation Function in Postoperative Glioma Patients. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9367919. [PMID: 35313514 PMCID: PMC8934211 DOI: 10.1155/2022/9367919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
To examine the influences of bevacizumab combined with intensity-modulated radiation therapy (IMRT) on postoperative brain glioma, particularly its impact on coagulation function and cognitive function, the complete clinical data of 156 patients undergoing glioma surgery in the neurosurgery department of our hospital between March 2015 and October 2018 were retrospectively analyzed. All patients underwent glioma surgery and were then assigned to the observation group (Obs group, n = 79, received bevacizumab combined with IMRT) or the control group (Con group, n = 77, received IMRT without bevacizumab) for analysis during postoperative treatment. The patients' short-term efficacy was evaluated, and their serum markers and coagulation function were compared, as well as the cognitive function, the occurrence of adverse reactions during treatment, the Karnofsky performance status (KPS) score, and quality of life after treatment. Patients' survival was followed up within 2 years after surgery. The Obs group showed a notably higher clinical remission rate and clinical control rate (DCR) than the Con group after treatment. The Obs group showed notably lower levels of interleukin-2 (IL-2), vascular endothelial growth factor (VEGF), IL-6, and epidermal growth factor (EGF), experienced notably shorter prothrombin time (PT) and activated partial thromboplastin time (APTT), and showed higher fibrinogen (FIB) and D-dimer (D-D) levels than Con group. The Obs group showed notably better cognitive function, KPS score, and quality of life than the Con group, but no notable difference was observed between them in the incidence of adverse reactions (P > 0.0500). The survival rates in the Obs group were higher than in the Con group. For patients with glioma, postoperative bevacizumab combined with IMRT delivers substantially higher clinical efficacy by lowering serum marker levels and improving cognitive function without significantly affecting coagulation function.
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Affiliation(s)
- Guo-Shi Lin
- Department of Neurosurgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, China
| | - Wei-Wei Wang
- Department of Neurosurgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, China
| | - Hong Lin
- Department of Neurosurgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, China
| | - Rui-Sheng Lin
- Department of Neurosurgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, China
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Kapoor A, Reddy N, Bhalavat R, Chandra M, Pareek V, Srivastava A, Moosa Z, Bauskar P, Kapoor A. Qualitative and dosimetric assessment of radiation-induced xerostomia in patients with oral cancers treated with 3DCRT versus IMRT: A prospective observational study. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alterio D, De Berardinis R, Augugliaro M, D’Urso P, Volpe S, Maffini F, Bruschini R, Marvaso G, Riccio S, Tagliabue M, Turturici I, Farneti A, Calabrese L, Starzynska A, Ferrari A, Zaffaroni M, Jereczek-Fossa BA, Sanguineti G, Ansarin M. Indication to postoperative radiotherapy for oral cavity squamous cell carcinoma: what’s new in the Depth of Infiltration (DOI) era? Br J Radiol 2021; 95:20210705. [DOI: 10.1259/bjr.20210705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives: The last edition of the American Joint Committee on Cancer (AJCC eighth) has introduced the depth of infiltration (DOI) as a new prognostic parameter in oral cavity squamous cell carcinomas (OCSCCs). Aim of this study is to analyze the impact of stage migration on the indication to postoperative radiotherapy (PORT). Methods: OCSCCs treated at two Institutions between 2014 and 2019 were retrieved. Per the AJCC eighth, only pT3 primarily OCSCCs were considered; availability of the pathologic specimen was a further inclusion criterion. Risk factors considered for PORT were: pT3-pT4, nodal involvement, positive/close surgical margins, perineural and lymph vascular invasion. Results: One-hundred forty-nine patients staged as pT3 AJCC eighth were included. A four-fold increase in the number of patients staged as pT3 from the seventh to the eighth AJCC was found. Stage migration to pT3 was equally due to the downstaging from former pT4 (38%) and upstaging of former pT1-pT2 (35%). Considering the former pT1-pT2 53 patients, 13 (25%) had no risk factors for PORT other than DOI. Among 25 cases with former pT1-pT2 and negative lymph nodes no additional risk factors were found in 11 (44%). Conclusion: Ninety percent of patients had at least one risk factor besides DOI and would have received PORT also according to the AJCC seventh; notably, of former pT1-pT2N0, half of them have been upstaged to pT3 in the current TNM classification. The role of PORT in this cohort of patients has not been clarified yet. Advances in knowledge: Other-than-DOI risk factors leading to PORT indication are highly prevalent in OCSSC patients classified as pT3 per the latest AJCC TNM staging system and should therefore be considered for a comprehensive oncological assessment.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Pasqualina D’Urso
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Fausto Maffini
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Bruschini
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Stefano Riccio
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Irene Turturici
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessia Farneti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Calabrese
- Division of Otorhinolaryngology, "San Maurizio" Hospital, Bolzano, Italy
| | - Anna Starzynska
- Department of Oral Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Sanguineti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Radiation Therapy in Adult Soft Tissue Sarcoma-Current Knowledge and Future Directions: A Review and Expert Opinion. Cancers (Basel) 2020; 12:cancers12113242. [PMID: 33153100 PMCID: PMC7693687 DOI: 10.3390/cancers12113242] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Radiation therapy (RT) is an integral part of the treatment of adult soft-tissue sarcomas (STS). Although mainly used as perioperative therapy to increase local control in resectable STS with high risk features, it also plays an increasing role in the treatment of non-resectable primary tumors, oligometastatic situations, or for palliation. This review summarizes the current evidence for RT in adult STS including typical indications, outcomes, side effects, dose and fractionation regimens, and target volume definitions based on tumor localization and risk factors. It covers the different overall treatment approaches including RT either as part of a multimodal treatment strategy or as a sole treatment and is accompanied by a summary on ongoing clinical research pointing at future directions of RT in STS. Abstract Radiation therapy (RT) is an integral part of the treatment of adult soft-tissue sarcomas (STS). Although mainly used as perioperative therapy to increase local control in resectable STS with high risk features, it also plays an increasing role in the treatment of non-resectable primary tumors, oligometastatic situations, or for palliation. Modern radiation techniques, like intensity-modulated, image-guided, or stereotactic body RT, as well as special applications like intraoperative RT, brachytherapy, or particle therapy, have widened the therapeutic window allowing either dose escalation with improved efficacy or reduction of side effects with improved functional outcome. This review summarizes the current evidence for RT in adult STS including typical indications, outcomes, side effects, dose and fractionation regimens, and target volume definitions based on tumor localization and risk factors. It covers the different overall treatment approaches including RT either as part of a multimodal treatment strategy or as a sole treatment, namely its use as an adjunct to surgery in resectable STS (perioperative RT), as a primary treatment in non-resectable tumors (definitive RT), as a local treatment modality in oligometastatic disease or as palliative therapy. Due to the known differences in clinical course, general treatment options and, consequently, outcome depending on lesion localization, the main part of perioperative RT is divided into three sections according to body site (extremity/trunk wall, retroperitoneal, and head and neck STS) including the discussion of special applications of radiation techniques specifically amenable to this region. The review of the current evidence is accompanied by a summary on ongoing clinical research pointing at future directions of RT in STS.
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