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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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Pillai S, Munguia-Lopez JG, Tran SD. Bioengineered Salivary Gland Microtissues─A Review of 3D Cellular Models and their Applications. ACS APPLIED BIO MATERIALS 2024; 7:2620-2636. [PMID: 38591955 DOI: 10.1021/acsabm.4c00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Salivary glands (SGs) play a vital role in maintaining oral health through the production and release of saliva. Injury to SGs can lead to gland hypofunction and a decrease in saliva secretion manifesting as xerostomia. While symptomatic treatments for xerostomia exist, effective permanent solutions are still lacking, emphasizing the need for innovative approaches. Significant progress has been made in the field of three-dimensional (3D) SG bioengineering for applications in gland regeneration. This has been achieved through a major focus on cell culture techniques, including soluble cues and biomaterial components of the 3D niche. Cells derived from both adult and embryonic SGs have highlighted key in vitro characteristics of SG 3D models. While still in its first decade of exploration, SG spheroids and organoids have so far served as crucial tools to study SG pathophysiology. This review, based on a literature search over the past decade, covers the importance of SG cell types in the realm of their isolation, sourcing, and culture conditions that modulate the 3D microenvironment. We discuss different biomaterials employed for SG culture and the current advances made in bioengineering SG models using them. The success of these 3D cellular models are further evaluated in the context of their applications in organ transplantation and in vitro disease modeling.
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Affiliation(s)
- Sangeeth Pillai
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dental Medicine and Oral Health Sciences, McGill University, 3640 Rue University, Montreal, QC H3A 0C7, Canada
| | - Jose G Munguia-Lopez
- Department of Mining and Materials Engineering, McGill University, 3610 University Street, Montreal, QC H3A 0C5, Canada
| | - Simon D Tran
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dental Medicine and Oral Health Sciences, McGill University, 3640 Rue University, Montreal, QC H3A 0C7, Canada
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Sharma S, Kumar Upadhyay A, Prakash A, Singodia P, Ravi Kiran S, Shankar R. Treatment Complications of Head and Neck Cancers and Rehabilitation Measures: A Narrative Review. Cureus 2024; 16:e61173. [PMID: 38933634 PMCID: PMC11204137 DOI: 10.7759/cureus.61173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Head and neck cancers (HNCs) are malignant tumors mainly from squamous cells in the head and neck tissues. Treatment involves a multidisciplinary approach with surgery, radiotherapy, and chemotherapy. However, the long-term prognosis for patients with advanced-stage tumors is guarded, with a median survival time of approximately 24 months. HNC patients have very high rates of depression and anxiety and the highest suicide rate among all cancers due to the intense and challenging nature of the treatment, underscoring the importance of our collective efforts. Rehabilitation success depends on various factors, including tumor, patient, and treatment-related factors. Patients may require post-treatment oral rehabilitation measures, including implants, obturators, and flexible dentures. These measures are crucial, but they often need to be more utilized. Patients may face challenges in maintaining oral hygiene and managing mucositis. Additionally, it is essential to address other intricacies such as trismus, xerostomia, gustatory dysfunctions, neuropathy, speech impairments, and psychological disturbances. Unfortunately, there is little literature on post-treatment rehabilitative measures. Despite its crucial role in improving patients' quality of life, rehabilitation often receives inadequate attention compared to treatment. Our narrative review, which covers various factors that affect rehabilitation, including oral rehabilitation measures and post-treatment complications, is anticipated to deliver practical insights to professionals and inspire positive changes in their regular practice.
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Affiliation(s)
- Swati Sharma
- Prosthodontics, Crown and Bridge & Oral Implantology, Tata Main Hospital, Jamshedpur, IND
| | | | | | | | - Sarat Ravi Kiran
- Oral and Maxillofacial Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Rama Shankar
- Oral and Maxillofacial Surgery, Tata Main Hospital, Jamshedpur, IND
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Sample CM, Uribe C, Rahmim A, Bénard F, Wu J, Clark H. Heterogeneous PSMA ligand uptake inside parotid glands. Phys Med 2024; 121:103366. [PMID: 38657425 DOI: 10.1016/j.ejmp.2024.103366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/28/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
The purpose of this investigation is to quantify the spatial heterogeneity of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) uptake within parotid glands. We aim to quantify patterns in well-defined regions to facilitate further investigations. Furthermore, we investigate whether uptake is correlated with computed tomography (CT) texture features. METHODS Parotid glands from [18F]DCFPyL PSMA PET/CT images of 30 prostate cancer patients were analyzed. Uptake patterns were assessed with various segmentation schemes. Spearman's rank correlation coefficient was calculated between PSMA PET uptake and feature values of a Grey Level Run Length Matrix using a long and short run length emphasis (GLRLML and GLRLMS) in subregions of the parotid gland. RESULTS PSMA PET uptake was significantly higher (p < 0.001) in lateral/posterior regions of the glands than anterior/medial regions. Maximum uptake was found in the lateral half of parotid glands in 50 out of 60 glands. The difference in SUVmean between parotid halves is greatest when parotids are divided by a plane separating the anterior/medial and posterior/lateral halves symmetrically (out of 120 bisections tested). PSMA PET uptake was significantly correlated with CT GLRLML (p < 0.001), and anti-correlated with CT GLRLMS (p < 0.001). CONCLUSION Uptake of PSMA PET is heterogeneous within parotid glands, with uptake biased towards lateral/posterior regions. Uptake within parotid glands was strongly correlated with CT texture feature maps.
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Affiliation(s)
- Caleb M Sample
- Department of Physics and Astronomy, Faculty of Science, University of British Columbia, Vancouver, BC, Canada; Department of Medical Physics, BC Cancer, Surrey, BC, Canada.
| | - Carlos Uribe
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC , Canada; Department of Functional Imaging, BC Cancer, Vancouver, BC, Canada; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, CA, Canada
| | - Arman Rahmim
- Department of Physics and Astronomy, Faculty of Science, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC , Canada; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, CA, Canada
| | - François Bénard
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC , Canada; Department of Functional Imaging, BC Cancer, Vancouver, BC, Canada; Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada
| | - Jonn Wu
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Haley Clark
- Department of Physics and Astronomy, Faculty of Science, University of British Columbia, Vancouver, BC, Canada; Department of Medical Physics, BC Cancer, Surrey, BC, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Sample C, Rahmim A, Benard F, Wu J, Clark H. PSMA PET/CT as a predictive tool for subregional importance estimates in the parotid gland. Biomed Phys Eng Express 2024; 10:025020. [PMID: 38271732 DOI: 10.1088/2057-1976/ad229c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/25/2024] [Indexed: 01/27/2024]
Abstract
Objective. Xerostomia and radiation-induced salivary gland dysfunction remain a common side effect for head-and-neck radiotherapy patients, and attempts have been made to quantify the heterogeneity of the dose response within parotid glands. Prostate Specific Membrane Antigen (PSMA) ligands have demonstrated high uptake in salivary glands, which has been shown to correlate with gland functionality. Here we compare several models of parotid gland subregional relative importance with PSMA positron emission tomography (PET) uptake. We then develop a predictive model for Clarket al's relative importance estimates using PSMA PET and CT radiomic features, and demonstrate a methodology for predicting patient-specific importance deviations from the population.Approach. Intra-parotid gland uptake was compared with four regional importance models using 30 [18F]DCFPyL PSMA PET images. The correlation of uptake and importance was ascertained when numerous non-overlapping subregions were defined, while a paired t-test was used to compare binary region pairs. A radiomics-based predictive model of population importance was developed using a double cross-validation methodology. A model was then devised for supplementing population-level subregional importance estimates for each patient using patient-specific radiomic features.Main Results. Anticorrelative relationships were found to exist between PSMA PET uptake and four independent models of subregional parotid gland importance from the literature. Kernel Ridge Regression with principal component analysis feature selection performed best over test sets (Mean Absolute Error = 0.08), with gray level co-occurrence matrix (GLCM) features being particularly important. Deblurring PSMA PET images with neural blind deconvolution strengthened correlations and improved model performance.Significance. This study suggests that regions of relatively low PSMA PET uptake in parotid glands may exhibit relatively high dose-sensitivity. We've demonstrated the utility of PSMA PET radiomic features for predicting relative importance within subregions of parotid glands. PSMA PET appears to be a promising quantitative imaging modality for analyzing salivary gland functionality.
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Affiliation(s)
- Caleb Sample
- Department of Physics and Astronomy, Faculty of Science, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Physics, BC Cancer, Surrey, BC, Canada
| | - Arman Rahmim
- Department of Physics and Astronomy, Faculty of Science, University of British Columbia, Vancouver, BC, Canada
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, Canada
| | - François Benard
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, Canada
- Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada
| | - Jonn Wu
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, Canada
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Haley Clark
- Department of Physics and Astronomy, Faculty of Science, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Physics, BC Cancer, Surrey, BC, Canada
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Nam K, Dos Santos HT, Maslow FM, Small T, Shanbhag V, Petris MJ, Baker OJ. Copper chelation reduces early collagen deposition and preserves saliva secretion in irradiated salivary glands. Heliyon 2024; 10:e24368. [PMID: 38298614 PMCID: PMC10828693 DOI: 10.1016/j.heliyon.2024.e24368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
Radiation therapy is a first-line treatment for head and neck cancer; however, it typically leads to hyposalivation stemming from fibrosis of the salivary gland. Current strategies to restore glandular function are dependent on the presence of residual functional salivary gland tissue, a condition commonly not met in patients with extensive fibrotic coverage of the salivary gland resulting from radiation therapy. Fibrosis is defined by the pathological accumulation of connective tissue (i.e., extracellular matrix) and excessive deposition of crosslinked (fibrillar) collagen that can impact a range of tissues and given that collagen crosslinking is necessary for fibrosis formation, inhibiting this process is a reasonable focus for developing anti-fibrotic therapies. Collagen crosslinking is catalyzed by the lysyl oxidase family of secreted copper-dependent metalloenzymes, and since that copper is an essential cofactor in all lysyl oxidase family members, we tested whether localized delivery of a copper chelator into the submandibular gland of irradiated mice could suppress collagen deposition and preserve the structure and function of this organ. Our results demonstrate that transdermal injection of tetrathiomolybdate into salivary glands significantly reduced the early deposition of fibrillar collagen in irradiated mice and preserved the integrity and function of submandibular gland epithelial tissue. Together, these studies identify copper metabolism as a novel therapeutic target to control radiation induced damage to the salivary gland and the current findings further indicate the therapeutic potential of repurposing clinically approved copper chelators as neoadjuvant treatments for radiation therapy.
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Affiliation(s)
- Kihoon Nam
- Christopher S. Bond Life Sciences Center, United States
- School of Medicine Department of Otolaryngology-Head and Neck Surgery, United States
| | - Harim Tavares Dos Santos
- Christopher S. Bond Life Sciences Center, United States
- School of Medicine Department of Otolaryngology-Head and Neck Surgery, United States
| | - Frank M. Maslow
- Christopher S. Bond Life Sciences Center, United States
- School of Medicine Department of Otolaryngology-Head and Neck Surgery, United States
| | - Travis Small
- Christopher S. Bond Life Sciences Center, United States
- School of Medicine Department of Otolaryngology-Head and Neck Surgery, United States
| | - Vinit Shanbhag
- Christopher S. Bond Life Sciences Center, United States
- Department of Biochemistry, United States
| | - Michael J. Petris
- Christopher S. Bond Life Sciences Center, United States
- Department of Biochemistry, United States
- Department of Ophthalmology, University of Missouri, Columbia, MO, 65211, United States
| | - Olga J. Baker
- Christopher S. Bond Life Sciences Center, United States
- School of Medicine Department of Otolaryngology-Head and Neck Surgery, United States
- Department of Biochemistry, United States
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Fowler EW, Witt RL, Jia X. Basement Membrane Mimetic Hydrogel Cooperates with Rho-Associated Protein Kinase Inhibitor to Promote the Development of Acini-Like Salivary Gland Spheroids. ADVANCED NANOBIOMED RESEARCH 2023; 3:2300088. [PMID: 38645834 PMCID: PMC11031203 DOI: 10.1002/anbr.202300088] [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] [Indexed: 04/23/2024] Open
Abstract
Successful engineering of functional salivary glands necessitates the creation of cell-instructive environments for ex vivo expansion and lineage specification of primary human salivary gland stem cells (hS/PCs). Herein, basement membrane mimetic hydrogels were prepared using hyaluronic acid, cell adhesive peptides, and hyperbranched polyglycerol (HPG), with or without sulfate groups, to produce "hyperGel+" or "hyperGel", respectively. Differential scanning fluorescence experiments confirmed the ability of the sulphated HPG precursor to stabilize fibroblast growth factor 10. The hydrogels were nanoporous, cytocompatibile and cell-permissive, enabling the development of multicellular hS/PC spheroids in 14 days. Incorporation of sulfated HPG species in the hydrogel enhanced cell proliferation. Culture of hS/PCs in hyperGel+ in the presence of a Rho kinase inhibitor, Y-27632 (Y-27), led to the development of spheroids with a central lumen, increased the expression of acinar marker aquaporin-3 at the transcript level (AQP3), and decreased the expression of ductal marker keratin 7 at both the transcript (KRT7) and the protein levels (K7). Reduced expression of transforming growth factor beta (TGF-β) targets SMAD2/3 was also observed in Y27-treated cultures, suggesting attenuation of TGF-β signaling. Thus, hyperGel+ cooperates with the ROCK inhibitor to promote the development of lumened spheroids with enhanced expression of acinar markers.
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Affiliation(s)
- Eric W. Fowler
- Department of Materials Science and Engineering, University of Delaware, Newark, Delaware, 19716, USA
| | - Robert L. Witt
- Helen F. Graham Cancer Center and Research Institute, Christiana Care, Newark, Delaware, 19713, USA
| | - Xinqiao Jia
- Department of Materials Science and Engineering, University of Delaware, Newark, Delaware, 19716, USA
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware, 19716, USA
- Delaware Biotechnology Institute, 590 Avenue 1743, Newark, DE 19713, USA
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Moral Nakamura D, da Graça Pinto H, Baena Elchin C, Thomazotti Berard L, Abreu Alves F, Azeredo Alves Antunes L, Pena Coto N. Efficacy of bethanechol chloride in the treatment of radiation-induced xerostomia in patients with head and neck cancer: A systematic review and meta-analysis. Radiother Oncol 2023; 186:109715. [PMID: 37207874 DOI: 10.1016/j.radonc.2023.109715] [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: 10/03/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND PORPUSE Salivary glands sustain collateral damage following radiotherapy (RT) to treat cancers of the head and neck, leading to complications, including xerostomia and hyposalivation. This systematic review (SR) with meta-analysis was performed to determine the effectiveness of bethanechol chloride in preventing salivary gland dysfunction in this context. MATERIALS AND METHODS Medline/Pubmed, Embase, Scopus, LILACS via Portal Regional BVS and Web of Science were searched electronically in accordance with the Cochrane manual and reported PRISMA guidelines. RESULTS 170 patients from three studies were included. Results from the meta-analysis suggest that bethanechol chloride is associated with increases in: whole stimulating saliva (WSS) after RT (Std. MD 0.66, 95% CI 0.28 to 1.03, P < 0.001); whole resting saliva (WRS) during RT (Std. MD 0.4, 95% CI 0.04 to 0.76, P = 0.03); and WRS after RT (Std. MD 0.45, 95% CI 0.04 to 0.86, P = 0.03). CONCLUSION The present study suggests that bethanechol chloride therapy may be effective in patients with xerostomia and hyposalivation.
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Affiliation(s)
- Denise Moral Nakamura
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
| | - Henrique da Graça Pinto
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
| | - Cintia Baena Elchin
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
| | - Lucas Thomazotti Berard
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
| | - Fabio Abreu Alves
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
| | - Lívia Azeredo Alves Antunes
- School of Dentistry, Fluminense Federal University, R. Dr. Silvio Henrique Braune, 22, 28625-650 Nova Friburgo, RJ, Brazil.
| | - Neide Pena Coto
- School of Dentistry, University of Sao Paulo, Av. Prof. Lineu Prestes, 2227, 05508-900 São Paulo, SP, Brazil.
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Nathan CAO, Asarkar AA, Entezami P, Corry J, Strojan P, Poorten VV, Makitie A, Eisbruch A, Robbins KT, Smee R, St John M, Chiesa-Estomba C, Winter SC, Beitler JJ, Ferlito A. Current management of xerostomia in head and neck cancer patients. Am J Otolaryngol 2023; 44:103867. [PMID: 36996514 DOI: 10.1016/j.amjoto.2023.103867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Radiotherapy (RT) continues to play a key role in the management of head and neck cancer (HNC). Xerostomia remains a principal detriment to the quality of life (QoL) for 80 % of surviving patients receiving head and neck radiation. Radiation-induced injury to the salivary glands is dose-dependent, and thus efforts have been focused on decreasing radiation to the salivary glands. Decreased saliva production reduces both short-term and long-term quality of life in head and neck survivors by impacting on taste and contributing to dysphagia. Several radioprotective agents to the salivary gland have been investigated. Although not widely practiced, surgical transfer of the submandibular gland prior to RT is the mainstay of surgical options in preventing xerostomia. This review focuses on the strategies to improve xerostomia following radiation therapy in head and neck cancers.
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Affiliation(s)
- Cherie-Ann O Nathan
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, LA, USA; Otolaryngology Section, Surgical Service, Overton Brooks VA Medical Center, Shreveport, LA, USA.
| | - Ameya A Asarkar
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, LA, USA
| | - Payam Entezami
- Department of Otolaryngology/Head and Neck Surgery, LSU Health Sciences Center, Shreveport, LA, USA; Otolaryngology Section, Surgical Service, Overton Brooks VA Medical Center, Shreveport, LA, USA
| | - June Corry
- Department of Radiation Oncology, Genesiscare St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Antti Makitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - K T Robbins
- Department of Otolaryngology/Head and Neck Surgery, Southern Illinois University, School of Medicine, Springfield, IL, USA
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | - Maie St John
- Department of Otolaryngology/Head and Neck Surgery, UCLA, CA, USA
| | - Carlos Chiesa-Estomba
- Otorhinolaryngology - Head & Neck Department - Donostia University Hospital, Biodonostia Research Institute, Deusto University, Spain
| | - Stuart C Winter
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Dörfler J, Freuding M, Zaiser C, Büntzel J, Keinki C, Käsmann L, Hübner J. Umbrella review: Summary of findings for acupuncture as treatment for radiation-induced xerostomia. Head Neck 2023; 45:1026-1044. [PMID: 36779370 DOI: 10.1002/hed.27297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/16/2022] [Accepted: 01/23/2023] [Indexed: 02/14/2023] Open
Abstract
Acupuncture is a common part of complementary medicine. However, traditional Chinese acupuncture has been built on concepts which are not in accordance with science-based medicine. Our aim was to critically assess the evidence presented in systematic reviews (SRs) and meta-analyses (MAs) about the effectiveness of acupuncture on radiotherapy induced xerostomia. A systematic search was conducted in February 2022. We evaluated all SRs/MAs using the AMSTAR-2 instrument. Eight SRs, with 12 controlled studies were included. All SRs summarize that the methodological drawbacks do not allow to give a clear statement about the effectiveness of acupuncture. While objective assessments in most SRs/MAs reported no difference between real and sham acupuncture, some favorable effects on subjective xerostomia symptoms are found. No clinical meaningful effectiveness of acupuncture on xerostomia has been proven so far, but positive subjective findings need to be explored more. While most SRs recommend further studies, studies involving patients with a serious cancer diagnosis are ethically questionable.
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Affiliation(s)
- Jennifer Dörfler
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Maren Freuding
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Christopher Zaiser
- Abteilung für Medizinische Statistik, Universitätsklinikum Jena, Jena, Germany
| | - Jens Büntzel
- Klinik für HNO-Erkrankungen, Kopf-Hals-Chirurgie, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - Christian Keinki
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Lukas Käsmann
- Abteilung für Radioonkologie, Universitätsklinikum, LMU München, Munich, Germany
| | - Jutta Hübner
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
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Liu L, Liang Z, Ma S, Li L, Liu X. Radioprotective countermeasures for radiation injury (Review). Mol Med Rep 2023; 27:66. [PMID: 36799170 PMCID: PMC9926870 DOI: 10.3892/mmr.2023.12953] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023] Open
Abstract
A series of physiological and pathological changes occur after radiotherapy and accidental exposure to ionizing radiation (IR). These changes cause serious damage to human tissues and can lead to death. Radioprotective countermeasures are radioprotective agents that prevent and reduce IR injury or have therapeutic effects. Based on a good understanding of radiobiology, a number of protective agents have achieved positive results in early clinical trials. The present review grouped known radioprotective agents according to biochemical categories and potential clinical use, and reviewed radiation countermeasures, i.e., radioprotectors, radiation mitigators and radiotherapeutic agents, with an emphasis on their current status and research progress. The aim of the present review is to facilitate the selection and application of suitable radioprotectors for clinicians and researchers, to prevent or reduce IR injury.
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Affiliation(s)
- Lianchang Liu
- National Health Commission Key Laboratory of Radiobiology, School of Public Health of Jilin University, Jilin, Changchun 130021, P.R. China,School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China,Department of Intervention, The Second Affiliated Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Zhenzhen Liang
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, P.R. China
| | - Shumei Ma
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China,Key Laboratory of Watershed Science and Health of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China,South Zhejiang Institute of Radiation Medicine and Nuclear Technology, Wenzhou, Zhejiang 325035, P.R. China
| | - Lan Li
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China,Key Laboratory of Watershed Science and Health of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China,South Zhejiang Institute of Radiation Medicine and Nuclear Technology, Wenzhou, Zhejiang 325035, P.R. China,Correspondence to: Professor Lan Li, School of Public Health and Management, Wenzhou Medical University, 1 North Zhongxin Road, Chashan, Wenzhou, Zhejiang 325035, P.R. China, E-mail:
| | - Xiaodong Liu
- National Health Commission Key Laboratory of Radiobiology, School of Public Health of Jilin University, Jilin, Changchun 130021, P.R. China,School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China,Key Laboratory of Watershed Science and Health of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China,South Zhejiang Institute of Radiation Medicine and Nuclear Technology, Wenzhou, Zhejiang 325035, P.R. China,Professor Xiaodong Liu, National Health Commission Key Laboratory of Radiobiology, School of Public Health of Jilin University, 1163 Xinmin Road, Changchun, Jilin 130021, P.R. China, E-mail:
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12
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Sample C, Jung N, Rahmim A, Uribe C, Clark H. Development of a CT-Based Auto-Segmentation Model for Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography-Delineated Tubarial Glands. Cureus 2022; 14:e31060. [DOI: 10.7759/cureus.31060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
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13
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Fried DV, Zhu T, Das SK, Shen C, Marks LB, Tan X, Chera BS. Prospective assessment of sparing the parotid ducts via MRI sialography for reducing patient reported xerostomia. Radiother Oncol 2022; 172:42-49. [DOI: 10.1016/j.radonc.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
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14
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Parke SC, Langelier DM, Cheng JT, Kline-Quiroz C, Stubblefield MD. State of Rehabilitation Research in the Head and Neck Cancer Population: Functional Impact vs. Impairment-Focused Outcomes. Curr Oncol Rep 2022; 24:517-532. [PMID: 35182293 DOI: 10.1007/s11912-022-01227-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Management of head and neck cancer (HNC) typically involves a morbid combination of surgery, radiation, and systemic therapy. As the number of HNC survivors grows, there is growing interest in rehabilitation strategies to manage HNC-related comorbidity. In this review, we summarize the current state of HNC rehabilitation research. RECENT FINDINGS We have organized our review using the World Health Organization's International Classification of Function (ICF) model of impairment, activity, and participation. Specifically, we describe the current research on rehabilitation strategies to prevent and treat impairments including dysphagia, xerostomia, dysgeusia, dysosmia, odynophagia, trismus, first bite syndrome, dysarthria, dysphonia, lymphedema, shoulder syndrome, cervicalgia, cervical dystonia and dropped head syndrome, deconditioning, and fatigue. We also discuss the broader impact of HNC-related impairment by exploring the state of rehabilitation literature on activity, participation, psychosocial distress, and suicidality in HNC survivors. We demonstrate that research in HNC rehabilitation continues to focus primarily on impairment-driven interventions. There remains a dearth of HNC rehabilitation studies directly examining the impact of rehabilitation interventions on outcomes related to activity and participation. More high-quality interventional studies and reviews are needed to guide prevention and treatment of functional loss in HNC survivors.
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Affiliation(s)
- Sara C Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Arizona, Phoenix, USA.
| | - David Michael Langelier
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre Toronto, Ontario, Canada
| | - Jessica Tse Cheng
- Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, TX, Houston, USA
| | - Cristina Kline-Quiroz
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, TN, Nashville, USA
| | - Michael Dean Stubblefield
- Department of Physical Medicine and Rehabilitation - Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, NJ, 07052, West Orange, USA
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15
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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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16
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Effect of Physical Therapy Modalities on Quality of Life of Head and Neck Cancer Survivors: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:jcm10204696. [PMID: 34682818 PMCID: PMC8539984 DOI: 10.3390/jcm10204696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022] Open
Abstract
The objective was to describe the effectiveness of different physical therapy modalities to improve Quality of Life (QoL) in Head and Neck Cancer (HNC) survivors. PubMed, Scopus, Web of Science, CINAHL and Cochrane Library were searched for randomized clinical controlled trials published until 30 April 2020. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. A total of 251 records were retrieved, and 10 met the inclusion criteria. Interventions whose parameters focus on a 12-week exercise programs of aerobic activity (walking) or Progressive Resistance Training (PRT) for the whole body are effective and safe modalities improving QoL in HNC survivors. Electrophysical agents did not show significant results between groups. As for the assessment of methodological quality, 4 of the 10 articles included had a high risk of overall bias. Only five articles provided sufficient information to conduct a meta-analysis for exercise program intervention on QoL, showing a tendency in favor of intervention group, even when the global results did not show statistically significant improvements (pooled Cohen's d 0.15; 95% CI: -0.25 to 0.54; I2 45.87%; p heterogeneity = 0.10). The present review and meta-analysis identified meaningful benefits of exercise on QoL of HNC survivors; this has been confirmed in a meta-analysis. This review adds evidence supporting exercise interventions on Head and Neck Cancer population whose opportunities for successful recovery after medical treatment are more limited.
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Iacovelli NA, Ingargiola R, Facchinetti N, Franceschini M, Romanello DA, Bossi P, Bergamini C, Alfieri S, Cavalieri S, Baron G, Aldini G, Locati L, Orlandi E. A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Study to Evaluate the Efficacy of Aqualief TM Mucoadhesive Tablets in Head and Neck Cancer Patients Who Developed Radiation-Induced Xerostomia. Cancers (Basel) 2021; 13:cancers13143456. [PMID: 34298670 PMCID: PMC8303446 DOI: 10.3390/cancers13143456] [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: 05/24/2021] [Revised: 07/03/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Xerostomia, the subjective complaint of dry mouth, is caused by therapeutic interventions or diseases. Nowadays, radiotherapy (RT) in patients with head and neck cancer (HNC) stands out as one of the most important causes of xerostomia. Currently available therapies for the treatment of xerostomia are still less than optimal and xerostomia still represents an unmet clinical need. In this article, we present the results of a prospective clinical study with a new product, AqualiefTM, in patients treated with curative RT with or without chemotherapy for HNC. AqualiefTM is based on two main ingredients, carnosine and karkadé, which have acid buffering and antioxidant properties. The study was performed on 30 patients, with 4 of the patients being lost during the study period. Each patient received randomly one of the two treatments, AqualiefTM or placebo, for 8 days. After a 10-day wash-out period, each patient received the other treatment for a further 8 days. The results show that AqualiefTM stimulated salivation in these patients and reduced the pH drop that was observed in an equivalent placebo-treated population of patients. Moreover, no serious, treatment-related adverse events were observed. AqualiefTM has shown positive results, although with limitations due to unsuccessful trial accrual. Therefore, it may be further investigated as a tool for the treatment of RT-related xerostomia.
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Affiliation(s)
- Nicola Alessandro Iacovelli
- Radiation Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (R.I.); (N.F.); (M.F.); (D.A.R.); (E.O.)
- Correspondence:
| | - Rossana Ingargiola
- Radiation Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (R.I.); (N.F.); (M.F.); (D.A.R.); (E.O.)
| | - Nadia Facchinetti
- Radiation Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (R.I.); (N.F.); (M.F.); (D.A.R.); (E.O.)
| | - Marzia Franceschini
- Radiation Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (R.I.); (N.F.); (M.F.); (D.A.R.); (E.O.)
| | - Domenico Attilio Romanello
- Radiation Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (R.I.); (N.F.); (M.F.); (D.A.R.); (E.O.)
| | - Paolo Bossi
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (P.B.); (C.B.); (S.A.); (S.C.); (L.L.)
| | - Cristiana Bergamini
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (P.B.); (C.B.); (S.A.); (S.C.); (L.L.)
| | - Salvatore Alfieri
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (P.B.); (C.B.); (S.A.); (S.C.); (L.L.)
| | - Stefano Cavalieri
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (P.B.); (C.B.); (S.A.); (S.C.); (L.L.)
| | - Giovanna Baron
- Department of Pharmaceutical Sciences (DISFARM), Università degli Studi di Milano, Via Mangiagalli 25, 20133 Milan, Italy; (G.B.); (G.A.)
| | - Giancarlo Aldini
- Department of Pharmaceutical Sciences (DISFARM), Università degli Studi di Milano, Via Mangiagalli 25, 20133 Milan, Italy; (G.B.); (G.A.)
| | - Laura Locati
- Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (P.B.); (C.B.); (S.A.); (S.C.); (L.L.)
| | - Ester Orlandi
- Radiation Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy; (R.I.); (N.F.); (M.F.); (D.A.R.); (E.O.)
- Radiation Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy
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Zhang YZ, Ge SJ, Leng QZ, Ma JJ, Liu HC. Preliminary study of the toxicity and radioprotective effects of zymosan in vitro and in vivo. BMC Pharmacol Toxicol 2021; 22:16. [PMID: 33731220 PMCID: PMC7968253 DOI: 10.1186/s40360-021-00482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to confirm the cytotoxicity of zymosan in vitro and in vivo and determine the appropriate treatment time and the dose of zymosan. METHODS AHH-1 cells and HIECs were administered by 0, 20, 40, 80 or 160 μg/mL zymosan. The CCK-8 assay and flow cytometry were used to evaluate the cell viability and apoptosis 24 h, 48 h, and 72 h after administration. Furthermore, 12 h before irradiation, the cells were treated with 0, 5, 10, or 20 μg/mL zymosan and then irradiated with 4 Gy X-rays. Cell viability and apoptosis were measured by the CCK-8 assay and flow cytometry at 24 h. In addition, the protective effect of zymosan against radiation in vitro was compared to that of 20 μg/mL LPS. In vivo, weight, the spleen index, and the thymus index were measured to evaluate the toxicity of 0, 5, 10, 20, and 10 mg/kg zymosan. In addition, rats were treated with 0, 2, 4, 8, or 10 mg/kg zymosan and then irradiated with 7 Gy X-rays. The survival rate, organ index were evaluated. The protective effect of zymosan against radiation in vivo was compared to that of 10 mg/kg LPS a positive control. RESULTS The viability and apoptosis of cells treated with different doses and treatment times of zymosan were not different from those of control cells (p < 0.05). Furthermore, cell viability and apoptosis were clearly improved after zymosan preadministration (p < 0.05). The radioprotective effect of zymosan was dose-dependent. In addition, the viability of cells pretreated with zymosan was higher than that of cells pretreated with LPS, and the apoptosis rate of zymosan-treated cells was lower than that of cells pretreated with LPS (p < 0.05). In vivo, weight, the spleen index and the thymus index were significantly decreased by zymosan at a concentration of 20 mg/kg (p < 0.05). Further experiments showed that the concentration at which zymosan exerted radioprotective effects was 10 mg/kg. The survival curves in the irradiated rats were barely separated between the LPS treatment and zymosan treatment. CONCLUSION Zymosan administration before radiation exposure significantly increased cell viability and the survival rates of rats.
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Affiliation(s)
- Yue-Zhi Zhang
- Laboratory of Biochemistry and Molecular Biology, Binzhou Medical University, Yantai, 264000, China
| | - Shu-Jing Ge
- Nursing Department, 970 Hospital of Chinese People's Liberation Army, Yantai, 264002, China
| | - Qing-Zhen Leng
- Cancer Non-Invasive Diagnosis and Treatment Center, 970 Hospital of Chinese People's Liberation Army, No. 7, ZhiChu South Road, Yantai, 264002, China
| | - Jian-Jun Ma
- Cancer Non-Invasive Diagnosis and Treatment Center, 970 Hospital of Chinese People's Liberation Army, No. 7, ZhiChu South Road, Yantai, 264002, China
| | - Han-Chen Liu
- Cancer Non-Invasive Diagnosis and Treatment Center, 970 Hospital of Chinese People's Liberation Army, No. 7, ZhiChu South Road, Yantai, 264002, China.
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19
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Sample CM, Wu J, Thomas S, Clark H. Incorporating parotid gland inhomogeneity into head-and-neck treatment optimization through the use of artificial base plans. J Appl Clin Med Phys 2021; 22:141-149. [PMID: 33565210 PMCID: PMC7984464 DOI: 10.1002/acm2.13192] [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: 10/16/2020] [Revised: 11/30/2020] [Accepted: 01/17/2021] [Indexed: 11/06/2022] Open
Abstract
Despite a great improvement in target volume dose conformality made possible in recent years by modulated therapies, xerostomia remains a common and severe side effect for head-and-neck radiotherapy patients. It is known that parotid glands exhibit a spatially varying dose response; however, the relative importance of subregions throughout the entire gland has yet to be incorporated into treatment plan optimization, with the current standard being to minimize the mean dose to whole parotid glands. The relative importance of regions within contralateral parotid glands has been recently quantified, creating an opportunity for the development of a method for including this data in plan optimization. We present a universal and straightforward approach for imposing varying sub-parotid gland dose constraints during inverse treatment planning by using patient-specific artificial base plans to penalize dose deposited in sensitive regions. In this work, the proposed method of optimization is demonstrated to reduce dose to regions of high relative importance throughout contralateral parotids and improve predictions for stimulated saliva output at 1-year post-radiotherapy. This method may also be applied to impose varying dose constraints to other organs-at-risk for which regional importance data exists.
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Affiliation(s)
- Caleb M Sample
- Department of Medical Physics, BC Cancer Agency, Vancouver, BC, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Jonn Wu
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Steven Thomas
- Department of Medical Physics, BC Cancer Agency, Vancouver, BC, Canada
| | - Haley Clark
- Department of Medical Physics, BC Cancer Agency, Surrey, BC, Canada
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20
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Baliga MS, Rao S, Hegde SK, Rao P, Simon P, George T, Venkatesh P, Baliga-Rao MP, Thilakchand KR. Usefulness of Honey as an Adjunct in the Radiation Treatment for Head and Neck Cancer: Emphasis on Pharmacological and Mechanism/s of Actions. Anticancer Agents Med Chem 2021; 22:20-29. [PMID: 33573581 DOI: 10.2174/1871520621666210126094509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the treatment of head and neck cancer (HNC), ionizing radiation is an important modality in achieving curative objectives. However, the effective use of radiation is compromised by the side effects resulting from the damage to the adjacent normal tissue. Preclinical studies carried out in the recent past have shown that the age old dietary agent honey, which also possess myriad medicinal use is beneficial in mitigating diverse radiation-induced side effects like mucositis, xerostomia, fatigue, weight loss and to promote healing of refractory wounds. OBJECTIVE The objective of this memoir is to review the beneficial effects of honey in mitigating radiation-induced side effects in HNC and to emphasize on the underlying mechanism of action for the beneficial effects Methods: Two authors searched Google Scholar, PubMed, Embase, and the Cochrane Library for publications up to December 2019 to assess the ability of honey in reducing the severity of radiation-induced ill effects in the treatment of HNC. Subsequently, the adjunct pharmacological effects and mechanism/s responsible were also searched for and appropriately used to substantiate the underlying mechanism/s of action for the beneficial effects. RESULTS The existing data is suggestive that honey is beneficial in mitigating the radiation-induced mucositis, xerostomia, healing of recalcitrant wounds in radiation exposed regions and multiple pathways mediate the beneficial effects especially, free radical scavenging, antioxidant, wound healing, anticancer, analgesic, anti-inflammatory, anabolic, anti-fatigue and anti-anaemic effects that add additional value to the use of honey as an adjunct in cancer therapy. CONCLUSION For the first time this review addresses the underlying pharmacological effects related to the beneficial effects of honey in radiation-induced damage, and attempts at emphasizes the lacunae that need further studies for optimizing the use of honey as an adjunct in radiotherapy of HNC. The authors suggest that future studies should be directed at understanding the detail molecular mechanisms responsible for the beneficial effects using validated cell culture and animal models of study. Large multi centric clinical trials with standardised honey is also needed to understand the clinical use of honey.
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Affiliation(s)
- Manjeshwar S Baliga
- Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka. India
| | - Suresh Rao
- Radiation Oncology, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka. India
| | - Sanath K Hegde
- Radiation Oncology, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka. India
| | - Pratima Rao
- Department of Orodental Pathology, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka. India
| | - Paul Simon
- Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka. India
| | - Thomas George
- Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka. India
| | - Ponemone Venkatesh
- Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka. India
| | | | - Karadka R Thilakchand
- Department of Anesthesiology, Karnataka Institute of Medical Sciences, Hubballi 580022. India
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Wu VWC, Ying MT, Kwong DL, Khong PL, Wong GK, Tam SY. A longitudinal study on parotid and submandibular gland changes assessed by magnetic resonance imaging and ultrasonography in post-radiotherapy nasopharyngeal cancer patients. BJR Open 2020; 2:20200003. [PMID: 33178971 PMCID: PMC7583169 DOI: 10.1259/bjro.20200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives With regard to the intensity modulated radiotherapy (IMRT) of nasopharyngeal carcinoma (NPC) patients, this longitudinal study evaluated the radiation-induced changes in the parotid and submandibular glands in terms of gland size, echogenicity and haemodynamic parameters. Methods 21 NPC patients treated by IMRT underwent MRI and ultrasound scans before radiotherapy, and at 6, 12, 18 and 24 months after treatment. Parotid and submandibular gland volumes were measured from the MRI images, whereas the parotid echogenicity and haemodynamic parameters including the resistive index, pulsatility index, peak systolic velocity and end diastolic velocity were evaluated by ultrasonography. Trend lines were plotted to show the pattern of changes. The correlations of gland doses and the post-RT changes were also studied. Results The volume of the parotid and submandibular glands demonstrated a significant drop from pre-RT to 6 months post-RT. The parotid gland changed from hyperechoic before RT to either isoechoic or hypoechoic after treatment. The resistive index and pulsatility index decreased from pre-RT to 6 month post-RT, then started to increase at 12 month time interval. Both peak systolic velocity and end diastolic velocity increased after 6 months post-RT then followed a decreasing trend up to 24 months post-RT. There was mild correlation between post-RT gland dose and gland volume, but not with haemodynamic changes. Conclusions Radiation from IMRT caused shrinkage of parotid and submandibular glands in NPC patients. It also changed the echogenicity and vascular condition of the parotid gland. The most significant changes were observed at 6 months after radiotherapy. Advances in knowledge It is the first paper that reports on the longitudinal changes of salivary gland volume, echogenicity and haemodynamic parameters altogether in NPC patients after radiotherapy. The results are useful for the prediction of glandular changes that is associated with xerostomia, which help to provide timely management of the complication when the patients attend follow-up visits.
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Affiliation(s)
- Vincent W C Wu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Michael Tc Ying
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Dora Lw Kwong
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Pek-Lan Khong
- Department of Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Gary Kw Wong
- Department of Clinical Oncology, Queen Mary Hospital, Sha Tin, Hong Kong
| | - Shing-Yau Tam
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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22
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Pereira RMDS, Bastos MDR, Ferreira MP, de Freitas O, de Macedo LD, de Oliveira HF, Ricz HMA, Motta ACF, Macedo AP, Tirapelli C, Pedrazzi V. Topical pilocarpine for xerostomia in patients with head and neck cancer treated with radiotherapy. Oral Dis 2020; 26:1209-1218. [PMID: 32248594 DOI: 10.1111/odi.13343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate a pilocarpine spray as a treatment for xerostomia in patients treated with radiotherapy (RT) for head and neck cancer (HNC). METHODS This was a placebo-controlled, double-blind, crossover clinical trial of patients complaining of dry mouth after RT for HNC. Forty patients were randomly assigned to either placebo or pilocarpine (1.54%) spray and instructed to use three times a day for 3 months. After 1-month washout period, patients were crossed over to receive placebo or pilocarpine. The assessments were salivary flow (Stimulated Whole Saliva Flow - SWSF), xerostomia (Xerostomia Inventory - XI), and quality of life (QoL/Oral Health Impact Profile - OHIP-14), assessed at baseline, 1 hr (only SWSF), and at 1, 2, and 3 months of treatment. RESULTS Posttreatment SWFS was not statistically different between pilocarpine and placebo regardless of the treatment sequence (paired T test; p > .05), except for the SWFS rates at 2 months after therapy. When comparing pilocarpine with placebo in the time points, there was no significant difference (p > .05) for QoL or XI. Significant differences in improvement in QoL and xerostomia experience appeared along time for pilocarpine group. CONCLUSION The topical application of pilocarpine spray tested was similar to placebo on SWSF assessments in patients treated with RT for HNC.
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Affiliation(s)
- Raony Môlim de Sousa Pereira
- Departament of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Mônica Danielle Ribeiro Bastos
- Departament of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Maíra Peres Ferreira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Osvaldo de Freitas
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Leandro Dorigan de Macedo
- Dentistry and Stomatology Division, Ribeirão Preto Clinical Hospital, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Hilton Marcos Alvez Ricz
- Ophthalmology, Otolaryngology and Head and Neck Surgery Department, Otolaryngology and Head and Neck Surgery Department, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Carolina Fragoso Motta
- Department of Stomatology, Public Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Paula Macedo
- Departament of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Camila Tirapelli
- Departament of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Vinicius Pedrazzi
- Departament of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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23
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Brook I. Late side effects of radiation treatment for head and neck cancer. Radiat Oncol J 2020; 38:84-92. [PMID: 33012151 PMCID: PMC7533405 DOI: 10.3857/roj.2020.00213] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022] Open
Abstract
Patients undergoing radiation therapy for head and neck cancer (HNC) experience significant early and long-term side effects. The likelihood and severity of complications depends on a number of factors, including the total dose of radiation delivered, over what time it was delivered and what parts of the head and neck received radiation. Late side effects include: permanent loss of saliva; osteoradionecrosis; radiation recall myositis, pharyngoesophageal stenosis; dental caries; oral cavity necrosis; fibrosis; impaired wound healing; skin changes and skin cancer; lymphedema; hypothyroidism, hyperparathyroidism, lightheadedness, dizziness and headaches; secondary cancer; and eye, ear, neurological and neck structures damage. Patients who undergo radiotherapy for nasopharyngeal carcinoma tend to suffer from chronic sinusitis. These side effects present difficult challenges to the patients and their caregivers and require life-long strategies to alleviate their deleterious effect on basic life functions and on the quality of life. This review presents these side effects and their management.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA
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Diffusion-weighted imaging as a follow-up modality for evaluation of major salivary gland function in nasopharyngeal carcinoma patients: a preliminary study. Strahlenther Onkol 2020; 196:530-541. [PMID: 32025803 PMCID: PMC7248033 DOI: 10.1007/s00066-020-01580-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/07/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the value of diffusion-weighted imaging (DWI) in assessing dynamic changes of major salivary gland function during follow-up post radiotherapy (RT) in nasopharyngeal carcinoma (NPC) patients. MATERIALS AND METHODS 31 consecutive patients with pathologically confirmed NPC scheduled for RT underwent six routine follow-up MRI examinations including DWI sequence prior to (pre-RT) and 1, 3, 6, 9, and 12 months post RT. Mean apparent diffusion coefficient (ADC) values of bilateral parotid glands (PGs) and submandibular glands (SMGs) were measured. Objective measurement of salivary flow rate (SFR) under unstimulated (uSFR) and stimulated conditions (sSFR) as well as subjective xerostomia assessment according to a patient-rated questionnaire were conducted before each MRI. Variance analysis was used to evaluate dynamic changes of ADC, SFR and xerostomia questionnaire summary scores (XQ-sum) at different timepoints and the correlation between ADC and XQ-sum. Pearson's correlation test was used to evaluate the correlations between pre- and post-RT changes of ADC (ΔADC) and SFR (ΔSFR) or mean RT dose. RESULTS At each timepoint, ADCs of PGs were significantly lower than of SMGs, uSFR was significantly lower than sSFR. For both PGs and SMGs, ADCpost-RT were all higher than ADCpre-RT, with significant differences. ADC1m-post-RT initially increased and changed little to ADC3m-post-RT, ADC6m-post-RT, ADC9m-post-RT, and ADC12m-post-RT, then gradually declined over time. The dynamic change trends of SFR were negatively paralleled to those of ADC, while that of XQ-sum was similar. Dose-response relationships were detected between salivary gland mean RT dose and ΔADC. In PGs, negative correlations between ΔsSFR9m-post-RT and ΔADC9m-post-RT, and ΔsSFR12m-post-RT and ΔADC12m-post-RT were detected. In SMGs, negative correlations between ΔsSFR12m-post-RT and ΔADC12m-post-RT, and ΔuSFR12m-post-RT and ΔADC12m-post-RT were also detected. The ADCs of patients with severe subjective xerostomia were significantly higher, while patients with moderate subjective xerostomia presented a tendency toward higher ADCs compared to those with mild xerostomia from 6 to 12 months post RT. CONCLUSION As part of routine follow-up MRI in NPC patients, DWI might be a promising modality for follow-up assessing the dynamic changes of major salivary gland function and might be more powerful in the late post-RT period.
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Affiliation(s)
- Matthias Karst
- Department of Anesthesiology, Pain Clinic, Hannover Medical School, Hannover, Germany
| | - Changwei Li
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens
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26
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Khreish F, Ebert N, Ries M, Maus S, Rosar F, Bohnenberger H, Stemler T, Saar M, Bartholomä M, Ezziddin S. 225Ac-PSMA-617/ 177Lu-PSMA-617 tandem therapy of metastatic castration-resistant prostate cancer: pilot experience. Eur J Nucl Med Mol Imaging 2019; 47:721-728. [PMID: 31758224 DOI: 10.1007/s00259-019-04612-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/11/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Up to 30% of patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) never respond or develop resistance to 177Lu-labeled PSMA-targeted radioligand monotherapy. Single-agent PSMA-targeted radioligand therapy (PRLT) with the alpha-emitter 225Ac showed promise against mCRPC but may cause severe and/or persistent xerostomia, which may substantially impair patients' quality-of-life. We hypothesized that when 177Lu-PSMA ligand alone is ineffective, tandem therapy with low-activity 225Ac-PSMA ligand plus full activity of the beta emitter may enhance efficacy while minimizing xerostomia severity. METHODS We retrospectively analyzed pilot experience with 1 course of 225Ac-PSMA-617/177Lu-PSMA-617 tandem therapy in our first 20 patients with mCRPC receiving this intervention after insufficiently responding to 177Lu-PSMA-617 monotherapy. This cohort had late-stage/end-stage disease with high baseline prostate-specific antigen (PSA) concentration (median 215 ng/mL), heavy pre-treatment (abiraterone and/or enzalutamide, and 177Lu-PRLT [median cumulative activity, 26.3 GBq] in 20/20 patients, 100%; docetaxel and/or cabazitaxel in 13/20 patients, 65%), and frequent Eastern Cooperative Oncology Group performance status of 2 (8/20 patients, 40%). RESULTS Median (minimum-maximum) administered activities were 225Ac-PSMA-617, 5.3 (1.5-7.9) MBq, and 177Lu-PSMA-617, 6.9 (5.0-11.6) GBq. Significant responders to tandem therapy received 177Lu-PSMA-617 monotherapy as maintenance (median [minimum-maximum]: 1 [0-5] cycle). After a median (minimum-maximum) 22 (14-63) weeks' follow-up, 13/20 patients (65%) had as best biochemical response a PSA decline > 50%. Median (95% confidence interval) progression-free survival was 19 (12-26) weeks, and overall survival was 48 (4-92) weeks post-tandem therapy administration. Xerostomia was reported as grade 1 (very mild) in 8/20 patients (40%), grade 2 (mild) in 5/20 (25%), and grade 3/4 in 0/20. CONCLUSIONS Our results suggest that a single course of tandem therapy with low-activity 225Ac-PSMA-617/full-activity 177Lu-PSMA-617 may safely enhance response to PRLT in men with late-stage/end-stage mCRPC while minimizing xerostomia severity. Formal study of this combination is warranted.
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Affiliation(s)
- Fadi Khreish
- Department of Nuclear Medicine, Saarland University, 66421, Homburg, Germany
| | - Niklas Ebert
- Department of Nuclear Medicine, Saarland University, 66421, Homburg, Germany
| | - Martin Ries
- Department of Nuclear Medicine, Saarland University, 66421, Homburg, Germany
| | - Stephan Maus
- Department of Nuclear Medicine, Saarland University, 66421, Homburg, Germany
| | - Florian Rosar
- Department of Nuclear Medicine, Saarland University, 66421, Homburg, Germany
| | | | - Tobias Stemler
- Department of Nuclear Medicine, Saarland University, 66421, Homburg, Germany
| | - Matthias Saar
- Department of Urology, Saarland University, 66421, Homburg, Germany
| | - Mark Bartholomä
- Department of Nuclear Medicine, Saarland University, 66421, Homburg, Germany
| | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University, 66421, Homburg, Germany.
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Taniguchi A, Susa T, Kogo H, Iizuka-Kogo A, Yokoo S, Matsuzaki T. Long-term Pilocarpine Treatment Improves Salivary Flow in Irradiated Mice. Acta Histochem Cytochem 2019; 52:45-58. [PMID: 31341340 PMCID: PMC6643095 DOI: 10.1267/ahc.19006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/28/2019] [Indexed: 12/11/2022] Open
Abstract
Radiation therapy for head and neck cancer frequently causes salivary gland dysfunction. Pilocarpine is a clinically approved and effective drug that induces saliva secretion, thereby keeping the oral mucosa moist and reducing discomfort in patients, but the effect is transient. We expected that this drug also has beneficial long-term effects that maintain the integrity of salivary glands by reducing, for instance, apoptosis. Here, we examined the effects of long-term pilocarpine administration in irradiated mice. The results indicated that long-term pilocarpine administration significantly improved salivary flow in irradiated mice, suggesting the potential beneficial effects of long-term administration. To elucidate the underlying mechanism, we analyzed the histology, apoptosis, and proliferation of acinar cells, and the expression of functional membrane proteins such as transmembrane member 16A, aquaporin-5, and Na-K-Cl cotransporter. Long-term pilocarpine treatment seemed to decrease irradiation-induced apoptosis, although the change was not statistically significant. The present results indicated that long-term administration of pilocarpine has beneficial effects on salivary flow in irradiated mice, and suggested that long-term administration possibly decreases apoptosis in irradiated salivary glands.
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Affiliation(s)
- Akie Taniguchi
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine
- Department of Anatomy and Cell Biology, Gunma University Graduate School of Medicine
| | - Taketo Susa
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine
- Department of Anatomy and Cell Biology, Gunma University Graduate School of Medicine
| | - Hiroshi Kogo
- Department of Anatomy and Cell Biology, Gunma University Graduate School of Medicine
| | - Akiko Iizuka-Kogo
- Department of Anatomy and Cell Biology, Gunma University Graduate School of Medicine
| | - Satoshi Yokoo
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine
| | - Toshiyuki Matsuzaki
- Department of Anatomy and Cell Biology, Gunma University Graduate School of Medicine
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Fujii T, Kawasoe K, Nishizawa Y, Kashima J, Tonooka A, Ohta A, Nitta K. A suspected case of drug-induced tubulointerstitial nephritis by pilocarpine hydrochloride. CEN Case Rep 2019; 8:246-251. [PMID: 31077057 PMCID: PMC6820638 DOI: 10.1007/s13730-019-00401-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/02/2019] [Indexed: 11/01/2022] Open
Abstract
A 63-year-old man with pharyngeal cancer had been prescribed pilocarpine hydrochloride for xerostomia after concomitant chemoradiotherapy. After 6 months of taking pilocarpine hydrochloride, he was referred to our hospital due to gradually developing renal insufficiency. The patient underwent detailed urinalysis, blood chemistry analysis, immune-serology testing. A renal biopsy was also performed. He was diagnosed with chronic tubulointerstitial nephritis (TIN) caused by lymphocytic infiltration of the interstitium, tubular atrophy, and interstitial fibrotic changes. Infections, autoimmune diseases, and genetic factors were ruled out as causes of TIN; a drug-induced lymphocyte stimulation test confirmed that he had high stimulation index scores for pilocarpine hydrochloride and a normal range stimulation score for other supplements. These results indicated that the TIN could have been induced by pilocarpine hydrochloride. Drug discontinuation partly improved his renal function and tubule marker levels. To our knowledge, this is the first report of TIN following administration of pilocarpine hydrochloride. This finding could contribute to future treatment decisions for patients with TIN and those using pilocarpine hydrochloride.
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Affiliation(s)
- Teruhiro Fujii
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan. .,Department IV, Internal Medicine, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
| | - Kentaro Kawasoe
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan.,Department IV, Internal Medicine, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Yuki Nishizawa
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan
| | - Jumpei Kashima
- Division of Pathology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan
| | - Akiko Tonooka
- Division of Pathology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan
| | - Akihito Ohta
- Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-0021, Japan
| | - Kosaku Nitta
- Department IV, Internal Medicine, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjuku-Ku, Tokyo, 162-8666, Japan
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