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de Camargo FCF, DeMoura JR, Cepeda FX, de Almeida Correia M, Nascimento RC, Fortes-Queiroz L, Ferreira FG, da Palma RK, Hussid MF, Chavantes MC, Trombetta IC. Photobiomodulation by low-level laser therapy in patients with obstructive sleep apnea: Study protocol clinical trial (SPIRIT compliant). Medicine (Baltimore) 2020; 99:e19547. [PMID: 32195961 PMCID: PMC7220119 DOI: 10.1097/md.0000000000019547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/13/2020] [Indexed: 11/26/2022] Open
Abstract
Obstructive sleep apnea (OSA) increases morbidity and mortality and it is associated with an increased cardiovascular risk. The gold standard treatment for OSA is positive airway pressure therapy (CPAP). However, it is an expensive treatment and several patients do not adapt to CPAP. GOAL The researchers will verify the effects of low-level laser therapy (LLLT) on OSA, when applied to the soft palate and on the tongue base. METHODS The researchers will select individuals of both sexes aged 30 to 60 years old who are sedentary and that present a high risk of OSA by the Berlin questionnaire. The evaluations pre and post interventions will be polysomnography; anthropometric and body composition measurements (Bioimpedance); metabolic syndrome risk factors (International Diabetes Federation); physical capacity (VO2 peak at the cardiopulmonary exercise test, CPET); endothelial function (flow-mediated dilatation, FMD); autonomic control (heart rate variability and sympathovagal balance). Those diagnosed with moderate and severe OSA (apnea/hypopnea index, AHI ≥15 events/h) will be invited to participate in the study and they will be randomized into 2 groups: LLLT treatment or placebo (C). The LLLT group will receive applications at 8 points on the soft palate and on the base of the tongue for 8 seconds for each point. The applications of LLLT will occur twice a week, with a minimum interval of 2 days between the applications for 2 months, when using a Therapy Plus NS 13678 Laser. The C group will have similar applications, but with the device turned off. EXPECTED RESULTS In the individuals with OSA, photobiomodulation through LLLT will decrease the AHI. Additionally, when LLLT is applied in the oral cavity, a highly vascularized region, this may cause improvements in the vascular function and in the autonomic and hemodynamic control. ETHICS AND DISSEMINATION This protocol was approved by the Research Ethics Committee of the Nove de Julho University, São Paulo, Brazil, on the date of March 11, 2019 (CAAE: 06025618.2.0000.5511 - Acceptance Number: 3.191.077). This trial has been registered with the Brazilian Registry of Clinical Trials (REBEC TRIAL RBR-42v548). This study is not yet recruiting. Issue date: November 4, 2019.
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Li KL, Lin JP, Chen YC, Lu CC. Dosimetric measurement of scattered radiation for simulated head and neck radiotherapy with homemade oral phantom. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:773-782. [PMID: 32417831 DOI: 10.3233/xst-200664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
During radiotherapy for head and neck tumours, the oral cavity and cheek area would be inevitably exposed to high energy radiation; thus, the material surface of the teeth, dental restorations with high atomic number, or alloy prosthodontics would generate backscatter electrons that cause the buccal mucosa adjacent to these materials to receive localized high dose enhancement, which primarily leads to side effects or oral mucositis. Based on the size of the adult oral cavity, this study aimed to use acrylic resin to create an oral phantom with two grooves on the left and right sides for placement of three molars. Moreover, the distance between the inner cheek and the side surface of the teeth could be accurately adjusted every 1 mm from 0 to 5 mm. This enhanced the dose in the buccal mucosa during head and neck radiotherapy and made the distribution measurement of the radiation dose simple and feasible at different depths (0-5 mm). Meanwhile, the study employed the film type optically stimulated luminescent dosimeter with a thickness of 0.3 mm to measure the absorbed dose inside the buccal mucosa to reduce the dose interference from radiotherapy. The study fixed three real molars in a row located at the left side of the phantom and employed 6 MV photons and intensity-modulated radiotherapy (IMRT) to treat and simulate oral cancer and measure the attenuation of the molar's backscatter dose from 0 to 5 mm in an up beam direction. The result showed that, in every 3 mm, the phantom had attenuated the enhancement of backscatter dose <3%. The irradiation dose enhancement in a single direction was twice higher than that through IMRT 7 field treatment. These measurement results were consistent with the results of previous studies.
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Zhai TT, Langendijk JA, van Dijk LV, Halmos GB, Witjes MJH, Oosting SF, Noordzij W, Sijtsema NM, Steenbakkers RJHM. The prognostic value of CT-based image-biomarkers for head and neck cancer patients treated with definitive (chemo-)radiation. Oral Oncol 2019; 95:178-186. [PMID: 31345388 DOI: 10.1016/j.oraloncology.2019.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/24/2019] [Accepted: 06/16/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to investigate whether quantitative CT image-biomarkers (IBMs) can improve the prediction models with only classical prognostic factors for local-control (LC), regional-control (RC), distant metastasis-free survival (DMFS) and disease-free survival (DFS) for head and neck cancer (HNC) patients. MATERIALS AND METHODS The cohort included 240 and 204 HNC patients in the training and validation analysis, respectively. Clinical variables were scored prospectively and IBMs of the primary tumor and lymph nodes were extracted from planning CT-images. Clinical, IBM and combined models were created from multivariable Cox proportional-hazard analyses based on clinical features, IBMs, and both for LC, RC, DMFS and DFS. RESULTS Clinical variables identified in the multivariable analysis included tumor-site, WHO performance-score, tumor-stage and age. Bounding-box-volume describing the tumor volume and irregular shape, IBM correlation representing radiological heterogeneity, and LN_major-axis-length showing the distance between lymph nodes were included in the IBM models. The performance of IBM LC, RC, DMFS and DFS models (c-index(validated):0.62, 0.80, 0.68 and 0.65) were comparable to that of the clinical models (0.62, 0.76, 0.70 and 0.66). The combined DFS model (0.70) including clinical features and IBMs performed significantly better than the clinical model. Patients stratified with the combined models revealed larger differences between risk groups in the validation cohort than with clinical models for LC, RC and DFS. For DMFS, the differences were similar to the clinical model. CONCLUSION For prediction of HNC treatment outcomes, image-biomarkers performed as good as or slightly better than clinical variables.
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Noble AR, Greskovich JF, Han J, Reddy CA, Nwizu TI, Khan MF, Scharpf J, Adelstein DJ, Burkey BB, Koyfman SA. Risk Factors Associated with Disease Recurrence in Patients with Stage III/IV Squamous Cell Carcinoma of the Oral Cavity Treated with Surgery and Postoperative Radiotherapy. Anticancer Res 2016; 36:785-792. [PMID: 26851040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The purpose of the present study was to identify variables associated with high risk of failure in patients with locally advanced squamous cell carcinoma of the oral cavity (SCC-OC). PATIENTS AND METHODS This retrospective study included 191 patients with stage III-IVb SCC-OC treated with post-operative radiotherapy (RT) or chemoradiotherapy (CRT) between 1995 and 2013. Disease-free (DFS) and overall survival (OS) were analyzed; variables associated with inferior DFS were identified. RESULTS Seventy-five patients (39%) recurred. DFS and five-year OS were 52% and 54%, respectively. Poorly differentiated tumors (p=0.03), recurrent tumors (p=0.02) and high nodal ratio (p=0.02) were associated with an increased risk of recurrence. CRT was associated with improved DFS in patients with positive margins and/or extracapsular extension (p=0.021). CONCLUSION Tumors that are recurrent, high grade, or have high nodal ratio are at risk of recurrence. Presence of these disease features should be taken into consideration for better risk stratification.
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Tkachev SI, Trofimova OP, Kostina NP, Maklakova AA, Timoshkina EM, Vekova NV. [Prophylaxis and treatment of radiation oral cavity mucositis by hydrogel preparations in patients with oropharyngeal cancer]. VOPROSY ONKOLOGII 2016; 62:531-535. [PMID: 30463113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Development of radiation mucositis in patients with oropharingeal cancer who are treated by radiation therapy leads to constrains breaks, decreases of the quality of life and makes the radiation dose in target insufficient. All above mentioned increases recurrence risk. Since 2010 there was developed and introduced the method of prophylaxis and treatment of radiation injuries of oral cavity in patients with oropharingeal cancer which gives an ability to improve radiation treatment outcomes and the quality of life of patients.
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Qiu M, Wei J, Wang J, Zeng X, Chen Q. [The research advancement in treatment of radiation oral mucositis]. ZHONGHUA KOU QIANG YI XUE ZA ZHI = ZHONGHUA KOUQIANG YIXUE ZAZHI = CHINESE JOURNAL OF STOMATOLOGY 2015; 50:593-597. [PMID: 26757626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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de Barros da Cunha SR, Ramos PAM, Nesrallah ACA, Parahyba CJ, Fregnani ER, Aranha ACC. The Effects of Ionizing Radiation on the Oral Cavity. J Contemp Dent Pract 2015; 16:679-687. [PMID: 26423505 DOI: 10.5005/jp-journals-10024-1740] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM The aim of this study is to present a literature review on the effects of the ionizing radiation from radiotherapy treatment on dental tissues. BACKGROUND Among the effects of increasing global life expectancy and longevity of the teeth in the oral cavity, increasing rates of neoplastic diseases have been observed. One of the important treatment modalities for head and neck neoplastic diseases is radiotherapy, which uses ionizing radiation as the main mechanism of action. Therefore, it is essential for dentists to be aware of the changes in oral and dental tissues caused by ionizing radiation, and to develop treatment and prevention strategies. RESULTS In general, there is still controversy about the effects of ionizing radiation on dental structures. However, qualitative and quantitative changes in saliva and oral microbiota, presence of oral mucositis and radiation-related caries are expected, as they represent the well-known side effects of treatment with ionizing radiation. Points that still remain unclear are the effects of radiotherapy on enamel and dentin, and on their mechanisms of bonding to contemporary adhesive materials. CONCLUSION Ionizing radiation has shown important interaction with organic tissues, since more deleterious effects have been shown on the oral mucosa, salivary glands and dentin, than on enamel. CLINICAL SIGNIFICANCE With the increasing number of patients with cancer seeking dental treatment before and after head and neck radiotherapy, it is important for dentists to be aware of the effects of ionizing radiation on the oral cavity.
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Tol JP, Delaney AR, Dahele M, Slotman BJ, Verbakel WFAR. Evaluation of a knowledge-based planning solution for head and neck cancer. Int J Radiat Oncol Biol Phys 2015; 91:612-20. [PMID: 25680603 DOI: 10.1016/j.ijrobp.2014.11.014] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/16/2014] [Accepted: 11/11/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Automated and knowledge-based planning techniques aim to reduce variations in plan quality. RapidPlan uses a library consisting of different patient plans to make a model that can predict achievable dose-volume histograms (DVHs) for new patients and uses those models for setting optimization objectives. We benchmarked RapidPlan versus clinical plans for 2 patient groups, using 3 different libraries. METHODS AND MATERIALS Volumetric modulated arc therapy plans of 60 recent head and neck cancer patients that included sparing of the salivary glands, swallowing muscles, and oral cavity were evenly divided between 2 models, Model(30A) and Model(30B), and were combined in a third model, Model60. Knowledge-based plans were created for 2 evaluation groups: evaluation group 1 (EG1), consisting of 15 recent patients, and evaluation group 2 (EG2), consisting of 15 older patients in whom only the salivary glands were spared. RapidPlan results were compared with clinical plans (CP) for boost and/or elective planning target volume homogeneity index, using HI(B)/HI(E) = 100 × (D2% - D98%)/D50%, and mean dose to composite salivary glands, swallowing muscles, and oral cavity (D(sal), D(swal), and D(oc), respectively). RESULTS For EG1, RapidPlan improved HI(B) and HI(E) values compared with CP by 1.0% to 1.3% and 1.0% to 0.6%, respectively. Comparable D(sal) and D(swal) values were seen in Model(30A), Model(30B), and Model60, decreasing by an average of 0.1, 1.0, and 0.8 Gy and 4.8, 3.7, and 4.4 Gy, respectively. However, differences were noted between individual organs at risk (OARs), with Model(30B) increasing D(oc) by 0.1, 3.2, and 2.8 Gy compared with CP, Model(30A), and Model60. Plan quality was less consistent when the patient was flagged as an outlier. For EG2, RapidPlan decreased D(sal) by 4.1 to 4.9 Gy on average, whereas HI(B) and HI(E) decreased by 1.1% to 1.5% and 2.3% to 1.9%, respectively. CONCLUSIONS RapidPlan knowledge-based treatment plans were comparable to CP if the patient's OAR-planning target volume geometry was within the range of those included in the models. EG2 results showed that a model including swallowing-muscle and oral-cavity sparing can be applied to patients with only salivary gland sparing. This may allow model library sharing between institutes. Optimal detection of inadequate plans and population of model libraries requires further investigation.
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Berhane H, Shinde A, Kalash R, Xu K, Epperly MW, Goff J, Franicola D, Zhang X, Dixon T, Shields D, Wang H, Wipf P, Li S, Gao X, Greenberger JS. Amelioration of radiation-induced oral cavity mucositis and distant bone marrow suppression in fanconi anemia Fancd2-/- (FVB/N) mice by intraoral GS-nitroxide JP4-039. Radiat Res 2014; 182:35-49. [PMID: 24932534 PMCID: PMC4101533 DOI: 10.1667/rr13633.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The altered DNA damage response pathway in patients with Fanconi anemia (FA) may increase the toxicity of clinical radiotherapy. We quantitated oral cavity mucositis in irradiated Fanconi anemia Fancd2(-/-) mice, comparing this to Fancd2(+/-) and Fancd2(+/+) mice, and we measured distant bone marrow suppression and quantitated the effect of the intraoral radioprotector GS-nitroxide, JP4-039 in F15 emulsion. We found that FA mice were more susceptible to radiation injury and that protection from radiation injury by JP4-039/F15 was observed at all radiation doses. Adult 10-12-week-old mice, of FVB/N background Fancd2(-/-), Fancd2(+/-) and Fancd2(+/+) were head and neck irradiated with 24, 26, 28 or 30 Gy (large fraction sizes typical of stereotactic radiosurgery treatments) and subgroups received intraoral JP4-039 (0.4 mg/mouse in 100 μL F15 liposome emulsion) preirradiation. On day 2 or 5 postirradiation, mice were sacrificed, tongue tissue and femur marrow were excised for quantitation of radiation-induced stress response, inflammatory and antioxidant gene transcripts, histopathology and assay for femur marrow colony-forming hematopoietic progenitor cells. Fancd2(-/-) mice had a significantly higher percentage of oral mucosal ulceration at day 5 after 26 Gy irradiation (59.4 ± 8.2%) compared to control Fancd2(+/+) mice (21.7 ± 2.9%, P = 0.0063). After 24 Gy irradiation, Fancd2(-/-) mice had a higher oral cavity percentage of tongue ulceration compared to Fancd2(+/+) mice irradiated with higher doses of 26 Gy (P = 0.0123). Baseline and postirradiation oral cavity gene transcripts were altered in Fancd2(-/-) mice compared to Fancd2(+/+) controls. Fancd2(-/-) mice had decreased baseline femur marrow CFU-GM, BFUe and CFU-GEMM, which further decreased after 24 or 26 Gy head and neck irradiation. These changes were not seen in head- and neck-irradiated Fancd2(+/+) mice. In radiosensitive Fancd2(-/-) mice, biomarkers of both local oral cavity and distant marrow radiation toxicity were ameliorated by intraoral JP4-039/F15. We propose that Fancd2(-/-) mice are a valuable radiosensitive animal model system, which can be used to evaluate potential radioprotective agents.
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Eliyas S, Porter R, Briggs P, Patel RR. Effects of radiotherapy to the jaws. I: The scale of the problem. THE EUROPEAN JOURNAL OF PROSTHODONTICS AND RESTORATIVE DENTISTRY 2013; 21:161-169. [PMID: 24479213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cancer care has become one of the main targets of the National Health Service in England and with cancer patients surviving longer, it is likely that head and neck cancer patients will make up a large proportion of patients seen within secondary care settings in the future. The management of these patients can be very difficult for a number of reasons. Part one of this paper attempts to highlight the major oral health problems encountered by these patients during and after their cancer treatment and supported by the current literature. Part two of this series will address the dental management of head and neck oncology patients undergoing radiotherapy with particular attention of possible improvement to current management strategies for these patients.
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Rahman S, Maillou P, Barker D, Donachie M. Radiotherapy and the oral environment the effects of radiotherapy on the hard and soft tissues of the mouth and its management. THE EUROPEAN JOURNAL OF PROSTHODONTICS AND RESTORATIVE DENTISTRY 2013; 21:80-87. [PMID: 23888531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Radiation therapy plays an important role in the care of patients with head and neck cancer. When the oral cavity and the salivary glands are exposed to high doses of radiation, there can be dramatic effects on the patient's oral health. The clinical consequences of radiation can include mucositis, hyposalivation, taste loss, osteoradionecrosis, radiation caries and trismus. This paper looks at the available literature regarding the effects of radiotherapy on the oral environment and outlines practical clinical approaches to prevent or reduce the adverse side effects of treatment.
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MacReady N. Looking treatment complications in the mouth. J Natl Cancer Inst 2013; 105:76-7. [PMID: 23303866 DOI: 10.1093/jnci/djs643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shao ZY, Tang ZS, Yan C, Jiang YT, Ma R, Liu Z, Huang ZW. Effects of intensity-modulated radiotherapy on human oral microflora. JOURNAL OF RADIATION RESEARCH 2011; 52:834-839. [PMID: 22104273 DOI: 10.1269/jrr.11085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study aimed to evaluate changes in the biodiversity of the oral microflora of patients with head and neck cancer treated with postoperative intensity-modulated radiotherapy (IMRT) or conventional radiotherapy (CRT). Pooled dental plaque samples were collected during the radiation treatment from patients receiving IMRT (n = 13) and CRT (n = 12). Denaturing gradient gel electrophoresis (DGGE) was used to analyze the temporal variation of these plaque samples. The stimulated and unstimulated salivary flow rates were also compared between IMRT and CRT patients. Reductions in the severity of hyposalivation were observed in IMRT patients compared with CRT patients. We also observed that the temporal stability of the oral ecosystem was significantly higher in the IMRT group (69.96 ± 7.82%) than in the CRT group (51.98 ± 10.45%) (P < 0.05). The findings of the present study suggest that IMRT is more conducive to maintaining the relative stability of the oral ecosystem than CRT.
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Aguiar GP, Jham BC, Magalhães CS, Sensi LG, Freire AR. A review of the biological and clinical aspects of radiation caries. J Contemp Dent Pract 2009; 10:83-89. [PMID: 19575058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The aim of this article is to review the clinical and biological features underlying the development and progression of radiation caries. BACKGROUND Although radiotherapy (RT) plays an important role in the management of patients with head and neck cancer (HNC), it is also associated with several undesired side effects such as radiation caries which is a common, yet serious, complication. To review the condition, the Pubmed database was searched using the keywords "radiotherapy," "radiation," "caries," "hyposalivation," "prevention" and "management". Only studies published in the English language were selected. Cross-referencing identified additionally relevant studies. REVIEW RESULTS RT leads to alterations in the dentition, saliva, oral microflora, and diet of patients. Consequently, irradiated patients are at increased risk for the development of a rapid, rampant carious process known as radiation caries. Motivation of patients, adequate plaque control, stimulation of salivary flow, fluoride use, and nutritional orientation are essential to reduce the incidence of radiation caries and ultimately improve the quality of life for HNC patients. CONCLUSION Radiation caries is an aggressive side effect of RT. Dentists play an important role in the prevention of the condition via comprehensive oral healthcare before, during, and after the active cancer therapy. CLINICAL SIGNIFICANCE Dentists should understand the clinical and biological aspects underlying radiation caries to prevent the development of lesions and provide optimal treatment when needed.
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Harding SA, Hodder SC, Courtney DJ, Bryson PJ. Impact of perioperative hyperbaric oxygen therapy on the quality of life of maxillofacial patients who undergo surgery in irradiated fields. Int J Oral Maxillofac Surg 2008; 37:617-24. [PMID: 18501562 DOI: 10.1016/j.ijom.2008.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 01/30/2008] [Accepted: 04/10/2008] [Indexed: 11/19/2022]
Abstract
From 2001 to 2005, 66 patients referred for perioperative hyperbaric oxygen therapy (HBO2) for debridement of necrotic tissue or prevention of radionecrosis were assessed with quality of life measures, before and after completion of HBO2 and surgery. The Medical Outcomes Short Form 36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) showed no significant changes. The European Organisation for Research and Treatment of Cancer Core (EORTC-C30) questionnaire showed significant improvement in pain, global health, and dyspnoea (p=0.011; p=0.027; p=0.008, respectively). The Head and Neck sub-module (H&N35) identified significant improvements in teeth, dry mouth and social contact (p=0.002; p=0.038; p=0.029, respectively). The University of Washington Scale (UW), showed significant changes in relation to chewing and shoulders (p=0.031; p=0.047). When sub-group analysis using 'osteoradionecrosis' and 'dental extraction or implants' was performed on the EORTC and UW data, variations in the patterns of significance were found. Adjunctive HBO2 should be considered for the treatment and prevention of some of the long-term complications of radiotherapy.
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Bonan PRF, Lopes MA, Pires FR, Almeida OPD. Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis. Braz Dent J 2007; 17:336-42. [PMID: 17262149 DOI: 10.1590/s0103-64402006000400013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2005] [Accepted: 09/11/2005] [Indexed: 11/21/2022] Open
Abstract
Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including prophylactic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1%) patients developed radiation caries and 5 out of 23 cases (21.3% - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental conditions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.
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Epperly MW, Wegner R, Kanai AJ, Kagan V, Greenberger EE, Nie S, Greenberger JS. Effects of MnSOD-Plasmid Liposome Gene Therapy on Antioxidant Levels in Irradiated Murine Oral Cavity Orthotopic Tumors. Radiat Res 2007; 167:289-97. [PMID: 17316075 DOI: 10.1667/rr0761.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 10/06/2006] [Indexed: 11/03/2022]
Abstract
Intraoral manganese superoxide dismutase (SOD2)-plasmid liposome (PL) radioprotective gene therapy prolongs the survival of mice with orthotopic oral cavity tumors within the irradiated field. To determine whether the mechanism involved effects in antioxidant pool, C57BL/6J mice bearing orthotopic oral cavity squamous cell carcinoma SCC-VII tumors received intraoral or intravenous MnSOD-PL gene therapy 24 h prior to 18 Gy irradiation to the head and neck region. Glutathione (GSH) levels and levels of radiation-generated nitric oxide and peroxynitrite were measured in orthotopic tumors and in adjacent oral mucosa. MnSOD-PL transfection of the SCC-VII tumor cells, but not normal embryo fibroblasts, produced acute radiosensitization. Furthermore, SCC-VII tumor cells demonstrated increased relative hydrogen peroxide (the product of MnSOD superoxide dismutation)-induced apoptosis in vitro. Radiation decreased levels of GSH and increased GPX in both tumor and normal cells in vitro, effects that were blunted by MnSOD-PL treatment. In vivo irradiation decreased GSH and GPX more effectively in tumors, and the decrease was not reversed by MnSOD-PL therapy. Intravenous but not intraoral administration of epitope-tagged hemagglutinin MnSOD-PL resulted in significant uptake in orthotopic tumors and decreased the levels of radiation-induced nitric oxide and peroxynitrite. Thus normal tissue radioprotective MnSOD-PL gene therapy radiosensitizes tumor cell lines in vitro and has a therapeutic effect on orthotopic tumors in part through its effects on tumor antioxidants.
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Borges L, Rex KL, Chen JN, Wei P, Kaufman S, Scully S, Pretorius JK, Farrell CL. A protective role for keratinocyte growth factor in a murine model of chemotherapy and radiotherapy-induced mucositis. Int J Radiat Oncol Biol Phys 2006; 66:254-62. [PMID: 16904525 DOI: 10.1016/j.ijrobp.2006.05.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 04/26/2006] [Accepted: 05/09/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the activity of palifermin (rHuKGF) in a murine model of mucosal damage induced by a radiotherapy/chemotherapy (RT/CT) regimen mimicking treatment protocols used in head-and-neck cancer patients. METHODS AND MATERIALS A model of mucosal damage induced by RT/CT was established by injecting female BDF1 mice with cisplatin (10 mg/kg) on Day 1; 5-fluorouracil (40 mg/kg/day) on Days 1-4, and irradiation (5 Gy/day) to the head and neck on Days 1-5. Palifermin was administered subcutaneously on Days -2 to 0 (5 mg/kg/day) and on Day 5 (5 mg/kg). Evaluations included body weight, organ weight, keratinocyte growth factor receptor expression, epithelial thickness, and cellular proliferation. RESULTS Initiation of the radiochemotherapeutic regimen resulted in a reduction in body weight in control animals. Palifermin administration suppressed weight loss and resulted in increased organ weight (salivary glands and small intestine), epithelial thickness (esophagus and tongue), and cellular proliferation (tongue and salivary glands). CONCLUSIONS Administration of palifermin before RT/CT promotes cell proliferation and increases in epithelial thickness in the oral mucosa, salivary glands, and digestive tract. Palifermin administration before and after RT/CT mitigates weight loss and a trophic effect on the intestinal mucosa and salivary glands, suggesting that palifermin use should be investigated further in the RT/CT settings, in which intestinal mucositis and salivary gland dysfunction are predominant side effects of cytotoxic therapy.
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Omer O, MacCarthy D, Nunn J, Cotter E. Oral health needs of the head and neck radiotherapy patient: 2. Oral and dental care before, during and after radiotherapy. ACTA ACUST UNITED AC 2006; 32:575-6, 578-80, 582. [PMID: 16379433 DOI: 10.12968/denu.2005.32.10.575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Head and neck cancer represents a heterogeneous group of neoplasms affecting a number of sites in the aerodigestive tract, histologically primarily epithelial in type. Most are sensitive to a treatment regime of ablative surgery followed by radiotherapy. The incidence of head and neck cancers is approximately 11.8 per 100,000 population and is the 8th commonest cancer in males and the 16th in females. Treatment comprises ablative surgery with, in 60% of cases, radiotherapy. The oral and dental sequelae of such treatment, and their management, is described. CLINICAL RELEVANCE Many of these cancers will manifest with oral signs and symptoms, thus placing the GDP in the unique position of being able to detect and positively influence outcomes. As well, the GDP has a vital, proactive role to play in supportive care before, during and following surgery and radiotherapy.
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MacCarthy D, Omer O, Nunn J, Cotter E. Oral health needs of the head and neck radiotherapy patient: 1. Epidemiology, effects of radiotherapy and role of the GDP in diagnosis. ACTA ACUST UNITED AC 2005; 32:512-4, 516-8, 521-2. [PMID: 16317884 DOI: 10.12968/denu.2005.32.9.512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Head and neck cancer represents a heterogeneous group of neoplasms affecting a number of sites in the aerodigestive tract, histologically primarily epithelial in type. Most are sensitive to a treatment regime of ablative surgery followed by radiotherapy. The incidence in Ireland of head and neck cancers is approximately 11.8 per 100,000 population and is the 8th commonest cancer in males and the 16th in females. Many of these cancers will manifest with oral signs and symptoms thus placing the GDP in the unique position of being able to detect and positively influence outcomes: the GDP also has a vital, proactive role to play in supportive care before, during and following surgery and radiotherapy. CLINICAL RELEVANCE The aim of this paper is to review the rationale for the different treatment modalities and the oral/dental side-effects of each.
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Al-Nawas B, Grötz KA. Prospective study of the long term change of the oral flora after radiation therapy. Support Care Cancer 2005; 14:291-6. [PMID: 16341728 DOI: 10.1007/s00520-005-0895-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 09/14/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this prospective study was to evaluate the long term change in oral pathogens following radiation therapy. METHODS Twenty-two patients with planned radiation therapy (>30 Gy) of head and neck squamous cell carcinoma were included. Before radiation therapy, after 3, 6, and 12 months samples from the deepest periodontal pocket were drawn. Five major periodontal pathogens were studied using DNA probes (Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteriodes forsythus, Treponema denticola). Stimulated saliva was sampled for the microbiologic study of caries pathogens (streptococci and lactobacilli). Plaque index and decayed, missing, filled tooth surfaces (DMF-S) were recorded. RESULTS A normalisation of the caries bacteria is not found correlating to a significant increase in the number of affected teeth (DMF-S) from 80.7 to 88.5 after 12 months. The plaque index remained unchanged. The incidence of periodontal pathogens did not significantly change during the follow up. CONCLUSION In contrast to radiation caries there seems to be no microbiological evidence for "radiation periodontitis". Despite of the intensive oral hygiene no reduction of the high number of caries pathogens is found, which leads to a high risk of tooth decay even 12 months after radiation.
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Jellema AP, Doornaert P, Slotman BJ, Leemans CR, Langendijk JA. Does radiation dose to the salivary glands and oral cavity predict patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with curative radiotherapy? Radiother Oncol 2005; 77:164-71. [PMID: 16256229 DOI: 10.1016/j.radonc.2005.10.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Revised: 09/12/2005] [Accepted: 10/03/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the association between the mean salivary gland and oral cavity dose, with patient-rated moderate and severe xerostomia and sticky saliva. PATIENTS AND METHODS One hundred and fifty-seven patients treated with bilateral irradiation for head and neck cancer were included. The parotid and submandibular glands and the oral cavity were delineated on plannings-CT scans. At baseline and 6 and 12 months self-reported xerostomia and sticky saliva were assessed using the EORTC QLQ-H&N35 questionnaire. RESULTS At 6 months a significant association between the mean parotid (MD(par)) and mean submandibular dose (MD(subm)) and xerostomia was observed (OR - MD(par): 1.17; P=0.002 and OR - MD(subm): 1.08; P = 0.02). Between MD(par) and MD(subm), a significant interaction term was present. No significant association was found with the oral cavity dose. Xerostomia was reversible depending on MD(par) and MD(subm). Considering Sticky saliva, a significant association was found at 6 and 12 months with MD(subm) (OR: 1.03; P < 0.001). The P50 for sticky saliva increased with elapsing time. CONCLUSIONS Both MD(par) and MD(subm) influence the risk of xerostomia in irradiated patients at 6 months. This probability as a function of the mean parotid dose significantly depended on the mean dose in the submandibular glands. Sticky saliva mainly depends on MD(subm).
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Klug C, Berzaczy D, Voracek M, Enislidis G, Rath T, Millesi W, Ewers R. Experience with microvascular free flaps in preoperatively irradiated tissue of the oral cavity and oropharynx in 303 patients. Oral Oncol 2005; 41:738-46. [PMID: 15978858 DOI: 10.1016/j.oraloncology.2005.03.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 03/29/2005] [Indexed: 11/18/2022]
Abstract
This study examined free flap reconstruction of surgical defects of the oral cavity and oropharynx after preoperative radiochemotherapy. Included in this analysis are 303 prospectively followed patients who underwent a multimodal treatment regime for advanced oral and oropharyngeal carcinoma. All patients received preoperative radiochemotherapy (Mitomycin C, 5-FU, 50 Gy), ablative surgery, and primary free flap reconstruction. Patient characteristics, surgical parameters like duration of surgery and ischaemia, size of defect, type of transplant, and clinical outcome parameters like duration of intensive care and hospitalization, type of complications, necessity and type of revision surgery were statistically evaluated. Overall flap success rate was 93.1%. Sixty seven patients required revision and 21 flaps (6.9%) were lost. Overall complication rate was 22.1%. Mean duration of intensive care (DOIC) and duration of overall postoperative hospitalization (DOH) were 11.0+/-9.6 days and 35.9+/-26.3 days, respectively. Flap success and flap related complications after 50 Gy focal radiation dosage were found in a comparable range as in published series of reconstructions in uncompromised tissue.
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Kearvell R, Kuan R, Preston R, Tanner P, Buck H, Hedges R. Acute radiation toxicity assessment of a 3-D conformal head and neck radiation treatment technique. ACTA ACUST UNITED AC 2005; 48:358-63. [PMID: 15344987 DOI: 10.1111/j.0004-8461.2004.01319.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients undergoing radiation treatment for head and neck cancer have many critical structures within or adjacent to the treatment area. Avoiding these critical structures is more efficient and easier using 3-D conformal planning. At Sir Charles Gairdner Hospital an investigation into the acute radiation toxicity was undertaken when the head and neck treatment technique was changed from the conventional 2-D plan to the conformal 3-D plan. Although the primary target volume (PTV), fraction size and overall dose remain the same for the two techniques, differing beam configurations mean that treatment fields enter and exit through different parts of the head and neck. Ten patients were initially assessed to gain a baseline appearance of their head and neck region, and then graded weekly according to the toxicity criteria during treatment and at 4, 8 and 12 weeks after treatment. The results of the assessment indicate that there is no increase in toxicity as a result of treating using the conformal head and neck technique.
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Suzuki A, Togawa T, Kuyama J, Nakahara T, Takenouchi T, Hatano K, Omura K. Correlation between angiogenesis and reduction ratio measured using201Tl chloride single photon emission computed tomography in patients with oral cavity squamous cell carcinoma. Ann Nucl Med 2004; 18:599-607. [PMID: 15586634 DOI: 10.1007/bf02984582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study is to examine the correlation between tumor angiogenesis and response to preoperative radiotherapy evaluated using 201Tl single photon emission computed tomography (Tl SPECT) in oral cavity squamous cell carcinoma (SCC). METHODS Tl SPECTs before and after preoperative radiotherapy were obtained from 11 patients diagnosed with SCC in oral cavity. Regions of interest were set around the tumor and scalp respectively, and the ratio of mean counts in the tumor to those in the scalp was calculated (T/N). Immunohistochemical staining for investigating microvessel density of pre-treatment biopsy specimen was performed using CD31 monoclonal antibody. We compared microvessel density with semi-quantitative parameters obtained using Tl SPECT (T/N at pre- an post-treatment, reduction ratio) and prognosis. RESULTS The subgroup with higher microvessel density showed a significantly higher reduction ratio than the one with lower microvessel density. Regarding prognosis, the subgroup with locoregional recurrent disease exhibited a significantly higher microvessel density than the one without recurrence. CONCLUSIONS In SCC of the oral cavity, there was a significant correlation between microvessel density and response to preoperative radiotherapy. Namely, it was revealed that change of 201Tl uptake after preoperative radiotherapy correlated with tumor angiogenesis of oral cavity SCC.
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MESH Headings
- Aged
- Carcinoma, Squamous Cell/blood supply
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/secondary
- Carcinoma, Squamous Cell/surgery
- Female
- Humans
- Image Interpretation, Computer-Assisted/methods
- Lymphatic Metastasis
- Male
- Middle Aged
- Mouth/diagnostic imaging
- Mouth/radiation effects
- Mouth/surgery
- Mouth Neoplasms/blood supply
- Mouth Neoplasms/diagnostic imaging
- Mouth Neoplasms/radiotherapy
- Mouth Neoplasms/surgery
- Neovascularization, Pathologic/complications
- Neovascularization, Pathologic/diagnostic imaging
- Preoperative Care/methods
- Prognosis
- Radiopharmaceuticals
- Reproducibility of Results
- Sensitivity and Specificity
- Statistics as Topic
- Thallium
- Tomography, Emission-Computed, Single-Photon/methods
- Treatment Outcome
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