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1

Shortening the Xerostomia Inventory  

PubMed Central

Objectives To determine the validity and properties of the Summated Xerostomia Inventory-Dutch Version in samples from Australia, The Netherlands, Japan and New Zealand. Study design Six cross-sectional samples of older people from The Netherlands (N = 50), Australia (N = 637 and N = 245), Japan (N = 401) and New Zealand (N = 167 and N = 86). Data were analysed using the Summated Xerostomia Inventory-Dutch Version. Results Almost all data-sets revealed a single extracted factor which explained about half of the variance, with Cronbach’s alpha values of at least 0.70. When mean scale scores were plotted against a “gold standard” xerostomia question, statistically significant gradients were observed, with the highest score seen in those who always had dry mouth, and the lowest in those who never had it. Conclusion The Summated Xerostomia Inventory-Dutch Version is valid for measuring xerostomia symptoms in clinical and epidemiological research.

Thomson, William Murray; van der Putten, Gert-Jan; de Baat, Cees; Ikebe, Kazunori; Matsuda, Ken-ichi; Enoki, Kaori; Hopcraft, Matthew; Ling, Guo Y

2011-01-01

2

Xerostomia in patients on chronic hemodialysis  

Microsoft Academic Search

Xerostomia is the subjective feeling of a dry mouth, which is relatively common in patients on chronic hemodialysis. Xerostomia can be caused by reduced salivary flow secondary to atrophy and fibrosis of the salivary glands, use of certain medications, restriction of fluid intake and old age. In patients undergoing hemodialysis, xerostomia is associated with the following problems: difficulties in chewing,

Luigi Tazza; Maurizio Bossola

2012-01-01

3

Optimal nocturnal humidification for xerostomia  

Microsoft Academic Search

Background. Xerostomia is associated with a diffi- culty of maintaining oral hygeine and with symptoms of daytime oral discomfort and nocturnal sleep disturbance. Methods. A pilot study was conducted to test the efficacy of a new method of delivering heated humidified air (37 degrees C, 100% water vapor saturated, at 20-25 L\\/min flow rate via spe- cially designed nasal prongs)

K. David Hay; Randall P. Morton

2006-01-01

4

Xerostomia: aetiology and management in cancer patients  

Microsoft Academic Search

Although oral complications are common sequelae of cancer\\/cancer treatment, only sporadic research is published in the literature.\\u000a It is clear that 'routine' oral hygiene measures are inadequate; a little time and effort may, however, reduce oral discomfort.\\u000a This is particularly true in the case of xerostomia, which is often thought to be a relatively minor symptom with few deleterious\\u000a effects.

Susan Holmes

1998-01-01

5

The prevalence of xerostomia in patients with removable prostheses.  

PubMed

Purpose: The objective of this study was to determine the prevalence of xerostomia among patients attending a dental clinic for provision of dentures and to investigate the oral cleanliness in those patients. Materials and Methods: Denture-wearing patients who reported dry mouth completed a questionnaire related to xerostomia. Dryness of the mouth was determined by clinical observation. Dental and denture cleanliness was determined using the Modified Debris Index. Results: One hundred twenty patients had xerostomia. Oral cleanliness was generally poor. Conclusion: There was a high prevalence of xerostomia in the patient population. A high proportion of subjects had poor oral cleanliness. PMID:24179964

Nikolopoulou, Fotoula; Tasopoulos, Theodoros; Jagger, Robert

6

Effect of Radiation-Induced Xerostomia on the Human Oral Microflora.  

National Technical Information Service (NTIS)

The caries-conducive impact of xerostomia was studied in 42 irradiated cancer patients. The radiation-induced xerostomia was paralleled by changes in the physical, microbial, biochemical, immunologic and dietary parameters of cariogenicity that collective...

S. Dreizen L. R. Brown

1976-01-01

7

The diagnostic suitability of a xerostomia questionnaire and the association between xerostomia, hyposalivation and medication use in a group of nursing home residents  

Microsoft Academic Search

The study objective was to explore the diagnostic suitability of the Xerostomia Inventory and the association between xerostomia,\\u000a hyposalivation and medication use in a group of nursing home residents. A cross-sectional study was carried out in 50 physically\\u000a impaired nursing home residents (20 men) with a mean age of 78.1 years (range, 53–98) in The Netherlands. The Xerostomia Inventory-Dutch\\u000a version was

Gert-Jan van der Putten; Henk S. Brand; Jos M. G. A. Schols; Cees de Baat

2011-01-01

8

Xerostomia and effects on quality of life in long-term head and neck cancer survivors  

Microsoft Academic Search

Problem: Few studies have evaluated the degree of xerostomia in long-term cancer survivors or its impact on quality of life (QOL). The purpose of this study was to objectively measure the degree of xerostomia and to determine the effect of xerostomia on the subjective quality of life of long-term survivors of head and neck cancer treated with external beam irradiation.Methods:

Rebecca Lynn Duke; Bruce H. Campbell; Christopher J. Schultz; Anne Marbella; Katherine B. Myers; Peter Layde

2004-01-01

9

Xerostomia and salivary flow in patients with orofacial pain compared with controls  

Microsoft Academic Search

ObjectivesPain in the orofacial region is frequently reported by patients in dental and medical offices. Facial pain, headache, masticatory abnormalities and other complaints often become chronic and may be associated with local disturbances, such as xerostomia and teeth abnormalities. The objective of this study was to investigate salivary flow and xerostomia in patients with orofacial pain.

Luciana A. da Silva; Manoel J. Teixeira; Jose T. T. de Siqueira; Silvia R. D. T. de Siqueira

2011-01-01

10

Postradiotherapy quality of life for head-and-neck cancer patients is independent of xerostomia  

SciTech Connect

Purpose: To determine the relationship between quality of life (QOL) and xerostomia over time for patients undergoing radiotherapy (RT) for head-and-neck cancer in a prospective clinical trial. Methods and materials: Patients with head-and-neck cancer were randomized to pilocarpine (n = 65) vs. placebo (n = 65) during RT. QOL was measured using the McMaster Head and Neck Radiotherapy Questionnaire (HNRQ). Xerostomia was measured on a linear analog scale. No statistically significant differences were observed between arms; all 130 patients were analyzed together. Results: Baseline QOL data were obtained for 98.5% of participants. The baseline HNRQ score of 5.7 declined significantly to 4.0 (p <0.0001) by RT Week 6 and returned to baseline (5.8) by 6 months after treatment. This represents a large, clinically important change of 1.7 of 7 (24%; effect size 1.34). The decline in HNRQ score during RT paralleled the onset of xerostomia on the linear analog scale (r = 0.36 at 1 month). After treatment, the QOL scores recovered without improvement in xerostomia. The trajectory of the linear analog scale score resembled that of the HNRQ's single xerostomia question (r = 0.75 at 1 month). Conclusion: Quality of life recovers to baseline after RT, despite persistent xerostomia. Either a response shift occurs or xerostomia in the absence of acute mucositis has a relatively small influence on overall QOL.

Ringash, Jolie [Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, ON (Canada)]. E-mail: jolie.ringash@rmp.uhn.on.ca; Warde, Padraig [Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, ON (Canada); Lockwood, Gina [Department of Biostatistics, Princess Margaret Hospital and the University of Toronto, Toronto, ON (Canada); O'Sullivan, Brian [Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, ON (Canada); Waldron, John [Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, ON (Canada); Cummings, Bernard [Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, ON (Canada)

2005-04-01

11

Does salivary gland scintigraphy predict response to pilocarpine in patients with post-radiotherapy xerostomia?  

Microsoft Academic Search

.   This study was undertaken to determine whether standard salivary gland scintigraphy may be used for the objective assessment\\u000a of salivary gland sialogogues, in particular oral pilocarpine, in the treatment of post-radiotherapy xerostomia. Nine patients,\\u000a with xerostomia following radiotherapy to the head and neck region underwent salivary gland scintigraphy with technetium-99m\\u000a pertechnetate (40 MBq) both before and following 1 month of

Rachel A. Cooper; Richard A. Cowan; Susan E. Owens; Stephen P. Jeans; Jacqueline K. Roberts; Philip G. Hillel; Nicholas J. Slevin; Ernest Allan; Nirmal K. Gupta; Conor D. Collins

1999-01-01

12

Impact of Radiation-Induced Xerostomia on Quality of Life After Primary Radiotherapy Among Patients With Head and Neck Cancer  

SciTech Connect

Purpose: To investigate the impact of xerostomia on overall quality of life (QoL) outcome and related dimensions among head and neck cancer patients treated with primary radiotherapy. Methods and Materials: A total of 288 patients with Stage I-IV disease without distant metastases were included. Late xerostomia according to the Radiation Therapy Oncology Group (RTOG-xerostomia) and QoL (European Organization for Research and Treatment of Cancer QLC-C30) were assessed at baseline and every 6th month from 6 months to 24 months after radiotherapy. Results: A significant association was found between RTOG-xerostomia and overall QoL outcome (effect size [ES] 0.07, p < 0.001). A significant relationship with global QoL, all functioning scales, and fatigue and insomnia was observed. A significant interaction term was present between RTOG-xerostomia and gender and between RTOG-xerostomia and age. In terms of gender, RTOG-xerostomia had a larger impact on overall QoL outcome in women (ES 0.13 for women vs. 0.07 for men). Furthermore, in women ES on individual scales were larger, and a marked worsening was observed with increasing RTOG-xerostomia. No different ES according to age was seen (ES 0.10 for 18-65 years vs. 0.08 for >65 years). An analysis of the impact of RTOG-xerostomia on overall QoL outcome over time showed an increase from 0.09 at 6 months to 0.22 at 24 months. With elapsing time, a worsening was found for these individual scales with increasing RTOG-xerostomia. Conclusions: The results of this prospective study are the first to show a significant impact of radiation-induced xerostomia on QoL. Although the incidence of Grade {>=}2 RTOG-xerostomia decreases with time, its impact on QoL increases. This finding emphasizes the importance of prevention of xerostomia.

Jellema, Anke Petra [Department of Radiation Oncology, University Medical Center, Utrecht (Netherlands); Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)], E-mail: a.p.jellema@umcutrecht.nl; Slotman, Ben J.; Doornaert, Patricia [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Leemans, C. Rene M.D. [Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam (Netherlands); Langendijk, Johannes A. [Department of Radiation Oncology, University Medical Center Groningen, Groningen (Netherlands)

2007-11-01

13

The Role of Saliva in Oral Health: Strategies for Prevention and Management of Xerostomia  

Microsoft Academic Search

Oral complications are the most frequent and debilitating se- quelae of radiation treatment for patients with head and neck cancer. Impaired salivary function and consequent xerostomia can persist for years after radiation treatment, significantly increasing the risk of oral and dental disease and negatively affecting patients' quality of life. Current evidence indicates that many patients undergoing radiation treatment do not

Mary Elizabeth Brosky

2007-01-01

14

Effectiveness of malic acid 1% in patients with xerostomia induced by antihypertensive drugs  

PubMed Central

Objectives: Assessing the clinical effectiveness of a topical sialogogue on spray (malic acid, 1%) in the treatment of xerostomia induced by antihypertensive drugs. Study Design: This research has been carried out through a randomized double-blind clinical trial. 45 patients suffering from hypertensive drugs-induced xerostomia were divided into 2 groups: the first group (25 patients) received a topical sialogogue on spray (malic acid, 1%) whereas the second group (20 patients) received a placebo. Both of them were administered on demand for 2 weeks. Dry Mouth Questionnaire (DMQ) was used in order to evaluate xerostomia levels before and after product/placebo application. Unstimulated and stimulated salivary flows rates, before and after application, were measured. All the statistical analyses were performed by using SPSS software v17.0. Different DMQ scores at the earliest and final stage of the trial were analysed by using Mann-Whitney U test, whereas Student’s T-test was used to analyse salivary flows. Critical p-value was established at p<0.05. Results: DMQ scores increased significantly (clinical recovery) from 1.21 to 3.36 points (p<0.05) after malic acid (1%) application whereas DMQ scores increased from 1.18 to 1.34 points (p>0.05) after placebo application. After two weeks of treatment with malic acid, unstimulated salivary flow increased from 0.17 to 0.242 mL/min whereas the stimulated one increased from 0.66 to 0.92 mL/min (p<0.05). After placebo application unstimulated flow ranged from 0.152 to 0.146 mL/min and stimulated flow increased from 0.67 to 0.70 mL/min (p>0.05). Conclusions: Malic acid 1% spray improved antihypertensive-induced xerostomia and stimulated the production of saliva. Key words:Xerostomia, hyposialia, malic acid, antihypertensive drugs.

Guardia, Javier; Aguilar-Salvatierra, Antonio; Cabrera-Ayala, Maribel; Mate-Sanchez de-Val, Jose E.; Calvo-Guirado, Jose L.

2013-01-01

15

Clinical Management of Salivary Gland Hypofunction and Xerostomia in Head-and-Neck Cancer Patients: Successes and Barriers  

SciTech Connect

The most significant long-term complication of radiotherapy in the head-and-neck region is hyposalivation and its related complaints, particularily xerostomia. This review addresses the pathophysiology underlying irradiation damage to salivary gland tissue, the consequences of radiation injury, and issues contributing to the clinical management of salivary gland hypofunction and xerostomia. These include ways to (1) prevent or minimize radiation injury of salivary gland tissue, (2) manage radiation-induced hyposalivation and xerostomia, and (3) restore the function of salivary gland tissue damaged by radiotherapy.

Vissink, Arjan [Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Grongingen (Netherlands); Mitchell, James B. [Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD (United States); Baum, Bruce J. [Molecular Physiology and Therapeutics Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD (United States); Limesand, Kirsten H. [Department of Nutritional Sciences, University of Arizona, Tucson, AZ (United States); Jensen, Siri Beier [Department of Oral Medicine, Institute of Odontology, Faculty of Health Sciences, University of Copenhagen, Copenhagen (Denmark); Fox, Philip C. [PC Fox Consulting, Spello (Italy); Elting, Linda S. [Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Langendijk, Johannes A. [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Coppes, Robert P. [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Department of Cell Biology, Section of Radiation and Stress Biology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Reyland, Mary E., E-mail: Mary.Reyland@UCDenver.ed [Department of Craniofacial Biology, University of Colorado Denver, Aurora, CO (United States)

2010-11-15

16

Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer  

Microsoft Academic Search

Purpose: To assess long-term xerostomia in patients receiving parotid-sparing radiation therapy (RT) for head-and-neck cancer, and to find the patient and therapy-related factors that affect its severity.Patients and Methods: From March 1994 through January 2000, 84 patients received comprehensive bilateral neck RT using conformal and multisegmental intensity-modulated RT (IMRT) aiming to spare the major salivary glands. Before RT and periodically

Avraham Eisbruch; Hyungjin M Kim; Jeffrey E Terrell; Lon H Marsh; Laura A Dawson; Jonathan A Ship

2001-01-01

17

Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life  

PubMed Central

Background and purpose To assess the impact of intensity modulated radiotherapy (IMRT) versus conventional radiation on late xerostomia and Quality of Life aspects in head and neck cancer patients. Patients and nethods Questionnaires on xerostomia in rest and during meals were sent to all patients treated between January 1999 and December 2003 with a T1-4, N0-2 M0 head and neck cancer, with parotid gland sparing IMRT or conventional bilateral neck irradiation to a dose of at least 60 Gy, who were progression free and had no disseminated disease (n = 192). Overall response was 85% (n = 163); 97% in the IMRT group (n = 75) and 77% in the control group (n = 88) the median follow-up was 2.6 years. The prevalence of complaints was compared between the two groups, correcting for all relevant factors at multivariate ordinal regression analysis. Results Patients treated with IMRT reported significantly less difficulty transporting and swallowing their food and needed less water for a dry mouth during day, night and meals. They also experienced fewer problems with speech and eating in public. Laryngeal cancer patients in general had fewer complaints than oropharynx cancer patients but both groups benefited from IMRT. Within the IMRT group the xerostomia scores were better for those patients with a mean parotid dose to the "spared" parotid below 26 Gy. Conclusion Parotid gland sparing IMRT for head and neck cancer patients improves xerostomia related quality of life compared to conventional radiation both in rest and during meals. Laryngeal cancer patients had fewer complaints but benefited equally compared to oropharyngeal cancer patients from IMRT.

van Rij, CM; Oughlane-Heemsbergen, WD; Ackerstaff, AH; Lamers, EA; Balm, AJM; Rasch, CRN

2008-01-01

18

Influence of parotid-sparing radiotherapy on xerostomia in head and neck cancer patients.  

PubMed

Radiotherapy (RT) for head and neck cancers causes permanent salivary gland dysfunction (SGD) and xerostomia. We have previously demonstrated the effectiveness of parotid-sparing RT on salivary function. The aim of this was to characterize the relationship between radiation dosages to parotid glands, SGD, xerostomia, and impaired quality of life (QOL). Ninety-three patients received unilateral (n=38) and bilateral (n=44) neck RT with parotid-sparing techniques, or standard three-field technique RT (n=11). Unstimulated and stimulated parotid saliva was collected pre-RT and 1 year post-RT. Assessment of QOL and xerostomia was conducted with three questionnaires. The results demonstrated that reduced radiation dosages to parotid glands were strongly associated with percentage of baseline parotid flow rates measured at 1 year post-RT. Unilateral and bilateral neck RT with parotid-sparing techniques were successful in preserving salivary output, compared to standard three beam RT techniques. Lower radiation dose to contralateral parotid glands was associated with greater percentage of baseline salivary flow rates at 1 year post-RT, fewer xerostomic complaints, and an enhanced QOL. PMID:12893079

Malouf, J Gabriel; Aragon, Cecilia; Henson, Brad S; Eisbruch, Avraham; Ship, Jonathan A

2003-01-01

19

Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review  

Microsoft Academic Search

BackgroundIrradiation-induced xerostomia seriously reduces quality of life for patients with head and neck cancer (HNC). Anecdotal evidence suggests that acupuncture may be beneficial.ObjectiveTo systematically review evidence on clinical effectiveness and safety of acupuncture in irradiation-induced xerostomia in patients with HNC.MethodsA detailed search was performed to identify randomised controlled trials (RCTs) and systematic reviews of RCTs on acupuncture in irradiation-induced xerostomia,

E M OSullivan; I J Higginson

2010-01-01

20

Toward mucoadhesive hydrogel formulations for the management of xerostomia: The physicochemical, Biological, and Pharmacological Considerations.  

PubMed

Although hydrogel formulations that may be applied to many mucosal surfaces are now readily accessible, little research effort has been concentrated on the development of systems that may be usefully employed for the prolonged hydration of the oral cavity. To this end, and set within the context of oral care in general, this review considers the requirements for the design of hydrogel formulations with an affinity for buccal cells and details methods for evaluating the performance of these formulations as treatments for the management of xerostomia. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 101A: 3327-3338, 2013. PMID:23529996

Tsibouklis, John; Middleton, Andrew M; Patel, Nisha; Pratten, Jonathan

2013-03-25

21

Reducing Xerostomia After Chemo-IMRT for Head-and-Neck Cancer: Beyond Sparing the Parotid Glands  

SciTech Connect

Purpose: To assess whether, in addition to sparing the parotid glands (PGs), xerostomia after chemotherapy plus intensity-modulated radiotherapy (chemo-IMRT) for head-and-neck cancer is affected by reducing the dose to the other salivary glands. Patients and Methods: In a prospective study, 78 patients with Stage III-IV oropharynx/nasopharynx cancer underwent chemo-IMRT, with the aim of sparing the parts of the bilateral PGs, oral cavity (OC) containing the minor salivary glands, and contralateral submandibular gland (SMG) outside the target (when contralateral level I was not a target). Before therapy and periodically for 24 months, validated patient-reported xerostomia questionnaire (XQ) scores and observer-graded xerostomia scores were recorded. Also, the stimulated and unstimulated saliva was measured selectively from each of the PGs and SMGs. The mean OC doses served as surrogates of minor salivary gland dysfunction. Regression models assessed the XQ and observer-graded xerostomia predictors. Results: Statistically significant predictors of the XQ score on univariate analysis included the OC, PG, and SMG mean doses and the baseline XQ score, time since RT, and both stimulated and unstimulated PG saliva flow rates. Similar factors were statistically significant predictors of observer-graded xerostomia. The OC, PG, and SMG mean doses were moderately intercorrelated (r = 0.47-0.55). On multivariate analyses, after adjusting for the PG and SMG doses, the OC mean dose (p < .0001), interval from RT (p < .0001), and stimulated PG saliva (p < .0025) were significant predictors of the XQ scores and the OC mean dose and time for observer-graded xerostomia. Although scatter plots showed no thresholds, an OC mean dose of <40 Gy and contralateral SMG mean dose of <50 Gy were each associated with low patient-reported and observer-rated xerostomia at almost all post-therapy points. Conclusion: The PG, SMG, and OC mean doses were significant predictors of both patient-reported and observer-rated xerostomia after chemo-IMRT, with OC doses remaining significant after adjusting for the PG and SMG doses. These results support efforts to spare all the salivary glands by IMRT, beyond the PGs alone.

Little, Michael [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Schipper, Matthew [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Cancer Center Biostatistics Core, University of Michigan, Ann Arbor, MI (United States); Feng, Felix Y.; Vineberg, Karen [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Cornwall, Craig; Murdoch-Kinch, Carol-Anne [Hospital Dentistry, University of Michigan, Ann Arbor, MI (United States); Eisbruch, Avraham, E-mail: eisbruch@umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)

2012-07-01

22

Grading xerostomia by physicians or by patients after intensity-modulated radiotherapy of head-and-neck cancer  

SciTech Connect

Purpose: To assess observer-based vs. patient self-reported scoring of xerostomia after intensity-modulated radiotherapy (IMRT) of head-and-neck (HN) cancer. Methods: A total of 38 patients who had received IMRT for HN cancer underwent xerostomia evaluations 6 to 24 months after completion of therapy using three methods each time: (1) Grading by 3 observers according to the Radiotherapy Oncology Group/European Organization for Research and Therapy of Cancer (RTOG/EORTC) system; (2) patient self-reported validated xerostomia questionnaire (XQ); and (3) major salivary gland flow measurements. Results: The interobserver agreement regarding the RTOG/EORTC grades was moderate: {kappa}-coefficient 0.54 (95% CI = 0.31-0.76). The correlations between the average RTOG/EORTC grades and the salivary flow rates were not statistically significant. A trend for significant correlation was observed between these grades and the percent (relative to the pretherapy) nonstimulated salivary flow rates (p = 0.07), but not with the percent stimulated flow rates. Better correlations were found between grading made more than the median time (15 min) after the last liquid sipping and the nonstimulated (but not the stimulated) flows compared with grading made shortly after sipping. In contrast, significant correlations were found between the XQ scores and the nonstimulated (p < 0.005) and the stimulated (p < 0.005) salivary flow rates, as well as with the percentages of the corresponding pretherapy values (p = 0.002 and 0.038, respectively). No significant correlation was found between the RTOG/EORTC grades and the XQ scores. The observer-based grades underestimated the severity of xerostomia compared with the patient self-reported scores. Conclusions: Patient self-reported, rather than physician-assessed scores, should be the main end points in evaluating xerostomia.

Meirovitz, Amichay [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Murdoch-Kinch, Carol Anne [School of Dentistry, University of Michigan, Ann Arbor, MI (United States); Schipper, Mathew [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Department of Biostatistics, University of Michigan, Ann Arbor, MI (United States); Pan, Charlie [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Eisbruch, Avraham [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)]. E-mail: eisbruch@umich.edu

2006-10-01

23

3D MR Sialography as a Tool to Investigate Radiation-Induced Xerostomia: Feasibility Study  

SciTech Connect

Purpose: To evaluate whether magnetic-resonance (MR) sialography can be used to investigate radiation-induced xerostomia. Preradiotherapy (pre-RT) and postradiotherapy (post-RT) MR sialographic images of the major salivary ducts (parotid and submandibular) were compared. Methods and Materials: Magnetic-resonance sialography was performed pre-RT, and 6 weeks and 6 months post-RT on 9 patients with T1-4N0-2M0 naso- or oropharyngeal tumors, on a 1.5-T MR scanner. Patients were positioned in the scanner, using a radiotherapy immobilization mask. Image registration of the MR sialograms pre- and post-RT with each other and with the CT and consequently the dose distribution was performed. A categorical scoring system was used to compare the visibility of ducts pre-RT and post-RT. Results: Good-quality MR sialographic images were obtained, and image registration was successful in all cases. The visibility score of the parotid ducts and submandibular ducts was reduced at 6 weeks post-RT, which means that the full trajectory of the salivary ducts, from the intraglandular space to the mouth cavity, was only partially visualized. For some of the parotid ducts, the visibility score improved at 6 months post-RT, but not for the submandibular ducts. The mean dose for the parotid glands was 35 Gy (1 standard deviation [SD] 3 Gy), and for the submandibular glands it was 62 Gy (SD, 8 Gy). Conclusion: Three-dimensional MR sialography is a promising approach for investigating xerostomia, because radiation-induced changes to the saliva content of the ducts can be visualized.

Astreinidou, Eleftheria [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands)]. E-mail: E.Astreinidou@umcutrecht.nl; Roesink, Judith M. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Raaijmakers, Cornelis P.J. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Bartels, Lambertus W. [Image Sciences Institute, Department of Radiology, University Medical Center Utrecht, Utrecht (Netherlands); Witkamp, Theo D. [Image Sciences Institute, Department of Radiology, University Medical Center Utrecht, Utrecht (Netherlands); Lagendijk, Jan J.W. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Terhaard, Chris H.J. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands)

2007-08-01

24

Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma  

PubMed Central

Background Xerostomia (dry mouth) after head/neck radiation is a common problem among cancer patients and available treatments are of little benefit. The objective of this trial was to determine if acupuncture can prevent xerostomia among head/neck patients undergoing radiotherapy. Methods A randomized, controlled trial among patients with nasopharyngeal carcinoma was conducted comparing acupuncture to standard care. Participants were treated at Fudan University Shanghai Cancer Center, Shanghai, China. Forty patients were randomized to acupuncture treatment and 46 to standard care. Patients were treated 3 times/week on the same days they received radiotherapy. Subjective measures included the Xerostomia Questionnaire (XQ) and MD Anderson Symptom Inventory for Head/Neck (MDASI-HN). Objective measures were unstimulated and stimulated whole salivary flow rates (UWSFR; SSFR). Patients were followed for 6 months after the end of radiotherapy. Results XQ scores for acupuncture were statistically significantly lower than controls starting in week 3 through the 6-months(P=0.003 at week3, all other P’s < 0.0001), with clinically significant differences as follows: week 11- RR 0.63 [95% CI, 0.45, 0.87]; 6 months - RR 0.38 [95% CI, 0.19, 0.76]. Similar findings were seen for MDASI-HN scores. Group differences emerged as early as 3 weeks into treatment for saliva (UWSFR, P = 0.0004), with greater saliva flow in the acupuncture group at week 7 (UWSFR, P < 0.0001; SSFR, P = 0.002) and 11 (UWSFR, P < 0.02; SSFR, P < 0.03) and at 6 months (SSFR, P < 0.003). Conclusions Acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved QOL.

Meng, Zhiqiang; Garcia, M. Kay; Hu, Chaosu; Chiang, Joseph; Chambers, Mark; Rosenthal, David I.; Peng, Huiting; Zhang, Ying; Zhao, Qi; Zhao, Genming; Liu, Luming; Spelman, Amy; Palmer, J. Lynn; Wei, Qi; Cohen, Lorenzo

2011-01-01

25

Lyman–Kutcher–Burman NTCP model parameters for radiation pneumonitis and xerostomia based on combined analysis of published clinical data  

Microsoft Academic Search

Knowledge of accurate parameter estimates is essential for incorporating normal tissue complication probability (NTCP) models into biologically based treatment planning. The purpose of this work is to derive parameter estimates for the Lyman–Kutcher–Burman (LKB) NTCP model using a combined analysis of multi-institutional toxicity data for the lung (radiation pneumonitis) and parotid gland (xerostomia). A series of published clinical datasets describing

V A Semenenko; X A Li

2008-01-01

26

Concise review: Adult salivary gland stem cells and a potential therapy for xerostomia.  

PubMed

The ability to speak, swallow, masticate, taste food, and maintain a healthy oral cavity is heavily reliant on the presence of saliva, the hugely important effect of which on our everyday lives is often unappreciated. Hyposalivation, frequently experienced by people receiving radiation therapy for head and neck cancers, results in a plethora of symptoms whose combined effect can drastically reduce quality of life. Although artificial lubricants and drugs stimulating residual function are available to ameliorate the consequences of hyposalivation, their effects are at best transient. Such management techniques do not address the source of the problem: a lack of functional saliva-producing acinar cells, resulting from radiation-induced stem cell sterilization. Post-radiotherapy stimulation of cell proliferation only results in improved saliva secretion when part of the tissue has been spared or when the dose to the salivary gland (SG) remains below a certain level. Therefore, stem cell replacement therapy may be a good option to treat radiation-induced hyposalivation. Substantial progress has been made lately in the understanding of cell turnover in the SG, and the recent identification of stem and progenitor cell populations in the SG provides a basis for studies toward development of a stem cell-based therapy for xerostomia. Here, we review the current state of knowledge of SG stem cells and their potential for use in a cell-based therapy that may provide a more durable cure for hyposalivation. PMID:23335219

Pringle, Sarah; Van Os, Ronald; Coppes, Robert P

2013-04-01

27

Lecithin-based emulsions for potential use as saliva substitutes in patients with xerostomia - viscoelastic properties.  

PubMed

The purpose of the present study was to investigate lecithin-rice bran oil rheological properties with the view to consider these as potential saliva substitutes in patients with severe xerostomia and salivary hypofunction. Pseudo-ternary phase diagrams of rice bran oil, lecithin and water mixtures were constructed and characterised using polarising light microscopy. Viscoelastic properties, which we hypothesise are important determinants in product performance, were analysed using both flow and oscillatory rheology. Rheological properties were influenced by composition, frequency and shear stress. Frequency-dependent viscoelasticity was observed in some formulations where viscosity dominated (tan?>1) at frequencies under 5Hz and elasticity dominated (tan?<1) at higher frequencies. Threshold frequencies were determined for each formulation, where a peak in loss tangent was observed, coinciding with a reduction in the storage modulus and increase in loss modulus. The frequency-dependent behaviour of emulsions are of interest because these combinations exhibit viscous behaviour at low frequencies, which may improve lubrication of the oral cavity at rest, whereas increased elasticity at higher frequencies may improve retention during higher-shear tasks such as swallowing and speaking. PMID:23965434

Hanning, Sara M; Yu, Tao; Jones, David S; Andrews, Gavin P; Kieser, Jules A; Medlicott, Natalie J

2013-08-18

28

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact  

Microsoft Academic Search

Purpose  This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction\\u000a and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The electronic databases of MEDLINE\\/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development\\u000a Consensus Conference on the Oral Complications of Cancer

S. B. Jensen; A. M. L. Pedersen; A. Vissink; E. Andersen; C. G. Brown; A. N. Davies; J. Dutilh; J. S. Fulton; L. Jankovic; N. N. F. Lopes; A. L. S. Mello; L. V. Muniz; C. A. Murdoch-Kinch; R. G. Nair; J. J. Napeñas; A. Nogueira-Rodrigues; D. Saunders; B. Stirling; I. von Bültzingslöwen; D. S. Weikel; L. S. Elting; F. K. L. Spijkervet; M. T. Brennan

2010-01-01

29

Ipsilateral irradiation for well lateralized carcinomas of the oral cavity and oropharynx: results on tumor control and xerostomia  

PubMed Central

Background In head and neck cancer, bilateral neck irradiation is the standard approach for many tumor locations and stages. Increasing knowledge on the pattern of nodal invasion leads to more precise targeting and normal tissue sparing. The aim of the present study was to evaluate the morbidity and tumor control for patients with well lateralized squamous cell carcinomas of the oral cavity and oropharynx treated with ipsilateral radiotherapy. Methods Twenty consecutive patients with lateralized carcinomas of the oral cavity and oropharynx were treated with a prospective management approach using ipsilateral irradiation between 2000 and 2007. This included 8 radical oropharyngeal and 12 postoperative oral cavity carcinomas, with Stage T1-T2, N0-N2b disease. The actuarial freedom from contralateral nodal recurrence was determined. Late xerostomia was evaluated using the European Organization for Research and Treatment of Cancer QLQ-H&N35 questionnaire and the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 3. Results At a median follow-up of 58 months, five-year overall survival and loco-regional control rates were 82.5% and 100%, respectively. No local or contralateral nodal recurrences were observed. Mean dose to the contralateral parotid gland was 4.72 Gy and to the contralateral submandibular gland was 15.30 Gy. Mean score for dry mouth was 28.1 on the 0-100 QLQ-H&N35 scale. According to CTCAE v3 scale, 87.5% of patients had grade 0-1 and 12.5% grade 2 subjective xerostomia. The unstimulated salivary flow was > 0.2 ml/min in 81.2% of patients and 0.1-0.2 ml/min in 19%. None of the patients showed grade 3 xerostomia. Conclusion In selected patients with early and moderate stages, well lateralized oral and oropharyngeal carcinomas, ipsilateral irradiation treatment of the primary site and ipsilateral neck spares salivary gland function without compromising loco-regional control.

Cerezo, Laura; Martin, Margarita; Lopez, Mario; Marin, Alicia; Gomez, Alberto

2009-01-01

30

A Novel Dose Constraint to Reduce Xerostomia in Head-and-Neck Cancer Patients Treated With Intensity-Modulated Radiotherapy  

SciTech Connect

Purpose: To investigate the predictors of incidence and duration of xerostomia (XT) based on parotid glands (PG), submandibular glands (SMG), and both glands taken as a whole organ (TG) in head-and-neck cancer patients treated with intensity-modulated radiotherapy. Methods and Materials: A prospective study was initiated in May 2003. Sixty-three head-and-neck patients (44 with nasopharynx cancer) were included in the analysis. Using the dose-volume histogram the PG, SMG, and TG mean doses were calculated. Unstimulated and stimulated salivary flow were measured and XT-related questionnaires were compiled before and at 3, 6, 12, 18, and 24 months after radiotherapy. Salivary gland toxicity was evaluated using the Radiation Therapy Oncology Group scale, and Grade >=3 toxicity was used as the endpoint. The XT incidence was investigated according to descriptive statistics and univariate and multivariate analysis. The Bonferroni method was used for multiple comparison adjustment. Results: After a reduced flow at 3 months after radiotherapy, recovery of salivary flow was observed over time. Primary site and salivary gland mean doses and volumes were identified in univariate analysis as prognostic factors. Multivariate analysis confirmed that TG mean dose (p = 0.00066) and pretreatment stimulated salivary flow (p = 0.00420) are independent factors for predicting XT. Conclusion: The TG mean dose correlates with XT as assessed by Radiation Therapy Oncology Group criteria, salivary output, and XT-related questionnaires. Our results suggest that TG mean dose is a candidate dose constraint for reducing XT, requiring considerably more validation in non-nasopharyngeal cancer patients.

Strigari, Lidia, E-mail: strigari@ifo.i [Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome (Italy); Benassi, Marcello; Arcangeli, Giorgio; Bruzzaniti, Vicente [Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome (Italy); Giovinazzo, Giuseppe; Marucci, Laura [Department of Radiotherapy, Regina Elena National Cancer Institute, Rome (Italy)

2010-05-01

31

Testing relationships between clinical and non-clinical variables in xerostomia: A structural equation model of oral health-related quality of life  

Microsoft Academic Search

Objectives  The aim of the study was to systematically test Wilson and Cleary’s [Wilson IB, Cleary PD. JAMA 1995; 273: 59–65] conceptual\\u000a model of the direct and mediated pathways between clinical and non-clinical variables in relation to the oral health-related\\u000a quality of life (OHRQoL) of patients with xerostomia.\\u000a \\u000a \\u000a \\u000a Methods  We collected measures of clinical variables, self-reported symptoms, OHRQoL, global oral health perceptions

Sarah R. Baker; Caroline L. Pankhurst; Peter G. Robinson

2007-01-01

32

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life  

Microsoft Academic Search

Purpose  This systematic review aimed to assess the literature for prevalence, severity, and impact on quality of life of salivary\\u000a gland hypofunction and xerostomia induced by cancer therapies.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The electronic databases of MEDLINE\\/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development\\u000a Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. Two independent

S. B. Jensen; A. M. L. Pedersen; A. Vissink; E. Andersen; C. G. Brown; A. N. Davies; J. Dutilh; J. S. Fulton; L. Jankovic; N. N. F. Lopes; A. L. S. Mello; L. V. Muniz; C. A. Murdoch-Kinch; R. G. Nair; J. J. Napeñas; A. Nogueira-Rodrigues; D. Saunders; B. Stirling; I. von Bültzingslöwen; D. S. Weikel; L. S. Elting; F. K. L. Spijkervet; M. T. Brennan

2010-01-01

33

Acupuncture for pilocarpine-resistant xerostomia following radiotherapy for head and neck malignancies 1 1 The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government  

Microsoft Academic Search

Objective: Xerostomia is a frequent and potentially debilitating toxicity of radiotherapy (XRT) for cancers of the head and neck. This report describes the use of acupuncture as palliation for such patients.Methods and Materials: Eighteen patients with xerostomia refractory to pilocarpine therapy after XRT for head and neck malignancy were offered acupuncture as palliation. All patients are without evidence of cancer

Peter A. S Johnstone; Y. Peter Peng; Byron C May; Warren S Inouye; Richard C Niemtzow

2001-01-01

34

Reducing the Risk of Xerostomia and Mandibular Osteoradionecrosis: The Potential Benefits of Intensity Modulated Radiotherapy in Advanced Oral Cavity Carcinoma  

SciTech Connect

Radiation therapy for squamous cell carcinoma of the oral cavity may be curative, but carries a risk of permanent damage to bone, salivary glands, and other soft tissues. We studied the potential of intensity modulated radiotherapy (IMRT) to improve target volume coverage, and normal tissue sparing for advanced oral cavity carcinoma (OCC). Six patients with advanced OCC requiring bilateral irradiation to the oral cavity and neck were studied. Standard 3D conformal radiotherapy (3DCRT) and inverse-planned IMRT dose distributions were compared by using dose-volume histograms. Doses to organs at risk, including spinal cord, parotid glands, and mandible, were assessed as surrogates of radiation toxicity. PTV1 mean dose was 60.8 {+-} 0.8 Gy for 3DCRT and 59.8 {+-} 0.1 Gy for IMRT (p = 0.04). PTV1 dose range was 24.7 {+-} 6 Gy for 3DCRT and 15.3 {+-} 4 Gy for IMRT (p = 0.001). PTV2 mean dose was 54.5 {+-} 0.8 Gy for 3DCRT and for IMRT was 54.2 {+-} 0.2 Gy (p = 0.34). PTV2 dose range was improved by IMRT (7.8 {+-} 3.2 Gy vs. 30.7 {+-} 12.8 Gy, p = 0.006). Homogeneity index (HI) values for PTV2 were closer to unity using IMRT (p = 0.0003). Mean parotid doses were 25.6 {+-} 2.7 Gy for IMRT and 42.0 {+-} 8.8 Gy with 3DCRT (p = 0.002). The parotid V30 in all IMRT plans was <45%. The mandible V50, V55, and V60 were significantly lower for the IMRT plans. Maximum spinal cord and brain stem doses were similar for the 2 techniques. IMRT provided superior target volume dose homogeneity and sparing of organs at risk. The magnitude of reductions in dose to the salivary glands and mandible are likely to translate into reduced incidence of xerostomia and osteoradionecrosis for patients with OCC.

Ahmed, Merina [Department of Radiotherapy, Royal Marsden Hospital, Sutton (United Kingdom); Hansen, Vibeke N. [Department of Physics, Royal Marsden Hospital, Sutton (United Kingdom); Harrington, Kevin J. [Department of Radiotherapy, Royal Marsden Hospital, Sutton (United Kingdom); Institute of Cancer Research, London (United Kingdom); Nutting, Christopher M. [Department of Radiotherapy, Royal Marsden Hospital, Sutton (United Kingdom)], E-mail: Chris.Nutting@rmh.nhs.uk

2009-10-01

35

Development of NTCP models for head and neck cancer patients treated with three-dimensional conformal radiotherapy for xerostomia and sticky saliva: The role of dosimetric and clinical factors  

Microsoft Academic Search

PurposeThe purpose of this multicentre prospective study was to investigate the significance of the radiation dose in the major and minor salivary glands, and other pre-treatment and treatment factors, with regard to the development of patient-rated xerostomia and sticky saliva among head and neck cancer (HNC) patients treated with primary (chemo-) radiotherapy ((CH)RT).

Ivo Beetz; Cornelis Schilstra; Fred R. Burlage; Phil W. Koken; Patricia Doornaert; Henk P. Bijl; Olga Chouvalova; C. René Leemans; Geertruida H. de Bock; Miranda E. M. C. Christianen; Bernard F. A. M. van der Laan; Arjan Vissink; Roel J. H. M. Steenbakkers; Johannes A. Langendijk

36

Influence of intravenous amifostine on xerostomia, tumor control, and survival after radiotherapy for head-and- neck cancer: 2-year follow-up of a prospective, randomized, phase III trial  

SciTech Connect

Purpose: To evaluate chronic xerostomia and tumor control 18 and 24 months after initial treatment with amifostine in a randomized controlled trial of patients with head-and-neck cancer; at 12 months after radiotherapy (RT), amifostine had been shown to reduce xerostomia without changing tumor control. Methods and Materials: Adults with head-and-neck cancer who underwent once-daily RT for 5-7 weeks (total dose, 50-70 Gy) received either open-label amifostine (200 mg/m{sup 2} i.v.) 15-30 min before each fraction of radiation (n = 150) or RT alone (control; n = 153). Results: Amifostine administration was associated with a reduced incidence of Grade {>=}2 xerostomia over 2 years of follow-up (p = 0.002), an increase in the proportion of patients with meaningful (>0.1 g) unstimulated saliva production at 24 months (p = 0.011), and reduced mouth dryness scores on a patient benefit questionnaire at 24 months (p < 0.001). Locoregional control rate, progression-free survival, and overall survival were not significantly different between the amifostine group and the control group. Conclusions: Amifostine administration during head-and-neck RT reduces the severity and duration of xerostomia 2 years after treatment and does not seem to compromise locoregional control rates, progression-free survival, or overall survival.

Wasserman, Todd H. [Department of Radiation Oncology, Washington University, St. Louis, MO (United States)]. E-mail: twasserman@bellsouth.net; Brizel, David M. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Henke, Michael [Clinic of Radiation Oncology, University of Freiburg, Freiburg (Germany); Monnier, Alain [Medical Oncology and Radiotherapy at the Centre Hospitalier Andre-Boulloche, Montbeliard (France); Eschwege, Francois [Department of Radiotherapy, Institute Gustave-Roussy, Villejuif Cedex (France); Sauer, Rolf [Department of Radiation Oncology, University of Erlangen, Erlangen (Germany); Strnad, Vratislav [Department of Radiation Oncology, University of Erlangen, Erlangen (Germany)

2005-11-15

37

Phase II Results of RTOG 0537: A Phase II/III Study Comparing Acupuncture-like Transcutaneous Electrical Nerve Stimulation Versus Pilocarpine in Treating Early Radiation-Induced Xerostomia  

PubMed Central

Purpose This phase II component of a multi-institutional phase II/III randomized trial assessed the feasibility and preliminary efficacy of acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) in reducing radiation-induced xerostomia. Methods Head and neck cancer patients who were 3–24 months from completing radiotherapy ± chemotherapy (RT±C) and experiencing xerostomia symptoms with basal whole saliva production ?0.1 ml/min and without recurrence were eligible. Patients received twice weekly ALTENS sessions (24 over 12 weeks) using a Codetron™ unit. The primary objective assessed the feasibility of ALTENS treatment. A patient was considered compliant if 19/24 ALTENS were delivered, with a targeted 85% compliance rate. Secondary objectives measured treatment-related toxicities and ALTENS effect on overall radiation-induced xerostomia burden using the University of Michigan Xerostomia-Related Quality of Life Scale (XeQOLS). Results Of 48 accrued patients, 47 were evaluable. Median age was 60 years; 84% were male, 70% completed RT±C for > 12 months and 21% had received prior pilocarpine. All ALTENS sessions were completed in 34 patients, but 9 and 1 completed 20–23 and 19 sessions respectively, representing a 94% total compliance rate. 6-month XeQOLS scores were available for 35 patients; 30 (86%) achieved a positive treatment response with a mean reduction of 35.9% (SD 36.1). Five patients developed grade 1–2 gastrointestinal toxicity and one had grade 1 pain event. Conclusions ALTENS treatment for radiation-induced xerostomia can be uniformly delivered in a cooperative multicenter setting and has possible beneficial treatment response. Given these results, the phase III component of this study was initiated.

Wong, Raimond K. W.; James, Jennifer L.; Sagar, Stephen; Wyatt, Gwen; Nguyen-Tan, Phuc Felix; Singh, Anurag K.; Lukaszczyk, Barbara; Cardinale, Francis; Yeh, Alexander M.; Berk, Lawrence

2011-01-01

38

Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: Initial report on a randomized controlled clinical trial  

SciTech Connect

Purpose: To compare directly the effect of intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) on salivary flow and quality of life (QoL) in patients with early-stage nasopharyngeal carcinoma (NPC). Methods and Materials: Fifty-one patients with T2, N0/N1, M0 NPC took part in a randomized controlled clinical study and received IMRT or CRT. Stimulated whole (SWS) and parotid (SPS) saliva flow were measured and Medical Outcomes Short Form 36 (SF-36), European Organization for Research and Treatment of Cancer (EORTC) core quetionnaire, and EORTC head-and-neck module (QLQ-H and N35) were completed at baseline and 2, 6, and 12 months after radiotherapy. Results: Forty-six patients (88%) were in disease remission 12 months after radiotherapy. At 12 months postradiotherapy, 12 (50.0%) and 20 patients (83.3%) in the IMRT group had recovered at least 25% of preradiotherapy SWS and SPS flow respectively, compared with 1 (4.8%) and 2 patients (9.5%), respectively, in the CRT group. Global health scores showed continuous improvement in QoL after both treatments (p < 0.001). However, after 12 months subscale scores for role-physical, bodily pain, and physical function were significantly higher in the IMRT group, indicating a better condition (p < 0.05). Dry mouth and sticky saliva were problems in both groups 2 months after treatment. In the IMRT group, there was consistent improvement over time with xerostomia-related symptoms significantly less common than in the CRT group at 12 months postradiotherapy. Conclusions: IMRT was significantly better than CRT in terms of parotid sparing and improved QoL for early-stage disease. The findings support the case for assessment of health-related QoL in relation to head-and-neck cancer using a site-specific approach.

Pow, Edmond [Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, Hong Kong (China); Kwong, Dora [Department of Clinical Oncology, Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong (China); McMillan, Anne S. [Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, Hong Kong (China)]. E-mail: annemcmillan@hku.hk; Wong, May [Periodontology and Dental Public Health, Faculty of Dentistry, University of Hong Kong, Hong Kong (China); Sham, Jonathan [Department of Clinical Oncology, Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong (China); Leung, Lucullus [Department of Clinical Oncology, Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong (China); Leung, W. Keung [Periodontology and Dental Public Health, Faculty of Dentistry, University of Hong Kong, Hong Kong (China)

2006-11-15

39

The effect of ammonium glycopyrrolate (Robinul®)-induced xerostomia on oral mucosal wetness and flow of gingival crevicular fluid in humans  

Microsoft Academic Search

The antisialogogue, ammonium glycopyrrolate (Robinul®), was used to reduce the salivary flow rate in healthy individuals with normal salivary function to determine whether the dry-mouth symptoms and reduced amounts and patterns of oral mucosal wetness found previously in hyposalivators could be induced by this means. After baseline measurements, the drug was given to 10 healthy volunteers and their resting whole-saliva

M. S Wolff; I Kleinberg

1999-01-01

40

Salivary Glands and the Aging Process: Mechanistic Aspects, Health-Status and Medicinal-Efficacy Monitoring  

Microsoft Academic Search

Xerostomia is a major complaint of many elderly individuals, and although they seek medical help, it usually provides no adequate relief. This complaint is considered a major clinical problem, since not less than 25% to 50%-60% of the population over the age of 65 complain of xerostomia. By definition, Xerostomia is a subjective feeling and in up to one-third of

R. M. Nagler

2004-01-01

41

Determination of Antibody to Streptococcus Mutans from Radiation-Induced Xerostomia Patients. Agglutination Activity Against Cariogenic Microorganisms, Active Immunoglobulin Classes and Post-Irradiation Caries Activity in Cancer Patients.  

National Technical Information Service (NTIS)

The relationship between specific agglutination (Ag) and caries activity during 30 month post radiation was assessed in 36 head and neck cancer patients. Ag titers in 444 saliva and 481 serum samples from these patients and 16 noncancer controls were dete...

L. R. Brown P. A. O'Neill S. Dreizen

1979-01-01

42

Adenoviral delivery of Tousled kinase for the protection of salivary glands against ionizing radiation damage  

Microsoft Academic Search

Oral complications of salivary hypofunction often afflict cancer patients undergoing radiotherapy for head and neck cancers. Dry mouth or xerostomia is an undesirable consequence of radiotherapy that compromises normal oral functions in addition to causing odynophagia and increasing the patient's risk of oral infections and dental caries. Radiation-induced xerostomia is irreversible, and palliative measures to provide symptomatic relief remain the

S Palaniyandi; Y Odaka; W Green; F Abreo; G Caldito; A De Benedetti; G Sunavala-Dossabhoy

2011-01-01

43

Benign parotid swellings: a review.  

PubMed Central

The one common factor associated with the innumerable causes of benign parotid enlargement is xerostomia which influences the quantity and quality of parotid secretion and thus paves the way for duct obstruction and pyogenic infection.

Watt, J

1977-01-01

44

Protective effect of amifostine on dental health after radiotherapy of the head and neck  

Microsoft Academic Search

Purpose: The cytoprotective agent amifostine has been shown to reduce the radiation-induced acute and chronic xerostomia in head and neck cancer patients. The purpose of this study was to evaluate whether or not amifostine also reduces the incidence of dental caries associated with the radiation-induced xerostomia.Methods and Materials: The dental status before and 1 year after radiotherapy was retrospectively compared

Volker Rudat; Jens Meyer; Felix Momm; Martin Bendel; Michael Henke; Vratislav Strnad; Knut Grötz; Andreas Schulte

2000-01-01

45

Chronic sialadenitis in patients with nodal osteoarthritis  

Microsoft Academic Search

SUMMARY Amongst the patients attending our combined oral medicine\\/rheumatology clinic, we have identified a subset presenting with xerostomia due to non-specific sialadenitis, who also suÄer from generalized nodal osteoarthritis (NOA). We have called this combination SOX syndrome: sialadenitis, osteoarthritis and xerostomia. In this study, we have examined the characteristics of these patients clinically and histologically, and then determined the prevalence

D. G. KASSIMOS; P. J. SHIRLAW; E. H. S. CHOY; K. HOCKEY; P. R. MORGAN; S. J. CHALLACOMBE; G. S. PANAYI

1997-01-01

46

Intensity-Modulated Radiotherapy Reduces Radiation-Induced Morbidity and Improves Health-Related Quality of Life: Results of a Nonrandomized Prospective Study Using a Standardized Follow-Up Program  

SciTech Connect

Purpose: The purpose of this study was to compare intensity-modulated radiation therapy (IMRT) and three-dimensional conventional radiotherapy (3D-CRT) with regard to patient-rated xerostomia, Radiation Therapy Oncology Group (RTOG) acute and late xerostomia and health-related quality of life (HRQoL) among patients with head and neck squamous cell carcinoma (HNSCC). Methods and Materials: Included were 241 patients with HNSCC treated with bilateral irradiation {+-} chemotherapy. Since 2000, all patients treated with HNSCC were included in a program, which prospectively assessed acute and late morbidity according to the RTOG and HRQoL on a routine basis at regular intervals. Before October 2004, all patients were treated with 3D-CRT (N = 150). After clinical implementation in October 2004, 91 patients received IMRT. In this study, the differences regarding RTOG toxicity, xerostomia, and other items of HRQoL were analyzed. Results: The use of IMRT resulted in a significant reduction of the mean dose of the parotid glands (27 Gy vs. 43 Gy (p < 0.001). During radiation, Grade 2 RTOG xerostomia was significantly less with IMRT than with 3D-CRT. At 6 months, the prevalence of patient-rated moderate to severe xerostomia and Grade 2 or higher RTOG xerostomia was significantly lower after IMRT versus 3D-CRT. Treatment with IMRT also had a positive effect on several general and head and neck cancer-specific HRQoL dimensions. Conclusions: IMRT results in a significant reduction of patient- and observer-rated xerostomia, as well as other head and neck symptoms, compared with standard 3D-CRT. These differences translate into a significant improvement of the more general dimensions of HRQoL.

Vergeer, Marije R. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)], E-mail: mr.vergeer@vumc.nl; Doornaert, Patricia A.H.; Rietveld, Derek H.F. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Leemans, C. Rene [Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam (Netherlands); Slotman, Ben J. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Langendijk, Johannes A. [Department of Radiation Oncology, University Medical Center Groningen, Groningen (Netherlands)

2009-05-01

47

Monitoring dosimetric impact of weight loss with kilovoltage (KV) cone beam CT (CBCT) during parotid-sparing IMRT and concurrent chemotherapy  

Microsoft Academic Search

PurposeParotid-sparing head and neck IMRT can reduce long term xerostomia. However, patients frequently experience weight loss and tumour shrinkage during treatment. We evaluate the use of kilo-voltage (kV) cone beam CT (CBCT) for dose monitoring and examine if the dosimetric impact of such changes on the parotid and critical neural structures warrants re-planning during treatment.

Kean Fatt Ho; Tom Marchant; Chris Moore; Gareth Webster; Carl Rowbottom; Hazel Penington; Lip Lee; Beng Yap; Andrew Sykes; Nick Slevin

48

A clinical and histopathological study of the oral component in sjögren’s syndrome  

Microsoft Academic Search

Problem: Sjögren’s syndrome (SS) is a chronic autoimmune disease, characterized by a progressive lymphocytic and plasma cell infiltration of the exocrine glands, particularly of the salivary and lacrimal glands. The progression of the disease leads to the decrease of the glandular function and consequently to the development of xerostomia and keratoconjunctivitis sicca. SS may occur alone (primary) or in association

Miriam S. Teixeira; Cleonice H. W. Hirata; Vilma C. C. Filizzola; Luc Louis Maurice Weckx

2004-01-01

49

Boyun Diseksiyonu ve Radyoterapi Sonras› Tükürük Ak›m›nda Meydana  

Microsoft Academic Search

Normal salivary flow is important for maintaining good oral hygiene. Lack of normal flow predisposes to an increased inci- dence of dental caries and symptomatic xerostomia. The sub- mandibular glands are responsible for 70% of resting salivary flow. In our study stimulated and unstimulated salivary flow ra- tes were examined on 23 cases whose submandibular salivary glands were removed unilaterally

Z. Alkan; S. Turgut

2000-01-01

50

Effect of human vasoactive intestinal peptide gene transfer in a murine model of Sjogren's syndrome  

Microsoft Academic Search

Background: Sjogren's syndrome (SS), an autoimmune exocrinopathy mainly affecting lachrymal and salivary glands, results in ocular and oral dryness (keratoconjunctivitis sicca and xerostomia). The aetiology and pathogenesis are largely unknown; currently, only palliative treatment is available. Objective: To determine whether gene transfer of vasoactive intestinal peptide (VIP), based on its immunomodulatory properties, might be useful in the management of SS.

B. M. Lodde; F. Mineshiba; J. Wang; A. P. Cotrim; S. Afione; P. P. Tak; B. J. Baum

2006-01-01

51

Complementary therapies for side effects of chemotherapy and radiotherapy in the upper gastrointestinal system  

Microsoft Academic Search

IntroductionChemotherapy and radiotherapy remain the mainstay of treatment for patients with advanced malignant disease that is incurable by local surgery. However, effective use of these therapies is limited by toxic effects. Serious side effects in the upper GI system include mucositis, xerostomia, nausea and vomiting. Standard care for these side effects is suboptimal. Recent studies suggest complementary and alternative medicine

Elad Schiff; Eran Ben-Arye

2011-01-01

52

Graft-versus-host disease, an eight case report and literature review  

Microsoft Academic Search

Graft versus host disease (GVHD) is a common complication in bone marrow transplant (BMT) patients. It is cha- racterized by systemic and oral cavity alterations. Depending on the timing of lesions, GVHD is classified as acute or chronic. Alterations in the oral cavity are lichenoid reticular lesions, erythema, ulcerations, and xerostomia. Sporadically, mucocele and pyogenic granulomas can be present. Aim:

Ronell Bologna Molina; María Teresa de Jesús; Vega González

2006-01-01

53

Oral manifestations of Sjögren's syndrome.  

PubMed

Sjögren's syndrome is a common autoimmune rheumatic disease. The most common symptoms of Sjögren's syndrome are extreme tiredness, along with dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). Saliva plays an essential role in numerous functions of the mouth. Xerostomia can be caused by medications, chronic diseases like Sjögren's syndrome, and medical treatments, such as radiation therapy and bone marrow transplant. Xerostomia can eventually lead to difficulty in swallowing, severe and progressive tooth decay, or oral infections. Despite having excellent oral hygiene, individuals with Sjögren's syndrome have elevated levels of dental caries, along with the loss of many teeth, early in the disease. Sjögren's syndrome alters the protein profile and brings about a change in the composition of saliva. There is an increase in the levels of lactoferrin, beta(2)-microglobulin, sodium, lysozyme C, and cystatin C, and a decrease in salivary amylase and carbonic anhydrase. Up to 90% of individuals with Sjögren's syndrome have antibodies targeting the Ro 60 and La autoantigens. Natural aging, regardless of Sjögren's syndrome, is also another factor that brings about a significant change in the composition of saliva. The most prevailing cause of xerostomia in elderly persons is the use of anticholinergic medications. Currently, there is no cure for Sjögren's syndrome, and treatment is mainly palliative. PMID:18362310

Mathews, S A; Kurien, B T; Scofield, R H

2008-04-01

54

Dendrobium candidum extract increases the expression of aquaporin-5 in labial glands from patients with Sjögren's syndrome  

Microsoft Academic Search

This study aimed to investigate the mechanism of Dendrobium candidum extract in promoting expression of aquaporin-5 for treatment of Sjögren's syndrome (SS). Sixteen patients with SS suffered from deficient secretion of saliva due to an autoimmune destruction of salivary glands leading to dry mouth symptoms (xerostomia). However, glandular dysfunction also occurred without destruction. Based upon its abnormal distribution in SS

Lin Xiao; Tzi Bun Ng; Yi-Bin Feng; Tong Yao; Jack Ho Wong; Ren-Min Yao; Lei Li; Fei-Zhi Mo; Yin Xiao; Pang-Chui Shaw; Ze-Min Li; Stephen Cho Wing Sze; Kalin Yanbo Zhang

2011-01-01

55

Salivary Gland Sparing and Improved Target Irradiation by Conformal and Intensity Modulated Irradiation of Head and Neck Cancer  

Microsoft Academic Search

The goals of this study were to facilitate sparing of the major salivary glands while adequately treating tumor targets in patients requiring comprehensive bilateral neck irradiation (RT), and to assess the potential for improved xerostomia. Since 1994 techniques of target irradiation and locoregional tumor control with conformal and intensity modulated radiation therapy (IMRT) have been developed. In patients treated with

Avraham Eisbruch; Jonathan A. Ship; Laura A. Dawson; Hyungjin M. Kim; Carol R. Bradford; Jeffrey E. Terrell; Douglas B. Chepeha; Theodore N. Teknos; Norman D. Hogikyan; Yoshimi Anzai; Lon H. Marsh; Randall K. Ten Haken; Gregory T. Wolf

2003-01-01

56

Quality of life after parotid-sparing IMRT for head-and-neck cancer: A prospective longitudinal study  

Microsoft Academic Search

PurposeParotid-sparing intensity-modulated radiotherapy (IMRT) for head-and-neck cancer reduces xerostomia compared with standard RT. To assess potential improvements in broader aspects of quality of life (QOL), we initiated a study of patient-reported QOL and its predictors after IMRT.

Alexander Lin; Hyungjin M Kim; Jeffrey E Terrell; Laura A Dawson; Jonathan A Ship; Avraham Eisbruch

2003-01-01

57

The Flow Rate of Unstimulated Human Labial Gland Saliva  

Microsoft Academic Search

Although the minor salivary glands contribute an important fraction of the resting flow of saliva, which may be particularly relevant in xerostomia, there is currently no precise method of measuring the flow from individual glands or recording the number of active glands in a given area. These experiments were devised to test a photographic method of assaying labial gland saliva

D. B. Ferguson

1996-01-01

58

76 FR 39159 - Schedule for Rating Disabilities; The Digestive System  

Federal Register 2010, 2011, 2012, 2013

...and swelling on eating; one or more salivary...is an autoimmune disorder that causes xerostomia...and swelling on eating; One or more salivary...an autoimmune disorder that also causes...immediately after eating or up to three hours...Gastric emptying disorders (including...

2011-07-05

59

Root bark extracts of Juncus effusus and Paeonia suffruticosa protect salivary gland acinar cells from apoptotic cell death induced by cis-platinum (II) diammine dichloride.  

PubMed

Cis-platinum (II) diammine dichloride (CDDP) is a platinum-based anticancer agent, and is often used for chemotherapy for malignant tumors, albeit CDDP has serious side-effects, including xerostomia (dry mouth). Since patients with xerostomia have reduced quality of life, it is urgent and important to identify nontoxic and natural agents capable of reducing the adverse effect of chemotherapy on salivary gland function. Therefore, we commenced an institutional collaborative project in which candidates of herbal extracts were selected from more than 400 bioactive herbal products for their potential therapeutic effects not only on xerostomia, but also on oral diseases. In the present study, we report on two Chinese medical herbal extracts from the root barks of Juncus effusus and Paeonia suffruticosa. The two extracts showed a protective effect in NS-SV-Ac cells from the cytotoxicity and apoptosis caused by CDDP. The effect was dependent on the p53 pathway, protein kinase B/Akt 1 and mitochondrial apoptosis-related proteins (i.e. Bcl-2 and Bax), but was not dependent on nuclear factor ?B. Notably, the apoptosis-protective effect of the extracts was not observed in adenocystic carcinoma cell lines. Although these extracts have been utilized in traditional Chinese medicine for hundreds of years, there are no reports to our knowledge, on their therapeutic effects on xerostomia. Thus, in the present study, we elucidated the potency of these herbal extracts as novel candidates for xerostomia to improve the quality of life of patients undergoing chemotherapy. PMID:24064583

Mukudai, Yoshiki; Kondo, Seiji; Shiogama, Sunao; Koyama, Tomoyuki; Li, Chunnan; Yazawa, Kazunaga; Shintani, Satoru

2013-09-20

60

Translation, cross-cultural adaptation, and validation of the Mouth Handicap in Systemic Sclerosis questionnaire (MHISS) into the Dutch language.  

PubMed

The Mouth Handicap in Systemic Sclerosis (MHISS) is a French-generic questionnaire evaluating mouth-opening restriction, dryness, and esthetic concerns. The aim of this study was to translate and adapt the MHISS questionnaire into the Dutch language and evaluate its psychometric properties. The MHISS was translated according to international guidelines, field-tested among 16 systemic sclerosis (SSc) patients, and adapted. Subsequently, the Dutch MHISS was administered to 52 SSc patients visiting the outpatient or day patient clinic of a university hospital and readministered after 2 weeks. Internal consistency was tested by computing Cronbach's alpha. Test-retest reliability was determined by computing the intraclass correlation coefficient (ICC) and validity by determining associations with measures of overall functioning (Health Assessment Questionnaire (HAQ)), maximum mouth opening (MMO, in millimeter), subjective xerostomia (visual analog scale), and objective xerostomia (Saxon test). Patients had mean ± standard deviation (SD) age and disease duration of 55?±?21 and 7.2?±?7.3 years. Twenty-seven (52 %) patients had diffuse cutaneous SSc. The mean Dutch MHISS score was 17.5 (SD 10.0) with Cronbach's alpha being 0.862. Dutch MHISS scores differed significantly between patients with high and low disability levels (HAQ, MMO, and subjective and objective xerostomia divided according to the median; paired t test). Spearman rank correlations with HAQ (r?=?0.599, p?=?0.000), MMO (r?=?-0.518, p?=?0.000), and subjective xerostomia (r?=?0.536, p?=?0.000) were moderate; correlation with objective xerostomia did not reach statistical significance. The ICC was 0.94. The Dutch version of the MHISS demonstrated good psychometric properties and is useful in assessing mouth disability in SSc patients. PMID:23881437

Schouffoer, A A; Strijbos, E; Schuerwegh, A J M; Mouthon, L; Vliet Vlieland, T P M

2013-07-24

61

Assessment of post-radiotherapy salivary glands  

PubMed Central

Salivary glands are usually irradiated during radiotherapy for head and neck cancers, which can lead to radiation-induced damage. Radiation-induced xerostomia (oral dryness) is the most common post-radiotherapy complication for head and neck cancer patients and can reduce the patient’s quality of life. Accurate and efficient salivary gland assessment methods provide a better understanding of the cause and degree of xerostomia, and may help in patient management. At present, there are different methods for the assessment of salivary gland hypofunction; however, none of them are considered to be standard procedure. This article reviews the value of common methods in the assessment of post-radiotherapy salivary glands.

Cheng, S C H; Wu, V W C; Kwong, D L W; Ying, M T C

2011-01-01

62

Acupuncture for Dysphagia after Chemoradiation Therapy in Head and Neck Cancer: A Case Series Report*  

PubMed Central

Background Dysphagia is a common side effect following chemoradiation therapy (CRT) in head and neck cancer (HNC) patients. Methods In this retrospective case series, ten HNC patients were treated with acupuncture for radiation-induced dysphagia and xerostomia. All patients were diagnosed with stage III/IV squamous cell carcinoma. Seven of 10 patients were percutaneous endoscopic gastrostomy (PEG) tube-dependent when they began acupuncture. Manual acupuncture and electroacupuncture were used once a week. Results Nine of 10 patients reported various degrees of subjective improvement in swallowing functions, xerostomia, pain and fatigue levels. Six (86%) of 7 PEG tube-dependent patients had their feeding tubes removed after acupuncture, with a median duration of 114 days (range 49–368) post CRT. One typical case is described in detail. Conclusions A relatively short PEG tube duration and reduced symptom severity following CRT were observed in these patients. Formal clinical trials are required to determine the causality of our observations.

Lu, Weidong; Posner, Marshall R.; Wayne, Peter; Rosenthal, David S.; Haddad, Robert I.

2010-01-01

63

Management of dental complications in a child with rhabdomyosarcoma.  

PubMed

Radiotherapy treatment options can cause adverse dental sequelae, including xerostomia, dental radiation caries, abnormal tooth development, and osteoradionecrosis (ORN). Hyperbaric oxygen (HBO) therapy can be used prophylactically or therapeutically to treat or reduce the risk of ORN. The purpose of this paper was to describe a case involving a 5-year-old male with rhabdomyosarcoma of the left temporal fossa and a history of radiation therapy who presented with gross radiation caries and xerostomia. Full-mouth extractions of all primary teeth were performed under general anesthesia, with the patient receiving HBO therapy before and after the surgery. The child was monitored postoperatively, and healing occurred with minimal post-operative complications. Based on his results, it can be concluded that hyperbaric oxygen therapy is an effective supplement to consider when treating children who have undergone radiation therapy and require dental care. PMID:23265172

Jalali, Golnaz; Unkel, John H; Reed, James A

64

Functional salivary gland regeneration by transplantation of a bioengineered organ germ  

PubMed Central

Salivary gland hypofunction, also known as xerostomia, occurs as a result of radiation therapy for head cancer, Sjögren’s syndrome or aging, and can cause a variety of critical oral health issues, including dental decay, bacterial infection, mastication dysfunction, swallowing dysfunction and reduced quality of life. Here we demonstrate the full functional regeneration of a salivary gland that reproduces the morphogenesis induced by reciprocal epithelial and mesenchymal interactions through the orthotopic transplantation of a bioengineered salivary gland germ as a regenerative organ replacement therapy. The bioengineered germ develops into a mature gland through acinar formations with a myoepithelium and innervation. The bioengineered submandibular gland produces saliva in response to the administration of pilocarpine and gustatory stimulation by citrate, protects against oral bacterial infection and restores normal swallowing in a salivary gland-defective mouse model. This study thus provides a proof-of-concept for bioengineered salivary gland regeneration as a potential treatment of xerostomia.

Ogawa, Miho; Oshima, Masamitsu; Imamura, Aya; Sekine, Yurie; Ishida, Kentaro; Yamashita, Kentaro; Nakajima, Kei; Hirayama, Masatoshi; Tachikawa, Tetsuhiko; Tsuji, Takashi

2013-01-01

65

Pilocarpine Disposition and Salivary Flow Responses Following Intravenous Administration to Dogs  

Microsoft Academic Search

Oral doses of pilocarpine increase salivary flow rates in patients afflicted with xerostomia (dry mouth). This study examined the pharmacokinetics of and a pharmacodynamic response (salivation) to intravenous pilocarpine nitrate administration in dogs. Disposition was linear over a dose range of 225–600 µg\\/kg; plasma concentrations were 10–120 µg\\/L. Elimination was rapid and generally biphasic, with a terminal elimination half-life of

Margaret L. Weaver; Jason M. Tanzer; Paul A. Kramer

1992-01-01

66

Effect of botulinum toxin type A injection into human masseter muscle on stimulated parotid saliva flow rate  

Microsoft Academic Search

Botulinum toxin type A (BTX-A) injection into the masseter muscles is used to treat masseteric hypertrophy. No serious side effects of BTX-A have been reported, but patients sometimes complain of xerostomia. The aim of this study was to evaluate the effect of injecting BTX-A into the masseter for the treatment of masseteric hypertrophy on the flow of saliva from the

J. S. Kwon; S. T. Kim; Y. M. Jeon; J. H. Choi

2009-01-01

67

Effects of EGF and bFGF on Irradiated Parotid Glands  

Microsoft Academic Search

Radiotherapy is common treatment for head-and-neck cancer, during which the salivary glands are often included within the radiation field. The most common side effect of this treatment is the development of oral dryness (xerostomia). This study considers the administration of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF or FGF2) at physiological concentrations before and after irradiation in

Taili T. Thula; Gregory Schultz; Roger Tran-Son-Tay; Christopher Batich

2005-01-01

68

The role of oral dryness in interdialytic weight gain by diabetic and non-diabetic haemodialysis patients  

Microsoft Academic Search

Background. Factors influencing the percentage of daily interdialytic weight gain (IDWG%) and their interactions in haemodialysis (HD) patients have not been well-defined, especially in diabetic patients. We analysed contributing factors for the increase of IDWG%, particularly xerostomia (oral dryness), among diabetic and non-diabetic HD patients. Methods. We collected 3 month prospective data in 184 stable HD patients (116 non-diabetic and

Junne-Ming Sung; Shih-Chen Kuo; Shu-Fen Chuang; Szu-Yuan Lee; Jeng-Jong Huang

69

Three-dimensional conformal radiotherapy for locally advanced (Stage II and worse) head-and-neck cancer: Dosimetric and clinical evaluation  

SciTech Connect

Purpose: To evaluate the dosimetric parameters of three-dimensional conformal radiotherapy (3D-CRT) in locally advanced head-and-neck tumors (Stage II and above) and the effects on xerostomia. Methods and Materials: A total of 49 patients with histologically proven squamous cell cancer of the head and neck were consecutively treated with 3D-CRT using a one-point setup technique; 17 had larynx cancer, 12 oropharynx, 12 oral cavity, and 6 nasopharynx cancer; 2 had other sites of cancer. Of the 49 patients, 41 received postoperative RT and 8 definitive treatment. Also, 13 were treated with cisplatin-based chemotherapy before and during RT; in 6 cases, 5-fluorouracil was added. The follow-up time was 484-567 days (median, 530 days). Results: One-point setup can deliver 96% of the prescribed dose to the isocenter, to the whole planning target volume, including all node levels of the neck and without overdosages. The mean dose to the primary planning target volume was 49.54 {+-} 4.82 Gy (51.53 {+-} 5.47 Gy for larynx cases). The average dose to the contralateral parotid gland was approximately 38 Gy (30 Gy for larynx cases). The maximal dose to the spinal cord was 46 Gy. A Grade 0 Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer xerostomia score corresponded to a mean dose of 30 Gy to one parotid gland. A lower xerostomia score with a lower mean parotid dose and longer follow-up seemed to give rise to a sort of functional recovery phenomenon. Conclusion: Three dimensional-CRT in head-and-neck cancers permits good coverage of the planning target volume with about 10-11 segments and one isocenter. With a mean dose of approximately 30 Gy to the contralateral parotid, we observed no or mild xerostomia.

Portaluri, Maurizio [Department of Radiotherapy, AUSL Br-1, 'Di Summa-Perrino' Hospital, Brindisi (Italy) and National Research Council, IFC, Lecce (Italy)]. E-mail: portaluri@hotmail.com; Fucilli, Fulvio I.M. [Department of Medical Physics, AUSL Br-1, 'Di Summa-Perrino' Hospital, Brindisi (Italy); Castagna, Roberta [Department of Radiotherapy, AUSL Br-1, 'Di Summa-Perrino' Hospital, Brindisi (Italy); Bambace, Santa [Department of Radiotherapy, AUSL Br-1, 'Di Summa-Perrino' Hospital, Brindisi (Italy); Pili, Giorgio [Department of Medical Physics, AUSL Br-1, 'Di Summa-Perrino' Hospital, Brindisi (Italy); Tramacere, Francesco [Department of Radiotherapy, AUSL Br-1, 'Di Summa-Perrino' Hospital, Brindisi (Italy); Russo, Donatella [Department of Radiotherapy, AUSL Br-1, 'Di Summa-Perrino' Hospital, Brindisi (Italy); Francavilla, Maria Carmen [Department of Radiotherapy, AUSL Br-1, 'Di Summa-Perrino' Hospital, Brindisi (Italy)

2006-11-15

70

Development of a Visual Analogue Scale questionnaire for subjective assessment of salivary dysfunction  

Microsoft Academic Search

Objective: This study’s objective was to develop a Visual Analogue Scale (VAS) xerostomia questionnaire and to evaluate the validity and reliability for the clinical diagnosis of salivary gland dysfunction. Study Design: Thirty-six healthy adults participated in this double-blind, crossover study. Each subject received an antisialagogue (glycopyrrolate) or placebo. Unstimulated and stimulated parotid and submandibular saliva samples were collected 16 times

Satishchandra Pai; Elisa M. Ghezzi; Jonathan A. Ship

2001-01-01

71

Oral stigmatic lesions of gastroesophageal reflux disease (GERD).  

PubMed

Patients with gastroesophageal reflux may have extra-esophageal manifestations. We report a 46 years old ex-smoker woman presenting with a sensation of burning mouth, xerostomia and glossitis. The patient had a history of heartburn, dysphonia and cough. Mouth examination showed a bad hygiene and abundant accumulation of plaque. Esophageal pH measurement was abnormal. Laryngoscopy showed a posterior laryngeal inflammation and mucous secretion. With these data, a diagnosis of gastroesophageal reflux was reached. PMID:23282706

Petruzzi, Massimo; Lucchese, Alberta; Campus, Guglielmo; Crincoli, Vito; Lauritano, Dorina; Baldoni, Edoardo

2012-07-01

72

Oral manifestations of triple A syndrome.  

PubMed

Triple A (four A; Allgrove syndrome) syndrome is a an autosomal recessive disorder characterized by alacrimia, achalasia, adrenocortical insufficiency, and various neurological abnormalities. We report a case of triple A syndrome in a 14-year-old female patient together with oral manifestations. The importance of this case report is to highlight the necessity of referring the young patients with xerostomia from dental to medical specialists. PMID:12911870

Vucicevic-Boras, V; Juras, D; Gruden-Pokupec, J S; Vidovic, A

2003-07-31

73

Symptom Management in Geriatric Oncology: Practical Treatment Considerations and Current Challenges  

Microsoft Academic Search

Opinion statement  Symptom management of the actively treated elderly cancer patient represents an undertreated and disproportionately understudied\\u000a cohort in oncology. There is a dearth of specific recommendations or guidelines regarding drug selection, dosing, and side\\u000a effects which account for changes in aging physiology, pharmacokinetics, and idiosynchratic reactions. In treating cardinal\\u000a symptoms and clusters of symptoms including pain, constipation, fatigue\\/weakness, nausea\\/vomiting, mucositis\\/xerostomia,

Katharine L. Barford; James T. D’Olimpio

2008-01-01

74

A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results  

Microsoft Academic Search

Objectives: In a prospective clinical study, we tested the hypothesis that sparing the parotid glands may result in significant objective and subjective improvement of xerostomia in patients with head-and-neck cancers. The functional outcome 6 months after the completion of radiation therapy is presented.Methods and Materials: From February 1997 to February 1999, 41 patients with head-and-neck cancers were enrolled in a

K. S. Clifford Chao; Joseph O Deasy; Jerry Markman; Joyce Haynie; Carlos A Perez; James A Purdy; Daniel A Low

2001-01-01

75

Impact of highly active antiretroviral therapy on salivary flow in patients with human-immuno deficiency virus disease in Southern India  

PubMed Central

Aims: To ascertain and compare between highly active antiretroviral therapy (HAART) and non-HAART patients, the stimulated salivary flow rates and unstimulated salivary flow rates (USFR and SSFR) and to correlate the salivary flow rates with immune suppression. Materials and Methods: One hundred human-immuno deficiency virus seropositive patients attending RAGAS-YRG CARE were examined and divided into two groups, a HAART group (patients on combination antiretroviral therapy) comprising 50 patients and a non-HAART group comprising 50 patients. The HAART group was followed every 3 months after the baseline visit (0) for a period of 9 months, during which a clinical oral examination and collection of unstimulated and stimulated saliva was done. Their salivary gland function was assessed using a xerostomia inventory during each visit. The study on non-HAART group was cross-sectional. Statistical Analysis: Statistical analysis were performed with the aid of the Statistical Package for the Social Sciences (SPSS version 10.05) software. Results: There was no significant difference in mean SSFR and USFR between the two groups at baseline. In the HAART group, the mean stimulated salivary flow rate increased from baseline to 3 months (P = 0.02), with the increase being maintained at 6 months and 9 months. When salivary flow rates were correlated with Cluster of Differentiation, CD4 counts, patients in the HAART group with a CD4 ? 200 at 6 months visit had a higher mean stimulated salivary flow rate when compared with patients with CD4 ? 200 (P = 0.02). The xerostomia inventory did not reveal any significant difference between the two groups and HAART was not significantly associated with xerostomia. Conclusion: In our study HAART was neither associated with xerostomia nor a reduction in salivary flow rate and immune suppression was not a significant factor for decreasing the salivary flow rate.

Pavithra, S; Ranganathan, K; Rao, UmaDevi K; Joshua, Elizabeth; Rooban, T; Kumarasamy, N

2013-01-01

76

Burning mouth syndrome and secondary oral burning.  

PubMed

Burning mouth syndrome is a complex disorder of unclear etiology that is most prevalent in perimenopausal women. It is often accompanied by dysguesia and subjective xerostomia. Recent evidence implicates both central and peripheral neuropathies, possibly representing a phantom pain syndrome in some patients. Ensuring that the patient's oral burning is not secondary to some other local or systemic factor is central to appropriate management. Current standard therapies include clonazepam, paroxetine, and cognitive behavioral therapy, and several promising new alternatives are described. PMID:21093630

Minor, Jacob S; Epstein, Joel B

2011-02-01

77

Prostaglandins as biochemical markers of radiation injury to the salivary glands after iodine-131 therapy?  

Microsoft Academic Search

.   Because salivary glands, as well as thyroid tissue, are able to concentrate radioiodine, the treatment of thyroid diseases\\u000a with iodine-131 may have secondary effects on salivary gland function which seriously impair the quality of life. Such effects\\u000a include sialoadenitis and xerostomia. Salivary secretion is stimulated by prosta- glandins (PGs). In this study we evaluate\\u000a whether 131I therapy influences the

Margarida Rodrigues; Ernst Havlik; Bernhard Peskar; Helmut Sinzinger

1998-01-01

78

Oral manifestations associated with HIV infection  

Microsoft Academic Search

Oral lesions are among the early signs of HIV infection and can predict progression to AIDS. The lesions commonly associated\\u000a with the infection include oral candidiasis, herpes simplex infection, oral Kaposi’s sarcoma, oral hairy leukoplakia, parotid\\u000a gland enlargement, gingival diseases, xerostomia, and recurrent oral ulcerations. The introduction of highly active antiretroviral\\u000a therapy has changed the epidemiology of some of the

Mostafa Nokta

2008-01-01

79

Beam intensity modulation using tissue compensators or dynamic multileaf collimation in three-dimensional conformal radiotherapy of primary cancers of the oropharynx and larynx, including the elective neck  

Microsoft Academic Search

Introduction: The treatment of midline tumors in the head and neck by conventional radiotherapy almost invariably results in xerostomia. This study analyzes whether a simple three-dimensional conformal radiotherapy (3D-CRT) technique with beam intensity modulation (BIM) (using a 10-MV beam of the MM50 Racetrack Microtron) can spare parotid and submandibular glands without compromising the dose distribution in the planning target volume

Erik B van Dieren; Peter J. C. M Nowak; Oda B Wijers; John R van Sörnsen de Koste; Henri van der Est; Dirk P Binnekamp; Ben J. M Heijmen; Peter C Levendag

2000-01-01

80

Potential Benefits of Scanned Intensity-Modulated Proton Therapy Versus Advanced Photon Therapy With Regard to Sparing of the Salivary Glands in Oropharyngeal Cancer  

Microsoft Academic Search

Purpose: To test the hypothesis that scanned intensity-modulated proton therapy (IMPT) results in a significant dose reduction to the parotid and submandibular glands as compared with intensity-modulated radiotherapy with photons (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) for oropharyngeal cancer. In addition, we investigated whether the achieved dose reductions would theoretically translate into a reduction of salivary dysfunction and xerostomia. Methods

Tara A. van de Water; Antony J. Lomax; Hendrik P. Bijl; Marije E. de Jong; Cornelis Schilstra; Eugen B. Hug; Johannes A. Langendijk

2011-01-01

81

Chronic sialadenitis in patients with nodal osteoarthritis.  

PubMed

Amongst the patients attending our combined oral medicine/rheumatology clinic, we have identified a subset presenting with xerostomia due to non-specific sialadenitis, who also suffer from generalized nodal osteoarthritis (NOA). We have called this combination SOX syndrome: sialadenitis, osteoarthritis and xerostomia. In this study, we have examined the characteristics of these patients clinically and histologically, and then determined the prevalence of SOX syndrome in patients with NOA compared to healthy age-matched controls. Patients were obtained from rheumatology clinics and a local old people's home. The series consisted of 35 patients with NOA and 18 age- and sex-matched controls without evidence of NOA or inflammatory rheumatic disease. There was no significant difference in age and sex between the two groups. None were on drugs known to induce xerostomia. The subjects were assessed for whole salivary, parotid saliva and lacrimal flow, autoantibodies, rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR). The whole saliva flow (mean +/- 95% CI) was 0.32 +/- 0.07 ml/min for the NOA group and 0.54 +/- 0.17 ml/min for the control group. The difference is statistically significant (P < 0.05, two-tailed Student's t-test). No statistically significant difference was found in the parotid and lacrimal flow rates of NOA and controls. Nine of the 35 NOA patients had reduced whole salivary flow (normal range > 0.02 ml/min) compared with only one out of 18 in the control group (P > 0.05, chi 2 test). All NOA patients with xerostomia and reduced whole salivary flow were RF, anti-Ro and anti-La negative, and had a normal ESR. Thus, 25% of subjects with NOA had clinical and laboratory features of SOX syndrome, suggesting that this is a defined disease entity. PMID:9448593

Kassimos, D G; Shirlaw, P J; Choy, E H; Hockey, K; Morgan, P R; Challacombe, S J; Panayi, G S

1997-12-01

82

Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy  

Microsoft Academic Search

Purpose: Submandibular salivary glands (SMGs) dysfunction contributes to xerostomia after radiotherapy (RT) of head-and-neck (HN) cancer. We assessed SMG dose-response relationships and their implications for sparing these glands by intensity-modulated radiotherapy (IMRT). Methods and Materials: A total of 148 HN cancer patients underwent unstimulated and stimulated SMG salivary flow rate measurements selectively from Wharton's duct orifices, before RT and periodically

Carol-Anne Murdoch-Kinch; Hyugnjin M. Kim; Karen A. Vineberg; Jonathan A. Ship; Avraham Eisbruch

2008-01-01

83

Sicca complex among Egyptian patients with chronic hepatitis C virus infection  

Microsoft Academic Search

The objective of this study was to assess the prevalence of sicca complex (SC) in patients with chronic hepatitis C virus\\u000a (HCV) infection and its association with clinical and laboratory features of liver disease. Subjective and objective criteria\\u000a of xerophthalmia and xerostomia were investigated in 120 HCV Egyptian patients. The lacrimal gland function was assessed by:\\u000a tear film break-up time

Zeinab Nawito; Amr Amin; Sohier Abu El-Fadl; Khaled Abu El Einen

84

Increased serum CA 19-9 antibodies in Sjögren's syndrome  

Microsoft Academic Search

A 67-year-old woman with a history of thyroiditis presented with recent intermittent epigastric pain and nausea. Hyperamylasaemia, oedema of the pancreas, and high serum levels of lipase and CA 19-9 were found. Xerostomia and dry eyes developed later, accompanied by an abnormal Schirmer's test. The diagnosis of Sjögren's syndrome was confirmed by increased anti-Ro and anti-La antibodies and the histological

R. Safadi; M. Ligumsky; E. Goldin; Y. Ilan; Y. S. Haviv; S. Nusair

1998-01-01

85

Sarcoidosis in a patient presenting with clinical and histological features of primary Sj?gren's syndrome.  

PubMed Central

A patient presenting with bilateral enlargement of parotid and lacrimal glands, xerostomia, and keratoconjunctiva sicca, whose labial biopsy specimen showed changes consistent with Sjögren's syndrome, is described. The patient was initially misdiagnosed as having primary Sjögren's syndrome (SS). Subsequent investigations, however, performed to exclude an associated lymphoma or sarcoidosis, showed histological changes of the latter. The possibility that early infiltrates of the salivary glands in sarcoid may mimic those of SS is discussed. Images

Melsom, R D; Speight, P M; Ryan, J; Perry, J D

1988-01-01

86

A phase II study to assess the efficacy of amifostine for submandibular/sublingual salivary sparing during the treatment of head and neck cancer with intensity modulated radiation therapy for parotid salivary sparing.  

PubMed

Intensity modulated radiation therapy (IMRT) allows for relative parotid salivary gland sparing for patients undergoing treatment for head and neck squamous cell cancer, but is less reliable for sparing the submandibular glands. Cytoprotection with amifostine (Ethyol; Medimmune Inc, Gaithersburg, MD) has been shown to decrease rates of acute and late xerostomia in patients undergoing radiation therapy for head and neck squamous cell cancer. The addition of amifostine to IMRT may augment parotid salivary sparing, and add submandibular/sublingual, and minor salivary gland sparing resulting in greater salivary flow rates and a more physiologic saliva. Eligible patients include those slated to receive definitive IMRT for early oropharynx cancer or postoperative RT, both without chemotherapy, for more advanced cancers. These include T1, T2 and favorable T3 (favorable, exophytic), N0-2b (small volume) M0 oropharynx cancers who are to receive bilateral neck RT. Postoperative patients with nodal metastases, T3 and T4 primaries, perineural invasion, and lymphovascular invasion will be eligible. Patients will receive 30 to 33 fractions. Clinical target volume (CTV) 1 will receive 60 to 66 Gy, CTV2 will receive 60 Gy, and CTV3 will receive 54 to 57 Gy. The mean dose goal for the parotid gland is 25 Gy. Patients will receive fixed-dose amifostine 500 mg subcutaneously 30 to 60 minutes before each radiation fraction. Subjective xerostomia questionnaires will be administered. Whole mouth and individual major salivary gland stimulated and unstimulated saliva will be collected before and after therapy at 6 weeks, 6 and 12 months. Xerostomia outcomes will be correlated with salivary dose volume histogram data. Accrual has not yet begun. The results of this study will give an indication of the objective and subjective benefit of combined IMRT physical parotid salivary sparing and amifostine chemical cytoprotection for combined salivary gland sparing and reduction in the rate of xerostomia in patients undergoing IMRT for head and neck squamous cell cancer. PMID:15726519

Rosenthal, David I; Chambers, Mark S; Weber, Randal S; Eisbruch, Avraham

2004-12-01

87

Methamphetamine abuse and "meth mouth".  

PubMed

Dental management for the patient who abuses drugs is always a challenge. The numbers of patients abusing methamphetamines appears to be increasing. The dentist needs to be aware of the clinical presentation and medical risks presented by these patients and to attempt to get the patient to seek professional help. Additionally, special attention will be necessary for the high prevalence and severity or oral manifestations including: rampant caries, enamel erosion, xerostomia, bruxism and muscle trismus. PMID:18405216

Rhodus, Nelson L; Little, James W

88

Methamphetamine abuse and "meth mouth".  

PubMed

Dental management for the patient who abuses drugs is always a challenge. The number of patients abusing methamphetamines appears to be increasing. The dentist needs to be aware of the clinical presentation and medical risks presented by these patients and to attempt to get the patient to seek professional help. Additionally, special attention will be necessary for the high prevalence and severity of oral manifestations including rampant caries, enamel erosion, xerostomia, bruxism, and muscle trismus. PMID:16317979

Rhodus, Nelson L; Little, James W

89

Primary Sjögren’s syndrome in Moroccan patients: characteristics, fatigue and quality of life  

Microsoft Academic Search

Our aim was to evaluate fatigue and quality of life (QoL) in Moroccan patients with primary Sjögren’s syndrome (PSS) and determine\\u000a their correlates with disease-related parameters. Fifty-seven consecutive patients with PSS according to the American-European\\u000a Consensus group (AEGG) criteria were included. Demographic, clinical, biological and immunological characteristics for all\\u000a patients were collected. Xerostomia was demonstrated by histological grading of lower

Yousra Ibn Yacoub; Samira Rostom; Assia Laatiris; Najia Hajjaj-Hassouni

90

Protection of Salivary Function by Concomitant Pilocarpine During Radiotherapy: A Double-Blind, Randomized, Placebo-Controlled Study  

SciTech Connect

Purpose: To investigate the effect of concomitant administration of pilocarpine during radiotherapy for head-and-neck squamous cell carcinoma (HNSCC) on postradiotherapy xerostomia. Methods and Materials: A prospective, double blind, placebo-controlled randomized trial including 170 patients with HNSCC was executed to study the protective effect of pilocarpine on radiotherapy-induced parotid gland dysfunction. The primary objective endpoint was parotid flow rate complication probability (PFCP) scored 6 weeks, 6 months, and 12 months after radiotherapy. Secondary endpoints included Late Effects of Normal Tissue/Somatic Objective Management Analytic scale (LENT SOMA) and patient-rated xerostomia scores. For all parotid glands, dose-volume histograms were assessed because the dose distribution in the parotid glands is considered the most important prognostic factor with regard to radiation-induced salivary dysfunction. Results: Although no significant differences in PFCP were found for the two treatments arms, a significant (p = 0.03) reduced loss of parotid flow 1 year after radiotherapy was observed in those patients who received pilocarpine and a mean parotid dose above 40 Gy. The LENT SOMA and patient-rated xerostomia scores showed similar trends toward less dryness-related complaints for the pilocarpine group. Conclusions: Concomitant administration of pilocarpine during radiotherapy did not improve the PFCP or LENT SOMA and patient-rated xerostomia scores. In a subgroup of patients with a mean dose above 40 Gy, pilocarpine administration resulted in sparing of parotid gland function. Therefore, pilocarpine could be provided to patients in whom sufficient sparing of the parotid is not achievable.

Burlage, Fred R. [Department of Radiation Oncology, University Medical Center Groningen, Groningen (Netherlands)], E-mail: f.r.burlage@rt.umcg.nl; Roesink, Judith M. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Kampinga, Harm H. [Department of Cell Biology, Section for Radiation and Stress Cell Biology, University Medical Center Groningen, Groningen (Netherlands); Coppes, Rob P. [Department of Radiation Oncology, University Medical Center Groningen, Groningen (Netherlands); Terhaard, Chris [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Langendijk, Johannes A.; Luijk, Peter van [Department of Radiation Oncology, University Medical Center Groningen, Groningen (Netherlands); Stokman, Monique A.; Vissink, Arjan [Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen (Netherlands)

2008-01-01

91

Intravenous amifostine during chemoradiotherapy for head-and-neck cancer: A randomized placebo-controlled phase III study  

SciTech Connect

Purpose: Clinical trials demonstrated the efficacy and safety of intravenous (i.v.) or subcutaneous (s.c.) amifostine for reducing xerostomia and mucositis after radiotherapy or radiochemotherapy for head-and-neck cancer. This randomized, double-blinded, placebo-controlled, phase III study evaluated the efficacy and safety of i.v. amifostine during radiochemotherapy for head-and-neck cancer. Methods and Materials: Patients from European and American study centers received i.v. amifostine 300 mg/m{sup 2} (n = 67) or placebo (n = 65) before carboplatin 70 mg/m{sup 2} and radiotherapy on Days 1 to 5 and 21 to 25, and i.v. amifostine 200 mg/m{sup 2} or placebo before radiotherapy on other days. Results: Toxicity incidences were (amifostine, placebo, p value): Grade 2 or higher acute xerostomia (39%, 34%, 0.715), Grade 3 or higher acute mucositis (39%, 22%, 0.055), Grade 2 or higher late xerostomia (37%, 24%, 0.235), and Grade 3 or higher treatment-related adverse events (42%, 20%, 0.008). One-year rates of locoregional failure, progression-free survival, and overall survival were not significantly different between treatments. Conclusions: The used amifostine doses were not able to reduce the toxicity of simultaneous radiochemotherapy for head-and-neck cancer. The safety of amifostine and the lack of tumor protection were consistent with previous studies.

Buentzel, Jens [Department of Otolaryngology, Head and Neck Surgery, Suedharzkrankenhaus Nodhausen, Nordhausen (Germany)]. E-mail: jens.buentzel@shk-ndh.de; Micke, Oliver [Department of Radiotherapy, Muenster University Hospital, Muenster (Germany); Adamietz, Irenaus A. [Department of Radiooncology, Ruheuniversitat Bochum, Herne (Germany); Monnier, Alain [Centre Hospitalier Andre-Boulloche, Monbeliard (France); Glatzel, Michael [Department of Radio-Therapy, Zentralklinikum Suhl, Suhl (Germany); Vries, Alexander de [Department of Radiooncology, Leopold Franz University of Innsbruck, Innsbruck (Austria)

2006-03-01

92

Intensity-Modulated Radiation Therapy With or Without Chemotherapy for Nasopharyngeal Carcinoma: Radiation Therapy Oncology Group Phase II Trial 0225  

PubMed Central

Purpose To investigate the feasibility of intensity-modulated radiation therapy (IMRT) with or without chemotherapy, and to assess toxicities, failure patterns, and survivals in patients with nasopharyngeal carcinoma (NPC). Patients and Methods Radiation consisted of 70 Gy given to the planning target volumes of primary tumor plus any N+ disease and 59.4 Gy given to subclinical disease, delivered over 33 treatment days. Patients with stage T2b or greater or with N+ disease also received concurrent cisplatin (100 mg/m2) on days 1, 22, and 43 followed by adjuvant cisplatin (80 mg/m2) on day 1; fluorouracil (1,000 mg/m2/d) on days 1 through 4 administered every 4 weeks for three cycles. Tumor, clinical status, and acute/late toxicities were assessed. The primary objective was to test the transportability of IMRT to a multi-institutional setting. Results Between February 2003 and November 2005, 68 patients with stages I through IVB NPC (of which 93.8% were WHO types 2 and 3) were enrolled. Prescribed IMRT (target delineation) was given to 83.8%, whereas 64.9% received chemotherapy per protocol. The estimated 2-year local progression-free (PF), regional PF, locoregional PF, and distant metastasis–free rates were 92.6%, 90.8%, 89.3%, and 84.7%, respectively. The estimated 2-year PF and overall survivals were 72.7% and 80.2%, respectively. Acute grade 4 mucositis occurred in 4.4%, and the worst late grade 3 toxicities were as follows: esophagus, 4.7%; mucous membranes, 3.1%; and xerostomia, 3.1%. The rate of grade 2 xerostomia at 1 year from start of IMRT was 13.5%. Only two patients complained of grade 3 xerostomia, and none had grade 4 xerostomia. Conclusion It was feasible to transport IMRT with or without chemotherapy in the treatment of NPC to a multi-institutional setting with 90% LRPF rate reproducing excellent reports from single institutions. Minimal grade 3 and lack of grade 4 xerostomia were encouraging.

Lee, Nancy; Harris, Jonathan; Garden, Adam S.; Straube, William; Glisson, Bonnie; Xia, Ping; Bosch, Walter; Morrison, William H.; Quivey, Jeanne; Thorstad, Wade; Jones, Christopher; Ang, K. Kian

2009-01-01

93

Microvascular transplantation of the rat submandibular gland.  

PubMed

Xerostomia results from salivary gland irradiation during treatment of head and neck malignancies. In addition to having difficulty with speech and swallowing, these patients experience loss of taste, dental caries, and chronic fungal infections. The paired submandibular glands provide 70 percent of the normal salivary flow and are difficult to shield during radiation therapy. Another sicca condition, xerophthalmia, may result from facial nerve injury or other medical disorders and results in pain, corneal ulceration, and possible vision loss. Treatment options for xerostomia are limited, and management of xerophthalmia usually focuses on the eyelids, rather than the fundamental problem of inadequate secretory protection. In this study, a rat model for submandibular gland microvascular transplantation was developed to assess the feasibility of salivary tissue transfer. Sixteen rats underwent submandibular gland transplantation from the neck to the groin. Fourteen of these rats underwent microvascular anastomosis of the vascular pedicle. Ten glands were assessed for viability at 4 days after transplantation, and four glands were examined after 7, 10, 14, or 21 days. By gross and histologic examination, 93 percent of transplanted glands showed expected long-term viability after at least 4 postoperative days. Microvascular techniques were shown to be applicable to the transplantation of submandibular gland salivary tissue. This has not previously been shown in a rat model. It is possible that submandibular glands could be transplanted to the eye for treatment of xerophthalmia and out of the neck during irradiation of the head and neck, with subsequent replantation after treatment as a means of preventing permanent xerostomia. PMID:11083564

Spiegel, J H; Zhang, F; Levin, D E; Singer, M I; Buncke, H J

2000-11-01

94

Using a Reduced Spot Size for Intensity-Modulated Proton Therapy Potentially Improves Salivary Gland-Sparing in Oropharyngeal Cancer  

SciTech Connect

Purpose: To investigate whether intensity-modulated proton therapy with a reduced spot size (rsIMPT) could further reduce the parotid and submandibular gland dose compared with previously calculated IMPT plans with a larger spot size. In addition, it was investigated whether the obtained dose reductions would theoretically translate into a reduction of normal tissue complication probabilities (NTCPs). Methods: Ten patients with N0 oropharyngeal cancer were included in a comparative treatment planning study. Both IMPT plans delivered simultaneously 70 Gy to the boost planning target volume (PTV) and 54 Gy to the elective nodal PTV. IMPT and rsIMPT used identical three-field beam arrangements. In the IMPT plans, the parotid and submandibular salivary glands were spared as much as possible. rsIMPT plans used identical dose-volume objectives for the parotid glands as those used by the IMPT plans, whereas the objectives for the submandibular glands were tightened further. NTCPs were calculated for salivary dysfunction and xerostomia. Results: Target coverage was similar for both IMPT techniques, whereas rsIMPT clearly improved target conformity. The mean doses in the parotid glands and submandibular glands were significantly lower for three-field rsIMPT (14.7 Gy and 46.9 Gy, respectively) than for three-field IMPT (16.8 Gy and 54.6 Gy, respectively). Hence, rsIMPT significantly reduced the NTCP of patient-rated xerostomia and parotid and contralateral submandibular salivary flow dysfunction (27%, 17%, and 43% respectively) compared with IMPT (39%, 20%, and 79%, respectively). In addition, mean dose values in the sublingual glands, the soft palate and oral cavity were also decreased. Obtained dose and NTCP reductions varied per patient. Conclusions: rsIMPT improved sparing of the salivary glands and reduced NTCP for xerostomia and parotid and submandibular salivary dysfunction, while maintaining similar target coverage results. It is expected that rsIMPT improves quality of life during and after radiotherapy treatment.

Water, Tara A. van de, E-mail: t.a.van.de.water@rt.umcg.nl [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Lomax, Antony J. [Centre for Proton Therapy, Paul Scherrer Institute, Villigen-PSI (Switzerland); Bijl, Hendrik P.; Schilstra, Cornelis [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Hug, Eugen B. [Centre for Proton Therapy, Paul Scherrer Institute, Villigen-PSI (Switzerland); Langendijk, Johannes A. [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands)

2012-02-01

95

The pertinence of oral health indicators in nutritional studies in the elderly.  

PubMed

BACKGROUND AND AIM: Studies concerning the more appropriate criteria for evaluating oral health in relation to nutrition in the elderly vary greatly. There is a need to identify the most relevant criteria for classifying dental indicators of mastication in nutritional studies, so these indicators may be considered for epidemiological and clinical purposes. The aim of this study was to explore the associations between nutritional deficit and measures of oral health in a group of elderly. METHODS: A convenience sample of independent elderly aged 65 years or more attending two primary care clinics in Beirut, Lebanon was selected. Data were collected from a questionnaire including the Mini-Nutritional Assessment (MNA), Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia and chewing problems. The oral examinations recorded decayed, missing and filled teeth (DMFT), the prosthetic status and the number of functional units (FU). RESULTS: The sample was composed of 121 women (mean age: 71.59 ± 5.97 years) and 80 men (mean age: 72.74 ± 6.98 years). They were allocated to two groups: 85 participants suffering from malnutrition (MNA score < 17, n = 17) or at risk of malnutrition (17 < MNA score < 24, n = 68) and 116 participants with a normal nutritional status (MNA score ? 24). Parameters that explain MNA variations were perception of xerostomia (OR = 3.49, 95% CI [1.66-7.34]), number of FU (OR = 2.79, 95% CI [1.49; 5.22]), and GOHAI score (OR = 2.905, 95% CI [1.40; 6.00]). CONCLUSION: Further studies exploring factors affecting nutrition in the elderly should take into consideration perception of xerostomia, number of FUs and GOHAI score. PMID:23773972

El Osta, Nada; Hennequin, Martine; Tubert-Jeannin, Stephanie; Abboud Naaman, Nada Bou; El Osta, Lana; Geahchan, Negib

2013-05-28

96

[Acute rhombencephalitis with fever and bilateral hearing loss secondary to Gougerot-Sjögren's syndrome].  

PubMed

The usual polymorphic central nervous system involvement observed in primary Sjögren's syndrome is classified as monofocal, multifocal or diffuse involvement. We present a case of acute rhombencephalitis associated with hearing loss that could correspond to an intermediate form between diffuse and monofocal involvement. The acute onset with fever and not clinical sign of xerostomia or xerophthalmia suggest the possibility of vascular-like or infectious-like forms. We emphasize the importance of obtaining a minor salivary gland biopsy for diagnosis of Sjögren's syndrome and suggest that Sjögren's syndrome could be frequently misdiagnosed. PMID:11965177

Devos, D; Bombois, S; Ferriby, D; Ruzza, I; De Seze, J; Pasquier, F

2002-02-01

97

Liquid-Supported Dentures: A Soft Option--A Case Report  

PubMed Central

Liquid-supported denture technique allows continued adaptation of denture to the mucosa both at resting and functional state. A complete denture prosthesis is unacceptable if it violates the foundation on which it rests. In this case, a technique for fabrication of a complete denture prosthesis that eliminates the disadvantages of tissue conditioners and soft liners (i.e., poor bond strength to acrylic, candidal colonization, etc.) and preserves the remaining tissues is described. Liquid-supported denture can be a permanent solution to some patients with problematic conditions like diabetes, xerostomia, atrophied ridge, and so forth.

Jain, Anoop; Puranik, Shivakumar; Jagadeesh, M. S.; Kattimani, Puttaraj; Akki, Savita; Kumar, Pawan; laxmi', Vijaya

2013-01-01

98

A comparative study of the effects of yohimbine and anetholtrithione on salivary secretion in depressed patients treated with psychotropic drugs  

Microsoft Academic Search

Objective: The present study compares the effects of yohimbine, an alpha2 adrenoceptor antagonist, and anetholtrithione, a reference drug in the treatment of dry mouth, in patients treated with psychotropic\\u000a drugs (tricyclic antidepressants or neuroleptics) and suffering from xerostomia. \\u000a \\u000a \\u000a \\u000a Methods: Ten patients were included in a randomized, double-blind, cross-over study, and receiving after yohimbine (3?×?6?mg per\\u000a day) or anetholtrithione (3?× 25?mg

H. Bagheri; L. Schmitt; M. Berlan; J. L. Montastruc

1997-01-01

99

Severe dental caries as the first presenting clinical feature in primary Sjögren's syndrome.  

PubMed

Background: Sjögren's syndrome is an autoimmune syndrome involving the exocrine glands specially the salivary and lacrimal glands leading to xerostomia and xerophtalmia. This paper presents a case with primary Sjögren's syndrome that severe dental caries were the first clinical manifestation. Case Presentation: A 42-year-old man was referred to the School of Dentistry, Tehran University of Medical Sciences due to unexplained severe dental decays. After systematic evaluation and consultation with the rheumatologist and the ophthalmologist, the diagnosis of primary Sjögren's syndrome was suggested and confirmed by serologic and histopathologic study. Conclusion: Primary Sjögren's syndrome should be considered in the differential diagnosis of patients with early severe dental caries. PMID:24009970

Ahmadi, Elham; Fallahi, Sasan; Alaeddini, Mojgan; Hasani Tabatabaei, Masoomeh

2013-01-01

100

Complications of head and neck radiation therapy and their management  

SciTech Connect

Patients who receive radiation therapy to the head and neck suffer potential complications and undesirable side-effects of this therapy. The extent of undesirable responses is dependent on the source of irradiation, the fields of irradiation, and the dose. The radiotherapist determines these factors by the extent, location, and radiosensitivity of the tumor. The potential undesirable side-effects are xerostomia, mucositis, fibrosis, trismus, dermatitis, photosensitivity, radiation caries, soft tissue necrosis, and osteoradionecrosis. Each of these clinical entities and their proposed management have been discussed.

Engelmeier, R.L.; King, G.E.

1983-04-01

101

Complete agenesis of major salivary glands.  

PubMed

A 4 year-old female patient was treated for persistent right-sided dacryocystitis and xerostomia. MRI was performed to screen for a dry syndrome; which resulted in the diagnosis of agenesis of the parotid and submandibular glands as well as lacrimal duct malformation. An MRI of each parent was normal. The mother's history revealed 4 days of pyrexia during the 8th week of amenorrhea. This was an isolated case, with no family history, characterized by a febrile episode during pregnancy at the period of main salivary gland genesis. Epigenetic mechanisms could be implicated. PMID:23993206

Berta, E; Bettega, G; Jouk, P S; Billy, G; Nugues, F; Morand, B

2013-08-28

102

Development of Sjögren's syndrome during treatment with recombinant human interferon-alpha-2b for chronic hepatitis C  

Microsoft Academic Search

A 63-year-old woman with type C chronic active hepatitis developed Sjgren's syndrome after being treated with recombinant\\u000a interferon-alpha-2b. After 3 months' interferon-alpha administration, serum levels of ?-globulin (4.5 g\\/dl) and titers of\\u000a antinuclear and anti-SS-A antibodies were greatly increased, anti-SS-B antibody appeared, and the erythrocyte sedimentation\\u000a rate was elevated. Although no xerostomia was exhibited, the patient experienced conjunctival dryness. Schirmer's

Hideaki Unoki; Atsushi Moriyama; Akinari Tabaru; Akihide Masumoto; Makoto Otsuki

1996-01-01

103

Severe Pulmonary Hypertension in Primary Sjögren's Syndrome.  

PubMed

A 65 year-old female with a history of xerostomia and xerophthalmia was presented with dyspnea on exertion (New York Heart Association class III). Echocardiography and cardiac catheterization demonstrated severe pulmonary hypertension (PH). Laboratory examinations showed positive anti-nuclear and anti-Ro/SS-A antibodies. Schirmer's test was positive and salivary gland scintigraphy revealed severely decreased tracer uptakes in both parotid and submandibular glands. By excluding other possible causes of PH during further examinations, she was diagnosed with severe PH associated with primary Sjögren's syndrome. Her dyspnea symptom was much improved with endothelin receptor antagonist and azathioprine. PMID:23964300

Hwang, Ji-An; Yang, Tae-Hyun; Lee, Ji-Young; Koo, Dong-Wan; Choi, In Suk; Cho, Sun-Young; Kim, Min-Sung

2013-07-31

104

[Sjögren's syndrome: diagnosis and systemic manifestations].  

PubMed

Sjögren's syndrome is an autoimmune exocrinopathy characterized by keratoconjunctivis sicca, xerostomia and immune-inflammatory systemic manifestations. The diagnosis is easy to establish when the patient presents with sicca complex as a main symptom, or recurring attacks of parotitis. However, it is way more complex when the disease begins with extraglandular features, such as non erosive polyarticular arthritis, Raynaud's phenomenon, peripheral or central nervous system involvement, kidney disease or interstitial pneumonary disease, or even vasculitis. In such circumstances, diagnosis is often delayed several years. PMID:22408869

Hatron, Pierre-Yves

2012-02-01

105

Oral manifestations and treatment of a child with Sjögren's syndrome.  

PubMed

Sjögren's syndrome (SS) is a chronic inflammatory systemic autoimmune disease affecting the exocrine, salivary and lacrimal glands. The condition occurs more often in adults and is rare in childhood. SS should be considered in the differential diagnosis of recurrent parotitis and keratoconjunctivitis sicca. Oral manifestations include early tooth decay and xerostomia. Treatment consists of operative dentistry and saliva management. This paper reports a case of a 10-year-old Brazilian boy with SS, stressing the oral manifestations, treatment conduct, clinical importance and need for an early diagnosis in order to improve the patient's quality of life. PMID:20819406

Sardenberg, Fernanda; Goursand, Daniela; Polletto, Luiz Thadeu; Vale, Miriam Pimenta; Zarzar, Patrícia Maria; Paiva, Saul Martins

106

Advances in radiation oncology for the management of oropharyngeal tumors.  

PubMed

The major benefits of modern radiation therapy (eg, intensity-modulated [x-ray] radiation therapy [IMRT]) for oropharyngeal cancer are reduced xerostomia and better quality of life. Intensity-modulated proton therapy may provide additional advantages over IMRT by reducing radiation beam-path toxicities. Several acute and late treatment-related toxicities and symptom constellations must be kept in mind when designing and comparing future treatment strategies, particularly because currently most patients with oropharyngeal carcinoma present with human papillomavirus-positive disease and are expected to have a high probability of long-term survival after treatment. PMID:23910474

Gunn, G Brandon; Frank, Steven J

2013-06-19

107

Concomitant diagnosis of primary Sj?gren's syndrome and systemic AL amyloidosis  

PubMed Central

A 48 year old woman was referred to hospital for buccal discomfort. Physical examination showed a macroglossia and features of xerostomia. She was diagnosed as having primary Sjögren's syndrome according to the criteria proposed by the European Community study group in 1993. Furthermore, a lower lip salivary gland biopsy showed amyloid deposits that were also seen in the stomach and in the bone marrow. Echocardiography was consistent with cardiac amyloidosis. Serum immunofixation identified a monoclonal IgG?. As far as is known, this is the first report of systemic primary amyloidosis associated with Sjögren's syndrome. The relation between these two disorders is discussed.??

Delevaux, I; Andre, M; Amoura, Z; Kemeny, J; Piette, J; Aumaitre, O

2001-01-01

108

3D-conformal-intensity modulated radiotherapy with compensators for head and neck cancer: clinical results of normal tissue sparing  

PubMed Central

Background To investigate the potential of parotic gland sparing of intensity modulated radiotherapy (3D-c-IMRT) performed with metallic compensators for head and neck cancer in a clinical series by analysis of dose distributions and clinical measures. Materials and methods 39 patients with squamous cell cancer of the head and neck irradiated using 3D-c-IMRT were evaluable for dose distribution within PTVs and at one parotid gland and 38 patients for toxicity analysis. 10 patients were treated primarily, 29 postoperatively, 19 received concomittant cis-platin based chemotherapy, 20 3D-c-IMRT alone. Initially the dose distribution was calculated with Helax ® and photon fluence was modulated using metallic compensators made of tin-granulate (n = 22). Later the dose distribution was calculated with KonRad ® and fluence was modified by MCP 96 alloy compensators (n = 17). Gross tumor/tumor bed (PTV 1) was irradiated up to 60–70 Gy, [5 fractions/week, single fraction dose: 2.0–2.2 (simultaneously integrated boost)], adjuvantly irradiated bilateral cervical lymph nodes (PTV 2) with 48–54 Gy [single dose: 1.5–1.8]). Toxicity was scored according the RTOG scale and patient-reported xerostomia questionnaire (XQ). Results Mean of the median doses at the parotid glands to be spared was 25.9 (16.3–46.8) Gy, for tin graulate 26 Gy, for MCP alloy 24.2 Gy. Tin-granulate compensators resulted in a median parotid dose above 26 Gy in 10/22, MCP 96 alloy in 0/17 patients. Following acute toxicities were seen (°0–2/3): xerostomia: 87%/13%, dysphagia: 84%/16%, mucositis: 89%/11%, dermatitis: 100%/0%. No grade 4 reaction was encountered. During therapy the XQ forms showed °0–2/3): 88%/12%. 6 months postRT chronic xerostomia °0–2/3 was observed in 85%/15% of patients, none with °4 xerostomia. Conclusion 3D-c-IMRT using metallic compensators along with inverse calculation algorithm achieves sufficient parotid gland sparing in virtually all advanced head and neck cancers. Since the concept of lower single (and total) doses in the adjuvantly treated volumes reduces acute morbidity 3D-c-IMRT nicely meets demands of concurrent chemotherapy protocols.

Wendt, Thomas G; Abbasi-Senger, Nasrin; Salz, Henning; Pinquart, Ines; Koscielny, Sven; Przetak, Susi-Marie; Wiezorek, Tilo

2006-01-01

109

Temporary diplopia upon hyoscine-N-butyl bromide administration: case report.  

PubMed

Hyoscine-N-butyl bromide is a widely used antispasmodic belonging to the belladonna alkaloid class of semisynthetic quaternary ammonium compounds. These compounds exert a spasmolytic action on the smooth muscles of the bile-gastrointestinal tract, genitourinary tract, salivary glands (xerostomia), and also on the visual apparatus - in particular, the irido-ciliary complex. As a consequence, they provoke collateral effects such as mydriasis and accommodation disturbances. We report the case of a 23-year-old woman who complained of not only "dry mouth" but also "cloudy vision" and a "diplopia", both of temporary type, 2 hours after oral administration of hyoscine-N-butyl bromide. PMID:23723687

Migliorini, R; Malagola, R; Mafrici, M; Spena, R; Arrico, L

2013-05-23

110

[Aging and the oral cavity].  

PubMed

Like all tissues in the human body, those within the buccal cavity undergo changes with ageing, which are observable in clinical practice. Such changes include the appearance of lingual varicosities, glossitis, atrophy of the taste papillae and of the salivary glands, with variable degrees of xerostomia, periodontal disease and predisposal to develop malignancies. Dental units may also be affected, with occurrence, among other processes, of abrasion, attrition, caries and lowered dentarian sensibility, phenomena of interest for the odontologist in handling geriatric patients. PMID:2699526

Pinzón Tofiño, M E; Gaitán Cepeda, L A

1989-03-01

111

Systematic reviews of oral complications from cancer therapies, Oral Care Study Group, MASCC\\/ISOO: methodology and quality of the literature  

Microsoft Academic Search

Background  Oral complications are commonly experienced by patients undergoing cancer therapies. The Oral Care Study Group of the Multinational\\u000a Association of Supportive Care in Cancer\\/International Society of Oral Oncology (MASCC\\/ISOO) has completed nine systematic\\u000a reviews including Bisphosphonate Osteonecrosis of the Jaw, Odontogenic\\/Periodontal Infection, Dysgeusia, Oral Fungal Infection,\\u000a Osteoradionecrosis, Trismus, Oral Pain, Oral Viral Infection, and Xerostomia.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The aims of these reviews

Michael T. Brennan; Linda S. Elting; Fred K. L. Spijkervet

2010-01-01

112

Clinical evaluation of the intraoral fluoride releasing system in radiation-induced xerostomic subjects. Part 1: Fluorides.  

PubMed

Radiation-induced xerostomia results in significant changes in the oral cavity particularly oral microbial changes, which include a marked increase in the number of cariogenic organisms, notably Streptococcus mutans and lactobacillus species. This loss of the capacity to secrete saliva creates or promotes the rapid onset and progression of rampant dental caries. In this 2-part series, the benefit of fluoride in reducing caries activity is presented. Part 1 discusses the historical and currently available fluoride preparations and Part 2 presents data of a recently completed trial investigating the benefit of an intraoral sodium fluoride releasing system. PMID:16891149

Chambers, Mark S; Mellberg, James R; Keene, Harris J; Bouwsma, Otis J; Garden, Adam S; Sipos, Tibor; Fleming, Terence J

2006-08-07

113

Longitudinal Assessment of Parotid Function in Patients Receiving Tomotherapy for Head-and-Neck Cancer  

Microsoft Academic Search

\\u000a \\u000a Background and Purpose:\\u000a   Conventional radiotherapy is associated with high doses to the salivary glands which causes xerostomia and adverse effects\\u000a on quality of life. The study aims to investigate the potential of helical tomotherapy (Hi-Art Tomotherapy®) to preserve parotid function in head-and-neck cancer patients.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods:\\u000a   Seven consecutive patients treated with helical tomotherapy at the UZ Brussel, Belgium, were

Mia Voordeckers; Hendrik Everaert; Koen Tournel; Dirk Verellen; Ilan Baron; Gretel Van Esch; Chris Vanhove; Guy Storme

2008-01-01

114

Temporary diplopia upon hyoscine-N-butyl bromide administration: case report  

PubMed Central

Hyoscine-N-butyl bromide is a widely used antispasmodic belonging to the belladonna alkaloid class of semisynthetic quaternary ammonium compounds. These compounds exert a spasmolytic action on the smooth muscles of the bile-gastrointestinal tract, genitourinary tract, salivary glands (xerostomia), and also on the visual apparatus - in particular, the irido-ciliary complex. As a consequence, they provoke collateral effects such as mydriasis and accommodation disturbances. We report the case of a 23-year-old woman who complained of not only “dry mouth” but also “cloudy vision” and a “diplopia”, both of temporary type, 2 hours after oral administration of hyoscine-N-butyl bromide.

Migliorini, R; Malagola, R; Mafrici, M; Spena, R; Arrico, L

2013-01-01

115

Simultaneous Integrated Boost Using Intensity-Modulated Radiotherapy Compared With Conventional Radiotherapy in Patients Treated With Concurrent Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma  

SciTech Connect

Purpose: To compare, in a retrospective study, the toxicity and efficacy of simultaneous integrated boost using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) in patients treated with concomitant carboplatin and 5-fluorouracil for locally advanced oropharyngeal cancer. Methods and Materials: Between January 2000 and December 2007, 249 patients were treated with definitive chemoradiation. One hundred patients had 70 Gy in 33 fractions using IMRT, and 149 received CRT at 70 Gy in 35 fractions. Overall survival, disease-free survival, and locoregional control were estimated using the Kaplan-Meier method. Results: Median follow-up was 42 months. Three-year actuarial rates for locoregional control, disease-free survival, and overall survival were 95.1% vs. 84.4% (p = 0.005), 85.3% vs. 69.3% (p = 0.001), and 92.1% vs. 75.2% (p < 0.001) for IMRT and CRT, respectively. The benefit of the radiotherapy regimen on outcomes was also observed with a Cox multivariate analysis. Intensity-modulated radiotherapy was associated with less acute dermatitis and less xerostomia at 6, 12, 24, and 36 months. Conclusions: This study suggests that simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy.

Clavel, Sebastien, E-mail: sebastien.clavel@umontreal.ca [Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, QC (Canada); Nguyen, David H.A.; Fortin, Bernard [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Despres, Philippe [Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, QC (Canada); Khaouam, Nader [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Donath, David [Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, QC (Canada); Soulieres, Denis [Department of Medical Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, QC (Canada); Guertin, Louis [Department of Head and Neck Surgery, Centre Hospitalier de l'Universite de Montreal, Montreal, QC (Canada); Nguyen-Tan, Phuc Felix [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada)

2012-02-01

116

[Study of the oral manifestations in diabetic children and their correlation variables].  

PubMed

Because children with type 1 diabetes (DM) are prone to diseases of the buccal cavity, in this transversal study we investigate the prevalence of dental caries, gingivitis and buccal alterations in 26 patients (16F/10M; average age: 10.3 years) from the Diabetic Children's Group at the Federal University Hospital of Santa Catarina, to verify possible correlations among the following variables: index of decayed, missing or filled permanent or deciduous teeth [DMFT or dmft], index of visible plaque [IVP], index of gum bleeding [IGB], dental calculi, gum recession, tongue abnormalities, xerostomia, burning sensation of the mucosa, age at DM diagnosis, administration of insulin; occurrence of DM-related complications; glycemia and glycosilated hemoglobin [GH]. The most frequent alterations were dental calculi (42.3%), xerostomia (38.5%), burning sensation (11.5%), and gum recession (7.7%). The median indices for DMFT/dmft, IVP and IGB were 2.0, 27.21% and 10.91%, respectively. Only age and the level of GH were significantly correlated to IVP (r2 = 0.61), whereas the IVP and hypoglycemia correlated to IGB (r2 = 0.63). We conclude that the older the patient and the higher the GH level, the higher the IVP; whereas the higher the IVP and the less frequent the crisis of mild hypoglycemia, the higher the IGB. PMID:15640899

Costa, Carolina C; Resende, Gimol B; Souza, Joeci M; Tavares, Silvia S; Almeida, Izabel C S S; Filho, Luiz Cesar C

2004-08-26

117

Does hyperbaric oxygen therapy have the potential to improve salivary gland function in irradiated head and neck cancer patients?  

PubMed

Following radiotherapy, many patients with osteoradionecrosis suffer from xerostomia, thereby decreasing their quality of life. Patients can develop problems with speech, eating, increased dental caries, dysphagia, fractured dentition, chronic refractory osteomyelitis and osteoradionecrosis. Symptoms associated with salivary gland dysfunction can be severe enough that patients terminate the course of their radiotherapy prematurely due to the decrease in their quality of life. Currently, the only treatments available to patients are palliative. A definitive treatment has yet to be discovered. Head and neck cancers, which comprise 5% of overall cancer treatments, rank 8th most expensive to treat in the United States today. Hyperbaric oxygen is being considered for the therapy of radiated salivary glands because it has been shown to stimulate capillary angiogenesis and fibroplasia in radiation treated tissues. It has been hypothesized that salivary acinar cells undergo apoptosis following radiation therapy. The purpose of this paper is to discuss the mechanisms of salivary gland injury and evaluate whether hyperbaric oxygen therapy improves salivary gland function in patients who develop xerostomia and osteoradionecrosis following head and neck radiation. PMID:23816249

Hadley, Tiffany; Song, Cassaundra; Wells, Lauren; Lehnhardt, Jennifer; Rogers, Marcy Wells; Anderson, Jeffery; Terry, Michael; Novy, Brian; Lo, Takkin

2013-07-02

118

Gastrointestinal and hepatic manifestations of Sjogren syndrome.  

PubMed

Sjogren syndrome (SS) is an autoimmune disease that affects exocrine glands and therefore may affect the gastrointestinal system, from the mouth, esophagus, and bowel to the liver and pancreas. Oral involvement in SS is mainly characterized by dryness, with a wide spectrum of symptoms, from mild-to-severe xerostomia with dysgeusia and tooth decay. The dysphagia, although common, does not correlate with the reduced salivary flow rate or the dysmotility that may be present. Dyspepsia, found in up to 23% of patients, may be associated with gastritis, reduced acid production, and antiparietal cell antibodies, but rarely pernicious anemia. Pancreatic involvement, although rare, includes pancreatitis and pancreatic insufficiency. The most common causes of liver disease are primary biliary cirrhosis, autoimmune hepatitis, nonalcoholic fatty liver disease, and hepatitis C virus (HCV). Although abnormal liver tests are found in up to 49% of patients, they are usually mild. Although sicca syndrome, abnormal histology of the salivary glands, and abnormal sialograms are common in primary biliary cirrhosis, the antibodies to Ro/SSA or La/SSB antigens are infrequent. Xerostomia, sialadenitis, abnormal salivary flow rates, and abnormal Schirmer test in HCV vary widely among the studies, although the antibodies to Ro/SSA or La/SSB are only 1%. Several studies show that HCV is in saliva, although how this may impact sicca syndrome or SS in HCV is unclear. SS as a disease of exocrine glands affects many parts of the gastrointestinal system. PMID:22157220

Ebert, Ellen Catherine

2012-01-01

119

[Sjogren's syndrome].  

PubMed

Sjogren's syndrome is a chronic inflammatory disease of unknown aethiology. It is characterized by decreased secretion of salivary and lacrimal glands, which induces keratoconjunctivitis sicca and xerostomia. Sjogren's syndrome is a central autoimmune disease, and it has characteristics of both organ-specific and generalized autoimmune diseases. It can exist as a primary disease or is associated with other autoimmune diseases (most freyuently with systemic lupus erythematosus or rheumatoid arthritis) and is classified as a secondary Sjogren's syndrome. The aethiology is multifactorial, and it has not yet been completely explained. In the pathogenesis of the disease the important role have genetic predisposition, chronic oestrogen stimulation, end viral infections, especially of the herpes virus group (EBV, CMV, HHV6) and retroviruses. In the clinical picture xerostomia, xerophtalmia and non-erosive arthritis are the most common features, with the whole spectrum of extraglandular manifestations of respiratory, gastrointestinal, skin, and haematologic, neurologic and endocrinologic disturbances. Pathohistological findings of minor labial salivary gland lymphocyte infiltration is the most specific and the most sensitive diagnostic criterion of Sjogren's syndrome. The diagnosis of keratoconjunctivitis sicca is made by Schrimer's test, Rose bengal dye staining and by the "tear break up time". Differential diagnosis of Sjogren's syndrome includes an extremely large number of various pathologic states. The treatment of Sjogren's syndrome consists of symptomatic treatment of dry mucosas (artificial tears, etc.) and also of antiinflammatory drugs, glucocorticoids, immunosuppressive drugs. Plasmapheresis and intravenous administration of immunoglobulins are used for immunosuppression in these patients. PMID:17974357

Raskovi?, S; Bogi?, M; Peri?-Popadi?, A; Tomi?-Spiri?, V

120

Amifostine reduces side effects and improves complete response rate during radiotherapy: Results of a meta-analysis  

SciTech Connect

Purpose: To evaluate the efficacy of amifostine in diminishing radiotherapy side effects and whether or not it protects the tumor. Methods and Materials: We performed a systematic review and meta-analysis of 14 included randomized controlled trials, comprising 1451 patients, comparing the use of radiotherapy vs. radiotherapy plus amifostine for cancer treatment. Results: The use of amifostine significantly reduced the risk of developing mucositis (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.29-0.48; p < 0.00001), esophagitis (OR, 0.38; CI, 0.26-0.54; p < 0.00001), acute xerostomia (OR, 0.24; CI, 0.15-0.36; p < 0.00001), late xerostomia (OR, 0.33; CI, 0.21-0.51; p < 0.00001), dysphagia (OR, 0.26; CI, 0.07-0.92; p 0.04), acute pneumonitis (OR, 0.15; CI, 0.07-0.31; p < 0.00001) and cystitis (OR, 0.17; CI, 0.09-0.32; p < 0.00001). There was no difference in overall response rate between the groups. However, complete response rate was superior for patients using amifostine (OR, 1.81; CI, 1.10-2.96; p = 0.02). Conclusions: This systematic review shows that amifostine significantly reduces the side effects of radiation therapy. The efficacy of radiotherapy was not itself affected by the use of this drug and patients receiving amifostine were able to achieve higher rates of complete response.

Sasse, Andre Deeke [Nucleo Brasileiro de Oncologia Baseada em Evidencias, Campinas, Sao Paulo (Brazil); Gontijo de Oliveira Clark, Luciana [Nucleo Brasileiro de Oncologia Baseada em Evidencias, Campinas, Sao Paulo (Brazil); Sasse, Emma Chen [Nucleo Brasileiro de Oncologia Baseada em Evidencias, Campinas, Sao Paulo (Brazil)]. E-mail: sasse@evidencias.com.br; Clark, Otavio Augusto Camara [Nucleo Brasileiro de Oncologia Baseada em Evidencias, Campinas, Sao Paulo (Brazil)

2006-03-01

121

Some factors influencing salivary function when treating with radiotherapy  

SciTech Connect

Salivary flow rate was studied in 29 patients treated with external irradiation to head and neck areas. Resting saliva samples were collected before, during the radiotherapy course and follow-up. Several parameters were investigated: field arrangement, amount of salivary glands irradiated, dose to these glands, initial FR, its recovery during and after irradiation, and influence of therapy interruption in FR. It was found that the level of the upper border of the field is a critical factor when using parallel-opposed lateral fields to the upper neck area and lateral face. More than 50% of the parotids have to be outside the fields to prevent severe dryness. Neck fields which do not encompass salivary glands do not decrease salivary secretion. There is some relation between the initial FR and the dose necessary to produce dryness: patients with high initial salivary FR require higher doses. FR recovery occurs during weekend interruptions before xerostomia develops. Interruptions of therapy for more than two weeks during the radiotherapy course prior to development of dryness might decrease late xerostomia, at least in patients with high initial FR. Objective recovery of the FR has not been observed after treatment in spite of the subjective improvement in the sensation of dryness of some patients.

Mira, J.G.; Wescott, W.B.; Starcke, E.N.; Shannon, I.L.

1981-04-01

122

Primary Sjögren's syndrome in Moroccan patients: characteristics, fatigue and quality of life.  

PubMed

Our aim was to evaluate fatigue and quality of life (QoL) in Moroccan patients with primary Sjögren's syndrome (PSS) and determine their correlates with disease-related parameters. Fifty-seven consecutive patients with PSS according to the American-European Consensus group (AEGG) criteria were included. Demographic, clinical, biological and immunological characteristics for all patients were collected. Xerostomia was demonstrated by histological grading of lower lip glandular biopsy. A Schirmer test was performed to measure lachrymal flow. Oral, ocular, skin, vaginal and tracheal dryness were evaluated by using a visual analogue scale (VAS). Fatigue was assessed by the Multidimensional assessment of fatigue (MAF) and the QoL by using the generic instrument: SF-36. 90% of our patients were women. The mean age of patients was 53.73 ± 7.69 years, and the mean disease duration was 5.38 ± 4.11 years. The mean oral dryness was 68.38 ± 20.29, and the mean ocular dryness was 51.91 ± 14.03. The mean total score of the MAF was 26.73 ± 8.33, and 87.5% of our patients experienced severe fatigue. Also, physical and mental domains of QoL were altered in a significant way, and the severity of fatigue had a negative impact on SF-36 scores. MAF and SF-36 scores were correlated with the delay of diagnosis, the intensity of xerostomia and the activity of joint involvement. A low socioeconomic and educational level had a negative impact on fatigue scores and QoL. Histological grading of lower lip glandular biopsy, immunological status and the severity of systemic involvement had no correlations with fatigue scores or the alteration of QoL. Patients receiving antidepressant have lesser fatigue and those receiving Methotrexate have better SF-36 scores. In our data, there was a high prevalence of fatigue in Moroccan patients with PSS associated with altered QoL. Severe fatigue and reduced QoL seem to be related to the severity of joint involvement, xerostomia and both educational and socioeconomic levels. Also, treatment with methotrexate and antidepressant seems to improve patients' living and QoL. An appropriate therapeutic intervention for depression and articular manifestations in PSS should be applied to improve patients' living. PMID:21786120

Ibn Yacoub, Yousra; Rostom, Samira; Laatiris, Assia; Hajjaj-Hassouni, Najia

2011-07-24

123

Iridium 192 implantation of squamous cell carcinomas of the oropharynx  

SciTech Connect

From 1970 to 1984, 127 patients with T1 or T2 carcinomas of the oropharynx were treated with external irradiation to the primary tumor and neck nodes to a dose of 45 Gy, followed by a further 30 Gy delivered by an iridium 192 implant to the primary tumor. Patients with clinically positive nodes had either further neck irradiation using electrons or a neck dissection. Crude 5-year disease-free survival was 66% for tonsillar carcinomas, 43% for soft palate, and 51% for base of tongue. Local control was 98%, 85%, and 76%, respectively. Regional control was 97% for N0 patients and 88% for N1-3. Soft tissue ulceration occurred in 17 patients; all healed spontaneously. The high rate of local control achieved in these patients while preserving function and minimizing xerostomia supports the use of this approach.21 references.

Mazeron, J.J.; Crook, J.; Martin, M.; Peynegre, R.; Pierquin, B. (Hospital Henri Mondor, Creteil (France))

1989-09-01

124

[Radiation therapy in head and neck cancer. Highlights from ASCO 2010].  

PubMed

In contrast to conventional radiotherapy, intensity modulated radiotherapy (IMRT) enables individually adjusted dose and intensity depending on tumor size and organs at risk, thus enabling radiotherapy of complex volumes in the head and neck area using high doses. Despite new data presented at the annual congress of the American Society of Clinical Oncology (ASCO), questions remain unanswered in two basic categories: (a) How do we use IMRT with other important advances in head and neck cancer treatment, such as altered fractionation, chemotherapy, and novel agents? (b) Does IMRT in its current form produce sufficient risk:benefit improvements in salivary gland sparing/less xerostomia, better targeting/local control and less late toxicity? Whether IMRT with its complex target volume definition and dose distribution leads to improved local control needs to be further investigated in relevant studies. PMID:20963390

Tribius, S; Petersen, C; Knecht, R; Ihloff, A S

2010-12-01

125

Failure to Control Caries in an AIDS-Affected Individual: A Case Report  

PubMed Central

Many patients today are living longer with certain health issues like human immunodeficiency virus (HIV). These patients take numerous medications (HAART: highly active antiretroviral therapy) that cause xerostomia, which increases caries risk. There are particular challenges when treating HIV-positive patients with decreased immune systems, which can also accelerate the progression of periodontal disease. This paper discusses one such case that was followed from 2002 to 2010 at the University of Pittsburgh School of Dental Medicine, where an HIV patient lost all his teeth despite investing thousands of dollars. It is also common sense that just performing restorations to decayed teeth is not enough to control the disease, but recommending a personalized preventive maintenance program to the patient is a must.

Nedwick-Castro, Karen A.; Vieira, Alexandre R.

2012-01-01

126

Image-Guided Radiotherapy for Locally Advanced Head and Neck Cancer  

PubMed Central

Treatment of locally advanced head and neck cancer remains a challenge because of the head and neck complex anatomy and the tumor invasion to the adjacent organs and/or metastases to the cervical nodes. Postoperative irradiation or concurrent chemoradiation may lead to damage of radiosensitive structures such as the salivary glands, mandible, cochlea, larynx, and pharyngeal muscles. Xerostomia, osteoradionecrosis, deafness, hoarseness of the voice, dysphagia, and aspiration remain serious complications of head and neck irradiation and impair patient quality of life. Intensity-modulated and image-guided radiotherapy by virtue of steep dose gradient and daily imaging may allow for decreased radiation of the organs at risk for complication while preserving loco-regional control.

Nguyen, Nam P.; Kratz, Sarah; Lemanski, Claire; Vock, Jacqueline; Vinh-Hung, Vincent; Olena Gorobets; Chi, Alexander; Almeida, Fabio; Betz, Michael; Khan, Rihan; Godinez, Juan; Karlsson, Ulf; Ampil, Fred

2013-01-01

127

Variation in oral health parameters between older people with and without mental disorders.  

PubMed

This study investigated the variation in the oral examination findings and the subjective oral complaints between older people with and without mental disorders. An interview and an oral investigation were performed in a group of older patients with mental disorders with a mean age of 71.9 years and in a group of older people without mental disease with a mean age of 70.2 years. The analysis did not reveal any statistically significant differences in the dental status of the participants and in the prevalence of oral ulcers and stomatitis. However xerostomia, burning mouth, dysgeusia, and oral malodor complaints were more frequent in patients with mental disorders, whereas general chewing complaints were less frequent. The multiple logistic regression analysis revealed that psychiatric illness was significantly associated with more complaints of dysgeusia and fewer chewing complaints. The increased prevalence of specific oral complaints in the older patients with mental disorders revealed the significant psychopathological compound of these symptoms. PMID:23980556

Kossioni, Anastasia; Kossionis, Georges E; Polychronopoulou, Argy

2013-01-07

128

Head and neck cancer resection and reconstruction: from past to present.  

PubMed

1. Head and neck tumors occur predominantly in men between 50 and 70 years of age who typically abuse tobacco or alcohol. These individuals often have poor oral hygiene and dentition as well as nutritional deficits, and achlorhydria, anemia, and iron and riboflavin deficits are common. 2. The tumor and treatment of head and neck cancer may cause many devastating effects, such as facial disfigurement, dysphagia, alterations in airway and communication, partial or total loss of taste and smell, xerostomia, pain, or fatigue. Treatment and rehabilitation may take months. 3. Although advances in technology and reconstructive surgery have not improved the overall survival rate, they preserve appearance, function, and, ultimately, the patient's quality of life. PMID:1412630

Droughton, M L; Krech, R L

1992-09-01

129

Isolated nail fold vasculitis in rheumatoid arthritis.  

PubMed Central

OBJECTIVES--To establish the clinical significance of isolated nail fold vasculitis in patients with rheumatoid arthritis (RA). METHODS--Patients attending hospital with established RA were assessed by a single observer using unaided vision. Isolated nail fold vasculitis (NFV) was diagnosed as small nail edge or nail fold lesions without any evidence of other extra-articular or systemic vasculitis. Patients were followed prospectively. RESULTS--Thirty patients with isolated NFV were identified and followed for a median interval of 22 months. Three patients died within three months of diagnosis and six developed complications possibly indicative of extra-articular disease: xerostomia (three), pericarditis (one), pleural effusion and empyaema (one), pulmonary fibrosis (one). No patient developed systemic vasculitis. CONCLUSION--Isolated NFV has a favourable prognosis compared with systemic vasculitis. There is a low risk of developing systemic or extra-articular disease.

Watts, R A; Carruthers, D M; Scott, D G

1995-01-01

130

Oral complications of cancer therapies. Description and incidence of oral complications  

SciTech Connect

No part of the body reflects the complications of cancer chemotherapy as visibly and as vividly as the mouth. The infectious, hemorrhagic, cytotoxic, nutritional, and neurologic signs of drug toxicity are reflected in the mouth by changes in the color, character, comfort, and continuity of the mucosa. The stomatologic complications of radiotherapy for oral cancer are physical and physiological in nature, transient or lasting in duration, and reversible or irreversible in type. Some linger as permanent mementos long after the cancer has been destroyed. They stem from radiation injury to the salivary glands, oral mucosa, oral musculature, alveolar bone, and developing teeth. They are expressed clinically by xerostomia, trismus, radiation dermatitis, nutritional stomatitis, and dentofacial malformation. In both cancer chemotherapy and cancer radiotherapy, the oral complications vary in pattern, duration, intensity, and number, with not every patient developing every complication. 21 references.

Dreizen, S. (Univ. of Texas Dental Branch, Houston (USA))

1990-01-01

131

Caries prevention for patients with dry mouth.  

PubMed

Patients with xerostomia, or dry mouth, resulting from various causes, are at higher risk for developing caries because of a loss of saliva and its benefits. A loss of saliva increases the acidity of the mouth, which affects many factors that contribute to the development of caries, such as proliferation of acid-producing bacteria, inability to buffer the acid produced by bacteria or from ingested foods, loss of minerals from tooth surfaces and inability to replenish the lost minerals, and loss of lubrication. Currently, a number of new products that can substitute for these functions of saliva or induce production of saliva are available in Canada. Some of these products are reviewed and a protocol for caries prevention in this high-risk population is proposed. PMID:21774875

Su, Nan; Marek, Cindy L; Ching, Victor; Grushka, Miriam

2011-01-01

132

Selenomethionine in Reducing Mucositis in Patients With Locally Advanced Head and Neck Cancer Who Are Receiving Cisplatin and Radiation Therapy  

ClinicalTrials.gov

Chemotherapeutic Agent Toxicity; Mucositis; Radiation Toxicity; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx; Stage IV Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Xerostomia

2013-06-14

133

Contact allergy masquerading as seronegative Sjögren's syndrome.  

PubMed

Primary Sjögren's syndrome is an autoimmune disease that presents with xerostomia and keratoconjunctivitis sicca (due to chronic lymphocytic inflammation of the salivary and lacrimal glands) and in some cases extraglandular features. Patients typically have positive antinuclear, anti-Ro, and anti-La antibodies; however, around 20% to 30% do not and are therefore termed seronegative. We present a case of a 58-year-old woman who was originally diagnosed with seronegative Sjögren's syndrome based on the American-European classification system. She had complete resolution of her clinical features on identification and avoidance of relevant contact allergens. Contact allergy should be considered in the differential diagnosis of seronegative Sjögren's syndrome, especially where atypical features such as facial rash, normal salivary gland imaging, or lichenoid histology exist. PMID:24119527

Gaikwad, Sophie L; Gaikwad, Rajiv; Akil, Mohammed; Ramsay, Helen M

2013-11-01

134

Relationship of oral disease to the presence of cytomegalovirus DNA in the saliva of AIDS patients.  

PubMed

Cytomegalovirus is an important pathogen in persons infected with human immunodeficiency virus. In this study a thorough oral examination was done and blood and urine cultures for cytomegalovirus were obtained from a group of 31 patients with acquired immunodeficiency syndrome with CD4 lymphocyte counts less than 150 cells/mm3. Whole saliva was also collected for detection of cytomegalovirus deoxyribonucleic acid (DNA) via the polymerase chain reaction. The presence of cytomegalovirus DNA in the saliva specimens was not related to the presence of cytomegalovirus in the urine, which suggests a local source of cytomegalovirus from salivary gland and kidney parenchyma. There was also a strong statistical relationship between salivary cytomegalovirus DNA and xerostomia (p = 0.0004), which suggests that cytomegalovirus may be a cause of salivary gland dysfunction in patients with acquired immunodeficiency syndrome with low CD4 counts. PMID:7614180

Greenberg, M S; Dubin, G; Stewart, J C; Cumming, C G; MacGregor, R R; Friedman, H M

1995-02-01

135

Recurrent inflammation of accessory parotid tissue associated with unilateral parotid gland aplasia: diagnostic and therapeutic implications.  

PubMed

Aplasia of the major salivary glands is a rare condition due to an alteration in the development of the ectodermal tissue of the oral cavity often related to other craniofacial abnormalities or alteration of structures deriving from the first or second archial branch, in particular the lacrimal glands; it can be total or partial and determine clinical states ranging from an asymptomatic condition to a severe xerostomia. The accessory parotid tissue is similar to normal parotid tissue, completely independent from the main gland and susceptible to the same pathological disorders. We describe a very unusual case of an inflammatory disorder of accessory parotid tissue in a 44-year-old male patient with concomitant, and previously unknown, aplasia of the main ipsilateral parotid gland. We also discuss the role of imaging and conservative therapeutic modalities such as botulinum toxin therapy and, in the future, minimally invasive endoscopic-assisted resection in the management of such salivary disorder. PMID:22218848

Capaccio, Pasquale; Luca, Nicola; Sigismund, Paolo Enrico; Pignataro, Lorenzo

2012-01-05

136

Primary sjögren syndrome manifested as localized cutaneous nodular amyloidosis.  

PubMed

Localized cutaneous nodular amyloidosis (LCNA) is the rarest type of cutaneous amyloidosis. Typically presenting as waxy nodules on the lower extremities, it demonstrates localized deposition of AL-type amyloid in immunohistologic study and is often associated with focal plasma cell proliferation. Sjögren syndrome, an autoimmune lymphoproliferative disorder, is characterized by keratoconjunctivitis sicca and xerostomia with lymphocytic infiltration of exocrine glands. As shown in case reports, the association of LCNA with Sjögren syndrome is considerable. Herein, we report a 78-year-old woman with LCNA, who was further surveyed and diagnosed with Sjögren syndrome. In light of the significant relation between these 2 diseases, further examination for coexistence of Sjögren syndrome in addition to systemic amyloidosis is well warranted. Prompt identification of an underlying Sjögren syndrome in LCNA with polyclonal immunoglobulin amyloid may have important therapeutic consequences. PMID:21946462

Wey, Shiow-Jiuan; Chen, Yi-Ming; Lai, Po-Ju; Chen, Der-Yuan

2011-10-01

137

Non-Syndromic Non-Familial Agenesis of Major Salivary Glands: A Report of Two Cases with Review of Literature  

PubMed Central

Agenesis of the major salivary glands is a rare and unusual condition, with only a few cases documented in the literature. The anomaly can be total or partial, unilateral or bilateral, and involve the parotid, submandibular, and sublingual glands. The resultant xerostomia leads to extensive dental demineralization. The authors report two cases with decreased saliva volume, impaired dental condition with extensive loss of tooth structure, and an astonishing pattern of dental destruction most notable on the facial and lingual surfaces of incisors and canines that can be best described as “chipping.” After detailed review of patient history, clinical examination, ultrasonography, contrast enhanced computed tomography, and magnetic resonance imaging a diagnosis of congenital absence of major salivary glands in both the patients was made. Dentists should be aware that salivary gland aplasia is an uncommon cause of dental deterioration. It may manifest itself not by extensive caries but as dental chipping effect. Early recognition and a therapeutic strategy can prevent further dental damage.

Mohan, Ravi Prakash Sasankoti; Verma, Sankalp; Chawa, Venkateswara Rao; Tyagi, Kuber

2013-01-01

138

Impact of Statistical Learning Methods on the Predictive Power of Multivariate Normal Tissue Complication Probability Models  

SciTech Connect

Purpose: To study the impact of different statistical learning methods on the prediction performance of multivariate normal tissue complication probability (NTCP) models. Methods and Materials: In this study, three learning methods, stepwise selection, least absolute shrinkage and selection operator (LASSO), and Bayesian model averaging (BMA), were used to build NTCP models of xerostomia following radiotherapy treatment for head and neck cancer. Performance of each learning method was evaluated by a repeated cross-validation scheme in order to obtain a fair comparison among methods. Results: It was found that the LASSO and BMA methods produced models with significantly better predictive power than that of the stepwise selection method. Furthermore, the LASSO method yields an easily interpretable model as the stepwise method does, in contrast to the less intuitive BMA method. Conclusions: The commonly used stepwise selection method, which is simple to execute, may be insufficient for NTCP modeling. The LASSO method is recommended.

Xu Chengjian, E-mail: c.j.xu@umcg.nl [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Schaaf, Arjen van der; Schilstra, Cornelis; Langendijk, Johannes A.; Veld, Aart A. van't [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)

2012-03-15

139

Clinical features and long-term treatment with pimozide in 65 patients with Gilles de la Tourette's syndrome.  

PubMed Central

During the last seven years 65 patients with Gilles de la Tourette's syndrome have been treated. Pimozide was used as the preferred drug because of our experience of treating other hyperkinesias which indicated fewer side-effects than with haloperidol. Of the 65 patients with Gilles de la Tourette's syndrome, 59 were treated with pimozide alone or in combination with tetrabenazine or clonidine. The dose ranges of pimozide were 0.5-9 mg per day. Eighty-one percent experienced a good clinical response without side-effects. The side-effects seen in our patients were sedation, gain in weight, depression, pseudoparkinsonism and akathisia; acute dystonic reactions, blurred vision, slurred speech and xerostomia did not occur. No cases of tardive dyskinesia were seen.

Regeur, L; Pakkenberg, B; Fog, R; Pakkenberg, H

1986-01-01

140

Alveolar bone loss and periodontal status in a bariatric patient: a brief review and case report.  

PubMed

To review the effects of obesity surgery on oral health and to present a case report of the periodontal condition of an obese woman who underwent bariatric surgery. A search of studies related to bariatric surgery and oral health was made in PubMed. For case report, BMI, salivary flow, and periodontal condition were evaluated during three different periods. The oral health problems found were dental wear, periodontal diseases, xerostomia, and dental caries. The patient who was evaluated before bariatric surgery and was followed up for 2 years, lost 40.4 kg, presented normal blood glucose levels and controlled hypertension without medication. Salivary flow remained of equal value in the first year, there was an increase in mean probing depth and there existed low bone density in these sites. Patients who have undergone bariatric surgery need to be closely monitored after surgery to prevent the development of oral complications, especially periodontal conditions. PMID:22002001

de Moura-Grec, Patrícia Garcia; Marsicano, Juliane Avansini; Rodrigues, Lívia M; de Carvalho Sales-Peres, Silvia Helena

2012-01-01

141

Oral findings in patients with acquired immunodeficiency syndrome.  

PubMed

Oral examinations of 103 consecutive patients with acquired immunodeficiency syndrome (AIDS) were performed. Of these patients, 74 (72%) were heterosexuals and 29 (28%) were homosexual or bisexual men. Lesions that were identified on subsequent examination were recorded separately. Oral candidiasis was the most common finding, occurring in 94 patients. Other findings were herpes simplex ulceration (ten patients), exfoliative cheilitis (nine patients), xerostomia (ten patients), "hairy" leukoplakia (seven patients), and Kaposi's sarcoma (four patients). A patchy, depapillated tongue was seen in six patients, and ulcers with uncertain cause were seen in three patients. Gingival bleeding, perioral molluscum contagiosum, and brown hairy tongue each occurred in one patient. In this study, "hairy" leukoplakia and Kaposi's sarcoma occurred exclusively in homosexual and bisexual men with AIDS, and occurred significantly more frequently in this group than in heterosexual patients with AIDS. There was no significant difference between these groups in the frequency of occurrence of other findings. PMID:3475658

Phelan, J A; Saltzman, B R; Friedland, G H; Klein, R S

1987-07-01

142

Oral lesions in Mexican HIV-infected patients.  

PubMed

One hundred and twenty-five HIV-infected patients, of whom 49 (39%) were at early stages of the infection (CDC-II & III) and 76 (61%) in CDC IV, were prospectively examined. In 100 (80%) one or more oral mucosal lesions were observed; candidiasis (51%) and hairy leukoplakia (43%) were the commonest. Erythematous candidiasis was more often seen (35%) than the pseudomembranous type (16%), and appeared with the higher values at early than later stages. The prevalence of hairy leukoplakia, oral hyperpigmentation and xerostomia were incremented in groups CDC-IV. Pseudomembranous candidiasis and exfoliative cheilitis increased significantly with severity of disease. Our study demonstrates that oral alterations associated to HIV are a frequent finding, both at early (76%) and late (83%) stages of the infection in Mexican patients. PMID:1962816

Ramírez, V; González, A; de la Rosa, E; González, M; Rivera, I; Hernández, C; Ponce de León, S

1990-11-01

143

Effect of reserpine on salivary gland radioiodine uptake in thyroid cancer  

SciTech Connect

Nine patients with thyroid cancer were treated with reserpine in an attempt to reduce radiation exposure to the salivary glands from 100-150 mCi doses of I-131 therapy to thyroid remnants or metastases. Three control patients were not treated with reserpine but did receive 100-150 mCi of I-131. Parotid/background ratios of activity after radioablative doses of I-131 in patients not treated with reserpine were significantly higher than the patients treated with reserpine, and this was also true seven days after the radioablative dose. Combined therapy with reserpine, chewing gum, lemon candies, and hydration is suggested for the prevention of sialadenitis and xerostomia due to large doses of radioiodine.

Levy, H.A.; Park, C.H.

1987-04-01

144

Total lymphoid irradiation therapy in refractory rheumatoid arthritis. Fifteen- to forty-month followup  

SciTech Connect

Twelve patients with refractory rheumatoid arthritis were treated with total lymphoid irradiation (TLI) to a total cumulative dose of 3,000 rads. Post-TLI morbidity/mortality included 8 patients with xerostomia, 4 with weight loss of greater than 10 kg, 3 with loss of 4 or more teeth, 3 with herpes zoster, 4 with bacterial infection that was fatal in 2, 3 with hypothyroidism, 1 with cutaneous vasculitis, and death from myocardial infarction in 1 patient and cardiorespiratory arrest in another. Ten of the patients were reevaluated 15-40 months (mean +/- SE, 30 +/- 2) after completion of TLI, and significant improvement was noted in several disease parameters including number of swollen joints, duration of morning stiffness, and 50-foot walking time. Blood lymphopenia and a decrease in helper T cells (T4) were also noted. These data suggest that changes in immunoregulation induced by TLI can produce longlasting alterations in rheumatoid arthritis, although adverse effects may limit its efficacy.

Brahn, E.; Helfgott, S.M.; Belli, J.A.; Anderson, R.J.; Reinherz, E.L.; Schlossman, S.F.; Austen, K.F.; Trentham, D.E.

1984-05-01

145

The dentist's role within the multi-disciplinary team maintaining quality of life for oral cancer patients in light of recent advances in radiotherapy.  

PubMed

Every year in Ireland over 400 people are diagnosed with head and neck cancer. Oral cancer, a specific type of head and neck cancer, is usually treated with surgery and often requires radiotherapy (RT). However, side effects of RT treatment, which include mucositis, xerostomia, radiation caries, trismus and osteoradionecrosis, can seriously compromise a patient's quality of life. Treatment for oral cancer patients is managed in a multidisciplinary team. General dental practitioners (GDPs), consultant/specialist dentists and oral-maxillofacial surgeons play an important role in these patients' care. Recent advances in the delivery of RT have not only improved locoregional control and survival rates, but have also reduced the incidence and severity of RT-associated side effects; however, no mode of RT delivery has successfully eliminated side effects. The role of dentists is essential in maintaining oral health and all patients should be dentally screened prior to commencing RT. Recent reports have attempted to standardise the quality of care for the oral cancer patient and have highlighted the significance of the role of the GDP. Despite the advancements in RT delivery, the dental team is still faced with a number of challenges, including the high number of patients lost to follow-up dental care, lack of an effective treatment for xerostomia, poor patient compliance, and a lack of standardised guidelines and funding. Addressing these challenges will involve increased communication between all members of the multidisciplinary team and increased involvement of the GDP, thereby ensuring that dental care continues to evolve concurrently with new methods of RT delivery. PMID:23858630

Brody, Sarah; Omer, Osama; McLoughlin, Jacinta; Stassen, Leo

146

Post-treatment late complications of nasopharyngeal carcinoma.  

PubMed

Radiotherapy (RT) or concurrent chemoradiation therapy (CCRT) is not only effective at patients' survival rates, but also produces undesirable late complications. The purpose of this study is to investigate the post-treatment late complications in nasopharyngeal carcinoma (NPC) patients, and to analyze the individual impact factors. We enrolled 188 newly diagnosed NPC patients who had received complete treatments and at least 3 years' follow-up between March 1984 and March 2010. Late complications were modified from the Toxicity Criteria of the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer. Of 188 patients, 132 were male and 56 were female. Eighty-eight patients received CCRT and the other 100 patients received RT alone. The median follow-up duration was 7.34 years (range 3.30-26.54). Only 5.3% of patients reported no complication during post-treatment follow-up. The most common major and minor complications were osteoradionecrosis (10.1%) and xerostomia (56.4%), respectively. There was no impact factor for age, underlying disease, and cancer staging. However, there was a negative impact factor for xerostomia and limb numbness in the CCRT group compared with the RT group. Besides, re-radiation for recurrent patients could increase the risk of major complications. Fortunately, these major complications were reduced after the introduction of intensity-modulated radiotherapy in 2003. The improvement of treatment modality decreased the risk of major complications. Physicians should pay more attentions and improve patients' quality of life during follow-up. PMID:22249834

Lee, Cheng-Chang; Ho, Ching-Yin

2012-01-15

147

Impact of submandibular gland excision on salivary gland function in head and neck cancer patients.  

PubMed

Head and neck cancer surgery is often associated with neck dissection and usually includes the submandibular glands. Literature data related to remaining salivary gland function after surgery is scarce and controversial. A reduction in salivary output and increase in complaints of xerostomia have been suggested. However, a compensatory salivary mechanism has also been reported. The aim of this prospective study was to evaluate the effect of neck dissection (with submandibular excision) on salivary gland function measured by salivary flow rate and salivary gland scintigraphy. A total of 80 patients with head and neck tumors were evaluated. The surgery group was composed of 37 patients, who underwent submandibular gland resection, and the non-surgery group of 43 patients evaluated prior to radiation and/or chemotherapy treatment. Whole unstimulated and stimulated saliva collection and salivary gland scintigraphy were performed in all patients. Twenty-one percent of patients in the surgery group reported xerostomia, whereas 7% in the non-surgery group. The mean unstimulated salivary flow was 0.60 and 0.94 m/min for the surgery and non-surgery groups, respectively (p=0.008). Nevertheless, no statistical difference in the stimulated salivary flow was observed between the groups (p=0.26). In addition, the mean uptake and excretion rates for parotid and remaining submandibular glands also showed no statistical difference. The data of the present study support the contention that submandibular gland resection causes a decrease in unstimulated salivary volume. However, the residual submandibular glands in the surgery group showed similar function to that of submandibular glands in the non-surgery group. Consequently, the compensatory salivary mechanism seems not to be a possibility. PMID:20227906

Jaguar, G C; Lima, E N P; Kowalski, L P; Pellizon, A C; Carvalho, A L; Alves, F A

2010-03-15

148

Correlation between viral load, plasma levels of CD4 - CD8 T lymphocytes and AIDS-related oral diseases: a multicentre study on 30 HIV+ children in the HAART era.  

PubMed

This experimental retrospective multicenter study carried out on 30 seropositive children treated with Highly Active Antiretroviral Therapy (HAART), between the ages of 18 months and 14 years, in the clinical categories Centers for Disease Control (CDC) classification 1993 A (mildly symptomatic), B (moderately symptomatic) and C (severely symptomatic) aims to: 1) clinically and immunologically demonstrate the therapeutic benefits of HAART; 2) monitor the frequency of AIDS-related oral diseases in seropositive children with HAART therapy; 3) monitor the plasma levels of total CD4, CD4 percent, CD8 percent, CD4-CD8 lymphocytes and viral load from 1997 to 30 April, 2011. The statistic methods used are the analysis of covariance and the Bonferroni Test. More than 100 AIDS-related oral diseases were found in the study samples, the most frequent being: oral candidiasis, oropharyngeal candidiasis, HSV-1 herpetic esophagyitis, herpetic gingivolstomatitis (RHOG), recurrent aphthous stomatitis (RAS), parotid swelling, oral hairy leukoplakia (OHL), Herpes simplex 1 (HSV-1), linear gingival erythema (LGE), necrotizing gingivitis (NUG), facial lipodistrophy, facial-cervical lymphadenopathy (FCL), xerostomia, dysgeusia, hyposmia, oral mucosa hyperpigmentation (OMP). The Bonferroni test showed a significant difference between the mean plasma values (mpVTL) of total CD4, CD4 percentage, CD4-CD8 T lymphocytes and Viral Load (VL) of the various oral diseases found in the study samples. The therapeutic benefits of HAART are: immune reconstitution; reduction of the HIV/AIDS-related stomatology diseases; prevention and cure of the AIDS correlated neoplasias; reduction in maternal-fetal transmission of the HIV virus. The negative effects of HAART in relation to odontostomatolgy are: increase in oral lesions from HPV; xerostomia; dysgeusia/ageusia, hyposmia, perioral paresthesia; hyperpigmentation of oral mucosa; facial lipodystrophy, recurrent aphthous stomatitis (RAS). No case of immune reconstitution inflammatory syndrome or human papillomavirus (HPV)-related oral diseases were found in this study. PMID:23034272

Nesti, M; Carli, E; Giaquinto, C; Rampon, O; Nastasio, S; Giuca, M R

149

Cervical Lymph Node Metastases From Unknown Primary Cancer: A Single-Institution Experience With Intensity-Modulated Radiotherapy  

SciTech Connect

Purpose: To determine the effectiveness and rate of complications of intensity-modulated radiotherapy (IMRT) in the treatment of cervical lymph node metastases from unknown primary cancer. Methods and Materials: Between February 2005 and November 2008, 25 patients with an unknown primary cancer underwent IMRT, with a median radiation dose of 70 Gy. The bilateral neck and ipsilateral putative pharyngeal mucosa were included in the target volume. All patients had squamous cell carcinoma, except for 1 patient who had adenosquamous differentiation. They were all treated with curative intent. Of the 25 included patients, 20 were men and 5 were women, with a median age of 54 years. Of these patients, 3 had Stage III, 18 had Stage IVa, and 4 had Stage IVb. Of the 25 patients, 18 (72%) received platinum-based chemotherapy in a combined-modality setting. Neck dissection was reserved for residual disease after definitive IMRT. Overall survival, disease-free survival, and locoregional control were calculated using the Kaplan-Meier method. Results: With a median follow-up of 38 months, the overall survival, disease-free survival, and locoregional control rates were all 100% at 3 years. No occurrence of primary cancer was observed during the follow-up period. The reported rates of xerostomia reduced with the interval from the completion of treatment. Nine patients (36%) reported Grade 2 or greater xerostomia at 6 months, and only 2 (8%) of them reported the same grade of salivary function toxicity after 24 months of follow-up. Conclusion: In our institution, IMRT for unknown primary cancer has provided good overall and disease-free survival in all the patients with an acceptable rate of complications. IMRT allowed us to address the bilateral neck and ipsilateral putative pharyngeal mucosa with minimal late salivary function toxicity. The use of concurrent chemotherapy and IMRT for more advanced disease led to good clinical results with reasonable toxicities.

Villeneuve, Hugo, E-mail: hugo.villeneuve@umontreal.ca [Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal, Montreal, QC (Canada); Despres, Philippe; Fortin, Bernard; Filion, Edith; Donath, David [Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal, Montreal, QC (Canada); Soulieres, Denis [Department of Medical Oncology, Centre hospitalier de l'Universite de Montreal, Montreal, QC (Canada); Guertin, Louis; Ayad, Tarek; Christopoulos, Apostolos [Department of Head and Neck Surgery, Centre hospitalier de l'Universite de Montreal, Montreal, QC (Canada); Nguyen-Tan, Phuc Felix [Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal, Montreal, QC (Canada)

2012-04-01

150

Efficacy and Toxicity of Chemoradiotherapy Using Intensity-Modulated Radiotherapy for Unknown Primary of Head and Neck  

SciTech Connect

Purpose: No single standard treatment paradigm is available for head-and-neck squamous cell carcinoma of an unknown primary (HNCUP). Bilateral neck radiotherapy with mucosal axis irradiation is widely used, with or without chemotherapy and/or surgical resection. Intensity-modulated radiotherapy (IMRT) is a highly conformal method for delivering radiation that is becoming the standard of care and might reduce the long-term treatment-related sequelae. We report the Dana-Farber Cancer Institute experience with IMRT-based treatment for HNCUP. Patients and Materials: A retrospective study of all patients treated at the Dana-Farber Cancer Institute for HNCUP with IMRT between August 2004 and January 2009. The primary endpoint was overall survival; the secondary endpoints were locoregional and distant control, and acute and chronic toxicity. Results: A total of 24 patients with HNCUP were included. Of these patients, 22 had Stage N2 disease or greater. All patients underwent neck computed tomography, positron emission tomography-computed tomography, and examination under anesthesia with directed biopsies. Of the 24 patients, 22 received concurrent chemotherapy, and 7 (29%) also underwent induction chemotherapy. The median involved nodal dose was 70 Gy, and the median mucosal dose was 60 Gy. With a median follow-up of 2.1 years, the 2-year actuarial overall survival and locoregional control rate was 92% and 100%, respectively. Only 25% of the patients had Grade 2 xerostomia, although 11 patients (46%) required esophageal dilation for stricture. Conclusion: In a single-institution series, IMRT-based chemoradiotherapy for HNCUP was associated with superb overall survival and locoregional control. The xerostomia rates were promising, but the aggressive therapy was associated with significant rates of esophageal stenosis.

Sher, David J., E-mail: dsher@lroc.harvard.edu [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States); Balboni, Tracy A. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States); Haddad, Robert I. [Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Department of Medicine, Brigham and Women's Hospital, Boston, MA (United States); Norris, Charles M. [Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, MA (United States); Posner, Marshall R. [Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Department of Medicine, Brigham and Women's Hospital, Boston, MA (United States); Wirth, Lori J. [Department of Medical Oncology, Massachusetts General Hospital, Boston, MA (United States); Goguen, Laura A.; Annino, Donald [Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, MA (United States); Tishler, Roy B. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States)

2011-08-01

151

Concurrent Chemotherapy and Intensity-Modulated Radiotherapy for Locoregionally Advanced Laryngeal and Hypopharyngeal Cancers  

SciTech Connect

Purpose: To perform a retrospective review of laryngeal/hypopharyngeal carcinomas treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT). Methods and Materials: Between January 2002 and June 2005, 20 laryngeal and 11 hypopharyngeal carcinoma patients underwent IMRT with concurrent platinum-based chemotherapy; most patients had Stage IV disease. The prescription of the planning target volume for gross, high-risk, and low-risk subclinical disease was 70, 59.4, and 54 Gy, respectively. Acute/late toxicities were retrospectively scored using the Common Toxicity Criteria scale. The 2-year local progression-free, regional progression-free, laryngectomy-free, distant metastasis-free, and overall survival rates were calculated using the Kaplan-Meier method. Results: The median follow-up of the living patients was 26 months (range, 17-58 months). The 2-year local progression-free, regional progression-free, laryngectomy-free, distant metastasis-free, and overall survival rate was 86%, 94%, 89%, 92%, and 63%, respectively. Grade 2 mucositis or higher occurred in 48% of patients, and all experienced Grade 2 or higher pharyngitis during treatment. Xerostomia continued to decrease over time from the end of RT, with none complaining of Grade 2 toxicity at this analysis. The 2-year post-treatment percutaneous endoscopic gastrostomy-dependency rate for those with hypopharyngeal and laryngeal tumors was 31% and 15%, respectively. The most severe late complications were laryngeal necrosis, necrotizing fascitis, and a carotid rupture resulting in death 3 weeks after salvage laryngectomy. Conclusion: These preliminary results have shown that IMRT achieved encouraging locoregional control of locoregionally advanced laryngeal and hypopharyngeal carcinomas. Xerostomia improved over time. Pharyngoesophageal stricture with percutaneous endoscopic gastrostomy dependency remains a problem, particularly for patients with hypopharyngeal carcinoma and, to a lesser extent, those with laryngeal cancer. Strategies using IMRT to limit the dose delivered to the esophagus/inferior constrictor musculature without compromising target coverage might be useful to further minimize this late complication.

Lee, Nancy Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)], E-mail: leen2@mskcc.org; O'Meara, William; Chan, Kelvin [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Della-Bianca, Cesar; Mechalakos, James G. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zhung, Joanne; Wolden, Suzanne L.; Narayana, Ashwatha [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Kraus, Dennis; Shah, Jatin P. [Department of Surgery, Division of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Pfister, David G. [Department of Medicine, Division of Head and Neck Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2007-10-01

152

Potential Benefits of Scanned Intensity-Modulated Proton Therapy Versus Advanced Photon Therapy With Regard to Sparing of the Salivary Glands in Oropharyngeal Cancer  

SciTech Connect

Purpose: To test the hypothesis that scanned intensity-modulated proton therapy (IMPT) results in a significant dose reduction to the parotid and submandibular glands as compared with intensity-modulated radiotherapy with photons (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) for oropharyngeal cancer. In addition, we investigated whether the achieved dose reductions would theoretically translate into a reduction of salivary dysfunction and xerostomia. Methods and Materials: Ten patients with N0 oropharyngeal carcinoma were used. The intensity-modulated plans delivered simultaneously 70 Gy to the boost planning target volume (PTV2) and 54 Gy to the elective nodal areas (PTV1). The 3D-CRT technique delivered sequentially 70 Gy and 46 Gy to PTV2 and PTV1, respectively. Normal tissue complication probabilities were calculated for salivary dysfunction and xerostomia. Results: Planning target volume coverage results were similar for IMPT and IMRT. Intensity-modulated proton therapy clearly improved the conformity. The 3D-CRT results were inferior to these results. The mean dose to the parotid glands by 3D-CRT (50.8 Gy), IMRT (25.5 Gy), and IMPT (16.8 Gy) differed significantly. For the submandibular glands no significant differences between IMRT and IMPT were found. The dose reductions obtained with IMPT theoretically translated into a significant reduction in normal tissue complication probability. Conclusion: Compared with IMRT and 3D-CRT, IMPT improved sparing of the organs at risk, while keeping similar target coverage results. The dose reductions obtained with IMPT vs. IMRT and 3D-CRT varied widely per individual patient. Intensity-modulated proton therapy theoretically translated into a clinical benefit for most cases, but this requires clinical validation.

Water, Tara A. van de, E-mail: t.a.van.de.water@rt.umcg.n [Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, Groningen (Netherlands); Lomax, Antony J. [Center for Proton Therapy, Paul Scherrer Institute, Villigen-PSI (Switzerland); Bijl, Hendrik P.; Jong, Marije E. de; Schilstra, Cornelis [Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, Groningen (Netherlands); Hug, Eugen B. [Center for Proton Therapy, Paul Scherrer Institute, Villigen-PSI (Switzerland); Langendijk, Johannes A. [Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, Groningen (Netherlands)

2011-03-15

153

Oropharyngeal candidosis relative frequency in radiotherapy patient for head and neck cancer  

PubMed Central

Background: Radiation given during treatment of oral and pharyngeal malignancy frequently causes alteration of the oral environment predisposing to the colonization of the oral mucosa by yeast species most frequently Candida. Objective: Thus, this study was undertaken in 107 patients to find out association between radiation therapy and frequency of oropharyngeal candidosis, to quantitate colony forming units (CFUs) to identify Candida at species level and to check the incidence of serotype A and B in C. albicans. Materials and Methods: The study was done on patients suffering from oropharyngeal cancer who were advised radiotherapy. The oral rinse collection method was used to collect the sample. Sabourauds Dextrose Agar (SDA) was used as primary culture media and subsequently speciation was done using standard techniques. The strains of C. albicans were serotyped employing the method described by Hansclever and Mitchell (1961, J Bacteriol 1961;82:570-3). Results: 26.16% patients were mycologically positive for candida before radiotherapy with CFUs 100. 14 ± 59.11 that increased to 60.74% patients during radiotherapy with an increase in CFUs to 490.15 ± 207.97. Clinically, grading of mucositis was done and also individual signs and symptoms were noted in each patient. The occurrence of erythmatous lesions, ulceration, and xerostomia were found to be statistically significant (P<0.05). C. albicans was the most frequently encountered species with higher prevalence of serotype A suggesting higher virulent species. Conclusion: It is proposed that in such patients taking radiotherapy prophylactic antifungal treatment should be given specially in patients showing development of oral mucosal lesions such as erythmatous lesions, ulcerations, and complaining about dryness of mouth, that is, xerostomia irrespective of presence or absence of clinical oral candidosis.

Suryawanshi, Hema; Ganvir, Sindhu M; Hazarey, Vinay K; Wanjare, Varsha S

2012-01-01

154

Tear and saliva ferning tests in Sjögren's syndrome (SS).  

PubMed

The purpose of this study was to evaluate the tear ferning test (TFT) and the saliva ferning test (SFT) as diagnostic tests for xerophthalmia and xerostomia respectively in patients with SS. Dried samples of freshly produced tears and saliva from: (A) 36 healthy controls without sicca symptoms, (B) 61 patients with primary SS, (C) 53 patients with secondary SS and (D) 22 patients with psychiatric disorders receiving antidepressants, were examined by polarizing light microscopy. All individuals included in the study were postmenopausal women. The crystallization was classified into 4 types according to the ferning phenomenon: uniformity, branching, spreading and integrity (type I normal and II, III, IV abnormal). Abnormal TFT was found in tear samples of: (A) 8/72 normal control eyes, (B) 110/122 prim SS eyes, (C) 86/106 sec SS eyes and (D) 30/44 psychiatric patients' eyes. Abnormal SFT was found in: (A) 6/36 of normal controls, (B) 59/61 of prim SS, (C) 51/53 of sec SS patients and (D) 16/22 of psychiatric patients. The differences of both TFT and SFT of patients with prim SS and sec SS versus controls were significant (p < 0.001). The sensitivity of TFT was found to be high both in prim SS (90%) and in sec SS (81%). In addition the specificities of TFT and SFT were high 89% and 83% respectively. On the other hand the differences of TFT and SFT in psychiatric patients receiving antidepressants versus normal controls were also significant (p < 0.05 and p < 0.025 respectively). According to our data TFT and SFT are simple, sensitive and specific tests to evaluate xerophthalmia and xerostomia in SS and probably in other conditions characterized by mucous membrane dryness. PMID:8777844

Maragou, M; Vaikousis, E; Ntre, A; Koronis, N; Georgiou, P; Hatzidimitriou, E; Sotsiou, F; Dantis, P

1996-03-01

155

Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: Update of the Memorial Sloan-Kettering experience  

SciTech Connect

Purpose: We previously demonstrated that intensity-modulated radiation therapy (IMRT) significantly improves radiation dose distribution over three-dimensional planning for nasopharynx cancer and reported positive early clinical results. We now evaluate whether IMRT has resulted in improved outcomes for a larger cohort of patients with longer follow-up. Methods and Materials: Since 1998, all 74 patients with newly diagnosed, nonmetastatic nasopharynx cancer were treated with IMRT using accelerated fractionation to 70 Gy; 59 received a hyperfractionated concomitant boost, and more recently 15 received once-daily treatment with dose painting. With the exception of Stage I disease (n = 5) and patient preference (n = 1), 69 patients received concurrent and adjuvant platinum-based chemotherapy similar to that in the Intergroup 0099 trial. Results: Patient characteristics: median age 45; 32% Asian; 72% male; 65% World Health Organization III; 6% Stage I, 16% Stage II, 30% Stage III, 47% Stage IV. Median follow-up is 35 months. The 3-year actuarial rate of local control is 91%, and regional control is 93%; freedom from distant metastases, progression-free survival, and overall survival at 3 years are 78%, 67%, and 83%, respectively. There was 100% local control for Stage T1/T2 disease, compared to 83% for T3/T4 disease (p = 0.01). Six patients failed at the primary site, with median time to local tumor progression 16 months; 5 were exclusively within the 70 Gy volume, and 1 was both within and outside the target volume. There is a trend for improved local control with IMRT when compared to local control of 79% for 35 patients treated before 1998 with three-dimensional planning and chemotherapy (p 0.11). Six months posttherapy, 21%, 13%, 15%, and 0% of patients with follow-up audiograms (n = 24 patients) had Grade 1, 2, 3, and 4 sensorineural hearing loss, respectively. For patients with >1 year follow-up (n = 59), rates of long-term xerostomia were as follows: 26% none, 42% Grade 1, 32% Grade 2, and zero Grade 3. Conclusions: The pattern of primary site failure within the target volume suggests locally advanced T stage disease may require a higher biologic dose to gross tumor. Rates of severe (Grade 3-4) ototoxicity and xerostomia are low with IMRT as a result of normal-tissue protection. Distant metastases are now the dominant form of failure, emphasizing the need for improved systemic therapy.

Wolden, Suzanne L. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)]. E-mail: woldens@mskcc.org; Chen, William C. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Pfister, David G. [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Kraus, Dennis H. [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Berry, Sean L. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zelefsky, Michael J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2006-01-01

156

In vivo antimuscarinic actions of the third generation antihistaminergic agent, desloratadine  

PubMed Central

Background Muscarinic receptor mediated adverse effects, such as sedation and xerostomia, significantly hinder the therapeutic usefulness of first generation antihistamines. Therefore, second and third generation antihistamines which effectively antagonize the H1 receptor without significant affinity for muscarinic receptors have been developed. However, both in vitro and in vivo experimentation indicates that the third generation antihistamine, desloratadine, antagonizes muscarinic receptors. To fully examine the in vivo antimuscarinic efficacy of desloratadine, two murine and two rat models were utilized. The murine models sought to determine the efficacy of desloratadine to antagonize muscarinic agonist induced salivation, lacrimation, and tremor. Desloratadine's effect on the cardiovascular system was explored in both rodent models. Results In the pithed rat, both desloratadine (1.0 mg/kg, i.v.) and the muscarinic M2 selective antagonist, methoctramine (0.5 mg/kg, i.v.), inhibited negative inotropic (left ventricular dP/dt) effects caused by oxotremorine, a nonselective muscarinic agonist (p < 0.05). Negative chronotropic effects caused by oxotremorine were inhibited by desloratadine, methoctramine, and the muscarinic M3 selective antagonist, 4-DAMP (1.0 mg/kg, i.v.). A late positive inotropic event observed after the initial decrease was inhibited by all three test compounds with desloratadine and 4-DAMP being the most efficacious. In the conscious animal, inhibition of baroreflex-mediated bradycardia was evaluated. Unlike atropine (0.5 mg/kg, i.v.), desloratadine did not alter this bradycardia. The antimuscarinic action of desloratadine on salivation, lacrimation, and tremor was also explored. In urethane-anesthetized (1.5 g/kg, i.p.) male ICR mice (25–35 g) desloratadine (1.0, 5.0 mg/kg) did not inhibit oxotremorine-induced (0.5 mg/kg, s.c.) salivation, unlike atropine (0.5 mg/kg) and 4-DAMP (1.0 mg/kg). In conscious mice, desloratadine failed to inhibit oxotremorine-induced (0.5 mg/kg, s.c.) salivation, lacrimation, and tremor. However, desloratadine did inhibit oxotremorine-induced tremor in phenylephrine pretreated animals. Conclusion The presented data demonstrate that the third generation antihistamine, desloratadine, does not significantly antagonize peripheral muscarinic receptors mediating salivation and lacrimation, therefore, xerostomia and dry eyes should not be observed with therapeutic use of desloratadine. Our data also indicate when administered to a patient with a compromised blood-brain barrier, desloratadine may cause sedation. Patients with compromised cardiovascular systems should be closely monitored when administered desloratadine based on our results that desloratadine has the ability to interfere with normal cardiovascular function mediated by muscarinic receptors.

Howell, G; West, L; Jenkins, C; Lineberry, B; Yokum, D; Rockhold, R

2005-01-01

157

Combined chemo-radiotherapy in locally advanced nasopharyngeal carcinomas  

PubMed Central

AIM: To provide efficacy and safety data about the combined use of radiotherapy and chemo-radiotherapy in nasopharyngeal carcinoma (NPC). METHODS: We reviewed data of 40 patients with locally advanced NPC treated with induction chemotherapy followed by concomitant chemo-radiotherapy (CCRT) (22/40 patients) or CCRT alone (18/40) from March 2006 to March 2012. Patients underwent fiberoscopy with biopsy of the primitive tumor, and computed tomography scan of head, neck, chest and abdomen with and without contrast. Cisplatin was used both as induction and as concomitant chemotherapy, while 3D conformal radiation therapy was delivered to the nasopharynx and relevant anatomic regions (total dose, 70 Gy). The treatment was performed using 6 MV photons of the linear accelerator administered in 2 Gy daily fraction for five days weekly. This retrospective analysis was approved by the review boards of the participating institutions. Patients gave their consent to treatment and to anonymous analysis of clinical data. RESULTS: Thirty-three patients were males and 7 were females. Median follow-up time was 58 mo (range, 1-92 mo). In the sub-group of twenty patients with a follow-up time longer than 36 mo, the 3-year survival and disease free survival rates were 85% and 75%, respectively. Overall response rate both in patients treated with induction chemotherapy followed by CCRT and in those treated with CCRT alone was 100%. Grade 3 neutropenia was the most frequent acute side-effect and it occurred in 20 patients. Grade 2 mucositis was seen in 29 patients, while grade 2 xerostomia was seen in 30 patients. Overall toxicity was manageable and it did not cause any significant treatment delay. In the whole sample population, long term toxicity included grade 2 xerostomia in 22 patients, grade 1 dysgeusia in 17 patients and grade 1 subcutaneous fibrosis in 30 patients. CONCLUSION: Both CCRT and induction chemotherapy followed by CCRT showed excellent activity in locally advanced NPC. The role of adjuvant chemotherapy remains to be defined.

Perri, Francesco; Della Vittoria Scarpati, Giuseppina; Buonerba, Carlo; Di Lorenzo, Giuseppe; Longo, Francesco; Muto, Paolo; Schiavone, Concetta; Sandomenico, Fabio; Caponigro, Francesco

2013-01-01

158

Multidisciplinary Management of Laryngeal Carcinoma  

SciTech Connect

The management of head and neck cancer has evolved into a multidisciplinary approach in which patients are evaluated before treatment and decisions depend on prospective multi-institutional trials, as well as retrospective outcome studies. The choice of one or more modalities to use in a given case varies with the tumor site and extent, as exemplified in the treatment of laryngeal squamous cell carcinomas. The goals of treatment include cure, laryngeal voice preservation, voice quality, optimal swallowing, and minimal xerostomia. Treatment options include transoral laser excision, radiotherapy (both definitive and postoperative), open partial laryngectomy, total laryngectomy, and neck dissection. The likelihood of local control and preservation of laryngeal function is related to tumor volume. Patients who have a relatively high risk of local recurrence undergo follow-up computed tomography scans every 3-4 months for the first 2 years after radiotherapy. Patients with suspicious findings on computed tomography might benefit from fluorodeoxyglucose positron emission tomography to differentiate post-radiotherapy changes from tumor.

Mendenhall, William M. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States)], E-mail: mendewil@shands.ufl.edu; Mancuso, Anthony A. [Department of Diagnostic Radiology, University of Florida College of Medicine, Gainesville, FL (United States); Hinerman, Russell W.; Malyapa, Robert S. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Werning, John W. [Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL (United States); Amdur, Robert J. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Villaret, Douglas B. [Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL (United States)

2007-10-01

159

Effect of botulinum toxin type A injection into human masseter muscle on stimulated parotid saliva flow rate.  

PubMed

Botulinum toxin type A (BTX-A) injection into the masseter muscles is used to treat masseteric hypertrophy. No serious side effects of BTX-A have been reported, but patients sometimes complain of xerostomia. The aim of this study was to evaluate the effect of injecting BTX-A into the masseter for the treatment of masseteric hypertrophy on the flow of saliva from the parotid gland. 34 volunteers enrolled in this study. A total of 25 units of BTX-A was injected into each side bilaterally at two points at the center of the lower third of the masseter muscle. Saliva was collected from the parotid gland over a period of 10 min to determine the flow rate for 18 weeks after injection. The flow rate was calculated by dividing the amount in milliliters by the collection time in minutes. There were no significant changes in the stimulated parotid saliva flow at 4, 8, 12 or 18 weeks compared with the baseline. Within this limited study, it can be concluded that BTX-A injection into the masseter does not cause any significant decrease in the production of saliva from the parotid gland. PMID:19231136

Kwon, J S; Kim, S T; Jeon, Y M; Choi, J H

2009-02-23

160

Effect of Long-term Smoking on Whole-mouth Salivary Flow Rate and Oral Health  

PubMed Central

Background and aims Change in the resting whole-mouth salivary flow rate (SFR) plays a significant role in patho-genesis of various oral conditions. Factors such as smoking may affect SFR as well as the oral and dental health. The primary purpose of this study was to determine the effect of smoking on SFR, and oral and dental health. Materials and methods One-hundred smokers and 100 non-tobacco users were selected as case and control groups, respectively. A questionnaire was used to collect the demographic data and smoking habits. A previously used questionnaire about dry mouth was also employed. Then, after a careful oral examination, subjects’ whole saliva was collected in the resting condition. Data was analyzed by chi-square test using SPSS 15. Results The mean (±SD) salivary flow rate were 0.38 (± 0.13) ml/min in smokers and 0.56 (± 0.16) ml/min in non-smokers. The difference was statistically significant (P=0.00001). Also, 39% of smokers and 12% of non-smokers reported experiencing at least one xerostomia symptom, with statistically significant difference between groups (p=0.0001). Oral lesions including cervical caries, gingivitis, tooth mobility, calculus and halitosis were significantly higher in smokers. Conclusion Our findings indicated that long-term smoking would significantly reduce SFR and increase oral and dental disorders associated with dry mouth, especially cervical caries, gingivitis, tooth mobility, calculus, and halitosis.

Rad, Maryam; Kakoie, Shahla; Niliye Brojeni, Fateme; Pourdamghan, Nasim

2010-01-01

161

Improved outcome of nasopharyngeal carcinoma treated with conventional radiotherapy  

SciTech Connect

Purpose: To describe the outcome of patients with nonmetastatic nasopharyngeal carcinoma (NPC) treated with conventional radiotherapy at a single institution. Methods and materials: From 1990 to 1999, 171 consecutive patients with NPC were treated with conventional (two-dimensional) radiotherapy. Tumor histology was undifferentiated in 82% of cases. Tumor-node-metastasis Stage (American Joint Committee on Cancer/International Union Against Cancer 1997 system) was I in 6%, II in 36%, III in 22%, and IV in 36% of patients. Mean total radiation dose was 68.4 Gy. Chemotherapy was given to 62% of the patients. The median follow-up for surviving patients was 6.3 years (range, 3.1-13.1 years). Results: The 5-year overall survival, disease-specific survival, and disease-free survival rates were 72%, 74%, and 62%, respectively. The 5-year local, regional, and distant control rates were 84%, 80%, and 83% respectively. Late effects of radiotherapy were prospectively recorded in 100 patients surviving without relapse; 44% of these patients had Grade 3 xerostomia, 33% had Grade 3 dental damage, and 11% had Grade 3 hearing loss. Conclusions: This analysis shows an improved outcome for patients treated from 1990 to 1999 compared with earlier retrospective series, despite the use of two-dimensional radiotherapy. Late toxicity, however, was substantial with conventional radiotherapy.

Palazzi, Mauro [Department of Radiotherapy, Istituto Nazionale Tumori, Milan (Italy)]. E-mail: mauro.palazzi@istitutotumori.mi.it; Guzzo, Marco [Department of Head and Neck Surgery, Istituto Nazionale Tumori, Milan (Italy); Tomatis, Stefano Ph.D. [Unit of Medical Physics, Istituto Nazionale Tumori, Milan (Italy); Cerrotta, Annamaria [Department of Radiotherapy, Istituto Nazionale Tumori, Milan (Italy); Potepan, Paolo [Department of Radiology, Istituto Nazionale Tumori, Milan (Italy); Quattrone, Pasquale [Department of Pathology, Istituto Nazionale Tumori, Milan (Italy); Cantu, Giulio [Department of Head and Neck Surgery, Istituto Nazionale Tumori, Milan (Italy)

2004-12-01

162

Targeted immobilisation of lysozyme in the enamel pellicle from different solutions.  

PubMed

Mouthwashes containing protective enzymes are required especially for patients suffering from xerostomia. The present study aimed to investigate the possibilities of modulating the immobilisation of lysozyme in the in situ pellicle layer. In situ formed pellicles were incubated in vitro for 10 min with various enzymatic buffer solutions containing lysozyme and additive enzymes such as transglutaminase or trypsin as well as polyphenolic compounds (cistus tea). After the rinses, the pellicle samples were incubated in collected whole saliva or in desorption solutions for 0, 20 and 40 min and the enzyme activities were measured. Furthermore, accumulation of lysozyme in the pellicle was visualised in ultrathin sections of the pellicle using the gold immunolabelling technique and transmission electron microscopy. Hen egg white lysozyme was accumulated in the in situ pellicle tenaciously. Up to 2.8-fold higher activities than in controls were observed. The addition of transglutaminase did not enhance the immobilisation of lysozyme activity, whereas the polyphenolic compound had no adverse effect. Accumulation of lysozyme in the acquired pellicle was confirmed by gold immunolabelling. Targeted and tenacious immobilisation of lysozyme in the acquired pellicle is possible. Poylphenolic compounds might be a relevant additive for mouthwashes containing lysozyme. PMID:19967422

Hannig, Christian; Spitzmüller, Bettina; Hoth-Hannig, Wiebke; Hannig, Matthias

2009-12-05

163

Limited scleroderma with pauci-immune glomerulonephritis in the presence of renal cell carcinoma.  

PubMed

Connective tissue disorders increase the risk of malignancy; conversely, they may manifest as rheumatological paraneoplastic syndromes due to an underlying malignancy. We describe the case of a patient with limited scleroderma whose rapid disease progression coincided with the discovery of a renal tumor. A woman, age 75 years, presented with a 3-month history of progressive difficulty grasping objects, unsteadiness, dyspnea, xerostomia, xerophthalmia, and significant weight loss. She had a 10-year history of gastroesophageal reflux and Raynaud's phenomenon. Pertinent physical examination findings included facial telangiectasias, bibasilar inspiratory rales, sclerodactyly, and absent pinprick and vibratory sensation in her toes. She also had swelling and tenderness in several metacarpophalangeal and interphalangeal joints and in both ankles. A renal mass was demonstrated on abdominal computed tomography. A left partial nephrectomy was performed, confirming an unclassified type of renal cell carcinoma, along with a focal proliferative crescentic pauci-immune glomerulonephritis. Medical therapy with rituximab, pulse methylprednisolone, and prednisone led to improvement in her symptoms. The patient's presentation is consistent with a rapid progression of pre-existing limited scleroderma with the development of new rheumatological symptoms, including vasculitis. We propose that this progression was secondary to paraneoplastic stimulation by the renal cell carcinoma. Clinicians should consider looking for a malignancy in patients with connective tissue disorders who present with a myriad of new symptoms. PMID:23656799

Abrich, Victor; Duvuru, Sudhir; Swanson, Howard J

2013-05-08

164

Burning mouth syndrome: a review and update.  

PubMed

Burning mouth syndrome (BMS) is characterized by the presence of burning sensation of the oral mucosa in the absence of clinically apparent mucosal alterations. It occurs more commonly in middle-aged and elderly women and often affects the tongue tip and lateral borders, lips, and hard and soft palate. In addition to a burning sensation, the patients with BMS may also complain unremitting oral mucosal pain, dysgeusia, and xerostomia. BMS can be classified into two clinical forms: primary and secondary BMS. The primary BMS is essential or idiopathic, in which the organic local/systemic causes cannot be identified and a neuropathological cause is likely. The diagnosis of primary BMS depends mainly on exclusion of etiological factors. The secondary BMS is caused by local, systemic, and/or psychological factors; thus, its diagnosis depends on identification of the exact causative factor. When local, systemic or psychological factors are present, treatment or elimination of these factors usually results in a significant clinical improvement of BMS symptoms. Vitamin, zinc, or hormone replacement therapy has been found to be effective for reducing the oral burning or pain symptom in some BMS patients with deficiency of the corresponding factor. If patients still have the symptoms after the removal of potential causes, drug therapy should be instituted. Previous randomized controlled clinical trials found that drug therapy with capsaicin, alpha-lipoic acid, clonazepam, and antidepressants may provide relief of oral burning or pain symptom. In addition, psychotherapy and behavioral feedback may also help eliminate the BMS symptoms. PMID:23772971

Sun, Andy; Wu, Kai-Ming; Wang, Yi-Ping; Lin, Hung-Pin; Chen, Hsin-Ming; Chiang, Chun-Pin

2013-06-16

165

Polymyositis with cytochrome C oxidase negative fibers--a pathological and clinical challenge.  

PubMed

Polymyositis (PM) with cytochrome C oxidase negative fibers also referred to as PM with mitochondrial pathology (PM-Mito) is characterized by the symptoms of inclusion body myositis (IBM) and by the myopathological findings of PM except for an increase of muscle fibers with insufficient mitochondrial cytochrome C oxidase activity. Few PM-Mito cases are published; mitochondrial ultrastructure has not been studied in these patients. We report 2 PM-Mito patients with later onset than usually seen in IBM and poor responsiveness to glucocorticoids. Electron microscopy of muscle fibers showed irregular mitochondrial ultrastructure. Sjögren syndrome related antinuclear antibodies (Anti-Ro and Anti-La) were found in one of the two patients but the typical clinical symptoms of Sjögren syndrome such as xerostomia and keratoconjunctivitis were absent in this patient. Taken together, our observations, viewed in conjunction with the current literature, suggest that PM-Mito is an underdiagnosed disease with a multifactorial pathogenesis that should be elucidated in further studies. We want to encourage clinicians and pathologists to consider the possibility of PM-Mito in patients with atypical PM or sIBM. PMID:23181976

Siepmann, Timo; Tesch, Manfred; Krause, Florian; Illigens, Ben Min-Woo; Stoltenburg-Didinger, Gisela

2012-11-20

166

The oral medicine of tooth wear.  

PubMed

This review illustrates, through a series of case histories, how oral medicine insights aid the diagnosis and management of patients with excessive tooth wear. The cases reviewed are drawn from the records of 500 southeast Queensland patients referred to the author over a 12 year period. Patients most at risk of dental erosion have work and sports dehydration, caffeine addiction, gastro-oesophageal reflux, asthma, diabetes mellitus, hypertension or other systemic diseases or syndromes that predispose to xerostomia. Saliva protects the teeth from the extrinsic and intrinsic acids which cause dental erosion. Erosion, exacerbated by attrition and abrasion, is the main cause of tooth wear. These cases illustrate that teeth, oral mucosa, salivary glands, skin and eyes should be examined for evidence of salivary hypofunction and attendant medical conditions. Based on comprehensive oral medicine, dietary analyses and advice, it would seem patients need self-management plans to deal with incipient chronic tooth wear. The alternative is the expensive treatment of pain, occlusal damage and pulp death required to repair the effects of acute severe tooth wear. PMID:11838870

Young, W G

2001-12-01

167

Analysis of saliva samples from oncological patients treated with 5-fluorouracil and leucovorin calcium by scanning electron microscopy with energy dispersive system.  

PubMed

This work presents a chemical and morphological analysis of samples of saliva taken from patients who were under treatment with intravenous chemotherapy with 5-fluorouracil and leucovorin calcium. Samples of saliva were extracted from fifteen patients during the three stages of the treatment: The initial stage (previous to the chemotherapy), the intermediate stage (during the chemotherapy), and the final stage (twenty-one days after finishing the treatment). An amount of 50 ?l was collected in each visit. Chemical contrast images were taken by means of scanning electron microscopy, and X-ray characteristic spectra were obtained from all the studied samples by using an energy dispersive system from all the studied samples. Images that correspond to the intermediate stage showed important differences with respect to the initial and final stages. In addition, X-ray spectra provided information about the present elements in saliva and their relative abundance allowed us to determine variations in the chemical composition. The backscattered electron images and X-ray spectra from the intermediate stage showed clusters of crystals with fluorine content higher than those obtained in initial and final stages. This fact probably indicates the passage of metabolites of 5-fluorouracil and leucovorin calcium from the plasma to the oral cavity. This finding enhances the hypothesis proposed by other authors about the secondary effects of the drugs on the stomatognathic system such as oral mucositis, dysgeusia, and xerostomia with or without hyposalivation. PMID:23647127

Mazzeo, Marcelo Adrián; Linares, Jorge Alberto; López, María Marcela; Bachmeier, Evelin; Wietz, Fernando Martín; Galván, Víctor; Valentinuzzi, María Cecilia; Riveros, José Alberto; Finkelberg, Ana

2013-05-01

168

Oral mucositis.  

PubMed

Mucositis and xerostomia are the most common oral complications of the non-surgical therapy of cancer. Mucositis, a common sequel of radio- (DXR), chemo-(CXR) and radiochemo-therapy in patients with cancer, or patients requiring haemopoietic stem cell transplants (HSCT), has a direct and significant impact on the quality of life and cost of care, and also affects survival--because of the risk of infection. Apart from dose reduction, preventive and treatment options for mucositis are scarce, although multiple agents have been tested. Evidence suggests that cryotherapy, topical benzydamine and amifostine might provide some benefit in specific situations. The recombinant human keratinocyte growth factor Palifermin (Kepivance) was recently approved as a mucositis intervention in patients receiving conditioning regimens before HSCT for the treatment of haematological malignancies. A number of mechanistically based interventions are in various stages of development. Unfortunately, many other approaches have not been rigorously tested. This paper reviews the clinical features, prevalence, diagnosis, complications, pathogenesis, prophylaxis and management of mucositis. PMID:16700732

Scully, C; Sonis, S; Diz, P D

2006-05-01

169

Relief of radiation-induced oral mucositis in head and neck cancer.  

PubMed

This study was a prospective, randomized clinical trial carried out to explore the efficacy of payayor in the prevention and relief of radiation-induced oral mucositis compared with benzydamine. Sixty patients with head and neck cancer, who have started to receive radiotherapy and met predetermined criteria, were randomly assigned into each group to use assigned products 3 times a day from the first to the last day of radiation. The first group used glycerin payayor, a Thai prepared herbal product, by dripping it into the mouth. Another group rinsed their mouths with benzydamine hydrochloride. The World Health Organization Mucositis Grading System was used to assess oral status every week and 2 weeks after radiation. Comparison of time to the onset, pain, severity, xerostomia, postponement of treatment, satisfaction of the solution, and body weight between the 2 groups was performed by t test. The average time to the onset of oral mucositis in the payayor group was significantly later, and its severity and pain score were less than those of the benzydamine group throughout the study period. Significantly higher satisfaction with the solution and higher body weight at the end of the study were shown in the payayor group. Payayor seemed to be superior to benzydamine for preventing and relieving radiation-induced oral mucositis. PMID:19104205

Putwatana, Panwadee; Sanmanowong, Phichanee; Oonprasertpong, Ladawal; Junda, Tiraporn; Pitiporn, Supaporn; Narkwong, Ladawan

170

Factors Associated With Oral Problems Among Adults With Spinal Cord Injury  

PubMed Central

Objective: To explore factors associated with self-reported current oral (tooth and gum) problems and oral pain in the past 12 months among adults with spinal cord injury. Methods: An online oral health survey on the South Carolina Spinal Cord Injury Association website. Respondents were 192 adult residents of the US who identified themselves as having spinal cord injury at least 1 year before the survey date. Results: Approximately 47% of respondents reported having oral problems at the time of the survey, and 42% reported experiencing oral pain in the 12 months before the survey date. Multiple predictor analyses (controlling for age, gender, income, and dental insurance) indicated that current oral problems were positively associated with dry mouth symptoms, financial barriers to dental care access, smoking, and paraplegia. Oral pain experienced in the past 12 months was positively associated with dry mouth symptoms, financial barriers to dental care access, minority race, and paraplegia. Conclusions: Adults with spinal cord injury reported a high prevalence of oral problems and oral pain. Those with paraplegia were more likely to report problems than those with tetraplegia. Because dry mouth and smoking were significantly associated with these problems, patient education from both dental and medical providers should emphasize awareness of the side effects of xerostomia-causing medications, dry mouth management, and smoking cessation. Findings also indicate unmet needs for low-cost preventive and treatment dental services for this vulnerable population.

Yuen, Hon K; Shotwell, Matthew S; Magruder, Kathryn M; Slate, Elizabeth H; Salinas, Carlos F

2009-01-01

171

Submandibular gland excision: long-term clinical outcome in 139 patients operated in a single institution.  

PubMed

In transcervical resection of the submandibular gland for benign lesions, only a limited risk of damage to neural structures can be accepted and a cosmetically satisfactory result is mandatory. In this retrospective case series, we evaluated 139 patients operated over a 10-year period and completed long-term clinical follow-up of 113 of these patients after a median of 81 months. In all patients, the operation was effective. We found a 4.3 % risk of reoperation for wound infection or postoperative hematomas and an 18.7 % risk of early paresis of the marginal branch of the facial nerve, which decreased to 2.7 % on long-term follow-up. We found a 4.4 % risk of permanent lingual nerve paresis, and no patients had damage to the hypoglossal nerve. Xerostomia was found in 22.1 % of the patients and could be quantified by the easily performed biscuit test. Only 2.5 % reported an unsatisfactory cosmetic result and all scars were ? 6 on the Vancouver Scar Scale. Problems with scarring were more common if there had been postoperative infection. We continue to use the lateral transcervical approach as standard in our institution for patients who cannot be managed by gland-sparing procedures. PMID:22941392

Springborg, Line Kanstrup; Møller, Martin Nue

2012-09-01

172

Diffusion-Weighted Magnetic Resonance Imaging to Evaluate Major Salivary Gland Function Before and After Radiotherapy  

SciTech Connect

Purpose: To evaluate diffusion-weighted (DW)-MRI as a noninvasive tool to investigate major salivary gland function before and after radiotherapy (RT) for head and neck cancer (HNC). Methods and Materials: DW-MRI was performed in 8 HNC patients before and after parotid-sparing RT (mean dose to the contralateral parotid gland <26 Gy). A DW sequence was performed once at rest and then repeated continuously during salivary stimulation. Apparent diffusion coefficient (ADC) maps for both parotid and submandibular glands were calculated. Findings were compared with salivary gland scintigraphy. Results: Before RT, the mean ADC value at rest was significantly lower in the parotid than in the submandibular glands. During the first 5 min of stimulation, the ADC value of the salivary glands showed a decrease, followed by a steady increase until a peak ADC, significantly higher than the baseline value, was reached after a median of 17 min. The baseline ADC value at rest was significantly higher after RT than before RT in the nonspared salivary glands but not in the spared parotid glands. In the contralateral parotid glands, the same response was seen as before RT. This pattern was completely lost in the nonspared glands. These results corresponded with remaining or loss of salivary function, respectively, as confirmed by salivary gland scintigraphy. Conclusions: Diffusion-weighted-MRI allows noninvasive evaluation of functional changes in the major salivary glands after RT and is a promising tool for investigating radiation-induced xerostomia.

Dirix, Piet [Department of Radiation Oncology, Leuvens Kankerinstituut (LKI), University Hospitals Leuven, Campus Gasthuisberg, Leuven (Belgium)], E-mail: piet.dirix@uzleuven.be; Keyzer, Frederik de; Vandecaveye, Vincent [Department of Radiology, Leuvens Kankerinstituut (LKI), University Hospitals Leuven, Campus Gasthuisberg, Leuven (Belgium); Stroobants, Sigrid [Department of Nuclear Medicine, Leuvens Kankerinstituut (LKI), University Hospitals Leuven, Campus Gasthuisberg, Leuven (Belgium); Hermans, Robert [Department of Radiology, Leuvens Kankerinstituut (LKI), University Hospitals Leuven, Campus Gasthuisberg, Leuven (Belgium); Nuyts, Sandra [Department of Radiation Oncology, Leuvens Kankerinstituut (LKI), University Hospitals Leuven, Campus Gasthuisberg, Leuven (Belgium)

2008-08-01

173

Hypokalemic paralysis as primary presentation of Fanconi syndrome associated with Sjögren syndrome.  

PubMed

Hypokalemic paralysis is a rare presentation of Fanconi syndrome (FS) caused by Sjögren Syndrome (SS). We describe a 39-year-old man who manifested flaccid paralysis of 4 limbs. Laboratory investigations showed profound hypokalemia (1.6 mmol/L) with renal K wasting, hyperchloremic metabolic acidosis with positive urine anion gap, hypophosphatemia with hyperphosphaturia, hypouricemia with hyperuricosuria, normoglycemic glycosuria, and abnormal serum creatinine concentration 2.2 mg/dL. A thorough survey for the cause of FS revealed that he had xerophthalmia and xerostomia accompanied by high anti-Ro antibody, positive Schirmer test, and delayed saliva excretion on sialoscintigraphy, confirming the diagnosis of SS. Potassium citrate, active vitamin D3, and high phosphate diet for his FS coupled with mycophenolate mofetil for SS resolved clinical symptoms and ameliorated renal function. Early recognition of HP due to the underlying SS-related FS with prompt therapy not only could terminate potentially life-threatening hypokalemia, but also improve renal outcome. PMID:20414123

Wang, Chih-Chiang; Shiang, Jeng-Chuan; Huang, Wen-Te; Lin, Shih-Hua

2010-06-01

174

CXCL13 is elevated in Sjogren's syndrome in mice and humans and is implicated in disease pathogenesis.  

PubMed

SS is an autoimmune disease. pSS affects exocrine glands predominantly, whereas sSS occurs with other autoimmune connective tissue disorders. Currently, care for patients with SS is palliative, as no established therapeutics target the disease directly, and its pathogenetic mechanisms remain uncertain. B-cell abnormalities have been identified in SS. CXCL13 directs B-cell chemotaxis and is elevated in several autoimmune diseases. In this study, we tested the hypothesis that CXCL13 is elevated in SS in mice and humans and that neutralization of the chemokine ameliorates disease in a murine model. We assayed CXCL13 in mouse models and human subjects with SS to determine whether CXCL13 is elevated both locally and systemically during SS progression and whether CXCL13 may play a role in and be a biomarker for the disease. Cxcl13 expression in salivary tissue increases with disease progression, and its blockade resulted in a modest reduction in glandular inflammation in an SS model. We demonstrate that in humans CXCL13 is elevated in serum and saliva, and an elevated salivary CXCL13 level distinguishes patients with xerostomia. These data suggest a role for CXCL13 as a valuable biomarker in SS, as 74% of patients with SS displayed elevated CXCL13 in sera, saliva, or both. Thus, CXCL13 may be pathogenically involved in SS and may serve as a new marker and a potential therapeutic target. PMID:23904442

Kramer, Jill M; Klimatcheva, Ekaterina; Rothstein, Thomas L

2013-07-31

175

Variants at multiple loci implicated in both innate and adaptive immune responses are associated with Sjögren's syndrome.  

PubMed

Sjögren's syndrome is a common autoimmune disease (affecting ?0.7% of European Americans) that typically presents as keratoconjunctivitis sicca and xerostomia. Here we report results of a large-scale association study of Sjögren's syndrome. In addition to strong association within the human leukocyte antigen (HLA) region at 6p21 (Pmeta = 7.65 × 10(-114)), we establish associations with IRF5-TNPO3 (Pmeta = 2.73 × 10(-19)), STAT4 (Pmeta = 6.80 × 10(-15)), IL12A (Pmeta = 1.17 × 10(-10)), FAM167A-BLK (Pmeta = 4.97 × 10(-10)), DDX6-CXCR5 (Pmeta = 1.10 × 10(-8)) and TNIP1 (Pmeta = 3.30 × 10(-8)). We also observed suggestive associations (Pmeta < 5 × 10(-5)) with variants in 29 other regions, including TNFAIP3, PTTG1, PRDM1, DGKQ, FCGR2A, IRAK1BP1, ITSN2 and PHIP, among others. These results highlight the importance of genes that are involved in both innate and adaptive immunity in Sjögren's syndrome. PMID:24097067

Lessard, Christopher J; Li, He; Adrianto, Indra; Ice, John A; Rasmussen, Astrid; Grundahl, Kiely M; Kelly, Jennifer A; Dozmorov, Mikhail G; Miceli-Richard, Corinne; Bowman, Simon; Lester, Sue; Eriksson, Per; Eloranta, Maija-Leena; Brun, Johan G; Gøransson, Lasse G; Harboe, Erna; Guthridge, Joel M; Kaufman, Kenneth M; Kvarnström, Marika; Jazebi, Helmi; Cunninghame Graham, Deborah S; Grandits, Martha E; Nazmul-Hossain, Abu N M; Patel, Ketan; Adler, Adam J; Maier-Moore, Jacen S; Farris, A Darise; Brennan, Michael T; Lessard, James A; Chodosh, James; Gopalakrishnan, Rajaram; Hefner, Kimberly S; Houston, Glen D; Huang, Andrew J W; Hughes, Pamela J; Lewis, David M; Radfar, Lida; Rohrer, Michael D; Stone, Donald U; Wren, Jonathan D; Vyse, Timothy J; Gaffney, Patrick M; James, Judith A; Omdal, Roald; Wahren-Herlenius, Marie; Illei, Gabor G; Witte, Torsten; Jonsson, Roland; Rischmueller, Maureen; Rönnblom, Lars; Nordmark, Gunnel; Ng, Wan-Fai; Mariette, Xavier; Anaya, Juan-Manuel; Rhodus, Nelson L; Segal, Barbara M; Scofield, R Hal; Montgomery, Courtney G; Harley, John B; Sivils, Kathy L

2013-10-06

176

Changes in the protein composition of whole saliva during radiotherapy in patients with oral or pharyngeal cancer  

SciTech Connect

We analyzed the radiation-induced changes in the flow rate and protein composition of stimulated whole saliva in eleven patients treated for malignant conditions of the head and neck. In all patients the radiation field covered all major salivary glands and a large area of the oral mucosa. Paraffin-stimulated whole saliva samples were collected once 2 to 21 days before therapy and then after 20, 40, and 60 gray (Gy) cumulative dose of irradiation. Five patients also provided samples 6 months after the therapy. Hyposalivation or xerostomia occurred in all patients, although the pretreatment secretion rates were already relatively low. Salivary amylase activities decreased with increasing dose of radiation, especially when expressed as the amount of enzyme secreted per minute. Unusually high salivary concentrations of albumin, lactoferrin, lysozyme, salivary peroxidase, myeloperoxidase, and total protein were observed during the therapy, but most values slowly returned to pretreatment levels after cessation of radiation. It is concluded that the observed qualitative changes in whole saliva components are net effects caused by the cancer itself, radiation therapy given, systemic diseases, or medications, as well as mucosal inflammations.

Makkonen, T.A.; Tenovuo, J.; Vilja, P.; Heimdahl, A.

1986-09-01

177

Oral manifestations of human immunodeficiency virus in children: An institutional study at highly active antiretroviral therapy centre in India  

PubMed Central

Context: More than 1000 children are newly infected with Human immunodefi ciency virus (HIV) every day, and of these more than half will die as a result of AIDS due to lack of access to HIV treatment. HIV disease varies considerably in children. Among those infected prenatally, some experience few or no symptoms for years, whereas in others the disease progresses rapidly. The risk factors that influence the development of such oral manifestations include, low CD4+ T cell count, xerostomia and lack of highly active antiretroviral therapy (HAART). Aims: To identify the oral manifestations of HIV in children receiving HAART. Materials and Methods: The study comprised 95 children receiving HAART. 95 HIV +ve children not receiving HAART and 95 HIV –ve children were also included for comparing the manifestations of HIV. Statistical Analysis Used: Statistical analysis was done using Fisher's Chi-square test. Probability value (P value) was obtained for the three groups. Results: The manifestations of HIV that were observed in children receiving HAART include dental caries (26%), periodontal diseases (23%), candidiasis (19%), hyperpigmentation (17%), ulcerative stomatitis (9%) and one case of mucocele. These manifestations were compared with HIV +ve children not receiving HAART and HIV –ve children to find manifestations with statistical significance. Conclusions: We conclude that HAART had increased the disease-free states in HIV +ve children on HAART promising them better life span. The incidence of oral lesions can further come down with adequate oral hygiene measures in HIV-infected children.

Ponnam, Srinivas Rao; Srivastava, Gautam; Theruru, Kotaih

2012-01-01

178

[Hypersalivation - inauguration of the S2k Guideline (AWMF) in short form].  

PubMed

Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This reduces social interaction chances and burdens daily care. Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, and saliva aspiration. Therefore, a multidisciplinary S2k guideline was developed. Diagnostic tools such as fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing studies generate important data on therapy selection and control. Especially traumatic and oncologic cases profit from swallowing therapy programmes in order to activate compensation mechanisms. In children with hypotonic oral muscles, oralstimulation plates can induce a relevant symptom release because of the improved lip closure. In acute hypersalivation, the pharmacologic treatment with glycopyrrolate and scopolamine in various applications is useful but its value in long-term usage critical. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long lasting saliva reduction. Surgical treatment should be reserved for isolated cases. External radiation is judged as ultima ratio. Therapy effects and symptom severity has to be followed, especially in neurodegenerative cases. The resulting xerostomia should be critically evaluated by the responsible physician regarding oral and dental hygiene. PMID:23900923

Steffen, A; Beutner, D; Hakim, S; Jost, W; Kahl, K G; Laskawi, R; Lencer, R; Mall, V; Mehrhoff, F-W; Meyners, T; Schönweiler, R; Schröder, S; Schröter-Morasch, H; Schuster, M; Steinlechner, S; Winterhoff, J; Zenk, J; Guntinas-Lichius, O

2013-07-30

179

Early responses to adenoviral-mediated transfer of the aquaporin-1 cDNA for radiation-induced salivary hypofunction  

PubMed Central

No conventional therapy exists for salivary hypofunction in surviving head and neck cancer patients with Radiation Therapy Oncology Group late grade 2–3 toxicity. We conducted a phase I clinical trial to test the safety and biologic efficacy of serotype 5, adenoviral-mediated aquaporin-1 cDNA transfer to a single previously irradiated parotid gland in 11 subjects using an open label, single-dose, dose-escalation design (AdhAQP1 vector; four dose tiers from 4.8 × 107 to 5.8 × 109 vector particles per gland). Treated subjects were followed at scheduled intervals. Multiple safety parameters were measured and biologic efficacy was evaluated with measurements of parotid salivary flow rate. Symptoms were assessed with a visual analog scale. All subjects tolerated vector delivery and study procedures well over the 42-d study period reported. No deaths, serious adverse events, or dose-limiting toxicities occurred. Generally, few adverse events occurred, and all were considered mild or moderate. No consistent changes were found in any clinical chemistry and hematology parameters measured. Objective responses were seen in six subjects, all at doses <5.8 × 109 vector particles per gland. Five of these six subjects also experienced subjective improvement in xerostomia. AdhAQP1 vector delivery to a single parotid gland was safe and transfer of the hAQP1 cDNA increased parotid flow and relieved symptoms in a subset of subjects.

Baum, Bruce J.; Alevizos, Ilias; Zheng, Changyu; Cotrim, Ana P.; Liu, Shuying; McCullagh, Linda; Goldsmith, Corinne M.; Burbelo, Peter D.; Citrin, Deborah E.; Mitchell, James B.; Nottingham, Liesl K.; Rudy, Susan F.; Van Waes, Carter; Whatley, Millie A.; Brahim, Jaime S.; Chiorini, John A.; Danielides, Stamatina; Turner, R. James; Patronas, Nicholas J.; Chen, Clara C.; Nikolov, Nikolay P.; Illei, Gabor G.

2012-01-01

180

A comparison of oral and dental manifestations in diabetic and non-diabetic uremic patients receiving hemodialysis  

PubMed Central

Background: The purpose of the study was to evaluate the oral and dental findings of uremic patients receiving hemodialysis and to compare the Results between diabetic and non-diabetic groups. Materials and Methods: A total of 100 patients undergoing hemodialysis were classified into diabetic and non-diabetic groups and examined for uremic oral manifestations, dental caries (DMFT), and periodontal status (CPITN). Mann-Whitney test of significance has been applied for analyzing DMFT score and chi-square test is used for analyzing CPITN score. Results: Of the study group, 46% were diabetic and only 11% of them did not have any oral manifestation. Oral manifestations observed were xerostomia and uremic odor, which contributed to 47 (23%) and 37 (17%), respectively. Hyperpigmentation was present in 26 (12%), macroglossia in 23 (11%), and uremic tongue coating in 24 (11%). Mucosal petechiae were seen in 17 patients contributing to 8% of total patients. Eleven patients had tongue pallor (5%), 9 patients had glossitis with depapillation (4%), and 7 patients had dysgeusia (3%). Angular cheilitis and gingival swelling were seen in 5 patients (2%). Conclusion: The oral and dental manifestations were higher in prevalence in the study group. However, there was no significant difference between the two groups.

Murali, Preethi; Narasimhan, Malathi; Periasamy, Soundararajan; Harikrishnan, Thamizh chelvan

2012-01-01

181

Dendrobium candidum extract increases the expression of aquaporin-5 in labial glands from patients with Sjögren's syndrome.  

PubMed

This study aimed to investigate the mechanism of Dendrobium candidum extract in promoting expression of aquaporin-5 for treatment of Sjögren's syndrome (SS). Sixteen patients with SS suffered from deficient secretion of saliva due to an autoimmune destruction of salivary glands leading to dry mouth symptoms (xerostomia). However, glandular dysfunction also occurred without destruction. Based upon its abnormal distribution in SS salivary glands, a potential role of the water channel protein aquaporin-5 (AQP-5) in the pathogenesis of SS was proposed. After oral administration of D. candidum extracted liquid (DCEL) for 1 week, saliva and salivary gland biopsies from labial glands of patients were collected and examined by employing immunoreactivity and immunohistochemistry techniques. Results showed that salivary secretion increased by about 65% in patients treated with DCEL as compared with the control group. Higher labeling indices (percentage of acinus area immunoreactive for AQP-5) in the biopsies were found in SS patients who had taken DCEL. This study demonstrated that D. candidum would regulate the expression of AQP-5 in labial glands of SS patients and thereby promoted secretion of saliva to improve dry mouth symptoms. PMID:20655712

Xiao, Lin; Ng, Tzi Bun; Feng, Yi-Bin; Yao, Tong; Wong, Jack Ho; Yao, Ren-Min; Li, Lei; Mo, Fei-Zhi; Xiao, Yin; Shaw, Pang-Chui; Li, Ze-Min; Sze, Stephen Cho Wing; Zhang, Kalin Yanbo

2010-07-23

182

[Trichomonosomycosis of the oral cavity].  

PubMed

Protozoa and fungi of the oral cavity, although frequently occuring and connected with considerable clinical adverse effects, are as yet insufficiently known. The aims of the study were to estimate the prevalence of common invasions of Trichomonas tenax and fungi, to associate the symptoms with the diagnosis of trichomonosis complicated by mycosis and to determine trichomonacidal properties of ornidazole, tinidazole and metronidazole. 936 dentist patients with different diagnoses were included into the study. The collected material consisted of rinsings, with simultaneous application of selective media, different for protozoa and for fungi 6ultures. Among the examined patients T. tenax was found in 90 cases including 85 cases where it occurred together with fungi (11 species), on the basis of which the diagnosis of trichomonosomycosis of the oral cavity was established. It was the most often in patients with leukoplakia and Lichen Wilsoni. We received a statistically significant association (0.001 xerostomia, burning sensation, periodontal pockets and denuded teeth. Trichomonas tenax was not found in any patiem with caries and with aphthe recidivans. PMID:16886453

Kurnatowska, A J; Kurnatowski, P

1999-01-01

183

Outcomes of Postoperative Simultaneous Modulated Accelerated Radiotherapy for Head-and-Neck Squamous Cell Carcinoma  

SciTech Connect

Purpose: To evaluate the treatment efficacy and toxicity of postoperative simultaneous modulated accelerated radiotherapy (SMART) for patients with head-and-neck squamous cell carcinoma (HNSCC). Methods and Materials: Between February 2003 and September 2008, 51 patients with histologically confirmed HNSCC received postoperative intensity-modulated radiotherapy (N = 33) or helical tomotherapy (N = 18) using SMART after curative surgical resection. The sites included were the oral cavity (OC), oropharynx (OP), larynx, and hypopharynx in 23, 20, 5, and 3 patients, respectively. Results: The median follow-up duration of all patients and surviving patients were 32 (range, 5-78 months) and 39 months (range, 9-77 months), respectively. The 3-year overall survival, cause-specific survival, disease-free survival, locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) in all patients were 71%, 77%, 75%, 85%, and 82%, respectively. Although no significant difference in 3-year LRRFS were found between OC (82%) and OP (82%) carcinomas, the 3-year DMFS was worse in cases of OC (66%) carcinoma compared with OP carcinoma (95%; p = 0.0414). Acute Grade 3 dermatitis, mucositis, and esophagitis occurred in 10%, 10%, and 2% of patients, respectively. At the last follow-up, Grade 3 xerostomia was documented in 10% of the patients. Young age ({<=}40 years) (p < 0.001) and OC carcinoma primary (p = 0.0142) were poor risk factors on univariate analysis for DMFS. Conclusion: Postoperative SMART was observed to be effective and safe in patients with HNSCC.

Moon, Sung Ho [Proton Therapy Center, National Cancer Center, Goyang (Korea, Republic of); Center for Specific Organs Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Jung, Yuh-Seog; Ryu, Jun Sun; Choi, Sung Weon; Park, Joo Yong; Yun, Tak; Lee, Sang Hyun [Center for Specific Organs Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Cho, Kwan Ho, E-mail: kwancho@ncc.re.kr [Proton Therapy Center, National Cancer Center, Goyang (Korea, Republic of); Center for Specific Organs Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

2011-09-01

184

Oral signs and symptoms in 160 Greek HIV-infected patients.  

PubMed

One hundred and sixty HIV-infected Greek patients were prospectively examined and the oral signs and symptoms were recorded. At the time of oral examination, 76 patients were asymptomatic seropositive, 47 were in ARC stage and 37 had AIDS. One or more oral findings were recorded in 90.6% of the patients while a total of 33 different lesions were observed. The more common oral lesions (highly suspicious) were candidiasis (61%), hairy leukoplakia (24%), periodontitis (19%), necrotizing gingivitis (11%) and Kaposi's sarcoma (12%). In addition some unclassified lesions or symptoms (xerostomia 26%, burning mouth syndrome 19%, patchy depapillated tongue 16%, hairy tongue 10%, exfoliative cheilitis 4%), were common while submandibular and cervical lymph node enlargement were found in 49% of the patients. Interestingly in 16 patients (10%) the suspicion of HIV infection was exclusively based on oral lesions. Our findings show that oral signs and symptoms are common and some times early manifestations of HIV infection and it is in association to those reported in previous studies. PMID:1316436

Laskaris, G; Hadjivassiliou, M; Stratigos, J

1992-03-01

185

[The clinical and cytological characteristics of the oral mucosa in Sjögren's disease and chronic parotitis].  

PubMed

Clinical stomatologic and cytologic studies were carried out in 31 patients with Sjogren's disease, 12 ones with chronic parotitis, and 5 normal subjects. Patients with Sjogren's disease, in contrast to those with chronic parotitis, develop clinically manifest signs of dry exfoliative cheilitis, xerostomia, atrophic changes in the buccal mucosa; this condition is associated with a very high caries intensity and no clinical manifestations of periodontitis or tartar. Elevated leukocyte levels in oral washings and oral fluid of patients with Sjogren's disease and chronic parotitis point to inflammations in the salivary glands, buccal mucosa, and periodontal tissues. Assessment of the leukocyte levels may be used for monitoring the disease course and treatment efficacy. A 3-5-fold enlargement of the deep-layer epitheliocytes, seen on the cytogram of oral washings, is characteristic of patients with Sjogren's disease, in contrast to those with chronic parotitis or normal subjects. A differentiated estimation of the epitheliocyte types in the cytogram of oral washings may be used in the diagnosis of Sjogren's disease along with the criteria suggested before. PMID:1798989

Pozharitskaia, M M; Makarova, O V; Malomud, Z P; Kats, A G

186

Limited Scleroderma with Pauci-Immune Glomerulonephritis in the Presence of Renal Cell Carcinoma  

PubMed Central

Connective tissue disorders increase the risk of malignancy; conversely, they may manifest as rheumatological paraneoplastic syndromes due to an underlying malignancy. We describe the case of a patient with limited scleroderma whose rapid disease progression coincided with the discovery of a renal tumor. A woman, age 75 years, presented with a 3-month history of progressive difficulty grasping objects, unsteadiness, dyspnea, xerostomia, xerophthalmia, and significant weight loss. She had a 10-year history of gastroesophageal reflux and Raynaud’s phenomenon. Pertinent physical examination findings included facial telangiectasias, bibasilar inspiratory rales, sclerodactyly, and absent pinprick and vibratory sensation in her toes. She also had swelling and tenderness in several metacarpophalangeal and interphalangeal joints and in both ankles. A renal mass was demonstrated on abdominal computed tomography. A left partial nephrectomy was performed, confirming an unclassified type of renal cell carcinoma, along with a focal proliferative crescentic pauci-immune glomerulonephritis. Medical therapy with rituximab, pulse methylprednisolone, and prednisone led to improvement in her symptoms. The patient’s presentation is consistent with a rapid progression of pre-existing limited scleroderma with the development of new rheumatological symptoms, including vasculitis. We propose that this progression was secondary to paraneoplastic stimulation by the renal cell carcinoma. Clinicians should consider looking for a malignancy in patients with connective tissue disorders who present with a myriad of new symptoms.

Abrich, Victor; Duvuru, Sudhir; Swanson, Howard J.

2013-01-01

187

[Analysis of oral mucosal lesions in patients referred to oral medicine specialists].  

PubMed

. The need for studies on prevalence of lesions in the field of oral medicine increases as more patients suffer from oral mucosal diseases. Data on prevalence of oral mucosal diseases throughout the world are scarce. Therefore, we have made a retrospective study of patients referred to the Department of Oral Medicine, University of Zagreb, during a period of one year, i.e. 2010. Data on patient age, gender and diagnosis were recorded. Out of 1118 analyzed clinical records of the patients, 756 (67.6%) were women and 362 (32.4%) were men. The age range of female patients was 54 +/- 19 years (mean age 62.17 years) and the male age range was 49+/-21 (mean age 64.17 years). The most common diagnosis was burning mouth syndrome (23.4%), followed by xerostomia (10.6%), traumatic ulceration (8.7%), geographic tongue (6.6%) and denture stomatitis (5.7%). Other diagnoses were found in a smaller percentage. Our results point out an increased need for oral medicine services. PMID:23991489

Brailo, Vlaho; Boras, Vanja Vuci?evi?; Pintar, Elizabeta; Juras, Danica Vidovi?; Karaman, Natasa; Rogulj, Ana Andabak

188

Prevalence of Oral Mucosal Lesions in Patients with Type 2 Diabetes Attending Hospital Universiti Sains Malaysia  

PubMed Central

Objectives: Diabetes mellitus is associated with a greater likelihood of developing certain oral mucosal disorders. This study was aimed at assessing the prevalence of oral mucosal lesions (OMLs) in patients with type 2 diabetes (DM2) and to investigate the association of such lesions with metabolic control of the disease. Methods: This cross-sectional study involved 391 patients with DM2 and 391 non-diabetic control subjects. Demographic information and data on the duration and type of diabetes, glycosylated hemoglobin (HbA1c) values, medical history, and current use of medication were obtained from medical records. Detailed oral examination was performed in accordance with international criteria. Results: The prevalence of OMLs was significantly higher among diabetic patients (45.5%) than among control subjects (38.4%) (P = 0.042). Patients with diabetes had a higher prevalence of geographic tongue (GT) (P = 0.017), denture stomatitis (P = 0.018), and angular cheilitis (P = 0.006) than controls. Overall, diabetic patients with poor metabolic control had a significantly higher prevalence of OMLs and xerostomia than patients with moderately and well-controlled disease (P < 0.05). Conclusion: The prevalence of OMLs was significantly higher in diabetic patients than in control subjects. Higher occurrence of OMLs was significantly associated with poor metabolic control.

AL-MAWERI, Sadeq Ali Ali; ISMAIL, Noorliza Mastura; ISMAIL, Abdul Rashid Ismail; AL-GHASHM, Abdulmlik

2013-01-01

189

Intensity-Modulated Radiotherapy for Sinonasal Cancer: Improved Outcome Compared to Conventional Radiotherapy  

SciTech Connect

Purpose: To evaluate clinical outcome and toxicity of postoperative intensity-modulated radiotherapy (IMRT) for malignancies of the nasal cavity and paranasal sinuses. Methods and Materials: Between 2003 and 2008, 40 patients with cancer of the paranasal sinuses (n = 34) or nasal cavity (n = 6) received postoperative IMRT to a dose of 60 Gy (n = 21) or 66 Gy (n = 19). Treatment outcome and toxicity were retrospectively compared with that of a previous patient group (n = 41) who were also postoperatively treated to the same doses but with three-dimensional conformal radiotherapy without intensity modulation, from 1992 to 2002. Results: Median follow-up was 30 months (range, 4-74 months). Two-year local control, overall survival, and disease-free survival were 76%, 89%, and 72%, respectively. Compared to the three-dimensional conformal radiotherapy treatment, IMRT resulted in significantly improved disease-free survival (60% vs. 72%; p = 0.02). No grade 3 or 4 toxicity was reported in the IMRT group, either acute or chronic. The use of IMRT significantly reduced the incidence of acute as well as late side effects, especially regarding skin toxicity, mucositis, xerostomia, and dry-eye syndrome. Conclusions: Postoperative IMRT for sinonasal cancer significantly improves disease-free survival and reduces acute as well as late toxicity. Consequently, IMRT should be considered the standard treatment modality for malignancies of the nasal cavity and paranasal sinuses.

Dirix, Piet, E-mail: piet.dirix@uzleuven.b [Department of Radiation Oncology, Leuvens Kankerinstituut (LKI), University Hospitals Leuven, campus Gasthuisberg, Leuven (Belgium); Vanstraelen, Bianca [Department of Radiation Oncology, Leuvens Kankerinstituut (LKI), University Hospitals Leuven, campus Gasthuisberg, Leuven (Belgium); Jorissen, Mark; Vander Poorten, Vincent [Department of Otorhinolaryngology-Head and Neck Surgery, Leuvens Kankerinstituut (LKI), University Hospitals Leuven, campus Gasthuisberg, Leuven (Belgium); Nuyts, Sandra [Department of Radiation Oncology, Leuvens Kankerinstituut (LKI), University Hospitals Leuven, campus Gasthuisberg, Leuven (Belgium)

2010-11-15

190

Inhibition of Candida albicans yeast-hyphal transition and biofilm formation by Solidago virgaurea water extracts.  

PubMed

Xerostomia is a decrease of saliva secretion, which can unbalance the oral microflora, mainly to the benefit of Candida albicans. The aim of the present study was to find a plant extract that could create an unfavourable environment for Candida, and would, therefore, be appropriate for use in a dry-mouth daily-care mouthwash. Water extract from the herbaceous plant Solidago virgaurea (Goldenrod) was selected due to its saponin content (plant detergents). Saponin concentrations reached 0.7 and 0.95 mg ml(-1) in S. virgaurea subsp. virgaurea and S. virgaurea subsp. alpestris extracts, respectively. C. albicans was grown in liquid medium and cells were counted by microscopic examination after 0, 4 and 24 h of incubation. Solidago extracts did not inhibit the growth of C. albicans (four strains), Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus mutans, Streptococcus salivarius or Enterococcus faecalis. When inocula were incubated with Solidago extract for 4 and 24 h, we observed a decrease in Candida yeast-hyphal transition. Candida biofilms were then prepared in microtitre plates and treated with plant extracts at 0 h, to estimate biofilm formation, or at 18 h to estimate the effect of the saponin on pre-formed biofilms. Biofilm formation and pre-formed biofilms were both strongly inhibited. In conclusion, the S. virgaurea extract was efficient against two key virulence factors of C. albicans: the yeast-hyphal transition phase and biofilm formation. PMID:22422572

Chevalier, Marlène; Medioni, Etienne; Prêcheur, Isabelle

2012-03-15

191

Evaluation by an Aeronautic Dentist on the Adverse Effects of a Six-Week Period of Microgravity on the Oral Cavity  

PubMed Central

Objective. HDT bed rest condition is a simulated microgravity condition in which subject lies on bed inclined ?6 degree feet up. To determine the influence of a simulated microgravity (HDT bed rest) on oral cavity, 10 healthy male volunteers were studied before, during, just after, and after 6 weeks of the simulated microgravity condition of ?6° head-down-tilt (HDT) bed rest. Materials and Methods. Facial nerve function, facial sensation, chemosensory system, salivary biomarkers were measured. Results. Lactate dehydrogenase, MIP 1 alpha, malonaldehyde, 8-hydroxydeoxyguanosine, and thiocyanate were found to increase significantly, while flow rate, sodium, potassium, calcium, phosphate, protein, amylase activity, vitamin E and C, and mouth opening were decreased in simulation environments in contradiction to normal. The threshold for monosodium glutamate (MSG) and capsaicin increased during microgravity as compared to normal conditions. Moderate pain of teeth, facial oedema, mild pain, loss of sensation of pain and temperature, decreased tongue, and mandibular movement in simulation microgravity environments were observed. Conclusions. These results suggest that reversible effect of microgravity is oedema of face, change in taste, abnormal expression of face, teeth pain, and xerostomia. Further study will be required on large scale on long-term effects of microgravity on oral cavity to prevent the adverse effects.

Rai, Balwant; Kaur, Jasdeep; Foing, Bernard H.

2011-01-01

192

[Quality of life for patients treated for head and neck carcinoma].  

PubMed

A large consensus admits that quality of life is a multifactorial concept including at least physical, psychical and social dimensions of the disease as well as symptoms related to the disease and to the requested treatments. Quality of life is actually considered as one of the major assessment criteria for taking care of patients with cancer and to evaluate results of clinical trials. Self-evaluation by the patient is considered as the gold standard to evaluate the clinical symptoms. This evaluation is not unambiguous. Medical doctors underestimate patients' symptoms. In the field of surgery, development of organ preservation strategies should be considered as one of the major improvement observed in the modern era of head and neck oncology. The role of xerostomia, the most frequent complication reported after head and neck radiation therapy, is major in this field. However, odynophagia is considered as the most detrimental component of quality of life. Radiation oncologists should realize the role of these parameters in order to include these concepts as relevant in the global evaluation of treatments. PMID:20724192

Maingon, P; Créhange, G; Bonnetain, F; Ligey-Bartolomeu, A; Chamois, J; Bruchon, Y; Romanet, P; Truc, G

2010-08-17

193

[Intensity modulated radiation therapy for head and neck cancer: The standard].  

PubMed

Combined radical radiation therapy for head and neck carcinoma should be planned with intensity modulated beams to provide a rapid answer to patients' requirements in terms of quality of treatment. The most frequent late toxicity of radiation therapy is xerostomia, which may be prevented by using this technique able to significantly spare salivary glands irradiation. Selection of indications is a very important step. The objective of sparing salivary functions, strongly associated with optimization criteria of quality of life should be considered as a main objective in irradiation of head and neck tumours. The various possibilities offered by this technique allowing to boost a target volume included in prophylactically irradiated regions could offer the possibility to escalate the dose in selected patients. The feasibility of this process is currently validated in prospective studies. Finally, routine implementation of intensity modulated radiation therapy should be performed with strong and robust quality assurance procedures, ensuring that the expected benefit could be increased with the current developments by using rotational techniques. PMID:21873094

Maingon, P; Créhange, G; Chamois, J; Khoury, C; Truc, G

2011-08-27

194

[Constraints to organs at risk for treatment of head and neck cancers by intensity modulated radiation therapy].  

PubMed

Constraint definitions in intensity modulated radiation therapy is a key point factor during the treatment planning process. In literature some data are available about dose constraints and volumes according to the tissue architectures. Following ICRU recommendations, organs at risk organized in a parallel structure could receive an acceptably small proportion of high dose component. Mean dose and dose volume histogram is a most convenient tool for incorporating such constraints. Organs described as a serial structure are supposed to receive less than the given maximum dose, directly linked to the occurrence of complications. Dmax is the best way to describe such events. These constraints are new tools in radiation therapy, available for optimizing the dose distribution in target volume, sparing the organs at risk to protect the organ function or at least decreasing the late functional damages like xerostomia. It is necessary to define with accuracy gross target volumes and clinical target volume with available radio-anatomical guidelines before introducing current constraints on each volume in the inverse dosimetry. The management of these constraints remains under the responsibility of the clinicians. A permanent compromise has to be chosen between homogeneity of the dose distribution in the target volume and the probability of preserving functions of organs at risk. PMID:15450517

Maingon, P; Mammar, V; Peignaux, K; Truc, G; Barillot, I

2004-08-01

195

Long-term maxillofacial effects of radiotherapy in young nasopharyngeal carcinoma patients: report of 3 cases.  

PubMed

Nasopharyngeal carcinoma (NPC) is a rare and distinct malignancy that arises from the epithelium of the nasopharynx. It accounts almost 1% of all pediatric malignancies. Oral complications of radiotherapy in the head and neck region are the result of the deleterious effects of radiation on salivary glands, oral mucosa, bone, dentition, masticatory musculature, and temporomandibular joints. Here we present 3 male NPC patients 13, 14 and 15 years old. One of them had stage III and the others stage IV diseases. Administered dose of radiation was 66 Gy for case I, 70 Gy for case II and 68 Gy for case III. The follow-up period was more than 12 months except for case III and all of them were disease free in their last visit. All attended dental clinics for dental and TMJ problems. Dentitions were severely affected, trismus and severe xerostomia. Long-term effects of radiotherapy which has a great impact on patients' quality of life and the role of supportive care and minimizing the late effects of ionizing radiation are discussed. PMID:24046991

Bekta?-Kayhan, K; Ozbek, C D; Yazicio?lu, O; Karagöz, G; Altun, M; Meral, R; Unür, M

2013-01-01

196

[Current opinion on diagnosis of primary Sjögren's syndrome].  

PubMed

For many years, Sjögren's syndrome was a purely descriptive diagnosis of symptoms such as xerostomia and dry eye (sicca syndrome). The different classification criteria proposed for Sjögren's syndrome comprise a rather variable spectrum of diagnostic possibilities, at one extreme of which we find an array of exclusively objective parameters while, at the other extreme, the objective parameters and patients' symptoms balance out. Improved accuracy in the diagnosis of Sjögren's syndrome can be attained only through the combination of a symptoms questionnaire, histopathology, scintigraphy or sialography or evaluation of the unstimulated salivary flow and specific autoantibodies. In these last few years, further methods have been proposed to increase diagnostic accuracy: the analysis of various salivary constituents, saliva and tear ferning tests, the search for new autoantigens and, above all the use of ultrasonography and magnetic resonance imaging. Color-power Doppler and magnetic resonance sialography have recently been proposed as promising techniques to improve sensitivity and diagnostic specificity. This study discusses the data present in the literature and personal experience regarding diagnostic methods in a group of 350 patients affected by primary Sjögren's syndrome. PMID:12379045

Andretta, M; Botsios, C; Ostuni, Pa; Sfriso, P; Papadaki, L; Mardirossian, V; Todesco, S

2002-08-01

197

Tear mucus ferning in patients with Sjögren's syndrome.  

PubMed

The purpose of this study is to evaluate the possibility of using the mucus ferning phenomenon of the tears as a diagnostic test for Keratoconjunctivitis sicca in patients with Sjögren's syndrome. Using a polarising light microscope dried samples were tested for ferning phenomenon collected from (1) 36 healthy controls, (2) 21 patients with primary Sjögren's syndrome, and (3) 15 patients with secondary Sjögren's syndrome. Patients with Sjögren's had xerostomia, abnormal salivary gland biopsy and at least two positive tests for Kerato-conjunctivitis sicca. Patterns of mucus crystallization were classified into 5 types according to uniformity, branch spreading and integrity (types I, II normal, types III, IV, V abnormal). Abnormal ferning was found in tear samples of 8 out of 72 normal control eyes, 38 out of 42 with primary Sjögren's syndrome and 25 out of 30 with secondary Sjögren's syndrome. The differences between both primary and secondary Sjögren's syndrome, in comparison to healthy controls, were significant (p < 0.001). The sensitivity of the method was found 90% for primary Sjögren's syndrome and 80% for secondary Sjögren's syndrome. According to our data, tear mucus ferning test is a simple, sensitive and specific test to estimate Keratoconjunctivitis sicca in patients with Sjögren's syndrome. PMID:7835183

Vaikoussis, E; Georgiou, P; Nomicarios, D

1994-01-01

198

Methamphetamine abuse: a review of the literature and case report in a young male.  

PubMed

Methamphethamine (TIK) is a highly addictive drug that acts as a stimulant for the central nervous system. It increases wakefulness and physical activity and can cause cardiac dysrhythmias, hypertension, hallucinations and violent behavior. Dental patients abusing methamphetamine often present with poor oral hygiene, xerostomia, rampant caries ("meth mouth") and excessive tooth wear. Management of these conditions is often challenging. A 24-year-old Caucasian man presented with severe dental pain, halitosis and self-reported poor dental appearance. A comprehensive examination including his medical history, panoramic radiographs and extra- and intraoral examination revealed 19 carious and erosive lesions. He reported using methamphetamine for eleven years and had not experienced much caries prior to using the drug. The patient's medical and dental histories along with radiographic and clinical findings led to a diagnosis of "meth mouth." Although various dental treatment options were offered to the patient, he opted for extraction of the most painful teeth in the left lower madibular quadrant and has yet to return for further treatment. This literature review and clinical case description of the oral manifestations of "meth mouth" is intended to alert dental practitioners to recognize and manage patients who are abusing methamphetamines. They should also be aware that these patients are often unreliable at following prevention advice as well as keeping follow-up appointments. PMID:21874893

Naidoo, S; Smit, D

2011-04-01

199

Salivary gland acinar cells regenerate functional glandular structures in modified hydrogels  

NASA Astrophysics Data System (ADS)

Xerostomia, a condition resulting from irradiation of the head and neck, affects over 40,000 cancer patients each year in the United States. Direct radiation damage of the acinar cells that secrete fluid and protein results in salivary gland hypofunction. Present medical management for xerostomia for patients treated for upper respiratory cancer is largely ineffective. Patients who have survived their terminal diagnosis are often left with a diminished quality of life and are unable to enjoy the simple pleasures of eating and drinking. This project aims to ultimately reduce human suffering by developing a functional implantable artificial salivary gland. The goal was to create an extracellular matrix (ECM) modified hyaluronic acid (HA) based hydrogel culture system that allows for the growth and differentiation of salivary acinar cells into functional acini-like structures capable of secreting large amounts of protein and fluid unidirectionally and to ultimately engineer a functional artificial salivary gland that can be implanted into an animal model. A tissue collection protocol was established and salivary gland tissue was obtained from patients undergoing head and neck surgery. The tissue specimen was assessed by histology and immunohistochemistry to establish the phenotype of normal salivary gland cells including the native basement membranes. Hematoxylin and eosin staining confirmed normal glandular tissue structures including intercalated ducts, striated ducts and acini. alpha-Amylase and periodic acid schiff stain, used for structures with a high proportion of carbohydrate macromolecules, preferentially stained acinar cells in the tissue. Intercalated and striated duct structures were identified using cytokeratins 19 and 7 staining. Myoepithelial cells positive for cytokeratin 14 were found wrapped around the serous and mucous acini. Tight junction components including ZO-1 and E-cadherin were present between both ductal and acinar cells. Ductal and acinar cells were identified in cultured cells from dispersed tissue. Biomarker studies with the salivary enzyme, alpha-amylase, and tight junction proteins, such as zonula occludens-1 and E-cadherin, confirmed the phenotype of these cells. Strong staining for laminin and perlecan/HSPG2 were noted in basement membranes and perlecan also was secreted and organized by cultured acinar populations, which formed lobular structures that mimicked intact glands when cultured on Matrigel(TM) or a bioactive peptide derived from domain IV of perlecan (PlnDIV). On either matrix, large acini-like lobular structures grew and formed connections between the lobes. alpha-Amylase secretion was confirmed by staining and activity assay. Biomarkers including tight junction protein E-cadherin and water channel protein, aquaporin 5 (AQP5) found in tissue, were expressed in cultured acinar cells. Cells cultured on Matrigel(TM) or PlnDIV peptide organized stress fibers and activated focal adhesion kinase (FAK). HA, a natural polysaccharide and a major component of the ECM, can be used to generate soft and pliable hydrogels. A culture system consisting of HA hydrogel and PlnDIV peptide was used to generate a 2.5D culture system. Acinar cells cultured on these hydrogels self-assembled into lobular structures and expressed tight junction components such as ZO-1. Acini-like structures were stained for the presence of alpha-amylase. Live/dead staining revealed the presence of apoptotic cells in the center of the acini-like structures, indicative of lumen formation. The functionality of these acini-like structures was studied by stimulating them with neurotransmitters to enhance their fluid and protein production. Acini-like structures treated with norepinephrine and isoproterenol showed increased granule formation as observed by phase contrast microscopy and alpha-amylase staining in the structures. Lobular structures on hydrogels were treated with acetylcholine to increase fluid production. The increase in intracellular calcium due to the activation of the M3 muscarinic receptor via binding to ac

Pradhan, Swati

200

Preliminary results of a phase I/II study of simultaneous modulated accelerated radiotherapy for nondisseminated nasopharyngeal carcinoma  

SciTech Connect

Purpose: To present preliminary results of intensity-modulated radiotherapy (IMRT) with the simultaneous modulated accelerated radiotherapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC). Methods and Materials: Twenty patients who underwent IMRT for nondisseminated NPC at the Asan Medical Center between September 2001 and December 2003 were prospectively evaluated. Intensity-modulated radiotherapy was delivered with the 'step and shoot' SMART technique at prescribed doses of 72 Gy (2.4 Gy/day) to the gross tumor volume, 60 Gy (2 Gy/day) to the clinical target volume and metastatic nodal station, and 46 Gy (2 Gy/day) to the clinically negative neck region. Eighteen patients also received cisplatin once per week. Results: The median follow-up period was 27 months. Nineteen patients completed the treatment without interruption; the remaining patient interrupted treatment for 2 weeks owing to severe pharyngitis and malnutrition. Five patients (25%) had Radiation Therapy Oncology Group Grade 3 mucositis, whereas 9 (45%) had Grade 3 pharyngitis. Seven patients (35%) lost more than 10% of their pretreatment weight, whereas 11 (55%) required intravenous fluids and/or tube feeding. There was no Grade 3 or 4 xerostomia. All patients showed complete response. Two patients had distant metastases and locoregional recurrence, respectively. Conclusion: Intensity-modulated radiotherapy with the SMART boost technique allows parotid sparing, as shown clinically and by dosimetry, and might also be more effective biologically. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.

Lee, Sang-wook [Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of)]. E-mail: lsw@amc.seoul.kr; Back, Geum Mun [Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Yi, Byong Yong [Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Choi, Eun Kyung [Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Ahn, Seung Do [Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Shin, Seong Soo; Kim, Jung-hun [Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Kim, Sang Yoon [Department of Otolaryngology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Lee, Bong-Jae [Department of Otolaryngology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Nam, Soon Yuhl [Department of Otolaryngology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Choi, Seung-Ho [Department of Otolaryngology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Kim, Seung-Bae [Dept. of Medical Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Park, Jin-hong [Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of); Lee, Kang Kyoo [Department of Radiation Oncology, School of Medicine, Wonkwang University, Icksan (Korea, Republic of); Park, Sung Ho; Kim, Jong Hoon [Dept. of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul (Korea, Republic of)

2006-05-01

201

Acceptance of hospital diets and nutritional status among inpatients with cancer.  

PubMed

OBJECTIVE: To verify acceptance of hospital diets as to the nutritional status among patients admitted to the Oncology/Hematology Unit of a tertiary care hospital. METHODS: A cross-sectional study conducted among 100 patients, aged >18 years, of both genders. Body mass index and subjective global nutritional evaluation by patients were used to detect the nutritional status. The rest-ingestion index was used to evaluate diet acceptance, and the reasons for non-acceptance were identified by means of a questionnaire. Data were expressed in means and standard deviation, or medians and percentages. Comparisons were made using the Student's t test, Wilcoxon Mann-Whitney test, and Pearson's ?² test. RESULTS: A total of 59% of patients were males, and mean age was 51.6±13.5 years. According to the global subjective nutritional evaluation done by the patients themselves, 33% of the participants were considered malnourished and the body mass index detected 6.3% of malnutrition. The main symptoms reported were lack of appetite, xerostomia (dry mouth), constipation, dysgeusia, odor-related nausea, and early satiety. The rest-ingestion index was approximately 37% and significantly greater among the malnourished relative to the well-nourished (58.8 versus 46.4%; p=0.04). The primary reasons reported for non-acceptance of the diet offered were lack of flavor, monotonous preparations, large quantities offered, lack of appetite, and inappropriate temperature of the meal. CONCLUSION: A high the rest-ingestion index was seen among the patients with cancer, especially those who were malnourished according to the global nutritional evaluation produced by the patient. PMID:23579742

Ferreira, Daiane; Guimarães, Tessa Gomes; Marcadenti, Aline

2013-03-01

202

Dry Mouth and Dietary Quality Among Older Adults in North Carolina  

PubMed Central

Objectives To quantify: (1) prevalence of dry mouth; (2) association of dry mouth with beverage intake and dietary quality; and (3) association of dry mouth with self-reported dietary accommodations to oral health deficits. Design Cross-sectional study; data from self-reports. Participants A multi-stage cluster sampling design was used to recruit 622 participants aged 60+ from rural North Carolina counties with substantial African American and American Indian populations. Measurements Data included the 11-item Xerostomia Inventory (XI); higher scores connote greater impact from dry mouth; a food frequency questionnaire (converted into Health Eating Index-2005 scores); and survey items on foods modified before consumption or avoided due to oral health problems. Results Dry mouth was associated with being female, lower education, and income below the poverty level. Although overall beverage consumption did not vary with dry mouth, consumption of certain sugar-sweetened beverages was positively associated with dry mouth. Overall dietary quality did not differ with dry mouth, but more severe dry mouth was associated with lower intake of whole grains and higher intakes of total fruits. Dry mouth was strongly associated with self-reported modification and avoidance of foods. Those in the highest tertile of dry mouth were more likely to modify several foods compared to the lowest tertile, and were more likely to avoid three or more foods. Conclusion Older adults appear to modify foods or selectively avoid foods in response to perceived dry mouth. Despite these behaviors, dry mouth does not result in reduced dietary quality.

Quandt, Sara A.; Savoca, Margaret R.; Leng, Xiaoyan; Chen, Haiying; Bell, Ronny A.; Gilbert, Gregg H.; Anderson, Andrea M.; Kohrman, Teresa; Arcury, Thomas A.

2011-01-01

203

Impact of Radiation and Chemotherapy on Risk of Dental Abnormalities: A Report from the Childhood Cancer Survivor Study  

PubMed Central

Purpose Describe frequencies and risk factors of altered oral health and odontogenesis in childhood cancer survivors. Patients and Methods 9308 survivors, diagnosed between 1970–1986, and 2951 siblings from Childhood Cancer Survivor Study completed a survey containing oral-dental health information. We analyzed treatment impact, socioeconomic data and patient demographics on dental outcomes using univariate and multivariate logistic regression models to estimate odds ratios (OR). Results In multivariate analysis, survivors more likely reported microdontia (OR 3.0, 95% confidence interval [CI] 2.4–3.8), hypodontia (OR 1.7, 95% CI 1.4–2.0), root abnormalities (OR 3.0, 95% CI 2.2–4.0), abnormal enamel (OR 2.4, 95% CI 2.0–2.9), teeth loss ?6 (OR 2.6, 95% CI 1.9–3.6), severe gingivitis (OR 1.2, 95% CI 1.0–1.5), xerostomia (OR 9.7, 95% CI 4.8–19.7). Controlling for chemotherapy and socio-economic factors, radiation exposure of ?20Gy to dentition was significantly associated with increased risk of ?1 dental abnormality. Dose-dependent alkylating agent therapy significantly increased risk ?1 anatomic/developmental dental abnormalities in survivors diagnosed <5 years of age (OR 1.7, 2.7, 3.3 for alkylating agent score of 1, 2, 3, respectively). Conclusion Radiation and chemotherapy are independent risk factors for adverse oral-dental sequelae among childhood cancer survivors. Patients receiving alkylating agents at < 5 years should be closely monitored.

Kaste, Sue C.; Goodman, Pamela; Leisenring, Wendy; Stovall, Marilyn; Hayashi, Robert; Yeazel, Mark; Beiraghi, Soraya; Hudson, Melissa M.; Sklar, Charles A.; Robison, Leslie L.; Baker, K. Scott

2009-01-01

204

Intensity-Modulated Radiotherapy for Head and Neck Cancer of Unknown Primary: Toxicity and Preliminary Efficacy  

SciTech Connect

Purpose: Unknown primary head and neck cancers often require comprehensive mucosal and bilateral neck irradiation. With conventional techniques, significant toxicity can develop. Intensity-modulated radiotherapy (IMRT) has the potential to minimize the toxicity. Methods and Materials: Between 2000 and 2005, 21 patients underwent IMRT for unknown primary head and neck cancer at our center. Of the 21 patients, 5 received IMRT with definitive intent and 16 as postoperative therapy; 14 received concurrent chemotherapy and 7 IMRT alone. The target volumes included the bilateral neck and mucosal surface. The median dose was 66 Gy. Acute and chronic toxicities, esophageal strictures, and percutaneous endoscopic gastrostomy tube dependence were evaluated. Progression-free survival, regional progression-free survival, distant metastasis-free survival, and overall survival were estimated with Kaplan-Meier curves. Results: With a median follow-up of 24 months, the 2-year regional progression-free survival, distant metastasis-free survival, and overall survival rate was 90%, 90%, and 85%, respectively. Acute grade 1 and 2 xerostomia was seen in 57% and 43% of patients, respectively. Salivary function improved with time. Percutaneous endoscopic gastrostomy tube placement was required in 72% with combined modality treatment and 43% with IMRT alone. Only 1 patient required percutaneous endoscopic gastrostomy support at the last follow-up visit. Two patients treated with combined modality and one treated with IMRT alone developed esophageal strictures, but all had improvement or resolution with dilation. Conclusion: The preliminary analysis of IMRT for unknown primary head and neck cancer has shown acceptable toxicity and encouraging efficacy. The analysis of the dosimetric variables showed excellent tumor coverage and acceptable doses to critical normal structures. Esophageal strictures developed but were effectively treated with dilation. Techniques to limit the esophageal dose could help further minimize this complication.

Klem, Michelle L. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)], E-mail: mlklem@yahoo.com; Mechalakos, James G. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wolden, Suzanne L.; Zelefsky, Michael J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Singh, Bhuvanesh; Kraus, Dennis; Shaha, Ashok; Shah, Jatin [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Pfister, David G. [Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Lee, Nancy Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2008-03-15

205

Modeling Plan-Related Clinical Complications Using Machine Learning Tools in a Multiplan IMRT Framework  

SciTech Connect

Purpose: To predict organ-at-risk (OAR) complications as a function of dose-volume (DV) constraint settings without explicit plan computation in a multiplan intensity-modulated radiotherapy (IMRT) framework. Methods and Materials: Several plans were generated by varying the DV constraints (input features) on the OARs (multiplan framework), and the DV levels achieved by the OARs in the plans (plan properties) were modeled as a function of the imposed DV constraint settings. OAR complications were then predicted for each of the plans by using the imposed DV constraints alone (features) or in combination with modeled DV levels (plan properties) as input to machine learning (ML) algorithms. These ML approaches were used to model two OAR complications after head-and-neck and prostate IMRT: xerostomia, and Grade 2 rectal bleeding. Two-fold cross-validation was used for model verification and mean errors are reported. Results: Errors for modeling the achieved DV values as a function of constraint settings were 0-6%. In the head-and-neck case, the mean absolute prediction error of the saliva flow rate normalized to the pretreatment saliva flow rate was 0.42% with a 95% confidence interval of (0.41-0.43%). In the prostate case, an average prediction accuracy of 97.04% with a 95% confidence interval of (96.67-97.41%) was achieved for Grade 2 rectal bleeding complications. Conclusions: ML can be used for predicting OAR complications during treatment planning allowing for alternative DV constraint settings to be assessed within the planning framework.

Zhang, Hao H. [Industrial and Systems Engineering Department, University of Wisconsin, Madison, WI (United States); Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD (United States); D'Souza, Warren D. [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD (United States)], E-mail: wdsou001@umaryland.edu; Shi Leyuan [Industrial and Systems Engineering Department, University of Wisconsin, Madison, WI (United States); Meyer, Robert R. [Computer Sciences Department, University of Wisconsin, Madison, WI (United States)

2009-08-01

206

Burning mouth syndrome: will better understanding yield better management?  

PubMed

"Burning mouth syndrome" (BMS) refers to a chronic orofacial pain disorder usually unaccompanied by mucosal lesions or other clinical signs of organic disease. BMS is typically characterized by a continuous, spontaneous, and often intense burning sensation as if the mouth or tongue were scalded or on fire. Burning mouth syndrome is a relatively common condition. The estimated prevalence of BMS reported in recent studies ranges between 0.7 and 4.6% of the general population. About 1.3 million American adults, mostly women in the postmenopausal period, are afflicted with BMS. The etiology of this disorder is poorly understood even though new evidence for a possible neuropathic pathogenesis of idiopathic BMS is emerging. Burning mouth syndrome may present as an idiopathic condition (primary BMS type) distinct from the symptom of oral burning that can potentially arise from various local or systemic abnormalities (secondary BMS type), including nutritional deficiencies, hormonal changes associated with menopause, local oral infections, denture-related lesions, xerostomia, hypersensitivity reactions, medications, and systemic diseases including diabetes mellitus. In more than a third of patients, multiple, concurrent causes of BMS may be identified. It is important to note that the diagnosis of BMS should be established only after all other possible causes have been ruled out. Professional delay in diagnosing, referring, and appropriately managing of BMS patients occurs frequently. Treatment should be tailored to each patient and it is recommended to practice the treatment in a multidisciplinary facility. This article discusses our current understanding of the etiology and pathogenesis of BMS. The authors have tried to emphasize new pharmacological approaches to manage this challenging disorder. PMID:17559486

Maltsman-Tseikhin, Alexander; Moricca, Paolo; Niv, David

2007-06-01

207

Rosai-Dorfman disease with factor XII deficiency.  

PubMed

A 17-year-old female patient presented with chronic symmetrical oligoarthritis of both knees and ankles, xerostomia, xerophthalmia, multiple bilateral lymphadenopathies in the cervical region, and bilateral parotid enlargement with the histological finding of chronic sialoadenitis. She had been already given methotrexate, chloroquine, and corticosteroids with the diagnosis of rheumatoid arthritis (RA) before referral to our outpatient clinic. Because her complaints and the lumps did not remit and she could be classified as neither RA nor primary Sjögren's syndrome (SS) according to 1987 ACR RA criteria or European preliminary criteria for SS, lymph node biopsy was repeated and revealed the diagnosis of Rosai-Dorfman disease (RDD) with the histological findings of histiocytes, phagocyting lymphocytes in enlarged sinuses, and mature plasma cells infiltrating the pulpa. All the medications were stopped after the pathological diagnosis of RDD and consulting with the Division of Hematology. She was reevaluated with magnetic resonance imaging, which showed dense infiltrative areas around knee and ankle joints, and computed tomography that showed a soft tissue mass surrounding the descending aorta and upper part of the abdominal aorta. Activated partial thromboplastin time was found to be prolonged in prebiopsy examinations, and factor XII deficiency was detected after detailed hematological evaluation. The symptoms of joint involvement were relieved with nonsteroidal antiinflammatory drugs. She has been followed-up without medication without obvious clinical or laboratory change. We herein report a patient with RDD mimicking RA and SS. We consider that RDD should be kept in mind especially in patients with resistant symptoms to conventional therapies, younger disease onset, and predominant parotid and lymph node enlargement. PMID:19326165

Kasapoglu Gunal, Esen; Kamali, Sevil; Akdogan, Mehmet Fatih; Cimen, Arif Oguz; Ocal, Lale; Agan, Mehmet; Gul, Ahmet; Inanc, Murat; Konice, Meral; Aral, Orhan

2009-03-27

208

Functional impairment in submandibular gland of rats induced by 5-fluorouracil and calcium leucovorin.  

PubMed

One of the main clinical problems during chemotherapy is the occurrence of severe systemic toxicities, including those related to the stomatognathic system, which contribute to reducing the patient's quality of life. The most frequent oral complications are mucositis, dysgeusia, inflammation, gingival bleeding and decreased salivary flow or hyposalivation, a factor that predisposes to xerostomia, and other local complications that alter the homeostasis of the system. The purpose of this study was to evaluate the functional activity of salivary glands in Wistar rats subject to chemotherapy by measuring salivary flow, glycogen levels and glandular tissue response to autonomic nervous system agonists. Five experimental groups were used: 1) Control group fed "ad libitum"; 2) 5-fluorouracil (20 mg/kg body weight); 3) Calcium leucovorin (10 mg/kg body weight); 4) 5-fluorouracil + calcium leucovorin (20 and 10 mg/kg, respectively) by intraperitoneal injection for five consecutive days and 5) control with paired diet. Groups 1 and 5 did not receive drugs. Treatment with fluorouracil + leucovorin produced an increase in stimulated salivary flow and a higher response to increasing doses of beta agonists compared to other experimental groups. In both groups treated with cytostatic drugs, blocking of glycogen consumption at the end of the experimental period was observed. Our work suggests that salivary secretion may be affected by a dual mechanism: the first would be toxicity induced by 5-FU, which would cause depression of the process of glucose utilization. The second mechanism would affect the sympathetic autonomic reflex arc. In this instance, the synergistic action of 5-FU + LV would have a negative effect on the nerve activity with a reduction of salivary secretion. This would explain the hyposalivation, cited by several authors in patients undergoing the 5-FU + LV scheme in the treatment of colon carcinoma. PMID:23798072

Mazzeo, Marcelo A; Linares, Jorge A; López, María M; Gallará, Raquel V; Bachmeier, Evelin; Wietz, Fernando M; Finkelberg, Ana B

2012-01-01

209

Antifungal effect of mouth rinses on oral Candida counts and salivary flow in treatment-naïve HIV-infected patients.  

PubMed

Oral candidiasis is a major problem in developing countries where antiretroviral therapy is available to a small percentage of the infected population. HIV patients are prone to xerostomia and predisposed to Candida infection. Preventing oral candidiasis is better than the frequent use of antifungals that may lead to the development of drug resistance. This study investigated the ability of commercial mouth rinses and sodium bicarbonate to reduce salivary Candida and to improve the saliva flow of HIV-positive patients. One hundred fifty HIV patients without oral candidiasis were examined for oral lesions initially and after 2, 4, and 12 weeks. Unstimulated saliva was collected; the volume was measured and cultured for yeasts. Subjects were provided with mouth rinses containing either benzydamine hydrochloride, benzydamine hydrochloride with chlorhexidine gluconate, triclosan with sodium fluoride, 5% sodium bicarbonate, or placebo and asked to rinse twice daily for 12 weeks. The effect of the mouth rinses and placebo on Candida counts and saliva flow was analyzed using analysis of variance (ANOVA). A total of 108 patients completed the trial, 35 missed appointments, 4 died, 2 developed oral candidiasis, and 1 herpetic lesion. Triclosan/fluoride decreased the Candida count more than the placebo (p = 0.005) while chlorhexidine/benzydamine hydrochloride (p = 0.001) and triclosan/fluoride mouthrinses (p = 0.002) increased the salivary flow during the initial 4 weeks. The most effective mouth rinse triclosan/fluoride decreased oral Candida counts and increased saliva flow. Studies are needed to determine the efficacy of these mouth rinses for the long-term prevention of clinical oral candidiasis in adult HIV-positive patients. PMID:18627277

Patel, Mrudula; Shackleton, Jo-Anne; Coogan, Maeve M; Galpin, Jacky

2008-08-01

210

Oral health and obesity indicators  

PubMed Central

Background In western Sweden, the aim was to study the associations between oral health variables and total and central adiposity, respectively, and to investigate the influence of socio-economic factors (SES), lifestyle, dental anxiety and co-morbidity. Methods The subjects constituted a randomised sample from the 1992 data collection in the Prospective Population Study of Women in Gothenburg, Sweden (n?=?999, 38-?>?=78 yrs). The study comprised a clinical and radiographic examination, together with a self-administered questionnaire. Obesity was defined as body mass index (BMI)?>?=30 kg/m2, waist-hip ratio (WHR)?>?=0.80, and waist circumference >0.88 m. Associations were estimated using logistic regression including adjustments for possible confounders. Results The mean BMI value was 25.96 kg/m2, the mean WHR 0.83, and the mean waist circumference 0.83 m. The number of teeth, the number of restored teeth, xerostomia, dental visiting habits and self-perceived health were associated with both total and central adiposity, independent of age and SES. For instance, there were statistically significant associations between a small number of teeth (<20) and obesity: BMI (OR 1.95; 95% CI 1.40-2.73), WHR (1.67; 1.28-2.19) and waist circumference (1.94; 1.47-2.55), respectively. The number of carious lesions and masticatory function showed no associations with obesity. The obesity measure was of significance, particularly with regard to behaviour, such as irregular dental visits, with a greater risk associated with BMI (1.83; 1.23-2.71) and waist circumference (1.96; 1.39-2.75), but not with WHR (1.29; 0.90-1.85). Conclusions Associations were found between oral health and obesity. The choice of obesity measure in oral health studies should be carefully considered.

2012-01-01

211

Intensity-Modulated Radiation Therapy with Concurrent Carboplatin and Paclitaxel for Locally Advanced Head and Neck Cancer: Toxicities and Efficacy  

PubMed Central

Background. Intensity-modulated radiation therapy (IMRT) and alternative chemotherapy regimens strive to maintain efficacy while minimizing toxicity in locally advanced head and neck cancer (LAHNC) treatment. Our experience with concurrent IMRT and taxane-based chemotherapy is presented. Methods. A retrospective review of 150 consecutive patients with LAHNC treated with IMRT and concurrent taxane-based chemotherapy with curative intent was performed. The IMRT fractionation regimen consisted of 69.3 Gy to gross disease (2.1 Gy/fraction) and 56.1 Gy to prophylactic nodal sites (1.7 Gy/fraction). Weekly paclitaxel (30 mg/m2) and carboplatin (area under the concentration–time curve [AUC], 1) were given concurrently to all patients, and 69% received weekly induction with paclitaxel (60 mg/m2) and carboplatin (AUC, 2). Results. Over 90% of patients received the prescribed radiation dose. Ninety-six percent completed five or more cycles of concurrent chemotherapy, with similar tolerability for induction chemotherapy. A percutaneous endoscopic gastrostomy (PEG) tube was required in 80 patients, with 10 maintaining PEG use >18 months. Acute grade 4 mucositis and dermatitis developed in 2.0% and 4.0% of patients, respectively. No patient experienced nadir sepsis, grade ?3 late xerostomia, or significant nephropathy or gastrointestinal toxicity. Median follow-up was 30 months. The 3-year locoregional control rate was 83.2% with disease-free survival and overall survival rates of 78.8% and 76.5%, respectively. Conclusion. Rates of acute and late toxicities were low, with excellent radiation dose delivery and impressive tumor control at 3 years, suggesting that concurrent carboplatin and paclitaxel with IMRT is a reasonable therapeutic option for the curative treatment of LAHNC.

Vlacich, Gregory; Diaz, Roberto; Thorpe, Steven W.; Murphy, Barbara A.; Kirby, Wyndee; Sinard, Robert J.; Shakhtour, Bashar; Shyr, Yu; Murphy, Patrick; Netterville, James L.; Yarbrough, Wendell G.

2012-01-01

212

Scleroderma and CREST syndrome: a case report in dentistry.  

PubMed

CREST syndrome is part of the heterogeneous scleroderma group of autoimmune diseases that cause thickening, hardening and tightening of the connective tissue in different parts of the body, and it may lead to complex disorders. CREST syndrome is characterized by the coexistence of calcinosis, Raynaud's phenomenon, esophageal hypomotility, sclerodactily and telangectasia. A 72-year-old caucasian woman is referred to the S. Gerardo Hospital of Monza, with a chief complaint of oral pain and difficulties in deglutition and eating, associated with denture instability and difficulties to fit it. She had been previously diagnosed with Raynaud's phenomenon, and afterwards with CREST syndrome. Extra-oral examination underlined taut, thickened and rigid skin, pallid-red irregular maculae all over the face, telangiectasias and acrocyanosis. Intra-oral examination showed no alteration of the mucosa, but we can observe tongue rigidity and some speckled red alternating with white spots on the hard palate and in the vestibule. We undermitted the patient the dental treatment of Sjogren's syndrome. The management of the Sjogren's syndrome is symptomatic and empirical, and involves the use of saliva secretion stimulators, salivary substitutes and coadjuvants. Dental treatment and prophylaxis are important to prevent the consequences of xerostomia, such as rampant caries, based on the administration of topical fluoride in toothpastes and rinses, and supplemented by fluoride gels and varnishes. Instruction and reinforcement of oral hygiene, along with frequent dental assessment and management by the dentist are essential measures to preserve the oral health of those affected with CREST syndrome in progression to SS, complicated with Sjogren's syndrome. PMID:21956352

Lauritano, D; Bussolati, A; Baldoni, M; Leonida, A

2011-09-01

213

Prevalence of Self-Perceived Oral Malodor in a Group of Thai Dental Patients  

PubMed Central

Objective: To determine the prevalence and correlated factors of self-reported oral malodor in Thai dental patients from Chulalongkorn Dental Hospital. Materials and Methods: A self-administered questionnaire was developed to assess the self-reported perception of oral malodor in 839 patients. Significant associations between self-perceived oral malodor and sociodemographics, oral problems and oral hygiene practice variables were determined by Chi-square test. Results: The prevalence of currently self-perceived oral malodor was 61.1%. A higher prevalence of self-perceived oral malodor was significantly correlated with a number of factors including being 30 years of age or older, having a high school or lower educational level, tongue coating, xerostomia, bleeding when brushing teeth, never receiving professional tooth cleaning and a lower toothbrushing frequency. However, multivariable analysis showed that tongue coating was the factor most strongly associated with self-perceived oral malodor (OR=3.53; CI=2.05–6.08), followed by bleeding when brushing teeth (OR= 2.96) and being 30 years of age or older (OR=2.46). Subjects with oral malodor perceived by themselves and others had a higher level of self-perceived oral malodor, a higher prevalence of bad odor when talking, in the morning and throughout the whole day, and a higher prevalence of consulting with other people in comparison with those with perception by themselves alone. Conclusion: Tongue coating, bleeding when brushing teeth and being 30 years of age or older were significantly associated with self-perceived oral malodor. The level of self-perceived oral malodor and consulting with other people was more prevalent in subjects with oral malodor perceived by themselves and others.

Youngnak-Piboonratanakit, P.; Vachirarojpisan, T.

2010-01-01

214

An overview of herbal supplement utilization with particular emphasis on possible interactions with dental drugs and oral manifestations.  

PubMed

Herbal medication in the United States is a popular form of therapy. This paper provides an overview of the utilization of herbal supplements with particular emphasis on possible interactions with oral health drugs and oral manifestations. Herbal supplements are regulated by the Dietary Supplement Health and Education Act (DSHEA), which limits their regulation by the U.S Food and Drug Administration (FDA). A number of studies indicate that there is a progressive increase in the utilization of herbal supplements. The majority of consumers of these products are white, middle-aged women who have some college education. Many of the consumers use pharmaceutical drugs concurrently, but most do not inform their health-care providers about their use of herbal supplements. Various herbal supplements have been reported or are suspected to interact with certain oral health drugs, the most important one being 1) bromelain, cayenne, chamomile, feverfew, dong quai, eleuthro/Seberian ginseng, garlic, ginkgo, ginger, ginseng and licorice interacting with aspirin; 2) aloe latex, ephedra, ginseng, rhubarb, cascara sagrada, licorice, and senna interacting with corticosteriods; 3) kava, St. John's wort, chamomile, and valerian interacting with central nervous system (CNS) depressant drugs; and 4) herbs acting on the gastrointestinal system, altering the absorption of several orally administered drugs. Further, the use of some herbal supplements has been reported to be associated with oral manifestations, including aphthous ulcers, lip and tongue irritation, and swelling with feverfew; gingival bleeding with feverfew and ginkgo; tongue numbness with echinacea; xerostomia with St. John's wort; oral and lingual dyskinesia with kava; and salivation with yohimbe. These potential effects of herbal supplements in conjunction with factors related to regulation restrictions suggest that the use of these products may be associated with various adverse reactions that can affect oral health and treatment. Dental hygienists should inform themselves about herbal supplements in order to offer appropriate oral health care to individuals who take these substances. PMID:12704968

Abebe, Worku

2003-01-01

215

Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy  

SciTech Connect

Purpose: Submandibular salivary glands (SMGs) dysfunction contributes to xerostomia after radiotherapy (RT) of head-and-neck (HN) cancer. We assessed SMG dose-response relationships and their implications for sparing these glands by intensity-modulated radiotherapy (IMRT). Methods and Materials: A total of 148 HN cancer patients underwent unstimulated and stimulated SMG salivary flow rate measurements selectively from Wharton's duct orifices, before RT and periodically through 24 months after RT. Correlations of flow rates and mean SMG doses were modeled throughout all time points. IMRT replanning in 8 patients whose contralateral level I was not a target incorporated the results in a new cost function aiming to spare contralateral SMGs. Results: Stimulated SMG flow rates decreased exponentially by (1.2%){sup Gy} as mean doses increased up to 39 Gy threshold, and then plateaued near zero. At mean doses {<=}39 Gy, but not higher, flow rates recovered over time at 2.2%/month. Similarly, the unstimulated salivary flow rates decreased exponentially by (3%){sup Gy} as mean dose increased and recovered over time if mean dose was <39 Gy. IMRT replanning reduced mean contralateral SMG dose by average 12 Gy, achieving {<=}39 Gy in 5 of 8 patients, without target underdosing, increasing the mean doses to the parotid glands and swallowing structures by average 2-3 Gy. Conclusions: SMG salivary flow rates depended on mean dose with recovery over time up to a threshold of 39 Gy. Substantial SMG dose reduction to below this threshold and without target underdosing is feasible in some patients, at the expense of modestly higher doses to some other organs.

Murdoch-Kinch, Carol-Anne [Department of Oral Medicine/Hospital Dentistry, University of Michigan, Ann Arbor, MI (United States); Kim, Hyugnjin M. [Department of Biostatistics, University of Michigan, Ann Arbor, MI (United States); Vineberg, Karen A. [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Ship, Jonathan [Department of Oral Medicine/Hospital Dentistry, University of Michigan, Ann Arbor, MI (United States); Eisbruch, Avraham [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)], E-mail: eisbruch@umich.edu

2008-10-01

216

Improved Dosimetric and Clinical Outcomes With Intensity-Modulated Radiotherapy for Head-and-Neck Cancer of Unknown Primary Origin  

SciTech Connect

Purpose: To compare differences in dosimetric, clinical, and quality-of-life endpoints among a cohort of patients treated by intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CRT) for head-and-neck cancer of unknown primary origin. Methods and Materials: The medical records of 51 patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Twenty-four patients (47%) were treated using CRT, and 27 (53%) were treated using IMRT. The proportions of patients receiving concurrent chemotherapy were 54% and 63%, respectively. Results: The 2-year estimates of overall survival, local-regional control, and disease-specific survival for the entire patient population were 86%, 89%, and84%, respectively. There were no significant differences in any of these endpoints with respect to radiation therapy technique (p > 0.05 for all). Dosimetric analysis revealed that the use of IMRT resulted in significant improvements with respect to mean dose and V30 to the contralateral (spared) parotid gland. In addition, mean doses to the ipsilateral inner and middle ear structures were significantly reduced with IMRT (p < 0.05 for all). The incidence of severe xerostomia in the late setting was 58% and 11% among patients treated by CRT and IMRT, respectively (p < 0.001). The percentages of patients who were G-tube dependent at 6 months after treatment were 42% and 11%, respectively (p < 0.001). Conclusions: IMRT results in significant improvements in the therapeutic ratio among patients treated by radiation therapy for head-and-neck cancer of unknown primary origin.

Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.ed [Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA (United States); Li Baoqing [Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA (United States); Farwell, D. Gregory [Department of Otolaryngology-Head and Neck Surgery, University of California Davis School of Medicine, Sacramento, CA (United States); Marsano, Joseph; Vijayakumar, Srinivasan; Purdy, James A. [Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA (United States)

2011-03-01

217

Intensity-Modulated Radiotherapy for Cervical Lymph Node Metastases From Unknown Primary Cancer  

SciTech Connect

Purpose: To compare the effectiveness of intensity-modulated radiotherapy (IMRT) and conventional (two-dimensional) radiotherapy in the treatment of cervical lymph node metastases from unknown primary cancer (UPC). Methods and Materials: Between February 2003 and September 2006, 23 patients with UPC of squamous cell carcinoma were treated with IMRT. Extended putative mucosal and bilateral nodal sites were irradiated to a median dose of 66 Gy. In 19 patients, IMRT was performed after lymph node dissection, and in 4 patients primary radiotherapy was given. The conventional radiotherapy group (historical control group) comprised 18 patients treated to a median dose of 66 Gy between August 1994 and October 2003. Results: Twenty patients completed treatment. As compared with conventional radiotherapy, the incidence of Grade 3 acute dysphagia was significantly lower in the IMRT group (4.5% vs. 50%, p = 0.003). By 6 months, Grade 3 xerostomia was detected in 11.8% patients in the IMRT group vs. 53.4% in the historical control group (p = 0.03). No Grade 3 dysphagia or skin fibrosis was observed after IMRT but these were noted after conventional radiotherapy (26.7%, p = 0.01) and 26.7%, p = 0.03) respectively). With median follow-up of living patients of 17 months, there was no emergence of primary cancer. One patient had persistent nodal disease and another had nodal relapse at 5 months. Distant metastases were detected in 4 patients. The 2-year overall survival and distant disease-free probability after IMRT did not differ significantly from those for conventional radiotherapy (74.8% vs. 61.1% and 76.3% vs. 68.4%, respectively). Conclusions: Use of IMRT for UPC resulted in lower toxicity than conventional radiotherapy, and was similar in efficacy.

Madani, Indira [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium)], E-mail: indira@krtkg1.ugent.be; Vakaet, Luc [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium); Bonte, Katrien [Division of Head and Neck Surgery, Ghent University Hospital, Ghent (Belgium); Boterberg, Tom; Neve, Wilfried de [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium)

2008-07-15

218

Short communication: oral lesions in HIV/AIDS patients undergoing HAART including efavirenz.  

PubMed

Oral lesions (OL) have an important prognostic value for HIV/AIDS patients. However, the behavior of OL in HIV/AIDS patients undergoing highly active antiretroviral therapy including efavirenz (HAART/EFV) has not been documented. Our objective was to establish the prevalence of OL in HIV/AIDS patients undergoing HAART/EFV and to compare it with the prevalence of OL in patients undergoing antiretroviral therapy including a protease inhibitor (HAART/PI). Seventy-three HIV/AIDS patients undergoing antiretroviral treatment for at least for 6 months at "La Raza" Medical Center's Internal Medicine Unit (IMSS, Mexico City) were included. To detect OL, a detailed examination of oral soft tissues was performed in each patient. Patient records recorded gender, seropositivity time, route of contagion, antiretroviral therapy type and duration, CD4 lymphocyte count/ml, and viral load. Two groups were formed: 38 patients receiving HAART/EFV [two nucleoside analogue reverse transcriptase inhibitors (NARTI) plus efavirenz] and 35 patients receiving HAART/PI (two NARTIs plus one PI). OL prevalence was established in each study group. The Chi-square test was applied (p < 0.05(IC95%)). OL prevalence in the HAART/EFV group (32%) was lower (p < 0.007) than in the HAART/PI group (63%). Candidosis was the most prevalent OL in both groups. Herpes labialis, HIV-associated necrotizing periodontitis, xerostomia, hairy leukoplakia, and nonspecific oral sores were identified. The highest prevalence for all OL was found in the HAART/PI group. These findings suggest that HIV/AIDS patients undergoing HAART/EFV show a lower prevalence of oral lesions than patients undergoing HAART/PI. PMID:18507528

Aquino-García, S I; Rivas, M A; Ceballos-Salobreña, A; Acosta-Gio, A E; Gaitán-Cepeda, L A

2008-06-01

219

A Prospective Study of Salivary Gland Function in Lymphoma Patients Receiving Head and Neck Irradiation  

SciTech Connect

Purpose: To determine the radiation dose-response relationship on salivary dysfunction and quality of life (QOL) over time in patients with lymphoma receiving radiation therapy (RT) to the head and neck (H and N). Methods and Materials: We conducted a prospective study on salivary-gland function in lymphoma patients receiving RT to the H and N. Fifteen patients were enrolled on the study. Dose-volume histograms and mean doses to the salivary glands were generated. Radiation-related toxicities and H and N-specific QOL were assessed before treatment and at prespecified time points posttreatment. Factors predicting a decrement in QOL were explored using Fisher's exact test. Results: During RT, 47% of patients experienced Grade >= 2 acute toxicity of the salivary gland, mucous membrane, or both. QOL scores improved over time, but up to one third of patients continued to have persistent oral symptoms at 2 years. At 6 months, a mean dose to at least one of the parotids of > 31 Gy was significantly associated with persistent dry mouth (100% vs. 17%, p = 0.02) and sticky saliva (100% vs. 25%, p = 0.04); a mean dose of > 11 Gy to the minor salivary glands was significantly associated with persistent sticky saliva (100% vs. 25%, p = 0.04), although the difference was no longer significant at 1 year. Conclusions: Limiting the mean parotid dose to <= 31 Gy and mean minor salivary gland dose to <= 11 Gy in lymphoma patients treated to the H and N may help reduce the risk of subacute xerostomia.

Rodrigues, Neesha A.; Killion, Leah; Hickey, Gail; Silver, Barbara [Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA (United States); Martin, Chrystalla; Stevenson, Mary Ann [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA (Israel); Mauch, Peter M. [Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA (United States); Ng, Andrea K., E-mail: ang@lroc.harvard.ed [Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA (United States)

2009-11-15

220

Nasopharyngeal Carcinoma Treated With Reduced-Volume Intensity-Modulated Radiation Therapy: Report on the 3-Year Outcome of a Prospective Series  

SciTech Connect

Purpose: To evaluate the efficacy of intensity-modulated radiotherapy (IMRT) using reduced clinical target volumes (CTV) in the treatment of nasopharyngeal carcinoma (NPC). Methods and Materials: Between August 2003 and December 2006, 323 patients with NPC were treated with IMRT according to this institutional protocol. Presenting stages were Stage II in 63, Stage III in 166, and Stage IVA/B in 94 patients. High-risk CTV encompassed gross tumor volume and entire nasopharyngeal mucosa with a margin. A reduced CTV was delineated for the remaining subclinical regions adjacent to the primary disease. Uninvolved neck nodes were delineated according to the Radiation Therapy Oncology Group (RTOG) / European Organisation for Research and Treatment of Cancer (EORTC) consensus excluding the deep jugular (i.e., lymph nodes in retrostyloid space above C1 vertebra) and submental nodes. Patients with locoregionally advanced diseases also received cisplatin-based chemotherapy. Results: With a median follow-up of 30 months (range, 4-53months), 12, 6, and 26 patients had developed local, regional, and distant failures, respectively. The 3-year estimated local control, regional control, metastasis-free survival, disease-free survival and overall survival were 95%, 98%, 90%, 85%, and 90%, respectively. Multivariate analyses revealed that T-classification had no predictive value for outcome, whereas N-classification was significant for predicting metastasis-free (p = 0.005) and overall survival (p =0.006). Ten patients (7.8%) experienced Grade II xerostomia at 24 months after treatment. No Grade III or IV late-toxicities were observed. Two patients died of treatment-induced complications. Conclusion: The IMRT approach using a reduced target volume provided favorable outcome for NPC with acceptable toxicity. This strategy needs to be optimized and then tested in a prospective setting to learn whether further improvement can be achieved.

Lin Shaojun [Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian (China); Pan Jianji, E-mail: jiadelu@gmail.co [Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian (China); Han Lu; Zhang Xiuchun; Liao Xiyi [Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian (China); Lu, Jiade J. [Department of Radiation Oncology, National University Cancer Institute, National University Health System, National University of Singapore (Singapore); Department of Radiation Oncology, Cancer Hospital of Fudan University, Shanghai (China)

2009-11-15

221

Long-Term Outcomes and Toxicity of Concurrent Paclitaxel and Radiation in the Treatment of Locally Advanced Head and Neck Cancer  

PubMed Central

Purpose To report the long-term outcomes and toxicity of a regimen of infusional paclitaxel delivered concurrently with radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Methods Between 1995 and 1999, 35 patients with non-metastatic stage III or IV SCCHN were treated with 3 cycles of paclitaxel as a 120-hour continuous infusion beginning days 1, 21, and 42 concurrent with radiation. The initial 16 patients received 105 mg/m2/cycle, and the subsequent 19 patients received 120 mg/m2/cycle. External beam radiation was delivered to 70.2–72 Gy in 5 fractions per week. Patients were followed to evaluate disease outcomes and the late toxicity of this regimen. Results Median follow-up for all patients is 56.5 months. The median survival was 56.5 months and the median time to local recurrence was not reached. Fifteen patients (43%) developed hypothyroidism. Eleven of the 33 patients who underwent percutaneous endoscopic gastrostomy tube (PEG) placement were PEG-dependent until death or last follow-up. Five patients (14%) required a tracheostomy until death, while 3 patients (9%) suffered from severe esophageal stricture. All evaluated long term survivors exhibited salivary hypofunction. Fibrosis in the radiation field occurred in 24 patients (69%). Conclusion Concurrent chemo-radiation therapy with a 120-hour infusion of paclitaxel provides long-term local control and survival in patients with SCCHN.Xerostomia, hypothyroidism, esophageal and pharyngeal complications, and subcutaneous fibrosis were common long-term toxicities; however, the vast majority of toxicities were grade 1 or 2.

Citrin, Deborah; Mansueti, John; Likhacheva, Anna; Sciuto, Linda; Albert, Paul S.; Rudy, Susan F.; Cooley-Zgela, Theresa; Cotrim, Ana; Solomon, Beth; Colevas, A. Dimitrios; Russo, Angelo; Morris, John C.; Herscher, Laurie; Smith, Sharon; Van Waes, Carter

2009-01-01

222

Long-term outcome and late toxicities of simultaneous integrated boost-intensity modulated radiotherapy in pediatric and adolescent nasopharyngeal carcinoma.  

PubMed

The application of simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in pediatric and adolescent nasopharyngeal carcinoma (NPC) is underevaluated. This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy. Thirty-four patients (aged 8-20 years) with histologically proven, non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study. The disease stage distribution was as follows: stage I, 1 (2.9%); stage III, 14 (41.2%); and stage IV, 19 (55.9%). All patients underwent SIB-IMRT and 30 patients also underwent cisplatin-based chemotherapy. The prescribed dose of IMRT was 64-68 Gy in 29-31 fractions to the nasopharyngeal gross target volume. Within the median follow-up of 52 months (range, 9-111 months), 1 patient (2.9%) experienced local recurrence and 4 (11.8%) developed distant metastasis (to the lung in 3 cases and to multiple organs in 1 case). Four patients (11.8%) died due to recurrence or metastasis. The 5-year locoregional relapse-free survival, distant metastasis-free survival, disease-free survival, and overall survival rates were 97.1%, 88.2%, 85.3%, and 88.2%, respectively. The most common acute toxicities were grades 3-4 hematologic toxicities and stomatitis. Of the 24 patients who survived for more than 2 years, 16 (66.7%) and 15 (62.5%) developed grades 1-2 xerostomia and ototoxicity, respectively. Two patients (8.3%) developed grade 3 ototoxicity; no grade 4 toxicities were observed. SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC, with mild incidence of late toxicities. Distant metastasis is the predominant mode of failure. PMID:24016394

Tao, Chang-Juan; Liu, Xu; Tang, Ling-Long; Mao, Yan-Ping; Chen, Lei; Li, Wen-Fei; Yu, Xiao-Li; Liu, Li-Zhi; Zhang, Rong; Lin, Ai-Hua; Ma, Jun; Sun, Ying

2013-09-10

223

Primary Sjögren syndrome in a 2-year-old patient: role of the dentist in diagnosis and dental management with a 6-year follow-up.  

PubMed

BACKGROUND. Primary Sjögren syndrome is a rare autoimmune disease, especially in children, mainly affecting girls (77%), and usually diagnosed around 10 years of age. Diagnosis during childhood is difficult, especially because of the diversity of the clinical presentation and difficulty obtaining reliable history data, accounting for a higher frequency of underdiagnosed cases. Differential conditions should be considered, especially the ones that promote xerostomia, such as diabetes, ectodermal dysplasia, rheumatoid arthritis, scleroderma, systemic lupus erythematosus, sarcoidosis, lymphoma, HIV and HTLV infection. Conditions associated with parotid enlargement should also be excluded, including juvenile recurrent parotitis (JRP), sialadenosis, sarcoidosis, lymphoma, infectious parotitis caused by streptococcal and staphylococcal infections, viral infections (paramyxovirus, Epstein-Barr virus, cytomegalovirus, and parvovirus), and diffuse infiltrative lymphocytosis syndrome (associated with HIV infection), and rare congenital conditions, such as polycystic parotid disease. CASE REPORT. A paediatric female patient was referred to our clinic for dental treatment complaining about dry mouth, oral discomfort, and dysphagia. The patient presented five of the required criteria to establish the diagnosis of pSS, including ocular symptoms, oral symptoms, evidence of keratoconjunctivitis sicca, focal sialadenitis confirmed by minor salivary gland biopsy, and evidence of major salivary gland involvement. Our patient did not have positive SS-A and SS-B autoantibodies. According to the literature, about 29% of individuals with pSS can present seronegativity for SS-A (anti-Ro) antibodies and about 33% can present seronegativity for SS-B (anti-La) antibodies. CONCLUSION. To the best of our knowledge, this is the youngest patient reported in the scientific English literature with pSS. Primary Sjögren syndrome has a wide clinical and immunologic spectrum and may progress with increased morbidity. Clinicians must be aware of the development of pSS in such an early age and exclude all possible differential findings to provide early diagnosis and treatment. PMID:21623979

De Oliveira, Marcio Augusto; De Rezende, Nathalie Pepe Medeiros; Maia, Célia Márcia Fernandes; Gallottini, Marina

2011-05-31

224

Sialometry and sialochemistry: diagnostic tools for Sj?gren's syndrome  

PubMed Central

BACKGROUND—The common occurrence of xerostomia in Sjögren's syndrome (SS) as well as the easy accessibility of saliva supports the use of sialometry and sialochemistry in the diagnosis of SS. Collection and analysis of whole saliva (oral fluid) is currently the routine technique for sialometry, despite the fact that it is rather inaccurate and impure.?OBJECTIVE—To assess the value of glandular sialometry and sialochemistry as diagnostic instruments in SS.?METHODS—In a group of 100 consecutive patients referred for diagnosis of SS, glandular secretory flow rates and a spectrum of salivary components (sodium, potassium, chloride, calcium, phosphate, urea, amylase, total protein) were assessed. The patients were classified as positive or negative for SS according to the revised European classification criteria.?RESULTS—Patients with SS differed clearly from those who tested negative for SS, showing lower submandibular/sublingual (SM/SL) flow rates and an appreciably changed salivary composition of parotid and SM/SL saliva. Besides changes in salivary flow rate and composition, distinct sialometric profiles were observed, characteristic of either early or late salivary manifestation of SS, or of the xerogenic side effects of medication.?CONCLUSIONS—Glandular sialometry and sialochemistry are not only useful tools for differentiating SS from other salivary gland disease in clinical practice, but they also have great potential as diagnostic criteria for SS, showing distinct sialometric and sialochemical changes as well as profiles. Being simple, safe (non-invasive), and sensitive (early disease detection), they have three major advantages over other oral tests for SS.??

Kalk, W; Vissink, A; Spijkervet, F; Bootsma, H; Kallenberg, C; Amerongen, A

2001-01-01

225

[Anticitrulin antibody and the extra-articular manifestations in rheumatoid arthritis].  

PubMed

A large proportion of rheumatoid arthritis (RA) patients develop extra-articular manifestations (EAM), which are associated with morbidity and early mortality. Anti cyclic citrullinated peptide (ACCP) antibody has proven to be highly specific for the diagnosis of RA, associated with severe joint damage and may have some role in the pathogenesis of EAM. The aim of this study was to determine the relationship between ACCP antibody and the presence of EAM in RA patients. Seventy four RA patients (ACR 1987) with EAM, > 18 years, more than 6 months duration were included, and an EAM free control, matched by sex and age, for each patient. Demographic, clinical and laboratory variables were compared using t-test, chi-square or Mann-Whitney test. Multivariate analysis was performed: p = 0.05. Patients with EAM presented a greater value of ACCP antibody (116 vs. 34, p < 0.01) and rheumatoid factor (108 vs. 34.5, p < 0.01). Independent association with current smoking habit (p = 0.02, OR = 3.78, 95%: 1.17-12.2), RF positive (p = 0.04, OR 3.23, CI 95%: 1.04 to 11.8) and ACCP antibody positive (p = 0.04, OR 3.23, 95% CI: 1.04-10) was found. The patients with xerostomia (109 vs. 34, p = 0.04), xerophthalmia (150 vs. 34, p < 0.01), subcutaneous nodules (141 vs. 34, p < 0.01) and pulmonary fibrosis (158 vs. 34, p = 0.04) had a higher degree of the ACCP antibody, than controls. In conclusion, ACCP antibody positive, RF positive and smoking were independent risk factors for the development of MEXA. PMID:23335701

Haye Salinas, María Jezabel; Retamozo, Soledad; Vetorazzi, Lorena; Peano, Natalia; Díaz Cuiza, Patricia Ericka; Castaños Menescardi, María Sol; Miretti, Evangelina María; Encinas, Laura Mariela; Alvarez, Ana Cecilia; Saurit, Verónica; Alvarellos, Alejandro; Caeiro, Francisco

2013-01-01

226

IMRT and carbon ion boost for malignant salivary gland tumors: interim analysis of the COSMIC trial  

PubMed Central

Background The COSMIC trial is designed to evaluate toxicity in dose-escalated treatment with intensity-modulated radiotherapy (IMRT) and carbon ion boost for malignant salivary gland tumors (MSGT) of the head and neck including patients with inoperable/ incompletely resected MSGTs (R2-group) and completely resected tumors plus involved margins or perineural spread (R1-group). Methods COSMIC is a prospective phase II trial of IMRT (25 × 2 Gy) and carbon ion boost (8 × 3 GyE). Primary endpoint is mucositis CTC°III, secondary endpoints are local control, progression-free survival, and toxicity. Evaluation of disease response is carried out according to the Response Evaluation Criteria in Solid Tumors (RECIST); toxicity is assessed using NCI CTC v 3.0. Results Twenty-nine patients were recruited from 07/2010 to 04/2011, all patients have at least completed first follow-up. Sixteen patients were treated in the R2-group, 13 in the R1-group. All treatments were completed as planned and well tolerated, mucositis CTC grade III was 25% (R2) and 15.4% (R1), no dysphagia CTC grade III was observed, no feeding tubes were necessary. Side-effects rapidly resolved, only 4 patients (13.8%) reported xerostomia grade II at first follow-up. Overall response rate (complete and partial response) according to RECIST in the R2-group is 68.8% at 6–8 weeks post treatment, all patients within this group showed radiological signs of treatment response. Conclusion No unexpected toxicity was observed, mucositis rates and other side effects do not differ between patients with visible residual tumor and macroscopically completely resected tumors. Initial treatment response is promising though longer follow-up is needed to assess local control. Trial registration Clinical trial identifier NCT 01154270

2012-01-01

227

Squamous cell carcinoma metastatic to cervical lymph nodes from unknown primary origin: the impact of chemoradiotherapy.  

PubMed

The management of cervical lymph node metastases of squamous cell carcinoma from an unknown primary site is still a therapeutic challenge. We report here our experience in treating these patients with chemoradiotherapy as a curative approach. Data from 40 patients were reviewed. In total, 20 (50%) patients underwent excisional biopsy. All patients underwent radiotherapy, which was delivered to both sides of the neck and pharyngeal mucosa (extensive field), and concurrent chemotherapy consisting of weekly cisplatin at a dose of 40 mg/m(2). The clinical stage of the cervical nodes at presentation was N1 in 25%, N2 in 60%, and N3 in 15%. Most patients (75%) developed at least grade 3 mucositis. Eight patients (20%) had grade 3 xerostomia and 18 patients (45%) required esophageal dilation for stricture. The 5-year overall survival(OS) rate of all patients was 67.5%. The 5-year OS rates of patients with N1, N2, and N3 lesions were 100%, 67%, and 41%, respectively (P = 0.046). The 5-year progression-free survival rate was 62.5%. In multivariate analysis, only N stage significantly affected OS(P = 0.022). Emergence of the occult primary was very limited (1 patient only). Our results suggest that extensive irradiation of both sides of the neck and pharyngeal mucosa with concurrent chemotherapy results in a lower emergence of primary tumor. Because the survival of patients with unknown primary is comparable to that of patients with known primary, an attempt at cure should always be made. PMID:22692070

Eldeeb, Hany; Hamed, Rasha Hamdy

2012-06-06

228

[Oral pathology in 161 asymptomatic and symptomatic HIV-positive patients].  

PubMed

The aim of this study was to establish the prevalence of oral manifestations in HIV-infected patients and to correlate their frequency with the clinical stage. One hundred and sixty one HIV-positive individuals were examined, of whom 64 (40%) were in stages CDC-II and III and 97 (60%) in stage CDC-IV. The patients were examined at the AIDS out-patient clinic of the Instituto Nacional de la Nutrición Salvador Zubirán. The oral exams were performed by three examiners who were intra and inter calibrated, so that standard clinical criteria were followed. One hundred and twenty five patients (78%) showed one or more oral lesions. The proportion of patients with oral lesions increased significantly (p less than 0.05) according to the severity of the infection. Hairy leukoplakia (40%) and erythematous candidiasis (31%) were the most frequent lesions. When the prevalence of the different oral lesions was compared between the patients at early stages with the patients at the late stage no significant differences were found; only the pseudomembranous candidiasis and the exfoliative cheilitis were found with significantly higher values at stage CDC-IV than at earlier stages (p less than 0.001 and p less than 0.05 respectively). No association was found between oral candidiasis and tobacco use or xerostomia. Our study demonstrates that the prevalence and clinical features of the oral manifestations found showed similarities with those reported in other countries, but ulcero-necrotizing gingivitis was not found in our patients. PMID:1523349

Ramírez, V; González, A; González, M; de la Rosa, E; Rivera, I; Hernández, C; Ponce de León, S

229

A comparison of mean parotid gland dose with measures of parotid gland function after radiotherapy for head-and-neck cancer: Implications for future trials  

SciTech Connect

Purpose: To determine the most adequate parameter to measure the consequences of reducing the parotid gland dose. Methods and Materials: One hundred eight patients treated with radiotherapy for various malignancies of the head and neck were prospectively evaluated using three methods. Parotid gland function was objectively determined by measuring stimulated parotid flow using Lashley cups and scintigraphy. To assess xerostomia-related quality of life, the head-and-neck cancer module European Organization for Research and Treatment of Cancer QLQ (Quality of Life Questionnaire) H and N35 was used. Measurements took place before radiotherapy and 6 weeks and 12 months after the completion of radiotherapy. Complication was defined for each method using cutoff values. The correlation between these complications and the mean parotid gland dose was investigated to find the best measure for parotid gland function. Results: For both flow and scintigraphy data, the best definition for objective parotid gland toxicity seemed to be reduction of stimulated parotid flow to {<=}25% of the preradiotherapy flow. Of all the subjective variables, only the single item dry mouth 6 weeks after radiotherapy was found to be significant. The best correlation with the mean parotid gland dose was found for the stimulated flow measurements. The predictive ability was the highest for the time point 1 year after radiotherapy. Subjective findings did not correlate with the mean parotid dose. Conclusions: Stimulated flow measurements using Lashley cups, with a complication defined as flow {<=}25% of the preradiotherapy output, correlated best with the mean parotid gland dose. When reduction of the mean dose to the parotid gland is intended, the stimulated flow measurement is the best method for evaluating parotid gland function.

Roesink, Judith M. [Department of Radiotherapy, University Hospital Utrecht, University Medical Center Utrecht, Utrecht (Netherlands)]. E-mail: J.M.Roesink@azu.nl; Schipper, Maria [Center for Biostatistics, Utrecht University, Utrecht (Netherlands); Busschers, Wim [Center for Biostatistics, Utrecht University, Utrecht (Netherlands); Raaijmakers, Cornelis P.J.; Terhaard, Chris H.J. [Department of Radiotherapy, University Hospital Utrecht, University Medical Center Utrecht, Utrecht (Netherlands)

2005-11-15

230

Protective effect of Yashtimadhu (Glycyrrhiza glabra) against side effects of radiation/chemotherapy in head and neck malignancies.  

PubMed

One of the very common side effects of Radiation/Chemotherapy especially of the head and neck malignancies is mucositis. Cancer therapy or the cancer itself may cause changes in the body chemistry that results in loss of appetite, pain, nausea, vomiting, diarrhea and very common mucositis which makes eating difficult. Loss of appetite is followed by an undesirable loss of weight due to insufficient amount of calories every day which can lead to loss of muscle mass and strength and other complications by causing interruptions of medical therapy, impeding effective cancer therapy. Mucositis cause decreased immunity and quality of life as well as poor tolerance to surgery and altered efficacy of Chemotherapy and Radiotherapy. The present study is designed with the objective to minimize the radiation induced mucositis, skin reaction, xerostomia, change in voice etc. with an Ayurvedic preparation Yashtimadhu Ghrita (processed ghee). Total 75 patients were randomly divided into four groups and drugs were administered: Group A with local application of Yashtimadhu powder and honey in the oral cavity for few minutes prior to radiotherapy along with oral intake of Yashtimadhu Ghrita; Group B with only local application of the Yashtimadhu powder and honey in the oral cavity; Group C patients administered with only local application of honey in the oral cavity; Group D on conventional modern medication controlled group. All these patients under four groups had received Radiotherapy and Chemotherapy for maximum duration of 7 weeks. Mucositis and Skin reactions were observed in 100% of patients with varying degree. The intensity of Radiation and Chemotherapy induced mucositis was reduced to a great extent by the trial drug. Yashtimadhu (Glycyrrhiza glabra) can be used effectively in prevention and treatment of oral mucositis post radiation and chemotheraphy in patients of cancer, especially of the head and neck region. It proves beneficial in two ways: (i) there were no interruptions in the treatment, and (ii) food intake was not severely affected leading to maintenance of nutritional status of the patients. PMID:22408302

Das, Debabrata; Agarwal, S K; Chandola, H M

2011-04-01

231

Long-Term Outcomes and Toxicity of Concurrent Paclitaxel and Radiotherapy for Locally Advanced Head-and-Neck Cancer  

SciTech Connect

Purpose: To report the long-term outcomes and toxicity of a regimen of infusion paclitaxel delivered concurrently with radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck. Patients and Methods: Between 1995 and 1999, 35 patients with nonmetastatic, Stage III or IV squamous cell carcinoma of the head and neck were treated with three cycles of paclitaxel as a 120-h continuous infusion beginning on Days 1, 21, and 42, concurrent with radiotherapy. The initial 16 patients received 105 mg/m{sup 2}/cycle, and the subsequent 19 patients received 120 mg/m{sup 2}/cycle. External beam radiotherapy was delivered to a dose of 70.2-72 Gy at five fractions weekly. Patients were followed to evaluate the disease outcomes and late toxicity of this regimen. Results: The median follow-up for all patients was 56.5 months. The median survival was 56.5 months, and the median time to local recurrence was not reached. Of the 35 patients, 15 (43%) developed hypothyroidism. Of the 33 patients who underwent percutaneous endoscopic gastrostomy tube placement, 11 were percutaneous endoscopic gastrostomy tube dependent until death or their last follow-up visit. Also, 5 patients (14%) required a tracheostomy until death, and 3 (9%) developed a severe esophageal stricture. All evaluated long-term survivors exhibited salivary hypofunction. Fibrosis in the radiation field occurred in 24 patients (69%). Conclusion: The results of our study have shown that concurrent chemoradiotherapy with a 120-h infusion of paclitaxel provides long-term local control and survival in patients with squamous cell carcinoma of the head and neck. Xerostomia, hypothyroidism, esophageal and pharyngeal complications, and subcutaneous fibrosis were common long-term toxicities; however, the vast majority of toxicities were grade 1 or 2.

Citrin, Deborah [Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States)], E-mail: citrind@mail.nih.gov; Mansueti, John; Likhacheva, Anna; Sciuto, Linda [Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Albert, Paul S. [Biometric Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Rudy, Susan F. [Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD (United States); Cooley-Zgela, Theresa [Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Cotrim, Ana [National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD (United States); Solomon, Beth [Speech Language Pathology Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD (United States); Colevas, A. Dimitrios [Head and Neck Oncology Program, Stanford Cancer Center, Stanford University, Stanford, CA (United States); Russo, Angelo [Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Morris, John C. [Metabolism Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States); Herscher, Laurie [Department of Radiation Oncology, Suburban Hospital, Bethesda, MD (United States); Smith, Sharon [Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States)] (and others)

2009-07-15

232

Phase I/II Study of Erlotinib Combined With Cisplatin and Radiotherapy in Patients With Locally Advanced Squamous Cell Carcinoma of the Head and Neck  

SciTech Connect

Purpose: Erlotinib, an oral tyrosine kinase inhibitor, is active against head-and-neck squamous cell carcinoma (HNSCC) and possibly has a synergistic interaction with chemotherapy and radiotherapy. We investigated the safety and efficacy of erlotinib added to cisplatin and radiotherapy in locally advanced HNSCC. Methods and Materials: In this Phase I/II trial 100 mg/m{sup 2} of cisplatin was administered on Days 8, 29, and 50, and radiotherapy at 70 Gy was started on Day 8. During Phase I, the erlotinib dose was escalated (50 mg, 100 mg, and 150 mg) in consecutive cohorts of 3 patients, starting on Day 1 and continuing during radiotherapy. Dose-limiting toxicity was defined as any Grade 4 event requiring radiotherapy interruptions. Phase II was initiated 8 weeks after the last Phase I enrollment. Results: The study accrued 9 patients in Phase I and 28 in Phase II; all were evaluable for efficacy and safety. No dose-limiting toxicity occurred in Phase I, and the recommended Phase II dose was 150 mg. The most frequent nonhematologic toxicities were nausea/vomiting, dysphagia, stomatitis, xerostomia and in-field dermatitis, acneiform rash, and diarrhea. Of the 31 patients receiving a 150-mg daily dose of erlotinib, 23 (74%; 95% confidence interval, 56.8%-86.3%) had a complete response, 3 were disease free after salvage surgery, 4 had inoperable residual disease, and 1 died of sepsis during treatment. With a median 37 months' follow-up, the 3-year progression-free and overall survival rates were 61% and 72%, respectively. Conclusions: This combination appears safe, has encouraging activity, and deserves further studies in locally advanced HNSCC.

Herchenhorn, Daniel, E-mail: herchenhorn@hotmail.co [Department of Medical Oncology, Instituto Nacional de Cancer, Rio de Janeiro (Brazil); Dias, Fernando L. [Department of Head and Neck Surgery, Instituto Nacional de Cancer, Rio de Janeiro (Brazil); Viegas, Celia M.P. [Department of Radiation Oncology, Instituto Nacional de Cancer, Rio de Janeiro (Brazil); Federico, Miriam H. [Universidade de Sao Paulo, Faculdade de Medicina, Sao Paulo (Brazil); Araujo, Carlos Manoel M. [Department of Radiation Oncology, Instituto Nacional de Cancer, Rio de Janeiro (Brazil); Small, Isabelle [Clinical Research Division, Instituto Nacional de Cancer, Rio de Janeiro (Brazil); Bezerra, Marcos [Department of Radiation Oncology, Instituto Nacional de Cancer, Rio de Janeiro (Brazil); Fontao, Karina M.D. [Medical Research, Roche Laboratories, Sao Paulo (Brazil); Knust, Renata E.; Ferreira, Carlos G. [Clinical Research Division, Instituto Nacional de Cancer, Rio de Janeiro (Brazil); Martins, Renato G. [University of Washington, Seattle, WA (United States)

2010-11-01

233

Doses to radiation sensitive organs and structures located outside the radiotherapeutic target volume for four treatment situations.  

PubMed

This study documents dosage to radiation sensitive organs/structures located outside the radiotherapeutic target volume for four treatment situations: (a) head and neck, (b) brain (pituitary and temporal lobe), (c) breast and (d) pelvis. Clinically relevant treatment fields were simulated on a tissue-equivalent anthropomorphic phantom and subsequently irradiated with Cobalt-60 gamma rays, 6- and 18-MV x-ray beams. Thermoluminescent dosimeters and diodes were used to measure absorbed dose. The head and neck treatment resulted in significant doses of radiation to the lens and thyroid gland. The total treatment lens dose (300-400 cGy) could be cataractogenic while measured thyroid doses (1000-8000 cGy) have the potential of causing chemical hypothyroidism, thyroid neoplasms, Graves' disease and hyperparathyroidism. Total treatment retinal (400-700cGy) and pituitary (460-1000 cGy) doses are below that considered capable of producing chronic disease. The pituitary treatment studied consisted of various size parallel opposed lateral and vertex fields (4 x 4 through 8 x 8 cm). The lens dose (40-200 cGy) with all field sizes is below those of clinical concern. Parotid doses (130-1200 cGy) and thyroid doses (350-600 cGy) are in a range where temporary xerostomia (parotid) and thyroid neoplasia development are a reasonable possibility. The retinal dose (4000 cGy) from the largest field size (8 x 8 cm2) is in the range where retinopathy has been reported. The left temporal lobe treatment also used parallel opposed lateral and vertex fields (7 x 7 and 10 x 10 cm). Doses to the pituitary gland (5200-6200 cGy), both parotids (200-6900 cGy), left lens (200-300 cGy) and left retina (1700-4500 cGy) are capable of causing significant future clinical problems. Right-sided structures received insignificant doses. Secondary malignancies could result from measured total treatment thyroid doses (670-980 cGy). Analysis of three breast/chest wall and regional nodal irradiation techniques demonstrated a 25-50% decrease in secondary lung dose with use of independent collimation compared to use of custom alloy blocking material. However, it is unlikely that a reduction in secondary dose of this magnitude would reduce the risk of treatment sequellae. In four-field "box" pelvic irradiation, secondary testes dose may result in temporary (clamshell shield) or permanent azoospermia, but is unlikely to impair androgen production. PMID:8407417

Foo, M L; McCullough, E C; Foote, R L; Pisansky, T M; Shaw, E G

1993-09-30

234

A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma  

SciTech Connect

Purpose: The aim of this study was to compare toxicity/efficacy of conventional radiotherapy using delayed accelerated concomitant boost radiotherapy (CBRT) vs. intensity-modulated radiotherapy (IMRT) in the setting of concurrent chemotherapy (CT) for locally advanced oropharyngeal carcinoma. Methods and Materials: Between September 1998 and June 2004, a total of 293 consecutive patients were treated at our institution for cancer of the oropharynx. Of these, 112 had Stage III/IV disease and squamous cell histology. In all, 41 were treated with IMRT/CT and 71 were treated with CBRT/CT, both to a median dose of 70 Gy. Most common CT was a planned two cycles given every 3 to 4 weeks of cisplatin, 100 mg/m{sup 2} i.v., but an additional cycle was given to IMRT patients when possible. Both groups were well-matched for all prognostic factors. Results: Median follow-up was 46 months (range, 3-93 months) for the CBRT patients and 31 months (range, 20-64 months) for the IMRT group. Three-year actuarial local-progression-free, regional-progression-free, locoregional progression-free, distant-metastases-free, disease-free, and overall survival rates were 85% vs. 95% (p = 0.17), 95% vs. 94% (p = 0.90), 82% vs. 92% (p = 0.18), 85% vs. 86% (p = 0.78), 76% vs. 82% (p = 0.57), and 81% vs. 91% (p = 0.10) for CBRT and IMRT patients, respectively. Three patients died of treatment-related toxicity in the CBRT group vs. none undergoing IMRT. At 2 years, 4% IMRT patients vs. 21% CBRT patients were dependent on percutaneous endoscopic gastrostomy (p = 0.02). Among those who had {>=}20 months follow-up, there was a significant difference in Grade {>=}2 xerostomia as defined by the criteria of Radiation Therapy and Oncology Group, 67% vs. 12% (p = 0.02), in the CBRT vs. IMRT arm. Conclusion: In the setting of CT for locally advanced oropharyngeal carcinoma, IMRT results in lower toxicity and similar treatment outcomes when compared with CBRT.

Lee, Nancy Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)]. E-mail: leen2@mskcc.org; Arruda, Fernando F. de [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Puri, Dev R. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wolden, Suzanne L. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Narayana, Ashwatha [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Mechalakos, James [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Venkatraman, Ennapadam S. [Department of Biostatics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Kraus, Dennis [Department of Surgery, Division of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Shaha, Ashok [Department of Surgery, Division of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Shah, Jatin P. [Department of Surgery, Division of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Pfister, David G. [Department of Medicine, Division of Head and Neck Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zelefsky, Michael J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2006-11-15

235

Treatment outcome for nasopharyngeal carcinoma in university malaya medical centre from 2004-2008.  

PubMed

Background: Nasopharyngeal carcinoma (NPC) is the commonest radiocurable cancer in Malaysia. This study aimed to determine the treatment outcomes and late effects of radiotherapy for NPC patients treated in University Malaya Medical Centre (UMMC). Materials and Methods: All newly diagnosed patients with NPC referred for treatment to the Oncology unit at UMMC from 2004-2008 were retrospectively analyzed. Treatment outcomes were 5 years overall survival (OS), disease free survival (DFS), cause-specific survival (CSS), loco- regional control (LRC) and radiotherapy-related late effects. The Kaplan-Meier method was used for survival analysis and differences in survival according to AJCC stage was compared using the log-rank test. Results: A total of 176 patients with newly diagnosed NPC were treated in UMMC during this period. Late presentation was common, with 33.5% presenting with T3-4 disease, 84.7% with N1-3 disease and 75.6% with AJCC stage 3-4 disease. Radical RT was given to 162 patients with 22.7% having RT alone and 69.3% having CCRT. The stipulated OTT was 7 weeks and 72.2% managed to complete their RT within this time period. Neoadjuvant chemotherapy was given to 14.8% while adjuvant chemotherapy was administered to 16.5%. The 5 years OS was 51.6% with a median follow up of 58 months. The 5 years OS according to stage were 81.8% for stage I, 77.9% for stage II, 47.4% for stage III and 25.9% for stage IV. The 5 years overall CSS, DFS and LRC were 54.4%, 48.4% and 70.6%, respectively. RT related late effects were documented in 80.2%. The commonest was xerostomia (66.7%). Other documented late effects were hearing deficit (17.3%), visual deficit (3.1%), neck stiffness (3.1%) , dysphagia (3.4%), cranial nerve palsy (2.5%), pneumonitis (0.6%) and hypothyroidism (1.2%). Conclusions: The 5 years OS and LRC in this study are low compared to the latest studies especially those utilizing IMRT. Implementation of IMRT for NPC treatment should be strongly encouraged. PMID:24083703

Chee Ee Phua, Vincent; Loo, Wei Hoong; Yusof, Mastura Md; Wan Ishak, Wan Zamaniah; Tho, Lye Mun; Ung, Ngie Min

2013-01-01

236

M3 muscarinic acetylcholine receptor plays a critical role in parasympathetic control of salivation in mice  

PubMed Central

The M1 and M3 subtypes are the major muscarinic acetylcholine receptors in the salivary gland and M3 is reported to be more abundant. However, despite initial reports of salivation abnormalities in M3-knockout (M3KO) mice, it is still unclear which subtype is functionally relevant in physiological salivation. In the present study, salivary secretory function was examined using mice lacking specific subtype(s) of muscarinic receptor. The carbachol-induced [Ca2+]i increase was markedly impaired in submandibular gland cells from M3KO mice and completely absent in those from M1/M3KO mice. This demonstrates that M3 and M1 play major and minor roles, respectively, in the cholinergically induced [Ca2+]i increase. Two-dimensional Ca2+-imaging analysis revealed the patchy distribution of M1 in submandibular gland acini, in contrast to the ubiquitous distribution of M3. In vivo administration of a high dose of pilocarpine (10 mg kg?1, s.c.) to M3KO mice caused salivation comparable to that in wild-type mice, while no salivation was induced in M1/M3KO mice, indicating that salivation in M3KO mice is caused by an M1-mediated [Ca2+]i increase. In contrast, a lower dose of pilocarpine (1 mg kg?1, s.c.) failed to induce salivation in M3KO mice, but induced abundant salivation in wild-type mice, indicating that M3-mediated salivation has a lower threshold than M1-mediated salivation. In addition, M3KO mice, but not M1KO mice, had difficulty in eating dry food, as shown by frequent drinking during feeding, suggesting that salivation during eating is mediated by M3 and that M1 plays no practical role in it. These results show that the M3 subtype is essential for parasympathetic control of salivation and a reasonable target for the drug treatment and gene therapy of xerostomia, including Sjögren's syndrome.

Nakamura, Takeshi; Matsui, Minoru; Uchida, Keiko; Futatsugi, Akira; Kusakawa, Shinji; Matsumoto, Nagisa; Nakamura, Kyoko; Manabe, Toshiya; Taketo, Makoto M; Mikoshiba, Katsuhiko

2004-01-01

237

Squamous cell carcinoma of the oral mucosa after release of submucous fibrosis and bilateral small radial forearm flap reconstruction.  

PubMed

Oral submucous fibrosis is a collagen disorder that affects the submucosal layer of the upper digestive tract. The major cause is the habit of betel quid chewing, which is common in central, southern, and southeast Asia. The progressive and irreversible course of disease results with trismus, dysphagia, xerostomia, and rhinolalia. The most serious complication of this disorder is the development of oral carcinoma, and the incidence in different series varies from 1.9 to 10 percent. A sufficient mouth opening can be achieved by complete release of fibrotic tissue, and coronoidectomy and temporal muscle myotomy when needed, and reconstruction of the resultant defect can be best achieved by microsurgical free-tissue transfer because of the discouraging results with skin grafting or local flaps. From April of 1997 to May of 2001, a total of 26 patients received reconstructive surgery with small radial forearm flaps after release of submucous fibrosis with or without temporalis muscle myotomy and coronoidectomy. All patients were men, with a mean age of 40.1 years (range, 18 to 62 years) and all had a history of betel nut chewing ranging from 8 to 40 years. The interincisal distance ranged from 5 to 29 mm, with a mean of 15 mm, before operation. After the release procedure, the interincisal distance increased to 40 mm (range, 35 to 50 mm). At a follow-up period of 3 to 48 months, the interincisal distance was a mean of 35 mm (range, 18 to 57 mm), with an average increase of 20 mm compared with the preoperative distance. During follow-up, three patients developed squamous cell carcinoma of the oral cavity 24 to 36 months after submucous fibrosis release. Two of them occurred in the release site and the other one occurred at the soft palate. Oral cancer occurred in three of 13 patients who had received release of submucous fibrosis and who were followed for longer than 2 years (range, 24 to 48 months), which means that 23 percent of these patients developed squamous cell carcinoma of the intraoral mucosa. High risk of cancer occurrence strongly indicates the importance of an earlier and more aggressive surgical approach toward submucous fibrosis, and long-term follow-up on a regular basis. The purpose of an early and aggressive approach to submucous fibrosis is to provide a good quality of life to the patient by improving oral hygiene and oral intake quality and at the same time to obtain a sufficient mouth opening, which is mandatory for the inspection of the excision site and the remaining oral mucosa during follow-up. PMID:12087228

Celik, Naci; Wei, Fu-chan; Chang, Yang-ming; Yang, Wen-guei; Chen, Da-jeng; Tsai, Chi-ying

2002-07-01

238

Oral health conditions and frailty in Mexican community-dwelling elderly: a cross sectional analysis  

PubMed Central

Background Oral health is an important component of general well-being for the elderly. Oral health-related problems include loss of teeth, nonfunctional removable dental prostheses, lesions of the oral mucosa, periodontitis, and root caries. They affect food selection, speaking ability, mastication, social relations, and quality of life. Frailty is a geriatric syndrome that confers vulnerability to negative health-related outcomes. The association between oral health and frailty has not been explored thoroughly. This study sought to identify associations between the presence of some oral health conditions, and frailty status among Mexican community-dwelling elderly. Methods Analysis of baseline data of the Mexican Study of Nutritional and Psychosocial Markers of Frailty, a cohort study carried out in a representative sample of people aged 70 and older residing in one district of Mexico City. Frailty was defined as the presence of three or more of the following five components: weight loss, exhaustion, slowness, weakness, and low physical activity. Oral health variables included self-perception of oral health compared with others of the same age; utilization of dental services during the last year, number of teeth, dental condition (edentate, partially edentate, or completely dentate), utilization and functionality of removable partial or complete dentures, severe periodontitis, self-reported chewing problems and xerostomia. Covariates included were gender, age, years of education, cognitive performance, smoking status, recent falls, hospitalization, number of drugs, and comorbidity. The association between frailty and dental variables was determined performing a multivariate logistic regression analysis. Final models were adjusted by socio-demographic and health factors Results Of the 838 participants examined, 699 had the information needed to establish the criteria for diagnosis of frailty. Those who had a higher probability of being frail included women (OR?=?1.9), those who reported myocardial infarction (OR?=?3.8), urinary incontinence (OR?=?2.7), those who rated their oral health worse than others (OR?=?3.2), and those who did not use dental services (OR?=?2.1). For each additional year of age and each additional drug consumed, the probability of being frail increased 10% and 30%, respectively. Conclusions Utilization of dental services and self-perception of oral health were associated with a higher probability of being frail.

2012-01-01

239

Intensity modulated radiotherapy (IMRT) combined with concurrent but not adjuvant chemotherapy in primary nasopharyngeal cancer - a retrospective single center analysis  

PubMed Central

Background We report our experience in 49 consecutive patients with nasopharyngeal carcinoma who were treated by Intensity-modulated radiation therapy (IMRT) combined with simultaneous but not adjuvant chemotherapy (CHT). Methods The medical records of 49 patients with histologically proven primary nasopharygeal carcinoma treated with IMRT and concurrent platin-based CHT (predominantly cisplatin weekly) were retrospectively reviewed. The majority of patients showed advanced clinical stages (stage III/IV:72%) with undifferentiated histology (82%). IMRT was performed in step-and-shoot technique using an integrated boost concept in 84%. In this concept, the boost volume covered the primary tumor and involved nodes with doses of 66–70.4 Gy (single dose 2.2 Gy). Uninvolved regional nodal areas were covered with doses of 54–59.4 Gy (median single dose 1.8 Gy). At least one parotid gland was spared. None of the patients received adjuvant CHT. Results The median follow-up for the entire cohort was 48 months. Radiation therapy was completed without interruption in all patients and 76% of the patients received at least 80% of the scheduled CHT. Four local recurrences have been observed, transferring into 1-, 3-, and 5-year Local Control (LC) rates of 98%, 90% and 90%. One patient developed an isolated regional nodal recurrence, resulting in 1-, 3-, and 5-year Regional Control (RC) rates of 98%. All locoregional failures were located inside the radiation fields. Distant metastases were found in six patients, transferring into 1-, 3, and 5-year Distant Control (DC) rates of 92%, 86% and 86%. Progression free survival (PFS) rates after 1, 3 and 5 years were 86%, 70% and 69% and 1-, 3- and 5-year Overall Survival (OS) rates were 96%, 82% and 79%. Acute toxicity???grade III mainly consisted of dysphagia (32%), leukopenia (24%), stomatitis (16%), infection (8%) and nausea (8%). Severe late toxicity (grade III) was documented in 18% of the patients, mainly as xerostomia (10%). Conclusion Concurrent chemoradiation without the addition of adjuvant chemotherapy cycles using IMRT with an integrated boost concept yielded good disease control and overall survival in patients suffering from primary nasopharyngeal cancer with acceptable acute side effects and limited rates of late toxicity.

2013-01-01

240

IMRT With Simultaneous Integrated Boost and Concurrent Chemotherapy for Locoregionally Advanced Squamous Cell Carcinoma of the Head and Neck  

SciTech Connect

Purpose: To evaluate the efficacy and toxicity of accelerated radiotherapy with concurrent chemotherapy in advanced head-and-neck squamous cell carcinoma. Methods and Materials: Between April 2003 and May 2008, 43 consecutive patients with advanced head-and-neck squamous cell carcinoma received accelerated chemoradiation with concurrent cisplatin or cetuximab. The doses for intensity-modulated radiotherapy with simultaneous integrated boost were 67.5, 60.0, and 54 Gy in 30 daily fractions of 2.25, 2.0, and 1.8 Gy to the planning target volumes for gross disease, high-risk nodes, and low-risk nodes, respectively. Results: Of the patients, 90.7% completed chemoradiotherapy as prescribed. The median treatment duration was 43 days (range, 38-55 days). The complete response rate was 74.4%. With median follow-up of 36.7 months (range, 16.8-78.1 months) in living patients, the estimated 1-, 2-, and 5-year locoregional control, overall survival, and disease-free survival rates were 82%, 82%, and 82%; 73%, 65%, and 61%; and 73%, 73%, and 70%, respectively. One treatment-related death occurred from renal failure. Grade 3 mucositis and dermatitis occurred in 13 patients (30.2%) and 3 patients (6.9%), respectively. Grade 2 xerostomia occurred in 12 patients (27.9%). In patients with adequate follow-up, 82% were feeding tube free by 6 months after therapy; 13% remained feeding tube dependent at 1 year. Grade 3 soft-tissue fibrosis, esophageal stricture, osteoradionecrosis, and trismus occurred in 3 patients (6.9%), 5 patients (11.6%), 1 patient (2.3%), and 3 patients (6.9%), respectively. Conclusions: Our results show that intensity-modulated radiotherapy with simultaneous integrated boost with concurrent chemotherapy improved local and regional control. Acute and late toxicities were tolerable and acceptable. A prospective trial of this fractionation regimen is necessary for further assessment of its efficacy and toxicity compared with other approaches.

Montejo, Michael E.; Shrieve, Dennis C. [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah (United States); Bentz, Brandon G.; Hunt, Jason P.; Buchman, Luke O. [Division of Otolaryngology-Head Neck Surgery, Department of Surgery, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah (United States); Agarwal, Neeraj [Department of Internal Medicine, Oncology Division, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah (United States); Hitchcock, Ying J., E-mail: ying.hitchcock@hci.utah.edu [Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah (United States)

2011-12-01

241

Monitoring Dosimetric Impact of Weight Loss With Kilovoltage (KV) Cone Beam CT (CBCT) During Parotid-Sparing IMRT and Concurrent Chemotherapy  

SciTech Connect

Purpose: Parotid-sparing head-and-neck intensity-modulated radiotherapy (IMRT) can reduce long-term xerostomia. However, patients frequently experience weight loss and tumor shrinkage during treatment. We evaluate the use of kilovoltage (kV) cone beam computed tomography (CBCT) for dose monitoring and examine if the dosimetric impact of such changes on the parotid and critical neural structures warrants replanning during treatment. Methods and materials: Ten patients with locally advanced oropharyngeal cancer were treated with contralateral parotid-sparing IMRT concurrently with platinum-based chemotherapy. Mean doses of 65 Gy and 54 Gy were delivered to clinical target volume (CTV)1 and CTV2, respectively, in 30 daily fractions. CBCT was prospectively acquired weekly. Each CBCT was coregistered with the planned isocenter. The spinal cord, brainstem, parotids, larynx, and oral cavity were outlined on each CBCT. Dose distributions were recalculated on the CBCT after correcting the gray scale to provide accurate Hounsfield calibration, using the original IMRT plan configuration. Results: Planned contralateral parotid mean doses were not significantly different to those delivered during treatment (p > 0.1). Ipsilateral and contralateral parotids showed a mean reduction in volume of 29.7% and 28.4%, respectively. There was no significant difference between planned and delivered maximum dose to the brainstem (p = 0.6) or spinal cord (p = 0.2), mean dose to larynx (p = 0.5) and oral cavity (p = 0.8). End-of-treatment mean weight loss was 7.5 kg (8.8% of baseline weight). Despite a {>=}10% weight loss in 5 patients, there was no significant dosimetric change affecting the contralateral parotid and neural structures. Conclusions: Although patient weight loss and parotid volume shrinkage was observed, overall, there was no significant excess dose to the organs at risk. No replanning was felt necessary for this patient cohort, but a larger patient sample will be investigated to further confirm these results. Nevertheless, kilovoltage CBCT is a valuable tool for patient setup verification and monitoring of dosimetric variation during radiotherapy.

Ho, Kean Fatt, E-mail: hokeanfatt@hotmail.com [Academic Radiation Oncology, The Christie NHS Foundation Trust, Manchester (United Kingdom); Marchant, Tom; Moore, Chris; Webster, Gareth; Rowbottom, Carl [North Western Medical Physics, The Christie NHS Foundation Trust, Manchester (United Kingdom); Penington, Hazel [Wade Radiotherapy Research Centre, The Christie NHS Foundation Trust, Manchester (United Kingdom); Lee, Lip; Yap, Beng; Sykes, Andrew; Slevin, Nick [Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester (United Kingdom)

2012-03-01

242

Salivary Gland Tumors Treated With Adjuvant Intensity-Modulated Radiotherapy With or Without Concurrent Chemotherapy  

SciTech Connect

Purpose: To analyze the recent single-institution experience of patients with salivary gland tumors who had undergone adjuvant intensity-modulated radiotherapy (IMRT), with or without concurrent chemotherapy. Patients and Methods: We performed a retrospective analysis of 35 salivary gland carcinoma patients treated primarily at the Dana-Farber Cancer Institute between 2005 and 2010 with surgery and adjuvant IMRT. The primary endpoints were local control, progression-free survival, and overall survival. The secondary endpoints were acute and chronic toxicity. The median follow-up was 2.3 years (interquartile range, 1.2-2.8) among the surviving patients. Results: The histologic types included adenoid cystic carcinoma in 15 (43%), mucoepidermoid carcinoma in 6 (17%), adenocarcinoma in 3 (9%), acinic cell carcinoma in 3 (9%), and other in 8 (23%). The primary sites were the parotid gland in 17 (49%), submandibular glands in 6 (17%), tongue in 4 (11%), palate in 4 (11%), and other in 4 (11%). The median radiation dose was 66 Gy, and 22 patients (63%) received CRT. The most common chemotherapy regimen was carboplatin and paclitaxel (n = 14, 64%). A trend was seen for patients undergoing CRT to have more adverse prognostic factors, including Stage T3-T4 disease (CRT, n = 12, 55% vs. n = 4, 31%, p = .29), nodal positivity (CRT, n = 8, 36% vs. n = 1, 8%, p = .10), and positive margins (n = 13, 59% vs. n = 5, 38%, p = .30). One patient who had undergone CRT developed an in-field recurrence, resulting in an overall actuarial 3-year local control rate of 92%. Five patients (14%) developed distant metastases (1 who had undergone IMRT only and 4 who had undergone CRT). Acute Grade 3 mucositis, esophagitis, and dermatitis occurred in 8%, 8%, and 8% (1 each) of IMRT patients and in 18%, 5%, and 14% (4, 1, and 3 patients) of the CRT group, respectively. No acute Grade 4 toxicity occurred. The most common late toxicity was Grade 1 xerostomia (n = 8, 23%). Conclusions: Treatment of salivary gland malignancies with postoperative IMRT was well tolerated with a high rate of local control. Chemoradiotherapy resulted in excellent local control in a subgroup of patients with adverse prognostic factors and might be warranted in select patients.

Schoenfeld, Jonathan D., E-mail: jdschoenfeld@partners.org [Department of Radiation Oncology, Harvard Radiation Oncology Program, Boston, MA (United States); Sher, David J. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States); Norris, Charles M. [Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, MA (United States); Haddad, Robert I.; Posner, Marshall R. [Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Department of Medicine, Brigham and Women's Hospital, Boston, MA (United States); Balboni, Tracy A.; Tishler, Roy B. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States)

2012-01-01

243

A case of juvenile Sjögren's syndrome with interstitial nephritis.  

PubMed

Primary Sjögren's syndrome (SS) is a rare autoimmune disease, especially in children. Juvenile primary SS with interstitial nephritis is rare in Japan. We report on a 12-year-old girl in whom salivary gland swelling had recurred from the age of 5 years, SS was diagnosed at the age of 10 years, and interstitial nephritis developed at the age of 12 years. The patient presented with a chief complaint of swelling of both parotid glands. The patient had a history of recurrent parotitis from 5 years of age, with episodes recurring 5 to 6 times a year and resolving within 3 days each time. However, at the age of 11 years, the patient had continuous mild swelling of the parotid glands. Examination on admission showed bilateral nontender parotid gland swelling; mild swelling of the lower extremities, xerostomia, and xerophthalmia but no exanthem. Laboratory findings were as follows: serum protein, 10.1 g/dL; immunoglobulin (Ig) G, 3,828 mg/dL; antinuclear antibodies, 1,280-fold; anti-Ro/SS-A antibody, 512-fold; anti-Ro/SS-B antibody, 4-fold; creatinine, 0.45 mg/dL; blood ?2-microglobulin, 2.2 mg/L (slightly elevated); and cystatin C, 0.86 mg/L. Urinalysis showed proteinuria and a ?2-microglobulin concentration of 11,265 mg/L. Thus, this patient had low molecular weight proteinuria. Schirmer's test showed decreased tear secretion (5 mm), and fluorescein staining showed marked bilateral superficial punctate keratitis. A lip biopsy showed infiltration by small round cells (mild to moderate), interstitial fibrosis, loss of salivary gland parenchyma, and atrophy, with no obvious epimyoepithelial islands, leading to a diagnosis of SS. Light microscopic examination of the renal biopsy specimens showed expansion of mononuclear cell infiltration in the renal interstitium, inflammatory cell infiltration of interstitial areas with edema and mild fibrosis, and tubulitis and mononuclear cell infiltration that included many lymphocytes and plasma cells. There were no pathological findings of glomerulonephritis. Small arteries showed no obvious abnormalities. Immunofluorescent staining showed slight, nonspecific deposition of IgM, but no deposition of IgG, complement 1q, 3, or 4. On the basis of the renal biopsy showing nonspecific chronic interstitial nephritis, renal tubular atrophy, and interstitial enlargement, tubulointerstitial nephritis associated with SS was diagnosed. PMID:22976609

Igarashi, Toru; Itoh, Yasuhiko; Shimizu, Akira; Igarashi, Tsutomu; Yoshizaki, Kaoru; Fukunaga, Yoshitaka

2012-01-01

244

Prediction of clinical toxicity in locally advanced head and neck cancer patients by radio-induced apoptosis in peripheral blood lymphocytes (PBLs)  

PubMed Central

Head and neck cancer is treated mainly by surgery and radiotherapy. Normal tissue toxicity due to x-ray exposure is a limiting factor for treatment success. Many efforts have been employed to develop predictive tests applied to clinical practice. Determination of lymphocyte radio-sensitivity by radio-induced apoptosis arises as a possible method to predict tissue toxicity due to radiotherapy. The aim of the present study was to analyze radio-induced apoptosis of peripheral blood lymphocytes in head and neck cancer patients and to explore their role in predicting radiation induced toxicity. Seventy nine consecutive patients suffering from head and neck cancer, diagnosed and treated in our institution, were included in the study. Toxicity was evaluated using the Radiation Therapy Oncology Group scale. Peripheral blood lymphocytes were isolated and irradiated at 0, 1, 2 and 8 Gy during 24 hours. Apoptosis was measured by flow cytometry using annexin V/propidium iodide. Lymphocytes were marked with CD45 APC-conjugated monoclonal antibody. Radiation-induced apoptosis increased in order to radiation dose and fitted to a semi logarithmic model defined by two constants: ? and ?. ?, as the origin of the curve in the Y axis determining the percentage of spontaneous cell death, and ?, as the slope of the curve determining the percentage of cell death induced at a determined radiation dose, were obtained. ? value was statistically associated to normal tissue toxicity in terms of severe xerostomia, as higher levels of apoptosis were observed in patients with low toxicity (p = 0.035; Exp(B) 0.224, I.C.95% (0.060-0.904)). These data agree with our previous results and suggest that it is possible to estimate the radiosensitivity of peripheral blood lymphocytes from patients determining the radiation induced apoptosis with annexin V/propidium iodide staining. ? values observed define an individual radiosensitivity profile that could predict late toxicity due to radiotherapy in locally advanced head and neck cancer patients. Anyhow, prospective studies with different cancer types and higher number of patients are needed to validate these results.

2010-01-01

245

Candidiasis and other oral mucosal lesions during and after interferon therapy for HCV-related chronic liver diseases  

PubMed Central

Background Oral lichen planus (OLP) is seen frequently in patients with hepatitis C virus (HCV) infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN) therapy for HCV infection. Methods Of 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 ± 12.94 years) who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out. Results Cultures of Candida from the tongue surfaces were positive in 7 (50.0%) of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14) of patients: OLP in three (21.4%), angular cheilitis in three (21.4%) and recurrent aphthous stomatitis in one (7.1%). OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1) and the 7 patients in whom Candida was not detected during IFN therapy (group 2). The prevalence of oral mucosal lesions (P=0.0075) and incidence of external use of steroids (P=0.0308) in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088). Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6th month of IFN administration was lower than in group 2 (P=0.0550). According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94). Conclusion We should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.

2012-01-01

246

Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: The Memorial Sloan-Kettering Cancer Center experience  

SciTech Connect

Purpose: To review the Memorial Sloan-Kettering Cancer Center's experience in using intensity-modulated radiation therapy (IMRT) for the treatment of oropharyngeal cancer. Methods and Materials: Between September 1998 and June 2004, 50 patients with histologically confirmed cancer of the oropharynx underwent IMRT at our institution. There were 40 men and 10 women with a median age of 56 years (range, 28-78 years). The disease was Stage I in 1 patient (2%), Stage II in 3 patients (6%), Stage III in 7 (14%), and Stage IV in 39 (78%). Forty-eight patients (96%) received definitive treatment, and 2 (4%) were treated in the postoperative adjuvant setting. Concurrent chemotherapy was used in 43 patients (86%). Patients were treated using three different IMRT approaches: 76% dose painting, 18% concomitant boost with IMRT in both am and pm deliveries, and 6% concomitant boost with IMRT only in pm delivery. Regardless of the approach, the average prescription dose to the gross tumor planning target volume was 70 Gy, while the average dose delivered to the subclinical volume was 59.4 Gy in the dose painting group and 54 Gy in the concomitant boost group. Percutaneous endoscopic gastrostomy feeding tubes (PEGs) were placed before the beginning of treatment in 84% of the patients. Acute and late toxicity were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. Toxicity was also evaluated using subjective criteria such as the presence of esophageal stricture, and the need for PEG usage. The local progression-free, regional progression-free, and distant metastases-free rates, and overall survival were calculated using the Kaplan-Meier method. Results: Three patients had persistent locoregional disease after treatment. The 2-year estimates of local progression-free, regional progression-free, distant metastases-free, and overall survival were 98%, 88%, 84%, and 98%, respectively. The worst acute mucositis experienced was Grade 1 in 4 patients (8%), Grade 2 in 27 (54%), and Grade 3 in 19 (38%). Xerostomia decreased with increasing time interval from the end of radiotherapy, and among the patients with at least 9 months of follow-up there was 67% Grade 0-1 and 33% Grade 2 toxicity. Of the 42 patients who required upfront PEG placement, 6 were still using PEG for nutrition at the time of this analysis. Three patients had cervical esophageal strictures, and of these, 1 was still PEG dependent 1 year after treatment. Two of these patients were treated with the IMRT concomitant boost am and pm approach, whereas the other was treated with the dose painting technique. Conclusions: Intensity-modulated radiotherapy achieved encouraging local control rates in patients with oropharyngeal carcinoma. Treatment toxicity was acceptable even in the setting of concurrent chemotherapy. Long-term follow-up is needed to confirm these preliminary findings.

Arruda, Fernando F. de [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Puri, Dev R. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zhung, Joanne [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Narayana, Ashwatha [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wolden, Suzanne [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Hunt, Margie [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Stambuk, Hilda [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Pfister, David [Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Kraus, Dennis [Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Shaha, Ashok [Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Shah, Jatin [Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Lee, Nancy Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)]. E-mail: leen2@mskcc.org

2006-02-01

247

RADIOIODINE TREATMENT OF METASTATIC THYROID CANCER: RELATIVE EFFICACY AND SIDE EFFECT PROFILE AFTER PREPARATION BY THYROID HORMONE WITHDRAWAL VS. RECOMBINANT HUMAN TSH.  

PubMed

Background: In order to effectively treat differentiated thyroid cancer (DTC) with radioiodine (RAI) it is necessary to raise serum TSH levels either endogenously by thyroid hormone withdrawal (THW) or exogenously by administration of recombinant human TSH (rhTSH). The aim of the study was to compare the relative efficacy and side effect profile of rhTSH vs. THW preparation for RAI therapy of metastatic DTC. Methods: 56 patients (31 women, 25 men) with RAI-avid distant metastases of DTC treated with either rhTSH-aided (n=15) or THW-aided RAI (n=41) and followed for 72+/-36.2 months were retrospectively analyzed. The groups were comparable in regard to mean size of target lesions (rhTSH vs THW 6.4 vs 4.8 cm, p=0.41), mean baseline thyroglobulin level (6995 vs 5544 ng/ml, p=0.83), distribution of micro-nodular and macro-nodular pulmonary metastases (67% vs 63%, p=0.54, 13% vs 15% p=0.64, respectively), osseous (53% vs 29%, p=0.09), brain (0% vs 2%, p=0.73), and liver/kidney metastases (13% vs 2%, p=0.61). Patients in the rhTSH group were older (rhTSH vs THW mean 62 vs 49 years, p= 0.01), and received lower cumulative RAI dose (256 vs 416 mCi, p=0.03), which was more frequently based on dosimetric calculation (80% vs 46%, p=0.024). Assessment of responses to treatment were based on RECIST 1.1 criteria. Results: Age-adjusted rates of complete response (CR), stable disease (SD) progressive disease (PD) and progression free survival (PFS) were not different between the groups (rhTSH vs THW CR Hazard Ratio (HR) 0.97, 95%CI 0.08-11.42, p=0.982, SD HR 3.22, 95%CI 0.79-13.18, p=0.104, PD HR 0.26, 96%CI 0.52-1.26, p=0.094, PFS HR 0.41, 95%CI 0.14-1.23, p=0.112). The only independent risk factor for non-responding to treatment and presentation with PD was age (HR 1.06, 95%CI 1.02-1.11, p=0.008). Age was also an independent factor affecting PFS (HR 1.04 for each year, 95%CI 1.02-1.07, p=0.001). Rates of leukopenia, thrombocytopenia, xerostomia and restrictive pulmonary disease after RAI were not significantly different (rhTSH vs. THW 30% vs. 28%, p=0.61, 10% vs. 0%, p=0.37, 0% vs. 12%, p=0.20, 0% vs. 2%, p=0.73, respectively). Conclusions: Patients with metastatic DTC prepared with rhTSH achieve comparable benefit of RAI therapy as those treated after THW. PMID:22191411

Klubo-Gwiezdzinska, Joanna; Burman, Kenneth D; Van Nostrand, Douglas; Mete, Mihriye; Jonklaas, Jacqueline; Wartofsky, Leonard

2011-12-22