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1

Galanthamine Treatment of Xerostomia.  

National Technical Information Service (NTIS)

Galanthamine treatment was carried out on 46 patients suffering from xerostomia. Galanthamine was administered subcutaneously daily to 20 patients, and received internally by 7 patients; electrophoresis with galanthamine was carried out on 19 patients. Af...

G. A. Vasilev I. F. Romacheva A. G. Kats A. T. Frolova

1973-01-01

2

Dry Mouth or Xerostomia  

MedlinePLUS

... Languages Español Xerostomia (dry mouth) occurs when the salivary glands do not make enough saliva (spit) to keep ... radiation treatments cause dry mouth by damaging the salivary glands. Chemotherapy causes dry mouth by making saliva thickerâ?? ...

3

Hyposalivation and xerostomia in dentate older adults  

PubMed Central

Background Older adults are susceptible to reduced saliva production related to certain medications, radiation and chronic conditions. Many of these people have many physical and oral health problems and limited access to dental care. The use of effective screening tools for xerostomia and hyposalivation would be helpful in identifying those at risk. The authors conducted a study to investigate the association between three measures of oral dryness: hyposalivation (low unstimulated salivary flow), self-reported xerostomia and clinically assessed dry mouth. Methods The authors included a convenience sample of 252 nondemented and dentate West Virginia participants 70 years and older who were part of a larger study on oral health and cognition among older adults. Participants completed a self-reported xerostomia index, provided an unstimulated salivary sample and underwent an oral assessment for the study. Results Twenty-eight (11.1 percent) had hyposalivation, eight of whom reported having xerostomia (sensitivity = 28.6 percent). Of the 43 participants who reported having xerostomia, only eight had hyposalivation (positive predictive value = 18.6 percent). Hyposalivation and self-reported xerostomia were not significantly related. Clinically assessed dry mouth correlated modestly, but significantly, with hyposalivation and self-reported xerostomia. Conclusions Obtaining routine unstimulated salivary flow rates in addition to self-reported information and oral evaluations may increase early detection of oral dryness, which would assist in implementing early interventions to improve patients’ quality of life. Clinical Implications Visually inspecting oral tissues for dryness and asking a patient if his or her mouth is dry are insufficient measures for clinicians to use to determine if the patient has hyposalivation. The authors recommend that clinicians determine the patients’ unstimulated salivary flow rate.

Wiener, R. Constance; Wu, Bei; Crout, Richard; Wiener, Michael; Plassman, Brenda; Kao, Elizabeth; McNeil, Daniel

2010-01-01

4

Xerostomia in hereditary gelsolin amyloidosis.  

PubMed

Hereditary gelsolin amyloidosis (AGel amyloidosis) is a rare, dominantly inherited systemic disease with worldwide distribution, caused by c.654G > A or c.654G > T gelsolin gene mutation. The disease mainly manifests with late-onset dystrophy of the cornea, laxity of the skin and dysfunction of the cranial nerves whereas the oral manifestations have remained less-studied. To examine if AGel amyloidosis also affects salivary gland function, we studied 27 patients. In a questionnaire, 89% of them reported oral dryness, and 74% oral and ocular dryness. Unstimulated (UWS) and stimulated whole salivary flow (SWS) rates were measured, and salivary proteins were analyzed in the patients and controls. Hyposalivation according to UWS was detected in 67% of the patients, while decreased SWS occurred in 63% of the patients and 19% of the controls (p = 0.001). The secretion rates of salivary total protein and IgA were significantly lower in patients than controls. Histopathological analyses of labial salivary gland biopsies showed deposition of gelsolin amyloid, atrophy and inflammation. This study showed that AGel amyloidosis belongs to the differential diagnostic choices to be kept in mind in the patients presenting with xerostomia, low secretion rates of salivary total protein and IgA and/or deposition of amyloid in the minor salivary glands. AGel amyloidosis patients should be advised for efficient dental care. PMID:23356404

Juusela, Pirjo; Tanskanen, Maarit; Nieminen, Anja; Kari, Kirsti; Suominen, Liisa; Uitto, Veli-Jukka; Kiuru-Enari, Sari

2013-03-01

5

Metabolic Imaging Biomarkers of Postradiotherapy Xerostomia  

SciTech Connect

Purpose: Xerostomia is a major complication of head and neck radiotherapy (RT). Available xerostomia measures remain flawed. [{sup 18}F]fluorodeoxyglucose-labeled positron emission tomography-computed tomography (FDG-PET-CT) is routinely used for staging and response assessment of head and neck cancer. We investigated quantitative measurement of parotid gland FDG uptake as a potential biomarker for post-RT xerostomia. Methods and Materials: Ninety-eight locally advanced head and neck cancer patients receiving definitive RT underwent baseline and post-RT FDG-PET-CT on a prospective imaging trial. A separate validation cohort of 14 patients underwent identical imaging while prospectively enrolled in a second trial collecting sialometry and patient-reported outcomes. Radiation dose and pre- and post-RT standard uptake values (SUVs) for all voxels contained within parotid gland ROI were deformably registered. Results: Average whole-gland or voxel-by-voxel models incorporating parotid D{sub Met} (defined as the pretreatment parotid SUV weighted by dose) accurately predicted posttreatment changes in parotid FDG uptake (e.g., fractional parotid SUV). Fractional loss of parotid FDG uptake closely paralleled early parotid toxicity defined by posttreatment salivary output (p < 0.01) and Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer xerostomia scores (p < 0.01). Conclusions: In this pilot series, loss of parotid FDG uptake was strongly associated with acute clinical post-RT parotid toxicity. D{sub Met} may potentially be used to guide function-sparing treatment planning. Prospective validation of FDG-PET-CT as a convenient, quantifiable imaging biomarker of parotid function is warranted and ongoing.

Cannon, Blake [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Schwartz, David L., E-mail: dschwartz3@nshs.edu [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Department of Radiation Medicine, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York (United States); Feinstein Institute for Medical Research, Manhasset, New York (United States); Dong Lei [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)

2012-08-01

6

Group acupuncture to relieve radiation induced xerostomia: a feasibility study  

Microsoft Academic Search

Background:A distressing complication of radiotherapy treatment for head and neck cancer is xerostomia (chronic oral dryness). Xerostomia is difficult to treat conventionally but there are reports that acupuncture can help. We conducted a feasibility study to examine the acceptability of a standardised group acupuncture technique and adherence to group sessions, together with acceptability of the objective and subjective measurements of

Richard Simcock; Lesley Fallowfield; Valerie Jenkins

2009-01-01

7

Xerostomia and medications among 32-year-olds  

PubMed Central

Objective To describe the prevalence and associations of xerostomia among adults in their early thirties, with particular attention to medication exposure as a putative risk factor. Material and Methods The prevalence and associations of xerostomia were investigated among 32-year-old participants in a long-standing prospective cohort study. Some 950 individuals were assessed at ages 26 and 32 years, with medications being recorded on both occasions. Results The prevalence of xerostomia was 10.0% (with no apparent gender difference), and was significantly higher among those taking antidepressants (odds ratio =4.7), iron supplements (OR =4.1) or narcotic analgesics (OR =2.4). Those taking antidepressants at both ages 26 and 32 years had 22 times the odds of reporting xerostomia. Conclusion Xerostomia may be a problem for a sizeable minority of young adults.

THOMSON, WILLIAM MURRAY; POULTON, RICHIE; BROADBENT, JONATHAN MARK; AL-KUBAISY, SHAIMA

2008-01-01

8

Drug induced xerostomia in elderly individuals: An institutional study  

PubMed Central

Introduction: With better health care facilities and nutritional levels the average life expectancy of Indian population has been on the rise over the years. Most of the geriatric population is under long-term medication. Aim: The aim of this study was to evaluate the synergistic effect of multiple xerostomia drugs. Materials and Methods: Unstimulated saliva was measured in 60 geriatric patients, and xerostomia questionnaire and quality-of-life scale were also administered. Results: There was a very highly significant reduction in the salivary flow rates of patients under multiple xerostomia-inducing drugs. Conclusion: The synergistic effect of the xerostomia inducing medication could be the possible factor responsible for reduced salivary flow in elderly individuals using such drugs

Shetty, Shishir Ram; Bhowmick, Sunanda; Castelino, Renita; Babu, Subhas

2012-01-01

9

Type 1 diabetes mellitus, xerostomia, and salivary flow rates  

Microsoft Academic Search

Objective: The Oral Health Science Institute at the University of Pittsburgh has completed a cross-sectional epidemiologic study of 406 subjects with type 1 diabetes and 268 control subjects without diabetes that assessed the associations between oral health and diabetes. This report describes the prevalence of dry-mouth symptoms (xerostomia), the prevalence of hyposalivation in this population, and the possible interrelationships between

Paul A. Moore; James Guggenheimer; Kenneth R. Etzel; Robert J. Weyant; Trevor Orchard

2001-01-01

10

Severity and impact of xerostomia in patients treated with botulinum toxin type b for cervical dystonia: Observations on the quality of life of patients with xerostomia  

Microsoft Academic Search

Background: Although dry mouth (xerostomia) has been reported with botulinum toxin type B used as treatment for cervical dystonia, the impact of this adverse effect (AE) on patients' activities of daily living (ADLs) has not been assessed.tObjective: The aim of this study was to examine the severity, duration, and impact of xerostomia in patients with cervical dystonia who reported this

Patrick Hogan; P. David Charles; Maureen Wooten Watts; Janice M. Massey; Tamara Miller; John Mackowiack

2004-01-01

11

Radiation-induced xerostomia: pathophysiology, clinical course and supportive treatment  

Microsoft Academic Search

Xerostomia, or oral dryness, is one of the most common complaints experienced by patients who have had radiotherapy of the\\u000a oral cavity and neck region. The hallmarks of radiation-induced damage are acinar atrophy and chronic inflammation of the\\u000a salivary glands. The early response, resulting in atrophy of the secretory cells without inflammation might be due to radiation-induced\\u000a apoptosis. In contrast,

H.-J. Guchelaar; A. Vermes; J. H. Meerwaldt

1997-01-01

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

Summary of: Xerostomia and chronic oral complications among patients treated with haematopoietic stem cell transplantation  

Microsoft Academic Search

Objective To assess the severity of xerostomia (subjective dry mouth) in haematopoietic stem cell transplantation (HSCT) patients and to investigate the association of xerostomia with other chronic oral complications.Design Cross-sectional study.Study participants and methods Participants were 48 patients with a history of HSCT recruited among members of the Dutch Stem Cell Transplantation Contact Group, and a comparison group of 41

A. Barasch

2009-01-01

14

Xerostomia and chronic oral complications among patients treated with haematopoietic stem cell transplantation  

Microsoft Academic Search

Objective To assess the severity of xerostomia (subjective dry mouth) in haematopoietic stem cell transplantation (HSCT) patients and to investigate the association of xerostomia with other chronic oral complications.Design Cross-sectional study.Study participants and methods Participants were 48 patients with a history of HSCT recruited among members of the Dutch Stem Cell Transplantation Contact Group, and a comparison group of 41

C. P. Bots; J. E. Raber-Durlacher; H. S. Brand

2009-01-01

15

Analysis of Factors Influencing the Development of Xerostomia during Intensity-Modulated Radiotherapy  

PubMed Central

OBJECTIVES Factors influencing xerostomia during intensity-modulated radiation therapy (IMRT) were assessed. METHODS A 6-week study of 32 head and neck cancer (HNC) patients was performed. Subjects completed the Xerostomia Inventory (XI) and provided stimulated saliva (SS) at baseline, week two and at end of IMRT. Influence of SS flow rate (SSFR), calcium and mucin 5b (MUC5b) concentrations and radiation dose on xerostomia was determined. RESULTS HNC subjects experienced mean SSFR decline of 36% by visit two (N=27; p=0.012) and 57% by visit three (N=20; p=0.0004), Concentrations of calcium and MUC5b increased, but not significantly during IMRT (p>0.05). Xerostomia correlated most with decreasing salivary flow rate as determined by Spearman correlations (p<0.04) and linear mixed models (p<0.0001). CONCLUSIONS Although IMRT is sparing to the parotid glands, it has an early effect on SSFR and the constituents in saliva in a manner that is associated with the perception of xerostomia.

Randall, Ken; Stevens, Jason; Yepes, Juan Fernando; Randall, Marcus E.; Kudrimoti, Mahesh; Feddock, Jonathan; Xi, Jing; Kryscio, Richard J.; Miller, Craig S.

2013-01-01

16

Self-reported prevalence and severity of xerostomia and its related conditions in individuals attending hospital for general health examinations.  

PubMed

The aim of this study was to investigate the prevalence, severity, and relationships between xerostomia and its related symptoms in individuals who attended hospital for general health examinations. Participants included 883 men and 618 women aged between 30 and 60 years. History of symptoms during the previous 6 months, current symptoms, and severity of current symptoms were evaluated using a questionnaire that included questions about xerostomia, burning mouth, taste disturbance, and oral malodor. The prevalence of xerostomia and its related symptoms was 60.2%; the prevalence of oral malodor was 52.3%, xerostomia 33.0%, burning mouth 13.6%, and taste disturbance 12.5%. Men in their 30s and women in their 60s showed significantly higher prevalence and greater severity of xerostomia, burning mouth, and taste disturbance compared with their counterparts. The prevalence of xerostomia, burning mouth, and taste disturbance, and the severity of xerostomia increased significantly with age in women. The prevalence and severity of these four symptoms were significantly related and the association was the highest between burning mouth and taste disturbance. In conclusion, xerostomia and its related symptoms were highly prevalent at all ages. The prevalence and severity of these symptoms were closely related. PMID:24238864

Lee, E; Lee, Y-H; Kim, W; Kho, H-S

2014-04-01

17

Mesenchymal stem cell therapy for salivary gland dysfunction and xerostomia: a systematic review of preclinical studies.  

PubMed

The most severe forms of xerostomia and salivary gland dysfunction, as well as a severely reduced quality of life, are seen in Sjögren syndrome (SS) and after radiotherapy for head and neck cancer. For both conditions, no effective regenerative therapies yet exist. Thus, the aim of this article was to assess, through systematic review, the potential benefit of mesenchymal stem cell (MSC) therapy in radiation-induced and SS-related salivary gland dysfunction and xerostomia. We searched PubMed/MEDLINE, Embase, Web of Science, the Cochrane Database of Systematic Reviews, the World Health Organization Clinical Trials Registry Platform, and Google Scholar. We identified 6 separate study comparisons eligible for inclusion. Owing to the limited number of studies, we conclude that more randomized, adequately powered clinical trials are needed to validate the potential beneficial effect of MSCs on salivary gland dysfunction and xerostomia. Nonetheless, the preliminary studies identified in the present review were encouraging for further research. PMID:24528792

Jensen, David Hebbelstrup; Oliveri, Roberto Stefan; Trojahn Kølle, Stig-Frederik; Fischer-Nielsen, Anne; Specht, Lena; Bardow, Allan; Buchwald, Christian

2014-03-01

18

Xerostomia After Treatment for Oral and Oropharyngeal Cancer Using the University of Washington Saliva Domain and a Xerostomia-Related Quality-of-Life Scale  

SciTech Connect

Purpose: The first aim of this study was to identify which clinical factors are associated with xerostomia in patients after treatment for oral and oropharyngeal squamous cell carcinoma, using the Xerostomia-Related Quality-of-Life Scale (XeQoLS) and the University of Washington Quality-of-Life Questionnaire Version 4 dry mouth item (UW-QOL v4). The second aim was to compare these two questionnaires and postulate a cutoff in the UW-QOL below which patients are doing sufficient badly to warrant further evaluation and support. Methods and Materials: In all, 371 patients alive and disease free treated between 1992 and 2005 were sent the survey, of whom 250 (67%) responded. Various clinical factors correlated with xerostomia, particularly adjuvant radiotherapy and Pstage. Results: In logistic regression analyses to predict three or more problems on the XeQoLS, only adjuvant radiotherapy (p < 0.001) was significant at the 5% level. There were significant (p < 0.001) correlations between the XeQoLS scores (total average and domain) with all the UW-QOL domain scores, the strongest with swallowing (-0.69), taste (-0.64), chewing (-0.64), mood (-0.60), and saliva (-0.59) domains. Patients scoring <70 (i.e., 0 or 30) on the UW-QOL could be used as a screening cutoff because it formed 1 in 5 of all patients (49/242) but accounted for half (299/566) of the significant problems generated by the XeQoLS. This also identified 13/21 patients with 10 or more problems. Conclusion: The UW-QOL saliva domain seems to be a suitable means of screening for dry mouth in head-and-neck clinics and could be used to trigger interventions.

Rogers, Simon N., E-mail: snrogers@doctors.org.u [Evidence-Based Practice Research Centre, Faculty of Health, Edge Hill University, Ormskirk (United Kingdom); Regional Maxillofacial Unit, University Hospital Aintree, Liverpool (United Kingdom); Johnson, Ian A. [Faculty of Medicine, University of Liverpool, Liverpool (United Kingdom); Lowe, Derek [Evidence-Based Practice Research Centre, Faculty of Health, Edge Hill University, Ormskirk (United Kingdom)

2010-05-01

19

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

Microsoft Academic Search

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

Amichay Meirovitz; Carol Anne Murdoch-Kinch; Mathew Schipper; Charlie Pan; Avraham. Eisbruch

2006-01-01

20

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

21

Open-Label, Long-Term Safety Study of Cevimeline in the Treatment of Postirradiation Xerostomia  

Microsoft Academic Search

Purpose: To assess the safety of long-term cevimeline treatment of radiation-induced xerostomia in patients with head-and-neck cancer; and to assess the efficacy of cevimeline in these patients. Methods and Materials: A total of 255 adults with head-and-neck cancer who had received more than 40 Gy of radiation 4 months or more before entry and had clinically significant salivary gland dysfunction

Mark S. Chambers; Christopher Uwe Jones; Merrill A. Biel; Randal S. Weber; Kenneth M. Hodge; Y. Chen; John M. Holland; Jonathan A. Ship; Robert Vitti; Ingrid Armstrong; Adam S. Garden; Robert Haddad

2007-01-01

22

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

23

A double-blind crossover trial of Oral Balance gel and Biotene ® toothpaste versus placebo in patients with xerostomia following radiation therapy  

Microsoft Academic Search

Following therapeutic irradiation of the head and neck, patients with profound xerostomia have complaints associated with oral dryness, effects upon use of oral prosthesis, speech, and taste. In addition, xerostomia may lead to risk of oral infections and rampant demineralization of teeth. The use of topical Oral Balance gel and Biotene® toothpaste (Laclede Professional Products, Gardena, CA) versus carboxymethylcellulose gel

J. B Epstein; S Emerton; N. D Le; P Stevenson-Moore

1999-01-01

24

Candidate chromosome 1 disease susceptibility genes for Sjogren's syndrome xerostomia are narrowed by novel NOD.B10 congenic mice.  

PubMed

Sjogren's syndrome (SS) is characterized by salivary gland leukocytic infiltrates and impaired salivation (xerostomia). Cox-2 (Ptgs2) is located on chromosome 1 within the span of the Aec2 region. In an attempt to demonstrate that COX-2 drives antibody-dependent hyposalivation, NOD.B10 congenic mice bearing a Cox-2flox gene were generated. A congenic line with non-NOD alleles in Cox-2-flanking genes failed manifest xerostomia. Further backcrossing yielded disease-susceptible NOD.B10 Cox-2flox lines; fine genetic mapping determined that critical Aec2 genes lie within a 1.56 to 2.17Mb span of DNA downstream of Cox-2. Bioinformatics analysis revealed that susceptible and non-susceptible lines exhibit non-synonymous coding SNPs in 8 protein-encoding genes of this region, thereby better delineating candidate Aec2 alleles needed for SS xerostomia. PMID:24685748

Mongini, Patricia K A; Kramer, Jill M; Ishikawa, Tomo-O; Herschman, Harvey; Esposito, Donna

2014-07-01

25

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

26

Cevimeline for the Treatment of Postirradiation Xerostomia in Patients With Head and Neck Cancer  

SciTech Connect

Purpose: To study the efficacy and safety of cevimeline in two double-blind trials (Studies 003 and 004) enrolling patients with head and neck cancer in whom xerostomia developed after radiotherapy. Methods and Materials: Subjects were randomly assigned to receive cevimeline, 30 mg three times daily, or placebo for 12 weeks, with the possibility of dose escalation to 45 mg three times daily at 6 weeks. The primary efficacy endpoint was the patient's final global evaluation of oral dryness; change in unstimulated salivary flow was a secondary endpoint. Results: Five hundred seventy subjects (284 in Study 003 and 286 in Study 004) were randomized. Significantly more cevimeline-treated subjects than placebo recipients (47.4% vs. 33.3%, p = 0.0162) in Study 003 reported improvement in dry mouth in the final global evaluation of oral dryness. No significant difference between groups in the final global evaluation was seen in Study 004, in which a high placebo response rate of 47.6% was observed. In both studies, cevimeline-treated subjects had significantly greater increases in the objective measure of unstimulated salivary flow than placebo recipients (p 0.0093 [Study 003] and p = 0.0215 [Study 004]), whereas no significant differences in stimulated salivary flow were observed. The most frequent adverse event was increased sweating. Conclusion: Cevimeline was well tolerated by patients with xerostomia after radiotherapy for head and neck cancer, and oral administration of 30-45 mg of cevimeline three times daily increased unstimulated salivary flow.

Chambers, Mark S. [Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: mchamber@mdanderson.org; Posner, Marshall [Dana Farber Cancer Center, Harvard University, Boston, MA (United States); Jones, Christopher Uwe [Radiological Associates of Sacramento, Sacramento, CA (United States); Biel, Merrill A. [Ear, Nose and Throat Specialty Care of Minnesota, Minneapolis, MN (United States); Hodge, Kenneth M. [Commonwealth Ear Nose and Throat, Louisville, KY (United States); Vitti, Robert [Daiichi Pharmaceutical Corporation, Montvale, NJ (United States); Armstrong, Ingrid [Daiichi Pharmaceutical Corporation, Montvale, NJ (United States); Yen, Cindy [Daiichi Pharmaceutical Corporation, Montvale, NJ (United States); Weber, Randal S. [Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

2007-07-15

27

A multicenter maintenance study of oral pilocarpine tablets for radiation-induced xerostomia.  

PubMed

Two hundred sixty-five patients with head and neck cancer who had previously participated in either a fixed-dose, dose-titration, or dose-ranging trial of oral pilocarpine hydrochloride tablets were enrolled in a 36-month multicenter maintenance study to evaluate the long-term safety and efficacy of oral pilocarpine for the treatment of radiation-induced xerostomia. In this open-label study, the initial drug dose was 5.0 mg tid, with possible adjustments from 2.5 to 10.0 mg tid or bid. Efficacy was evaluated by subjective measures of oral function. Safety evaluations were based on self-report of symptoms (or of adverse effects), various examinations, and laboratory tests. There was significant improvement in all criteria of oral function. Sweating was the most frequent adverse experience (55%). Less frequent side effects, mild to moderate in nature, included increased urinary frequency, lacrimation, and rhinitis. Side effects usually diminished within hours after the cessation of therapy. We conclude that oral pilocarpine at these doses effectively and safely reduces the symptoms of radiation-induced xerostomia. PMID:8723429

Jacobs, C D; van der Pas, M

1996-03-01

28

Cost-effectiveness landscape analysis of treatments addressing xerostomia in patients receiving head and neck radiation therapy  

PubMed Central

Head and neck (H&N) radiation therapy (RT) can induce irreversible damage to the salivary glands thereby causing long-term xerostomia or dry mouth in 68%–85% of the patients. Not only does xerostomia significantly impair patients’ quality-of-life (QOL) but it also has important medical sequelae, incurring high medical and dental costs. In this article, we review various measures to assess xerostomia and evaluate current and emerging solutions to address this condition in H&N cancer patients. These solutions typically seek to accomplish 1 of the 4 objectives: (1) to protect the salivary glands during RT, (2) to stimulate the remaining gland function, (3) to treat the symptoms of xerostomia, or (4) to regenerate the salivary glands. For each treatment, we assess its mechanisms of action, efficacy, safety, clinical utilization, and cost. We conclude that intensity-modulated radiation therapy is both the most widely used prevention approach and the most cost-effective existing solution and we highlight novel and promising techniques on the cost-effectiveness landscape.

Sasportas, Laura S.; Hosford, Andrew T.; Sodini, Maria A.; Waters, Dale J.; Zambricki, Elizabeth A.; Barral, Joelle K.; Graves, Edward E.; Brinton, Todd J.; Yock, Paul G.; Le, Quynh-Thu; Sirjani, Davud

2014-01-01

29

Association of Xerostomia and Assessment of Salivary Flow Using Modified Schirmer Test among Smokers and Healthy Individuals: A Preliminutesary Study  

PubMed Central

Background and Objective: Several oral diseases such as dental caries, periodontitis and oral infections can be a major concern in patients suffering from mouth dryness. Whole mouth salivary flow is affected by many factors which may include habits like smoking. The aim of the present study was to investigate the incidence of xerostomia and hyposalivation among smokers. Materials and Methods: The study groups included 60 smokers and 60 healthy non-tobacco users as case and control groups respectively. A questionnaire was used to collect the smoking habits and symptoms associated with xerostomia. Measurement of unstimulated whole mouth salivary flow for 3 minutesutes was performed using modified Schirmer test. The results were subjected to statistical analysis. Results: The prevalence of xerostomia symptom was 37% in smokers and it was 13% in non-smokers, with a statistically significant difference between groups (p=0.003). The prevalence of hyposalivation was 43% in smokers, whereas it was only 8% in the control group (p< 0.001). Conclusion: Xerostomia symptoms with significant reduction in unstimulated whole mouth salivary flow were associated with long term smoking.

Dyasanoor, Sujatha; Saddu, Shweta Channavir

2014-01-01

30

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

31

Bone marrow-derived cells: A potential approach for the treatment of xerostomia.  

PubMed

Transplantations of bone marrow-derived cells (BMDCs) are traditionally used for hematologic diseases, but there are increasing numbers of clinical trials using BMDC treatments for non-hematologic disorders, including autoimmune diseases. BMDCs are recently reported to improve organ functions. This paper will review available reports supporting the role of BMDCs in reducing xerostomia (i.e. re-establishing salivary gland functions) due to head and neck irradiation for cancer therapies and in Sjögren's syndrome. There are reports that BMDCs provide a beneficial effect on the saliva production. BMDCs positively affect blood vessels stability and regeneration in irradiated salivary glands. Also, BMDCs provide an immunomodulatory activity in mice with Sjögren's-like disease. While the exact mechanisms by which BMDCs improve organ functions remain controversial, there is preliminary evidence that a combination of them (such as cell transdifferentiation, vasculogenesis, and paracrine effect) occur in salivary glands. PMID:21035563

Tran, Simon D; Sumita, Yoshinori; Khalili, Saeed

2011-01-01

32

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

33

Open-Label, Long-Term Safety Study of Cevimeline in the Treatment of Postirradiation Xerostomia  

SciTech Connect

Purpose: To assess the safety of long-term cevimeline treatment of radiation-induced xerostomia in patients with head-and-neck cancer; and to assess the efficacy of cevimeline in these patients. Methods and Materials: A total of 255 adults with head-and-neck cancer who had received more than 40 Gy of radiation 4 months or more before entry and had clinically significant salivary gland dysfunction received cevimeline hydrochloride 45 mg t.i.d. orally for 52 weeks. Adverse events (AEs), their severity, and their relationship to the study medication were assessed by each investigator. The efficacy assessment was based on subjects' global evaluation of oral dryness on a scale of 0 (none) to 3 (severe). Results: Overall, 175 subjects (68.6%) experienced expected treatment-related AEs, most mild to moderate. The most frequent was increased sweating (47.5%), followed by dyspepsia (9.4%), nausea (8.2%), and diarrhea (6.3%). Fifteen subjects (5.9%) experienced Grade 3 treatment-related AEs, of which the most frequent was increased sweating. Eighteen subjects (7.1%) reported at least one serious AE, and 45 subjects (17.6%) discontinued study medication because of an AE. The global efficacy evaluation at the last study visit showed that cevimeline improved dry mouth in most subjects (59.2%). Significant improvement was seen at each study visit in the mean change from baseline of the numeric global evaluation score (p < 0.0001). Conclusions: Cevimeline 45 mg t.i.d. was generally well tolerated over a period of 52 weeks in subjects with xerostomia secondary to radiotherapy for cancer in the head-and-neck region.

Chambers, Mark S. [Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail: mchamber@mdanderson.org; Jones, Christopher Uwe [Radiological Associates of Sacramento, Sacramento, CA (United States); Biel, Merrill A. [Ear, Nose and Throat Specialty Care of Minnesota, Minneapolis, MN (United States); Weber, Randal S. [Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Hodge, Kenneth M. [Commonwealth Ear Nose and Throat, Louisville, KY (United States); Chen, Y. [Department of Radiation Oncology, University of Rochester Cancer Center, Rochester, NY (United States); Holland, John M. [Department of Radiation Oncology, Oregon Health and Science University, Portland, OR (United States); Ship, Jonathan [Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY (United States); Vitti, Robert; Armstrong, Ingrid [Daiichi Pharmaceutical Corporation, Montvale, NJ (United States); Garden, Adam S. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Haddad, Robert [Dana Farber Cancer Center, Harvard University, Boston, MA (United States)

2007-12-01

34

A preliminary report on patient acceptance of a novel intra-oral lubricating device for the management of radiotherapy-related xerostomia  

Microsoft Academic Search

Management of radiotherapy-related xerostomia is difficult. Saliva substitutes are helpful but the effects are short-lived. The purpose of the study was to develop a prototype intra-oral lubricating device for the management of radiotherapy-related xerostomia and to evaluate patient acceptance. An intra-oral lubricating device was fabricated that incorporated a reservoir in the palatal vault and permitted slow release of saliva substitute

Andrew Y. L. Kam; Anne S. McMillan; Edmond H. N. Pow; Katherine C. M. Leung; Henry W. K. Luk

2005-01-01

35

A Phase II Study of Submandibular Gland Transfer Prior to Radiation for Prevention of Radiation-induced Xerostomia in Head-and-Neck Cancer (RTOG 0244)  

SciTech Connect

Purpose: We report the results of a phase II study to determine the reproducibility of a submandibular salivary gland transfer (SGT) surgical technique for prevention of radiation (XRT)-induced xerostomia in a multi-institutional setting and to assess severity of xerostomia. Methods and Materials: Eligible patients had surgery for primary, neck dissection, and SGT, followed by XRT, during which the transferred salivary gland was shielded. Intensity modulated radiation therapy, amifostine, and pilocarpine were not allowed, but postoperative chemotherapy was allowed. Each operation was reviewed by 2 reviewers and radiation by 1 reviewer. If 13 or more (of 43) were 'not per protocol,' then the technique would be considered not reproducible as per study design. The secondary endpoint was the rate of acute xerostomia, grade 2 or higher, and a rate of {<=}51% was acceptable. Results: Forty-four of the total 49 patients were analyzable: male (81.8%), oropharynx (63.6%), stage IV (61.4%), median age 56.5 years. SGT was 'per protocol' or within acceptable variation in 34 patients (77.3%) and XRT in 79.5%. Nine patients (20.9%) developed grade 2 acute xerostomia; 2 had grade 0-1 xerostomia (4.7%) but started on amifostine/pilocarpine. Treatment for these 11 patients (25.6%) was considered a failure for the xerostomia endpoint. Thirteen patients died; median follow-up for 31 surviving patients was 2.9 years. Two-year overall and disease-free survival rates were 76.4% and 71.7%, respectively. Conclusions: The technique of submandibular SGT is reproducible in a multicenter setting. Seventy-four percent of patients were prevented from XRT-induced acute xerostomia.

Jha, Naresh, E-mail: naresh.jha@albertahealthservices.ca [University of Alberta, Cross Cancer Institute, Edmonton, Alberta (Canada)] [University of Alberta, Cross Cancer Institute, Edmonton, Alberta (Canada); Harris, Jonathan [Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States)] [Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Seikaly, Hadi [University of Alberta, Edmonton, Alberta (Canada)] [University of Alberta, Edmonton, Alberta (Canada); Jacobs, John R. [Wayne State University School of Medicine, Detroit, Michigan (United States)] [Wayne State University School of Medicine, Detroit, Michigan (United States); McEwan, A.J.B. [University of Alberta, Cross Cancer Institute, Edmonton, Alberta (Canada)] [University of Alberta, Cross Cancer Institute, Edmonton, Alberta (Canada); Robbins, K. Thomas [St. John's Hospital Cancer Institute, Springfield, Illinois (United States)] [St. John's Hospital Cancer Institute, Springfield, Illinois (United States); Grecula, John [Ohio State University Medical Center, Columbus, Ohio (United States)] [Ohio State University Medical Center, Columbus, Ohio (United States); Sharma, Anand K. [Medical University of South Carolina, Charleston, South Carolina (United States)] [Medical University of South Carolina, Charleston, South Carolina (United States); Ang, K. Kian [University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

2012-10-01

36

Autotransplantation of cryopreserved minor salivary glands: a new approach for management of radiation-induced xerostomia.  

PubMed

To date, it still is impossible to successfully prevent radiation-induced xerostomia. Therefore, further research, particularly regarding treatment, is urgently warranted. Lower labial mucosa with its submucosal minor salivary glands (MSGs) of approximately 2.5 x 3 cm can be prepared by means of a surgical knife or Ellman Surgitron high-frequency/low-temperature radiosurgical device. Also we can consider area of the palatine fovea to find and remove MSGs. We can find locations containing more MSGs via scintigraphy techniques and positron emission tomography. Removing of MSGs can be done 1-2 weeks before start of radiotherapy. Subsequently the MSGs containing complex graft should be cryopreserved via liquid nitrogen for long-term storage. Autotransplantation surgery will be carried out 2-3 months after radiotherapy. The frozen tissue could be thawed rapidly in a 37 degrees C water bath for 2-3 min. Host site should be as far as possible to the radiation zone and has a good blood supply. Hyperbaric oxygen therapy (30 treatment sessions before and 10 sessions after re-implantation) is strongly recommended. An aggressive short or medium-term antibiotic treatment will necessary to avoid infection. Immunosuppressive treatment will not require. The main criticism with this hypothesis is viability and usefulness of MSGs containing graft, after being frozen and subsequently thawed. PMID:19729251

Kolahi, Jafar; Mansourian, Marjan

2010-01-01

37

Intensity-modulated radiotherapy significantly reduces xerostomia compared with conventional radiotherapy  

SciTech Connect

Purpose: Xerostomia is a severe complication after radiotherapy for oropharyngeal cancer, as the salivary glands are in close proximity with the primary tumor. Intensity-modulated radiotherapy (IMRT) offers theoretical advantages for normal tissue sparing. A Phase II study was conducted to determine the value of IMRT for salivary output preservation compared with conventional radiotherapy (CRT). Methods and Materials: A total of 56 patients with oropharyngeal cancer were prospectively evaluated. Of these, 30 patients were treated with IMRT and 26 with CRT. Stimulated parotid salivary flow was measured before, 6 weeks, and 6 months after treatment. A complication was defined as a stimulated parotid flow rate <25% of the preradiotherapy flow rate. Results: The mean dose to the parotid glands was 48.1 Gy (SD 14 Gy) for CRT and 33.7 Gy (SD 10 Gy) for IMRT (p < 0.005). The mean parotid flow ratio 6 weeks and 6 months after treatment was respectively 41% and 64% for IMRT and respectively 11% and 18% for CRT. As a result, 6 weeks after treatment, the number of parotid flow complications was significantly lower after IMRT (55%) than after CRT (87%) (p = 0.002). The number of complications 6 months after treatment was 56% for IMRT and 81% for CRT (p = 0.04). Conclusions: IMRT significantly reduces the number of parotid flow complications for patients with oropharyngeal cancer.

Braam, Petra M. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands)]. E-mail: P.M.Braam@umcutrecht.nl; Terhaard, Chris H.J. M.D. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Roesink, Judith M. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Raaijmakers, Cornelis P.J. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands)

2006-11-15

38

Treatment Planning Constraints to Avoid Xerostomia in Head-and-Neck Radiotherapy: An Independent Test of QUANTEC Criteria Using a Prospectively Collected Dataset  

SciTech Connect

Purpose: The severe reduction of salivary function (xerostomia) is a common complication after radiation therapy for head-and-neck cancer. Consequently, guidelines to ensure adequate function based on parotid gland tolerance dose-volume parameters have been suggested by the QUANTEC group and by Ortholan et al. We perform a validation test of these guidelines against a prospectively collected dataset and compared with a previously published dataset. Methods and Materials: Whole-mouth stimulated salivary flow data from 66 head-and-neck cancer patients treated with radiotherapy at the British Columbia Cancer Agency (BCCA) were measured, and treatment planning data were abstracted. Flow measurements were collected from 50 patients at 3 months, and 60 patients at 12-month follow-up. Previously published data from a second institution, Washington University in St. Louis (WUSTL), were used for comparison. A logistic model was used to describe the incidence of Grade 4 xerostomia as a function of the mean dose of the spared parotid gland. The rate of correctly predicting the lack of xerostomia (negative predictive value [NPV]) was computed for both the QUANTEC constraints and Ortholan et al. recommendation to constrain the total volume of both glands receiving more than 40 Gy to less than 33%. Results: Both datasets showed a rate of xerostomia of less than 20% when the mean dose to the least-irradiated parotid gland is kept to less than 20 Gy. Logistic model parameters for the incidence of xerostomia at 12 months after therapy, based on the least-irradiated gland, were D{sub 50} = 32.4 Gy and and {gamma} = 0.97. NPVs for QUANTEC guideline were 94% (BCCA data), and 90% (WUSTL data). For Ortholan et al. guideline NPVs were 85% (BCCA) and 86% (WUSTL). Conclusion: These data confirm that the QUANTEC guideline effectively avoids xerostomia, and this is somewhat more effective than constraints on the volume receiving more than 40 Gy.

Moiseenko, Vitali, E-mail: vmoiseenko@bccancer.bc.ca [Department of Medical Physics, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada); Wu, Jonn [Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada); Hovan, Allan [Department of Oral Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada); Saleh, Ziad; Apte, Aditya; Deasy, Joseph O. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Harrow, Stephen [Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada); Rabuka, Carman; Muggli, Adam [Department of Oral Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada); Thompson, Anna [Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC (Canada)

2012-03-01

39

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

PubMed

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 dose response for radiation pneumonitis (RP) and xerostomia were identified for this analysis. The data support the notion of large volume effect for the lung and parotid gland with the estimates of the n parameter being close to unity. Assuming that n = 1, the m and TD(50) parameters of the LKB model were estimated by the maximum likelihood method from plots of complication rate as a function of mean organ dose. Ninety five percent confidence intervals for parameter estimates were obtained by the profile likelihood method. If daily fractions other than 2 Gy had been used in a published report, mean organ doses were converted to 2 Gy/fraction-equivalent doses using the linear-quadratic (LQ) formula with alpha/beta = 3 Gy. The following parameter estimates were obtained for the endpoint of symptomatic RP when the lung is considered a paired organ: m = 0.41 (95% CI 0.38, 0.45) and TD(50) = 29.9 Gy (95% CI 28.2, 31.8). When RP incidence was evaluated as a function of dose to the ipsilateral lung rather than total lung, estimates were m = 0.35 (95% CI 0.29, 0.43) and TD(50) = 37.6 Gy (95% CI 34.6, 41.4). For xerostomia expressed as reduction in stimulated salivary flow below 25% within six months after radiotherapy, the following values were obtained: m = 0.53 (95% CI 0.45, 0.65) and TD(50) = 31.4 Gy (95% CI 29.1, 34.0). Although a large number of parameter estimates for different NTCP models and critical structures exist and continue to appear in the literature, it is hard to justify the use of any single parameter set obtained at a selected institution for the purposes of biologically based treatment planning. Our expectation is that the proposed model parameters based on cumulative experience at various institutions are more representative of the overall practice of radiation therapy than any single-institution data, and could be more readily incorporated into clinical use. PMID:18199912

Semenenko, V A; Li, X A

2008-02-01

40

Salivary Gland Function 5 Years After Radioactive Iodine Ablation in Patients with Differentiated Thyroid Cancer: Direct Comparison of Pre- and Postablation Scintigraphies and Their Relation to Xerostomia Symptoms  

PubMed Central

Background Chronic sialadenitis is one of the most frequent chronic complications after radioactive iodine (RAI) therapy for thyroid cancer. To evaluate the long-term effects of RAI ablation on salivary gland function, we investigated scintigraphic changes in salivary glands by direct comparison of two salivary gland scintigraphies (SGSs) taken before and at 5 years after an RAI ablation. Methods SGS was performed just before RAI ablation (pre-SGS) and ?5 years after RAI ablation (F/U SGS) in 213 subjects who underwent thyroidectomy for thyroid cancer. The uptake score (U score) was graded, and the ejection fraction (EF) was quantified for the parotid and submandibular glands at pre-SGS and F/U SGS. Changes in salivary gland function were graded as mild, moderate, or severe according to the differences in U score and EF between the two SGSs. Xerostomia was assessed and compared with the SGS findings. Results Worsening of the U score was observed in 182 of 852 salivary glands (total: 21.3%; mild: 4.2%, moderate: 7.4%, severe: 9.7%), and 47.4% of the patients had a worsening U score for at least one of four salivary glands. A decrease in EF was observed in 173 of 852 salivary glands (total: 20.3%; mild: 5.4%, moderate: 6.8%, severe: 8.1%), and 43.7% of the patients experienced a decrease in the EF of at least one of the four salivary glands. Bilateral parotid gland dysfunction was the most commonly observed condition. Thirty-five (16.4%) patients complained of xerostomia at 5 years after RAI ablation. Scintigraphic changes in salivary gland function and xerostomia were more common in patients receiving 5.55?GBq, compared with 3.7?GBq. Xerostomia was more common in patients with submandibular gland dysfunction than those with parotid gland dysfunction (68.8% vs. 33.3%, p<0.05). The number of dysfunctional salivary glands was correlated with xerostomia (p<0.01). Conclusion About 20% of the salivary glands were dysfunctional on SGS 5 years after a single RAI ablation, especially in patients who received higher doses of RAI. While parotid glands are more susceptible to 131I-related damage, xerostomia was more associated with submandibular gland dysfunction and the prevalence of dysfunctional salivary glands.

Jeong, Shin Young; Kim, Hae Won; Lee, Sang-Woo; Ahn, Byeong-Cheol

2013-01-01

41

A preliminary report on patient acceptance of a novel intra-oral lubricating device for the management of radiotherapy-related xerostomia.  

PubMed

Management of radiotherapy-related xerostomia is difficult. Saliva substitutes are helpful but the effects are short-lived. The purpose of the study was to develop a prototype intra-oral lubricating device for the management of radiotherapy-related xerostomia and to evaluate patient acceptance. An intra-oral lubricating device was fabricated that incorporated a reservoir in the palatal vault and permitted slow release of saliva substitute by the patient. Preliminary clinical testing was done in five patients with radiotherapy-related xerostomia. A measure incorporating seven questions was used to explore patient acceptance. The device was simple to fabricate using materials available in a technical laboratory. All patients were able to wear the device for at least 4 h per day throughout the test period. The device was considered easy to use and clean. Some impairment of speech and chewing was noted although this appeared to be related to the bulkiness of the reservoir. General oral comfort was improved due to the lubricating effect. The bulk of the reservoir was reduced as a consequence of patient feedback. The design addressed key problems associated with previous lubricating systems. Patient reports on oral functioning with the device in situ provided pivotal information on the device's utility. PMID:15895267

Kam, Andrew Y L; McMillan, Anne S; Pow, Edmond H N; Leung, Katherine C M; Luk, Henry W K

2005-09-01

42

Using Multivariate Regression Model with Least Absolute Shrinkage and Selection Operator (LASSO) to Predict the Incidence of Xerostomia after Intensity-Modulated Radiotherapy for Head and Neck Cancer  

PubMed Central

Purpose The aim of this study was to develop a multivariate logistic regression model with least absolute shrinkage and selection operator (LASSO) to make valid predictions about the incidence of moderate-to-severe patient-rated xerostomia among head and neck cancer (HNC) patients treated with IMRT. Methods and Materials Quality of life questionnaire datasets from 206 patients with HNC were analyzed. The European Organization for Research and Treatment of Cancer QLQ-H&N35 and QLQ-C30 questionnaires were used as the endpoint evaluation. The primary endpoint (grade 3+ xerostomia) was defined as moderate-to-severe xerostomia at 3 (XER3m) and 12 months (XER12m) after the completion of IMRT. Normal tissue complication probability (NTCP) models were developed. The optimal and suboptimal numbers of prognostic factors for a multivariate logistic regression model were determined using the LASSO with bootstrapping technique. Statistical analysis was performed using the scaled Brier score, Nagelkerke R2, chi-squared test, Omnibus, Hosmer-Lemeshow test, and the AUC. Results Eight prognostic factors were selected by LASSO for the 3-month time point: Dmean-c, Dmean-i, age, financial status, T stage, AJCC stage, smoking, and education. Nine prognostic factors were selected for the 12-month time point: Dmean-i, education, Dmean-c, smoking, T stage, baseline xerostomia, alcohol abuse, family history, and node classification. In the selection of the suboptimal number of prognostic factors by LASSO, three suboptimal prognostic factors were fine-tuned by Hosmer-Lemeshow test and AUC, i.e., Dmean-c, Dmean-i, and age for the 3-month time point. Five suboptimal prognostic factors were also selected for the 12-month time point, i.e., Dmean-i, education, Dmean-c, smoking, and T stage. The overall performance for both time points of the NTCP model in terms of scaled Brier score, Omnibus, and Nagelkerke R2 was satisfactory and corresponded well with the expected values. Conclusions Multivariate NTCP models with LASSO can be used to predict patient-rated xerostomia after IMRT.

Ting, Hui-Min; Chang, Liyun; Huang, Yu-Jie; Wu, Jia-Ming; Wang, Hung-Yu; Horng, Mong-Fong; Chang, Chun-Ming; Lan, Jen-Hong; Huang, Ya-Yu; Fang, Fu-Min; Leung, Stephen Wan

2014-01-01

43

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 5 Hz 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

2013-11-18

44

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

45

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

46

Differences in Salivary Flow Level, Xerostomia, and Flavor Alteration in Mexican HIV Patients Who Did or Did Not Receive Antiretroviral Therapy  

PubMed Central

Introduction. Objective and subjective alterations related to salivary flow have been reported in patients infected with human immunodeficiency virus (HIV), and these alterations are associated with the introduction of antiretroviral therapy. The aim of the current study was to discern whether these alterations are disease induced or secondary to drug therapy. Objective. The objective was to determine the relationships between low salivary flow, xerostomia, and flavor alterations in HIV patients who did or did not receive antiretroviral therapy. Materials and Methods. In this cross-sectional study, HIV patients were divided into two groups based on whether they had received antiretroviral therapy. Those patients with a previous diagnosis of any salivary gland disease were excluded. A survey was used to assess subjective variables, and colorimetry and salivary flow rates were measured using the Schirmer global test. Results. A total of 293 patients were included. The therapy group showed a significantly lower average salivary flow than did the group without therapy, and we observed that the flow rate tended to decrease after one year of therapy. The results were not conclusive, despite significant differences in xerostomia and flavor alteration between the groups. Conclusion. The study results suggest that antiretroviral therapy can cause cumulative damage that affects the amount of salivary flow.

Lopez-Verdin, Sandra; Andrade-Villanueva, Jaime; Zamora-Perez, Ana Lourdes; Bologna-Molina, Ronell; Cervantes-Cabrera, Jose Justino

2013-01-01

47

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

48

Xerostomia (Dry Mouth)  

MedlinePLUS

... the head and neck. Surgical removal of the salivary glands — If a mass develops in a salivary gland, surgical removal of the gland may be recommended. ... as long as its cause remains. If the salivary glands have been removed or destroyed, the condition is ...

49

Dry Mouth (Xerostomia)  

MedlinePLUS

... There are several reasons why these glands (called salivary glands) might not work right. Side effects of some medicines. More than 400 medicines can cause the salivary glands to make less saliva. For example, medicines for ...

50

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

51

Impact of Salivary Gland Dosimetry on Post-IMRT Recovery of Saliva Output and Xerostomia Grade for Head-and-Neck Cancer Patients Treated With or Without Contralateral Submandibular Gland Sparing: A Longitudinal Study  

SciTech Connect

Purpose: To observe the recovery of saliva output and effect on xerostomia grade after intensity-modulated radiotherapy (IMRT) with or without contralateral submandibular gland (cSMG) sparing and to assess the impact of salivary gland dosimetry on this recovery among patients with head-and-neck cancer. Methods and Materials: Between May 2007 and May 2008, 52 patients with head-and-neck cancer received definitive (n = 5 patients) and postoperative (n = 47 patients) IMRT at our institution, with at least one parotid gland spared. Of these patients, 26 patients with a low risk of recurrence in the cSMG region underwent IMRT and had their cSMGs spared (cSMG-sparing group). The remaining 26 high-risk patients had no cSMGs spared (cSMG-unspared group). Xerostomia grades and salivary flow rates were monitored at five time points (before IMRT and at 2, 6, 12, and 18 months after IMRT). Results: Average mean doses and mean volumes receiving 30 Gy (V30) of the cSMGs were lower in the cSMG-sparing group than in the cSMG-unspared group (mean dose, 20.4 Gy vs. 57.4 Gy; mean V30, 14.7% vs. 99.8%, respectively). Xerostomia grades at 2 and 6 months post-IMRT were also significantly lower among patients in the cSMG-sparing group than in the cSMG-unspared group, but differences were not significant at 12 and 18 months after IMRT. Patients in the cSMG-sparing group had significantly better mean unstimulated salivary flow rates at each time point post- IMRT as well as better mean stimulated salivary flow rates at 2 months post-IMRT. Conclusions: Recovery of saliva output and grade of xerostomia post-IMRT in patients whose cSMGs were spared were much better than in patients whose cSMGs were not spared. The influence of the mean doses to the cSMG and parotid gland on the recovery of saliva output was equivalent to that of the mean V30 to the glands.

Wang Zhonghe; Yan Chao [Division of Radiation Oncology, the Shanghai Ninth Peoples Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai (China); Zhang Zhiyuan; Zhang Chenping [Department of Oral and Maxillofacial Surgery, the Shanghai Ninth Peoples Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai (China); Hu Haisheng; Tu Wenyong [Division of Radiation Oncology, the Shanghai Ninth Peoples Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai (China); Kirwan, Jessica [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida (United States); Mendenhall, William M., E-mail: mendwm@shands.ufl.edu [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida (United States)

2011-12-01

52

The impact of xerostomia on oral-health-related quality of life among younger adults  

Microsoft Academic Search

BACKGROUND: Recent research has suggested that chronic dry mouth affects the day-to-day lives of older people living in institutions. The condition has usually been considered to be a feature of old age, but recent work by our team produced the somewhat surprising finding that 10% of people in their early thirties are affected. This raises the issue of whether dry

W Murray Thomson; Herenia P Lawrence; Jonathan M Broadbent; Richie Poulton

2006-01-01

53

Human adipose tissue?derived stem cells alleviate radiation?induced xerostomia.  

PubMed

Hyposalivation is an intractable side?effect of radiotherapy for head and neck cancer. It is caused by the irreversible loss of acinar cells and decreased saliva secretion. However, this situation severely compromises the quality of life of affected patients. Currently, there is no effective treatment for this condition. In the present study, we developed a novel approach to regenerate the function of the irradiation?damaged salivary glands using human adipose tissue?derived stem cell (hADSC) intraglandular transplantation. ZsGreen?labeled hADSCs were adoptively transferred into Sprague?Dawley (SD) rat submandibular glands immediately following exposure to 18 Gy irradiation. A higher salivary flow rate (SFR) was observed in the hADSC?treated group. Tissue improvement, including angiogenesis, anti?apoptosis and anti?fibrosis, was detected in the hADSC?treated glands as compared to the untreated glands. Quantitative reverse transcription PCR (RT-qPCR) revealed a significantly higher expression of vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), cyclooxygenase?2 (COX?2) and matrix metalloproteinase?2 (MMP?2) in the hADSC?treated rats. Furthermore, immunohistochemical analysis indicated that the hADSCs had differentiated into acinar and ductal cells in the rat submandibular glands. Thus, our results suggest that hADSCs are able to regenerate irradiation?damaged salivary glands through glandular transplantation. PMID:25017690

Xiong, Xueyan; Shi, Xiujuan; Chen, Fengshan

2014-09-01

54

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

Microsoft Academic Search

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

Laura Cerezo; Margarita Martín; Mario López; Alicia Marín; Alberto Gómez

2009-01-01

55

Placebo-Controlled Clinical Trial of Use of 10% Hydrogen Peroxide Whitening Strips for Medication-Induced Xerostomia  

Microsoft Academic Search

Objective: A randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the effectiveness and safety of peroxide-containing strip-based tooth whitening among subjects with medication-induced hyposalivation. Methods: Eligibility for this tooth whitening study was limited to dentate adults taking xerogenic medications with an unstimulated salivary flow ?0.2 ml\\/min. After giving informed consent, 42 subjects were randomized using a 2:1 ratio to

Athena S. Papas; Gerard Kugel; Mabi Singh; Matthew L. Barker; Robert W. Gerlach

2009-01-01

56

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

PubMed

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 flow rate was measured at 0, 15, 60, 105 and 150 min thereafter. At the same times, the thickness of the layer of residual mucosal saliva (a measure of residual mucosal wetness) at each of 22 intraoral sites was also determined. The saliva flow rate fell from a mean of 0.45 +/- 0.07 ml/min to a mean of 0.05 +/- 0.02 ml/mm by 1 h and slowly thereafter to a mean of 0.02 +/- 0.01 to 0.03 +/- 0.01 ml/min for the remainder of the experiment. Onset of dryness symptoms was observed approx. 30 min after giving the drug. Simultaneously, the residual saliva at each of the 22 sites teted decreased to a thickness level previously found in patients with hyposalivation and who exhibited an intense feeling of dry mouth. Despite these decreases in thickness, the pattern of residual mucosal wetness throughout the mouth remained more or less unchanged. As in earlier studies, wetness was least on the hard palate and highest on the posterior dorsum of the tongue. An altered taste of the residual saliva in the mouth and an increased feeling of roughness as the tongue was passed over labial and buccal mucosal surfaces were noted. The amount of gingival crevicular fluid (GCF) in 12 gingival sites in each of the participants was also measured. Unlike the reduction in salivary flow, changes in GCF over the 150 min of the study were negligible. From this it was concluded that GCF could contribute much more to the oral fluids in dry-mouth than in normal individuals, especially when there is greater gingival inflammation. PMID:10206327

Wolff, M S; Kleinberg, I

1999-02-01

57

Salivary Pacemakers: A review  

PubMed Central

Xerostomia is the medical term for the subjective complaint of dry mouth due to a lack of saliva. Xerostomia is sometimes colloquially called pasties, cottonmouth, drooth, doughmouth or des (like a desert). Several diseases, treatments and medications can cause xerostomia. It is also common in smokers. Treatment of xerostomia is a common clinical challenge in the oral medicine practice. Although some treatments have been used to improve the symptoms of xerostomia, none is completely satisfactory for the patients who suffer of this alteration. This review is aimed at presenting new developments for the treatment of xerostomia.

Sarapur, Shriprasad; Shilpashree, H. S.

2012-01-01

58

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

59

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

60

Bad Breath (Halitosis)  

MedlinePLUS

... Dry mouth ( xerostomia ) — This can be caused by salivary gland problems, medicines or "mouth breathing." A large number ... dentist will examine your teeth, gums, mouth and salivary glands. He or she also will feel your head ...

61

Using a Bayesian Feature-selection Algorithm to Identify Dose-response Models Based on the Shape of the 3D Dose-distribution: An Example from a Head-and-neck Cancer Trial  

Microsoft Academic Search

A reduction in salivary flow and xerostomia are common side-effects after radiotherapy of head and neck tumours. Xerostomia can be modeled based on the dose to the parotid glands. To date, all spatial information has been discarded and dose-response models are usually reduced to the mean dose. We present novel morphological dose-response models and use multivariate Bayesian logistic regression to

Florian Buettner; Sarah L Gulliford; Steve Webb; Mike Partridge; Aisha B. Miah; Kevin J. Harrington; Christopher M. Nutting

2010-01-01

62

Oral health status of 207 head and neck cancer patients before, during and after radiotherapy  

Microsoft Academic Search

The aim of this retrospective study was to describe the oral health status of patients before, during, and after radiotherapy\\u000a (RT) for the treatment of head and neck cancer (HNC). Before RT, the following data was collected: presence of unrecoverable\\u000a teeth, residual roots, unerupted teeth, use of dentures, periodontal alterations, caries, candidiasis, and xerostomia. Mucositis,\\u000a candidiasis, and xerostomia were evaluated

Bruno C. Jham; Patricia M. Reis; Erika L. Miranda; Renata C. Lopes; Andre L. Carvalho; Mark A. Scheper; Addah R. Freire

2008-01-01

63

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

64

Clinical evaluation of BIOXTRA in relieving signs and symptoms of dry mouth after head and neck radiotherapy of cancer patients at Seyed-al-Shohada Hospital, Isfahan, Iran  

PubMed Central

Background: Radiotherapy of head and neck cancers causes acute and chronic xerostomia and acute mucositis. Xerostomia increases risk of radiation caries and affects on oral comfort, fit of prostheses, speech, swallowing, and the growth of caries-producing organisms. Salivary flow rate can be measured by asking patients some questions. There are different types of commercial synthetic saliva such as BIOXTRA, but until now, no one can effectively relieve xerostomia. We tried to design a clinical research on BIOXTRA efficacy for treating xerostomia. Materials and Methods: In this research, 58 patients with head and neck cancer (except salivary gland cancers) treated in Seyed-al-Shohada Hospital. The patients received at least 40-50 GY; and after 2 months of compilation treatment, they were evaluated by asking about having xerostomia. Before and after treatment with the BIOXTRA, the PH of the oral cavity, candida albicans, and lactobacillus counts measured and documented in laboratory. We used BIOXTRA for 2 weeks, 3 times daily, and then re-evaluated patients with some questions. Results: The counts of candida albicans and lactobacilli statistically significant decreased. Conclusion: Xerostomia for most patients improved clinically during the day and night while PH of the oral cavity increased.

Gookizadeh, Abbas; Emami, Hamid; Najafizadeh, Nadia; Roayaei, Mahnaz

2012-01-01

65

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

66

Radiotherapy Dose-Volume Effects on Salivary Gland Function  

PubMed Central

Publications relating parotid dose-volume characteristics to radiotherapy-induced salivary toxicity were reviewed. Late salivary dysfunction has been correlated to the mean parotid gland dose, with recovery occurring with time. Severe xerostomia (defined as long-term salivary function of <25% of baseline) is usually avoided if at least one parotid gland is spared to a mean dose of less than ?20 Gy or if both glands are spared to less than ?25 Gy (mean dose). For complex, partial-volume RT patterns (e.g., intensity-modulated radiotherapy), each parotid mean dose should be kept as low as possible, consistent with the desired clinical target volume coverage. A lower parotid mean dose usually results in better function. Submandibular gland sparing also significantly decreases the risk of xerostomia. The currently available predictive models are imprecise, and additional study is required to identify more accurate models of xerostomia risk.

Deasy, Joseph O.; Moiseenko, Vitali; Marks, Lawrence; Chao, K. S. Clifford; Nam, Jiho; Eilsbruch, Avraham

2013-01-01

67

Radiotherapy Dose-Volume Effects on Salivary Gland Function  

SciTech Connect

Publications relating parotid dose-volume characteristics to radiotherapy-induced salivary toxicity were reviewed. Late salivary dysfunction has been correlated to the mean parotid gland dose, with recovery occurring with time. Severe xerostomia (defined as long-term salivary function of <25% of baseline) is usually avoided if at least one parotid gland is spared to a mean dose of less than {approx}20 Gy or if both glands are spared to less than {approx}25 Gy (mean dose). For complex, partial-volume RT patterns (e.g., intensity-modulated radiotherapy), each parotid mean dose should be kept as low as possible, consistent with the desired clinical target volume coverage. A lower parotid mean dose usually results in better function. Submandibular gland sparing also significantly decreases the risk of xerostomia. The currently available predictive models are imprecise, and additional study is required to identify more accurate models of xerostomia risk.

Deasy, Joseph O., E-mail: jdeasy@radonc.wustl.ed [Department of Radiation Oncology, Washington University School of Medicine and Alvin J. Siteman Cancer Center, St. Louis, MO (United States); Moiseenko, Vitali [Department of Medical Physics, British Columbia Cancer Agency-Vancouver Cancer Center, Vancouver, BC (Canada); Marks, Lawrence [Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (United States); Chao, K.S. Clifford [Department of Radiation Oncology, Columbia School of Medicine, New York, NY (United States); Nam, Jiho [Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (United States); Eisbruch, Avraham [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI (United States)

2010-03-01

68

[Interdisciplinary approach in a patient with IgG4-associated Mikulicz's disease].  

PubMed

The clinical picture of enlarged submandibular gland and/or enlarged lacrimal gland often leads to difficulties in differential diagnostics. From the perspective of rheumatology Sjögren's syndrome should be excluded especially in patients who complained of xerophthalmia and xerostomia for longer than 3 months. In this article the authors report the case of a patient who presented to clarify swelling of the submandibular gland and xerostomia. In close cooperation with rheumatologists, otolaryngologists and pathologists the diagnosis of IgG4-associated sialoadenitis (IgG4-associated Mikulicz's disease) could be reached. PMID:24129423

Triantafyllias, K; Karaiskaki, N; Hansen, T; Galle, P R; Schwarting, A

2013-11-01

69

Room service improves patient food intake and satisfaction with hospital food  

Microsoft Academic Search

Cancer therapy causes side effects that interfere with oral intake. Frequently, patients undergoing such therapy suffer from anorexia, nausea, vomiting, food aversions, dysgeusia, and xerostomia, all which adversely affect oral intake. Adequate nutrition intake is an important part of therapy for the cancer patient, especially when that patient is a child. Children who are well nourished are better able to

Ruth Williams; Karen Virtue; Alisa Adkins

1998-01-01

70

Tissue Levels of WR-1065, the Active Metabolite of Amifostine (Ethyol®), Are Equivalent following Intravenous or Subcutaneous Administration in Cynomolgus Monkeys  

Microsoft Academic Search

Amifostine (Ethyol®) is a cytoprotective drug approved for the reduction of xerostomia in head and neck cancer when administered to patients receiving postoperative radiation therapy. Although amifostine is approved for intravenous infusion, the off-label subcutaneous route of administration has become more prevalent. Although human patient data indicate higher plasma bioavailability of the active metabolite (WR-1065) following intravenous compared to subcutaneous

Christine M. Bachy; Christine A. Fazenbaker; Gizachew Kifle; Michael P. McCarthy; David R. Cassatt

2004-01-01

71

The effect of hyperbaric oxygen therapy on quality of life in oral and oropharyngeal cancer patients treated with radiotherapy  

Microsoft Academic Search

Radiotherapy is used in the setting of curative treatment for head and neck cancer. Xerostomia and related problems occur when major salivary glands are included in the irradiation fields. This reduces quality of life (QOL). Hyperbaric oxygen therapy (HBOT) is a well accepted treatment or prevention modality for osteoradionecrosis of the jawbones and soft-tissue necrosis. It is unknown if and

N. L. Gerlach; R. Barkhuysen; J. H. A. M. Kaanders; G. O. R. J. Janssens; W. Sterk; M. A. W. Merkx

2008-01-01

72

AVALIAÇÃO DOS FATORES DE RISCO DENTAIS E DE MALIGNIDADE EM RADIOTERAPIA DA CABEÇA E DO PESCOÇO ASSESSMENT OF DENTAL AND MALIGNANCY RISK FACTORS IN HEAD AND NECK RADIOTHERAPY  

Microsoft Academic Search

The head and neck cancer accounts for approximately 5% of malignant neoplasm in a male\\/female ratio of 3:1. Several ways of treatment have been proposed such as: radiotherapy, chemotherapy, surgery or a combination of therapies. The radiotherapy induces undesirable complications in oral cavity such mucositis, xerostomia, radiation caries, trismus, lost of taste, soft tissue necrosis and osteoradionecrosis. These complications may

Luiz Carlos; Ferreira DA SILVA; Michele Nascimento PAULINELLI; Regis Almeida MEIRA

73

A simplified CT-based definition of the lymph node levels in the node negative neck  

Microsoft Academic Search

Introduction and purpose: Using three dimensional (3D) conformal radiotherapy (CRT) techniques for elective neck irradiation (ENI) may allow for local disease control to be maintained while diminishing xerostomia by eliminating major salivary glands (or parts thereof) from the treatment portals. The standardization of CT based target volumes for the clinically negative (elective) neck is a prerequisite for 3DCRT. The aim

Oda B. Wijers; Peter C. Levendag; Terence Tan; Erik B. van Dieren; John van Sörnsen de Koste; Henri van der Est; Suresh Senan; Peter J. C. M. Nowak

1999-01-01

74

IMRT for Carcinomas of the Oropharynx and Oral Cavity  

Microsoft Academic Search

The major potential advantages of IMRT have been addressed in a number of preliminary clinical investigations\\/trials which have generated encouraging results that salivary gland sparing can be achieved with improvements in xerostomia without risking increased failure rates. Dose escalation trials, although documenting the potential of IMRT as a tool for dose escalation, require refinement and intense physician involvement but have

Rupert K. Schmidt-Ullrich; David Buck; Nesrin Dogan; Jeffrey Siebers; Monica Morris; Yan Wu

75

Sleep disorders and the dental patient: An overview  

Microsoft Academic Search

This article is intended to briefly describe common sleep disorders of interest to the dental profession and to render general management guidelines. Topics include sleep-related bruxism, xerostomia, hypersalivation, gastroesophageal reflux, apnea, and the effect of orofacial pain on sleep quality. The term sleep-related is used instead of the term nocturnal because some of the activities described can occur with daytime

Gilles J. Lavigne; Jean-Paul Goulet; Marco Zuconni; Florence Morisson; Frank Lobbezoo

1999-01-01

76

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

77

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

78

ONCOLOGY AGENTS NOT LISTED IN SEER BOOK 8  

Cancer.gov

DO NOT CODE To reduce the cumulative renal toxicity associated with repeated administration of cisplatin in patients with advanced ovarian cancer; Reduction of platinum toxicity in non-sma ll cell lung cancer; To reduce post-radiation xerostomia for head and neck cancer where the radiation port includes a substantial portion of the parotid glands.

79

Effect of 'bakumondo-to', a Chinese-Japanese herbal medicine, on cultured and dispersed salivary gland cells.  

PubMed

'Bakumondo-to', a Chinese-Japanese herbal medicine, has been used for patients with xerostomia in Japan. Although the efficacy of this medicine for xerostomia has been reported, the pharmacological basis was only partially understood. The aim of this study was to clarify the direct effect of Bakumondo-to on salivary gland cells using isolated and cultured cells. In the physiological experiment using the fluorescent dye fura-2, Bakumondo-to showed no direct effect on isolated parotid gland cells. On the other hand, Bakumondo-to, when applied to cultured salivary gland cells, showed enhancement effects on cell proliferation. After inspection by transmission electron microscopy, we concluded that Bakumondo-to did not show an increase in the number of secretion granules but did increase the mean size of secretion granules in parotid gland cells. These mechanisms, together with other in vivo effecters, may contribute to clinical efficacy. PMID:8844463

Kagami, H; Horie, K; Nishiguchi, H; Shigetomi, T; Ueda, M

1996-08-01

80

Functional magnetic resonance imaging (fMRI) changes and saliva production associated with acupuncture at LI-2 acupuncture point: a randomized controlled study  

PubMed Central

Background Clinical studies suggest that acupuncture can stimulate saliva production and reduce xerostomia (dry mouth). We were interested in exploring the neuronal substrates involved in such responses. Methods In a randomized, sham acupuncture controlled, subject blinded trial, twenty healthy volunteers received true and sham acupuncture in random order. Cortical regions that were activated or deactivated during the interventions were evaluated by functional magnetic resonance imaging (fMRI). Saliva production was also measured. Results Unilateral manual acupuncture stimulation at LI-2, a point commonly used in clinical practice to treat xerostomia, was associated with bilateral activation of the insula and adjacent operculum. Sham acupuncture at an adjacent site induced neither activation nor deactivation. True acupuncture induced more saliva production than sham acupuncture. Conclusion Acupuncture at LI-2 was associated with neuronal activations absent during sham acupuncture stimulation. Neuroimaging signal changes appear correlated to saliva production.

Deng, Gary; Hou, Bob L; Holodny, Andrei I; Cassileth, Barrie R

2008-01-01

81

Toxicities affecting Quality of Life After Chemo-IMRT of Oropharyngeal Cancer: Prospective Study of Patient-Reported, Observer-Rated, and Objective Outcomes  

PubMed Central

Purpose After conventional radiotherapy for head and neck cancer, xerostomia has traditionally been the major effector of patient-reported quality of life (QOL), and recent publications suggest that dysphagia has an even stronger effect. We hypothesized that IMRT aiming to spare the salivary glands and swallowing structures reduced, or eliminated, the effects of these toxicities on QOL. Methods and Materials Prospective longitudinal study: 72 patients with Stage III-IV oropharyngeal cancer treated uniformly with definitive chemo-IMRT sparing the salivary glands and swallowing structures. Overall QOL was assessed by summary scores of the Head Neck QOL (HNQOL) and University of Washington QOL (UWQOL) questionnaires, as well as HNQOL “Overall Bother” question. QOL, observer-rated toxicities (CTCAE v2), and objective evaluations (videofluoroscopy assessing dysphagia and saliva flow rates assessing xerostomia) were recorded pre-therapy through 2 years post-therapy. Correlations between toxicities/objective evaluations and overall QOL were assessed using longitudinal repeated measures of analysis and Pearson correlations. Results All observer-rated toxicities and QOL scores worsened 1-3 months after therapy and improved through 12 months, with minor further improvements through 24 months. At 12 months, dysphagia grades 0-1, 2, and 3, were observed in 95%, 4%, and 1% of patients, respectively. Using all post-therapy observations, observer-rated dysphagia was highly correlated with all overall QOL measures (p<0.0001), while xerostomia, mucosal, and voice toxicities were significantly correlated with some, but not all, overall QOL measures, with lower correlation coefficients than dysphagia. Late overall QOL (?6 or ?12 months post-therapy) was primarily associated with observer-rated dysphagia, and to a lesser extent with xerostomia. Videofluoroscopy scores, but not salivary flows, were significantly correlated with some of the overall QOL measures. Conclusion After chemo-IMRT, while late dysphagia was on average mild, it was still the major correlate of QOL. Further efforts to reduce swallowing dysfunction are likely to yield additional gains in QOL.

Hunter, Klaudia U; Schipper, Mathew; Feng, Felix Y; Lyden, Teresa; Haxer, Mark; Murdoch-Kinch, Carol-Anne; Cornwall, Benjamin; Lee, Connie SY; Chepeha, Douglas B; Eisbruch, Avraham

2012-01-01

82

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

83

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

84

Pulmonary hypertension in primary Sjögren’s syndrome: report of a case and review of the literature  

Microsoft Academic Search

A 61-year-old female with a history of vaginal dryness, Raynaud’s phenomenon, xerostomia and xerophthalmia presented with exertional dyspnoea and weakness. Laboratory and instrumental examinations enabled us to make the diagnosis of primary Sjögren’s syndrome, while cardiologic and imaging investigations evidenced isolated pulmonary hypertension and ruled out pulmonary fibrosis. Oral anticoagulant and furosemide therapy induced a partial improvement of exertional dyspnoea

M. Bertoni; L. Niccoli; G. Porciello; L. Storri; C. Nannini; A. Manes; M. Palazzini; N. Galiè; F. Cantini

2005-01-01

85

Rosai–Dorfman disease with factor XII deficiency  

Microsoft Academic Search

A 17-year-old female patient presented with chronic symmetrical oligoarthritis of both knees and ankles, xerostomia, xerophthalmia,\\u000a multiple bilateral lymphadenopathies in the cervical region, and bilateral parotid enlargement with the histological finding\\u000a of chronic sialoadenitis. She had been already given methotrexate, chloroquine, and corticosteroids with the diagnosis of\\u000a rheumatoid arthritis (RA) before referral to our outpatient clinic. Because her complaints and

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

2009-01-01

86

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

87

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

88

[IMRT in cervix cancer: Towards a new standard?].  

PubMed

Intensity modulated radiation therapy has demonstrated its ability to prevent xerostomia in the treatment of head and neck cancers, as well as post-radiation related proctitis in prostate cancer. In the management of cervical carcinomas, many published dosimetric studies have shown its ability to limit the irradiation of organs at risk. However, clinical data remain limited to comparisons of cohorts, mostly retrospective, but promising. This review aims to update the current state of knowledge. PMID:24461378

Mazeron, R; Dumas, I; El Khouri, C; Lévy, A; Attar, M; Haie-Meder, C

2014-03-01

89

Xerostomic complaints induced by an anti-sialogogue in healthy young vs. older adults.  

PubMed

Complaints of xerostomia and salivary hypofunction are common in older adults. However, recent studies reported that dehydration-induced salivary hypofunction caused fewer xerostomic complaints in older compared with young adults. This may predispose older adults to developing oral problems that will subsequently not receive attention from health care providers. Since many medications are known to inhibit salivation, this study attempted to determine if an anticholinergic drug (glycopyrrolate) had a differential effect on xerostomic complaints in young vs. older adults. Eighteen young (age 20-38 yrs) and 18 older (age 60-77 yrs) healthy adults were given a 4.0 micrograms/kg dose of i.v. glycopyrrolate. For 6 hrs after drug administration, stimulated parotid salivary flow was collected, and an eight-item Visual Analogue Scale (VAS) subjective xerostomia test was given. At several time points post-i.v. glycopyrrolate, salivary flow rates were consistently lower in older compared with young adults. For some measures of xerostomic complaint (time to first complaint; time to maximum complaint; mean maximum complaint), there were no age-related differences for all VAS items. However, a trend for increased xerostomic complaints in older adults was demonstrated (time to recovery; total duration of complaint; number xerostomic at 6 hrs). These findings suggest that, given equal doses of an anti-sialogogue, salivary hypofunction is greater in healthy older adults, while increased complaints of xerostomia are not as consistent. PMID:11803641

Patel, P S; Ghezzi, E M; Ship, J A

2001-01-01

90

Early and late oral features of chronic graft-versus-host disease  

PubMed Central

Background Chronic graft-versus-host disease is a serious complication of allogeneic hematopoietic cell transplantation, and the mouth is one of the affected sites. Objective The aim of this study was to evaluate the oral features of this disease after hematopoietic cell transplantation. Methods This was a cross-sectional multicenter study that enrolled patients submitted to transplantation. Oral evaluations used the National Institutes of Health criteria, salivary flow rates, and the range of mouth opening. Pain and xerostomia were evaluated through a visual analogue scale. Patients were divided into two groups based on the transplantation time (up to one year and more than one year). Results Of the 57 evaluated recipients, 44 had chronic graft-versus-host disease: ten (22.72%) in the group with less than one year after transplantation, and 34 (77.27%) in the group with more than one year after transplantation. Lichenoid/hyperkeratotic plaques, erythematous lesions, xerostomia, and hyposalivation were the most commonly reported oral features. Lichenoid/hyperkeratotic plaques were significantly more common in patients within the first year after the transplant. The labial mucosa was affected more in the first year. No significant changes occurred in the frequency of xerostomia, hyposalivation, and reduced mouth opening regarding time after transplantation. Conclusion Oral chronic graft-versus-host disease lesions were identified early in the course of the disease. The changes observed in salivary gland function and in the range of mouth opening were not correlated with the time after transplantation.

Gomes, Alessandra Oliveira Ferrari; Torres, Sandra Regina; Maiolino, Angelo; dos Santos, Cesar Werneck Noce; Silva Junior, Arley; Correa, Maria Elvira Pizzigatti; Moreira, Maria Claudia Rodrigues; Goncalves, Lucio de Souza

2014-01-01

91

Treatment of nasopharyngeal carcinoma by tomotherapy: five-year experience  

PubMed Central

Purpose To analyze of survival curve and toxicity outcomes for patients treated for nasopharyngeal carcinoma (NPC) by intensity-modulated radiotherapy (IMRT) delivered by helical TomoTherapy (HT). Materials and methods Since May 2006, 72 patients with primary NPC were treated. In 67 cases PET-CT was used to help delineate the gross tumor volume (GTV); in 4 of these cases distant metastases in bone, mediastinal lymph nodes and unexpected small neck nodes were detected by high SUV uptake. 3, 22, 19, and 27 patients, respectively, had AJCC stage I to IV disease. Patients received a median total dose of 72 Gy to the GTV, 64.8 Gy to the elective PTV, and 54 Gy to the clinically negative neck region. Results At a median follow-up of 41 months (range 0.2 to 67 months), no patient has recurred locally. Two patients with stage IIb disease, both of whom received chemotherapy, recurred regionally. Ten patients developed distant metastases. One died from progressive disease with initial proved bony metastasis. Two patients with stage IIb disease, both of whom received chemotherapy, experienced neck node recurrence. 5-year locoregional control rate was 97%; freedom from distant metastases was 84.6% at 5 years. No evidence of disease was detected in 13 early stage (I/IIa/IIb) patients who did not receive chemotherapy. Acute grade 3 toxicity occurred in four patients and grade 4 in two patients. Late toxicities were low, with no grade 3+ xerostomia, grade 2 xerostomia in two patients (3%), and grade 3 hearing loss in two patients (3%). Conclusions HT resulted in excellent long-term disease control and survival in heterogeneous NPC patients. Generally mild acute and late toxicity, with low rates of xerostomia, were obtained. Image-guided HT offers the ability to deliver conformal, OAR-sparing dose distributions to a wide variety of NPC patients with good long-term clinical outcomes.

2013-01-01

92

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

93

Effects of furosemide and bendroflumethiazide on saliva flow rate and composition.  

PubMed

Aim of this study was to evaluate the effect on saliva flow rate and composition and on perceived xerostomia. The study used a Latin square design, all subjects being once daily (at 7.00 a.m.) taking the bendroflumethiazide (2.5 mg), furosemide (40 mg), or placebo, in a randomised order. Each treatment period of 7 days was separated by wash-out periods of 14 days. Unstimulated and paraffin chewing stimulated whole saliva, and 3% citric acid stimulated parotid and submandibular-sublingual secretion were collected twice daily, at 7.30 a.m., with the patients in a fasting condition (morning values), and at 10.30 a.m., about 2 h after intake of a standard breakfast (lunchtime values), on day 0 (baseline), day 1 (acute treatment), and day 7 (chronic treatment). Saliva flow rates were measured and all four secretions were analysed for the concentration of sodium, potassium, chloride, and total protein. Xerostomia was assessed by means of a Visual Analogue Scale. Statistical analysis used the Wilcoxon signed rank test. For flow rate, only that of submandibular-sublingual secretion was affected, significantly so in the morning during chronic treatment with both drugs. In resting whole saliva the output of both sodium and chloride tended to decrease especially during treatment with bendroflumethiazide, while in submandibular-sublingual secretion the output of all the electrolytes was decreased, especially for potassium and chloride and during treatment with furosemide. Further, xerostomia tended to increase during treatment with furosemide, statistically significant at lunchtime during chronic treatment. In conclusion, this study has demonstrated a modest effect on salivary flow rate and a more pronounced effect on saliva composition, especially in submandibular-sublingual secretion during treatment of healthy volunteers with therapeutic doses of two different diuretics, encouraging clinical studies in hypertensive patients and basic research as to the presence of a thiazide sensitive Na-Cl cotransporter in human salivary glands. PMID:15126132

Nederfors, T; Nauntofte, B; Twetman, S

2004-07-01

94

Efficacy and Safety of Subcutaneous Amifostine in Minimizing Radiation-Induced Toxicities in Patients Receiving Combined-Modality Treatment for Squamous Cell Carcinoma of the Head and Neck  

SciTech Connect

Purpose: To report long-term data from a prospective trial of subcutaneous (s.c.) amifostine in patients who received chemoradiotherapy for squamous cell carcinoma of the head and neck (SCCHN). Methods and Materials: Patients {>=}18 years of age with previously untreated Stage III/IV SCCHN received fractionated radiotherapy, 1.8-2.0 Gy/day, 5 days per week, to a total dose of 70-72 Gy, plus weekly paclitaxel (40 mg/m{sup 2}) and carboplatin (100 mg/m{sup 2}) administered intravenously (i.v.) for 6 weeks. All patients received 500 mg s.c. amifostine 30-60 min before radiotherapy with antihistamine and antiemetic prophylaxis. Results: Twenty patients were evaluable (median age, 55 years). The incidence of Grade 2 xerostomia was 42% and 29% at 12 and 18 months, respectively; there were no reports of Grade {>=}3 xerostomia. Grade {>=}3 mucositis occurred in 30% of patients, with median time to resolution of 12.5 weeks (range, 5-17 weeks). Survival estimates at 1 and 2 years were 95% and 71%, respectively. All patients experienced Grade 2 weight loss; 7 patients (35%) experienced Grade {<=}2 nausea/vomiting. There were no reports of Grade {>=}3 amifostine-related adverse events. Conclusions: Subcutaneous amifostine was well tolerated by patients receiving chemoradiotherapy for SCCHN, with lower rates of nausea/vomiting than reported in trials with i.v. amifostine. Xerostomia and mucositis rates were similar to those reported in trials with i.v. amifostine.

Law, Amy [Department of Hematology/Oncology, Geisinger Medical Center, Danville, PA (United States)], E-mail: alaw1@geisinger.edu; Kennedy, Thomas; Pellitteri, Phillip [Department of ENT, Head and Neck Surgery, Geisinger Medical Center, Danville, PA (United States); Wood, Craig [Department of Hematology/Oncology, Geisinger Medical Center, Danville, PA (United States); Christie, Douglas; Yumen, Omar [Department of Radiation Oncology, Geisinger Medical Center, Danville, PA (United States)

2007-12-01

95

[The x-ray changes in the parotid salivary glands of patients with Sjögren's disease].  

PubMed

The data obtained upon sialography of the parotid glands (PG) in 28 patients with Sjogren's disease (SD) were compared to clinical SD manifestations, PG regional circulation and histological picture of the labial salivary glands. 24 patients exhibited classical sialography characterized by sialoectasias, enlarged ducts, obscure outlines of the latter. 4 sialograms displayed the duct narrowing, noncontrast parenchyma outlines, unclear images of sialoectasias. Severe xerostomia, marked dryness of the vermilion border, rare enlargement of the salivary glands and parotitis recurrences occurred more frequently in patients with narrow efferent PG ducts. These changes are attributed to vascular sclerosis, devascularization, stromal sclerosis and parenchymal PG atrophy. PMID:7940341

Varshavski?, A I; Guberskaia, T A; Panchenko, K I

1994-01-01

96

Salivary gland scintigraphy--a suitable substitute for sialography?  

PubMed

By comparing 27 patients who had both scintigraphy and sialography in the assessment of salivary gland disease, scintigraphy has been shown to correlate well with abnormal sialograms. It is suggested that scintigraphy could become the initial screening procedure in the assessment of salivary gland disease. A normal scintiscan is unlikely to miss significant pathology (as demonstrated by sialography), but sialography must always be performed if there is a suspicion of duct obstruction on scintigraphy. Patients suspected of focal salivary gland pathology such as tumour have not been investigated. The series documents the findings in patients who presented with facial pain, swelling or xerostomia suggesting sialadenitis, duct occlusion or Sjögren's syndrome. PMID:2334830

Pilbrow, W J; Brownless, S M; Cawood, J I; Dynes, A; Hughes, J D; Stockdale, H R

1990-03-01

97

NO SToPS: Reducing treatment breaks during chemoradiation for head and neck cancer.  

PubMed

The addition of chemotherapy to radiation aids in the survival of patients with head and neck cancer but also increases acute toxicity, primarily painful oral mucositis and dermatitis exacerbated by xerostomia. The consequences of these side effects often result in hospitalization and breaks in treatment, which lead to lower locoregional control and survival rates. No strategies reliably prevent radiation-induced mucositis; therefore, emphasis is placed on management to prevent treatment breaks. The NO SToPS approach describes specific multidisciplinary strategies for management of nutrition; oral care; skin care; therapy for swallowing, range of motion, and lymphedema; pain; and social support to assist patients through this difficult therapy. PMID:20880816

Lambertz, Colleen K; Gruell, Jacque; Robenstein, Valerie; Mueller-Funaiole, Vicki; Cummings, Karrie; Knapp, Vaughn

2010-10-01

98

Radionuclide salivary imaging usefulness in a private otolaryngology practice  

SciTech Connect

Radionuclide salivary gland scans were performed on 44 patients using sodium pertechnetate Tc 99m. The accuracy of the scans and their usefulness in the clinical treatment of the patients were reviewed. The scan provided helpful information in 31 of 38 cases in which adequate follow-up data were available, although it proved diagnostic in only six patients. It was particularly useful in the evaluation of primary salivary gland neoplasms, acute and chronic sialadenitis, and sialolithiasis, as well as in the differential diagnosis of xerostomia. The value of this procedure in the elucidation of a variety of morphologic and functional diseases of these glands warrants its greater application in private otolaryngologic practices.

Schall, G.L.; Smith, R.R.; Barsocchini, L.M.

1981-01-01

99

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

2013-01-01

100

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

101

Severe Osteolysis of the Mandibular Angle and Total Condylolysis in Progressive Systemic Sclerosis  

PubMed Central

Progressive systemic sclerosis is an autoimmune disease characterized by gradual deposition of abnormal collagen which causes fibrous changes of the skin and visceral organs such as lung, heart, and kidney, which lead to serious complication. Microangiopathy and firm skin cause extrinsic pressure and obliteration of the vessels that lead to ischemia and destruction of the underlying bone. Salivary gland fibrosis causes xerostomia that increases risk of dental caries. Therefore, oral hygiene instruction (OHI) and preventive dentistry are recommended for these patients. We present a 36-year-old female that suffers from systemic sclerosis with total lysis of the mandibular condyle.

Rahpeyma, Amin; Zarch, Seyed Hosein Hoseini; Khajehahmadi, Saeedeh

2013-01-01

102

[Pure autonomic failure].  

PubMed

We present the case of a 64-year-old woman who, in the past 5 years, complained of constipation/diarrhea, hyposudoresis, xerostomia and xerophthalmia, dysuria and orthostatic hypotension. Cardiovascular reflexes analysis revealed sympathetic and parasympathetic failure. Norepinephrine was markedly reduced, both lying and after tilt. Norepinephrine infusion determined a significant rise in blood pressure, allowing the diagnosis of denervation hypersensitivity. The diagnosis of pure autonomic failure was made. Therapy with 9 alpha fludrocortisone and metoclopramide was initiated with marked and sustained symptomatic effect. PMID:8140921

Ducla-Soares, J L; Guerreiro, A S; Póvoa, P; Alvares, E; Guerreiro, L; Carrilho, F; Santos, M; Figueirinhas, J; Carvalho, M

1993-11-01

103

Polaprezinc prevents oral mucositis associated with radiochemotherapy in patients with head and neck cancer.  

PubMed

Oral mucositis is frequent but serious adverse event associated with radiotherapy or radiochemotherapy in head and neck cancer severely impairs health-related quality of life, leading to poor prognosis due to discontinuation of the therapy. Although a number of compounds have been tested for prophylaxis of oral mucositis, few of them are satisfactory. We investigated the effect of polaprezinc (zinc L-carnosine), a gastric mucosal protective drug, on radiochemotherapy-induced oral mucositis, pain, xerostomia and taste disturbance in patients with head and neck cancer. Patients were randomly assigned to receive polaprezinc (n = 16) or azulene oral rinse as the control (n = 15). The incidence rates of mucositis, pain, xerostomia and taste disturbance were all markedly lower in polaprezinc group than in control. Moreover, the use of analgesics was significantly (p = 0.003) less frequent and the amount of food intake was significantly (p = 0.002) higher in polaprezinc group than in control. On the other hand, tumor response rate in patients with neoadjuvant radiochemotherapy was not significantly affected by polaprezinc, in which the response rate (complete plus partial response) was 88% for polaprezinc and 92% for control (p = 1.000). Therefore, it is highly assumable that polaprezinc is potentially useful for prevention of oral mucositis and improvement of quality of life without reducing the tumor response. PMID:20104529

Watanabe, Tomoko; Ishihara, Masashi; Matsuura, Katsuhiko; Mizuta, Keisuke; Itoh, Yoshinori

2010-10-15

104

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

105

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

PubMed Central

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.

2013-01-01

106

Prognostic factors in head-and-neck cancer patients treated with surgery followed by intensity-modulated radiotherapy (IMRT), 3D-conformal radiotherapy, or conventional radiotherapy.  

PubMed

In 148 head-and-neck cancer patients treated with surgery plus radiotherapy (RT), IMRT, 3D-conformal RT, and conventional RT and 10 potential prognostic factors were evaluated for overall survival (OS), metastasis-free survival (MFS), and loco-regional control (LC). On univariate analysis, ECOG performance status, T-stage, AJCC-stage, extent of resection, and pre-RT hemoglobin level (>or=12 g/dl better than <12 g/dl) were significantly associated with treatment outcome, whereas RT technique had no significant impact. On multivariate analysis, performance status maintained significance for OS (P=0.019), AJCC-stage for LC (P=0.034), extent of resection for OS (P=0.045) and MFS (P=0.021), pre-RT hemoglobin for MFS (P<0.001). IMRT was associated with less xerostomia than conformal RT and conventional RT (17% versus 63% and 73%, P=0.037). Otherwise, acute and late toxicity was similar. Outcome was significantly associated with performance status, tumor stage, extent of resection, and pre-RT hemoglobin. The three radiation techniques provided similar disease control. IMRT was effective in significantly reducing xerostomia. PMID:17005437

Rades, Dirk; Fehlauer, Fabian; Wroblesky, Junes; Albers, Dirk; Schild, Steven E; Schmidt, Rainer

2007-07-01

107

Outcome predictors affecting the efficacy of clonazepam therapy for the management of burning mouth syndrome (BMS).  

PubMed

BMS is a common condition characterized by chronic oral mucosal pain condition and primarily affects elderly women. Although clonazepam therapy has been widely used due to its efficacy, it is not always effective because of the complexity of BMS pathogenesis. In this study, we have investigated outcome predictors of clonazepam therapy in patients with BMS. One hundred patients with BMS (7 men and 93 women, mean age 58.5 ± 10.8 years) were instructed to take 0.5mg of clonazepam once or twice daily for 4 weeks. The patients were sub-grouped according to psychological status, salivary flow rate, presence of psychiatric medications, symptom area and duration, symptom severity, presence of oral parafunctions, and accompanying oral complaints. The changes in symptoms were analyzed and compared between the sub-groups. Subjects with T-scores ?50 for each psychological symptom dimension, a greater degree of initial symptoms (visual analog scale (VAS)?5), and accompanying oral complaints, such as xerostomia and taste disturbance, displayed greater decreases in symptoms compared with their counterparts. In conclusion, psychological status, initial symptom severity, and the presence of xerostomia and/or taste disturbance can serve as outcome predictors of clonazepam therapy for patients with BMS. PMID:22040716

Ko, Ji-Young; Kim, Moon-Jong; Lee, Sang-Goo; Kho, Hong-Seop

2012-01-01

108

Current cell models for bioengineering a salivary gland: a mini-review of emerging technologies  

PubMed Central

Saliva plays a major role in maintaining oral health. Patients afflicted with a decrease in saliva secretion (symptomatically, xerostomia) exhibit difficulty in chewing and swallowing foods, tooth decay, periodontal disease, and microbial infections. Despite recent improvements in treating xerostomia (e.g., saliva stimulants, saliva substitutes, and gene therapy), there is a need of more scientific advancements that can be clinically applied toward restoration of compromised salivary gland function. Here we provide a summary of the current salivary cell models that have been used to advance restorative treatments via development of an artificial salivary gland. These models represent initial steps toward clinical and translational research, to facilitate creation of clinically safe salivary glands. Further studies in salivary cell lines and primary cells are necessary to improve survival rates, cell differentiation, and secretory function. Additionally, the characterization of salivary progenitor and stem cell markers are necessary. Although these models are not fully characterized, their improvement may lead to the construction of an artificial salivary gland that is in high demand for improving the quality of life of many patients suffering from salivary secretory dysfunction.

Nelson, J; Manzella, K; Baker, OJ

2013-01-01

109

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

2013-01-01

110

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

111

Oral mucosal status and major salivary gland function  

SciTech Connect

Normal salivary function is considered to be critical for the maintenance of healthy oral mucosa. However, few studies have examined mucosal changes in patients with objectively documented salivary gland performance. In the present report, the mucosal status of 298 subjects being evaluated in a dry mouth clinic was assessed. A complete oral examination was performed and unstimulated and stimulated salivary samples were collected separately from the parotid and submandibular/sublingual glands. Data were analyzed according to diagnosis and salivary output after the assignment of an oral mucosal rating to each subject. In general, the mucosal surfaces were well preserved and infections were not seen. Patients evaluated for Sjoegren's syndrome and radiation-induced xerostomia had the lowest salivary gland performance but displayed a mucosal status similar to denture-wearing healthy subjects or patients with normal salivary flow who had idiopathic xerostomia. However, those patients with a total lack of salivary flow rarely had normal-appearing oral mucosa. These results confirm a role for saliva in oral mucosal preservation and also suggest that other factors may act to maintain oral mucosal integrity.

Wolff, A.; Fox, P.C.; Ship, J.A.; Atkinson, J.C.; Macynski, A.A.; Baum, B.J. (National Institute of Dental Research, Bethesda, MD (USA))

1990-07-01

112

Evaluation of Protective Effect of Propolis on Parotid Salivary Glands in Gamma-irradiated Rats.  

PubMed

Objective and background: One of the most signifcant side effects of radiotherapy for head and neck cancers is xerostomia as a result of salivary gland damage. Considering pharmaco- logical effects of propolis, we evaluated its protective effect on salivary glands subjected to radiotherapy of head and neck cancer patients. Materials and methods: Twenty-one male albino rats (8-11 W, 190 ± 5 gm) were divided into three groups of seven animals. Scintigraphy was performed in all the groups. Then groups 1 (S) and 2 (SR) received normal saline injections and group 3 (PR) received propolis injection over 3 days. After that groups 2 and 3 were exposed to gamma radiation and all the rats underwent scintigraphic assessment on third day and 70th day after irra- diation. The lips and tongues of rats in groups 2 and 3 were examined for mucositis daily in frst 10 days. At the end, the parotid glands of all rats were examined histologically. Results: Scintigraphy results of third and 70th day after irra- diation showed statistically signifcant differences between PR and SR as well as SR and S. However, there was no signifcant difference between the PR and S groups. Histopathologic assessment demonstrated signifcant difference between SR, PR and S. Conclusion: These results suggest that propolis has protective effects on salivary gland function in animal models whilst it did not prevent radiation-induced histologic changes in tissues. Further investigations are needed to elucidate mechanisms of propolis actions. Clinical signifcance: Regarding to the results of this study, propolis may be useful in reduction xerostomia due to radiation to salivary glands and may be helpful for head and neck cancer patients. Keywords: Propolis, Scintigraphy, Xerostomia. How to cite this article: Motallebnejad M, Abedi SM, Seyedmajidi M, Moghadamnia AA, Ashrafpour M, Salehi M, Moslemi D, Ghorbani A. Evaluation of Protective Effect of Propolis on Parotid Salivary Glands in Gamma-irradiated Rats. J Contemp Dent Pract 2014;15(1):8-11. Source of support: Nil Confict of interest: None. PMID:24939257

Motallebnejad, Mina; Abedi, Seyed Mohammad; Seyedmajidi, M; Moghadamnia, Aa; Ashrafpour, M; Salehi, M; Moslemi, D; Ghorbani, A

2014-01-01

113

Oral health-related quality of life in diabetic patients: comparison of the Persian version of Geriatric Oral Health Assessment Index and Oral Health Impact Profile: A descriptive-analytic study  

PubMed Central

Background Diabetes mellitus is one of the systemic disease which is show important oral manifestation and influence oral health. This study describes how diabetes mellitus affects oral health and oral health-related quality of life. The aim of this study was to evaluate the oral health and oral health-related quality of life of diabetic patients and compare the discriminative capability of Persian versions of two GOHAI and OHIP-14 questionnaires in these patients. Methods A total of 350 patients with Type II diabetes mellitus, referring to the Diabetes Clinic, were selected and data were collected by GOHAI and OHIP-14 questionnaires completed by patients and clinical examinations. Oral health parameters (CAL,BI,GI,PLI,DMFT and xerostomia) were measured, also concurrent validity and conformity of two questionnaires were assessed. In order to test Discriminant analysis capabilities of two questionnaires, ADD and SC scores of questionnaires were divided into two parts and a logistic regression model was designed, which included subjective and objective variables. Results Mean patients age was 55 years (with 75.4% female patients). The results showed that some oral conditions such as xerostomia, clinical attachment loss, number of missing teeth and plaque index were correlated to diabetes control level (HbA1c) and type of anti-diabetic medication. ADD and SC scores of two questionnaires were at high level. However, the effect of oral problems on decreasing OHRQoL was evident. Both questionnaires had acceptable concurrent validity and conformity. Moreover, there was a strong correlation between GOHAI and OHIP-14. OHIP-14 questionnaire had a higher discriminant analysis capability compared to GOHAI and better diagnosed patients who needed dental treatments: patients with higher GI, xerostomia and those wearing partial dentures. Conclusion Diabetic patients did not show acceptable oral health status and in some extent, oral problems affected oral health-related quality of life. Psychotherapy courses and solving oral problems of the patients can improve OHRQoL. OHIP-14 had higher discriminant analysis capability and was more effective in diagnosing oral problems.

2014-01-01

114

Is dentistry going to get into the salivary diagnostics game or watch from the sidelines?  

PubMed

What is salivary diagnostics and why should you care? Most of us dentists try to avoid or control saliva as it interferes with access, or chemical interactions in dental materials or impression materials, or when it is simply a nuisance. Periodically, we may note reduced flow or encounter a patient with xerostomia. Correspondingly, we then manage the many of today's existing commercialized oral-based tests were yesterday's proposed ideas or concepts, captured in the 1993 New York Academy of Sciences Conference on oral based diagnostics. When coupled with the emerging point-of-care technology, the potential of salivary diagnostics is even more compelling. In this section, I hope to elucidate for the reader the potential of salivary diagnostics for the dental profession and So what is the value proposition? How could this disruptive technology serve the dentist and the patients they treat? What must occur to facilitate the ongoing development and introduction of salivary diagnostics into the marketplace? PMID:23858673

Jacobson, Jed J

2013-01-01

115

Clinical application of a soft denture liner: a case report.  

PubMed

Patients with thin, nonresilient mucosa, poor ridge morphology, chronic xerostomia, and acquired or congenital defects are candidates for soft denture liners. Soft denture liners may be placed during fabrication of the new denture or during relining of the existing dentures. Soft mandibular denture liners are ideal for senior patients with resorbed mandibular ridges who need replacement of existing dentures to correct excessively closed vertical dimension of occlusion and for patients who have maxillary complete dentures and mandibular natural teeth, severe loss of maxillary ridge, and clenching habits. Soft denture liners should be used only when needed because of their short service life. However, for those patients who cannot tolerate hard denture bases, soft liners are an appropriate alternative treatment. PMID:8602422

Williamson, R T

1995-06-01

116

Variants at multiple loci implicated in both innate and adaptive immune responses are associated with Sj?gren's syndrome  

PubMed Central

Sjögren’s syndrome is a common autoimmune disease (~0.7% of European Americans) typically presenting as keratoconjunctivitis sicca and xerostomia. In addition to strong association within the 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). Suggestive associations with Pmeta<5×10?5 were observed with 29 regions including TNFAIP3, PTTG1, PRDM1, DGKQ, FCGR2A, IRAK1BP1, ITSN2, and PHIP amongst others. These results highlight the importance of genes involved in both innate and adaptive immunity in Sjögren’s syndrome.

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.; G?ransson, Lasse G.; Harboe, Erna; Guthridge, Joel M.; Kaufman, Kenneth M.; Kvarnstrom, Marika; Jazebi, Helmi; Graham, Deborah S. Cunninghame; 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; Ronnblom, 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. Moser

2013-01-01

117

Oral Complications and Management Strategies for Patients Undergoing Cancer Therapy  

PubMed Central

With cancer survival rate climbing up over the past three decades, quality of life for cancer patients has become an issue of major concern. Oral health plays an important part in one's overall quality of life. However, oral health status can be severely hampered by side effects of cancer therapies including surgery, chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. Moreover, prevention and treatment of these complications are often overlooked in clinical practice. The present paper aims at drawing health care professionals' attention to oral complications associated with cancer therapy by giving a comprehensive review. Brief comments on contemporary cancer therapies will be given first, followed by detailed description of oral complications associated with cancer therapy. Finally, a summary of preventive strategies and treatment options for common oral complications including oral mucositis, oral infections, xerostomia, and dysgeusia will be given.

2014-01-01

118

Characteristics of lacrimo-auriculo-dento-digital (LADD) syndrome: case report of a family and literature review.  

PubMed

We describe a family with lacrimo-auriculo-dento-digital syndrome (LADD). A 13-year-old boy had cup-shaped ears, deafness, unilateral choanal atresia, bilateral nasolacrimal duct obstruction, xerostomia, alacrima due to congenital absence of lacrimal glands, agenesis of salivary glands, chronic dacryocystitis, keratoconjunctivitis sicca, ptosis, nail dysplasia of the thumb, shortness of fifth toe, temporal bone abnormality and epilepsy. His younger sister had shortened middle phalanx of fifth digits. His middle sister had hypodontia, shortened distal phalanx of fifth digit, agenesis of salivary glands, mild hearing loss and exotropia. His older sister had left nasolacrimal duct obstruction and aplasia of both parotid glands. The oldest sister had hypodontia and divergent excess exotropia. His mother had hypodontia. These findings are consistent with LADD syndrome. An autosomal dominant pattern of inheritance with variable expressivity has been demonstrated. Renal and uro-genital anomalies have been noted variably. PMID:16460812

Inan, Umit Ubeyt; Yilmaz, Mustafa Deniz; Demir, Yavuz; Degirmenci, Bumin; Ermis, Sitki Samet; Ozturk, Faruk

2006-07-01

119

Adverse effects of radioactive iodine-131 treatment for differentiated thyroid carcinoma.  

PubMed

Use of radioactive iodine is an essential adjuvant treatment strategy after thyroidectomy in patients with differentiated thyroid carcinoma. Although generally safe, radioiodine therapy has some potential side effects, classified as early and late complications, which we have reviewed in this paper. Early complications include gastrointestinal symptoms, radiation thyroiditis, sialadenitis/xerostomia, bone marrow suppression, gonadal damage, dry eye, and nasolacrimal duct obstruction. The late complications include secondary cancers, pulmonary fibrosis, permanent bone marrow suppression, and genetic effects. As I is an efficacious form of treatment that can significantly decrease the rate of mortality, recurrence, and metastasis, and as the side effects are often minor and well tolerated, radioiodine therapy remains the principal mode of treatment for patients with differentiated thyroid carcinoma. PMID:24751702

Fard-Esfahani, Armaghan; Emami-Ardekani, Alireza; Fallahi, Babak; Fard-Esfahani, Pezhman; Beiki, Davood; Hassanzadeh-Rad, Arman; Eftekhari, Mohammad

2014-08-01

120

Lymphocytic mastitis preceding Sjögren's syndrome.  

PubMed

Sjögren's syndrome (SS) is a chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands and B cell hyperreactivity. Lacrimal and salivary glands are the most commonly involved causing keratoconjunctivitis sicca and xerostomia. A wide variety of other glandular and extraglandular manifestations can occur in SS. Lymphocytic mastitis is a rare presentation of several conditions including diabetes mellitus and autoimmune disorders. We report a case of a 43-year-old woman with a four-year history of arthralgias and positive antinuclear antibodies who developed a right painless breast mass. Biopsy revealed lymphocytic mastitis with predominant B cells. One year later she developed severe constitutional symptoms, sicca symptoms, lymphadenopathy, anemia, and interstitial lung disease. Serologies and minor salivary gland were consistent with the diagnosis of SS. This case further supports the association of lymphocytic mastitis with autoimmune diseases and demonstrates that it can even precede the clinical diagnosis of these entities. PMID:20496529

Ríos, Grissel; Peredo, Rubén A

2010-06-01

121

Burning mouth syndrome: an enigmatic disorder.  

PubMed

Burning mouth syndrome (BMS) is a chronic oral pain or burning sensation affecting the oral mucosa, often unaccompanied by mucosal lesions or other evident clinical signs. It is observed principally in middle-aged patients and postmenopausal women and may be accompanied by xerostomia and altered taste. Burning mouth syndrome is characterized by an intense burning or stinging sensation, preferably on the tongue or in other areas of mouth. This disorder is one of the most common, encountered in the clinical practice. This condition is probably of multifactorial origin; however the exact underlying etiology remains uncertain. This article discusses several aspects of BMS, updates current knowledge about the etiopathogenesis and describes the clinical features as well as the diagnosis and management of BMS patients. PMID:24096230

Javali, M A

2013-01-01

122

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

2013-01-01

123

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

124

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

125

Mode of interaction of 1,4-dioxane agonists at the M2 and M3 muscarinic receptor orthosteric sites.  

PubMed

The methyl group in cis stereochemical relationship with the basic chain of all pentatomic cyclic analogues of ACh is crucial for the agonist activity at mAChR. Among these only cevimeline (1) is employed in the treatment of xerostomia associated with Sjögren's syndrome. Here we demonstrated that, unlike 1,3-dioxolane derivatives, in the 1,4-dioxane series the methyl group is not essential for the activation of mAChR subtypes. Docking studies, using the crystal structures of human M2 and rat M3 receptors, demonstrated that the 5-methylene group of the 1,4-dioxane nucleus of compound 10 occupies the same lipophilic pocket as the methyl group of the 1,3-dioxolane 4. PMID:24980056

Del Bello, Fabio; Bonifazi, Alessandro; Quaglia, Wilma; Mazzolari, Angelica; Barocelli, Elisabetta; Bertoni, Simona; Matucci, Rosanna; Nesi, Marta; Piergentili, Alessandro; Vistoli, Giulio

2014-08-01

126

Science behind human saliva  

PubMed Central

Saliva is a complex fluid, which influences oral health through specific and nonspecific physical and chemical properties. The importance of saliva in our everyday activities and the medicinal properties it possesses are often taken for granted. However, when disruptions in the quality or quantity of saliva do occur in an individual, it is likely that he or she will experience detrimental effects on oral and systemic health. Often head and neck radiotherapy has serious and detrimental side effects on the oral cavity including the loss of salivary gland function and a persistent complaint of a dry mouth (xerostomia). Thus, saliva has a myriad of beneficial functions that are essential to our well-being. Although saliva has been extensively investigated as a medium, few laboratories have studied saliva in the context of its role in maintaining oral and general health.

Tiwari, Manjul

2011-01-01

127

Recent Advances in Oncology Acupuncture and Safety Considerations in Practice  

PubMed Central

Opinion statement Oncology acupuncture is a new and emerging field of research. Recent advances from published clinical trials have added evidence to support the use of acupuncture for symptom management in cancer patients. Recent new developments include (1) pain and dysfunction after neck dissection; (2) radiation-induced xerostomia in head and neck cancer; (3) aromatase inhibitor-associated arthralgia in breast cancer; (4) hot flashes in breast cancer and prostate cancer; and (5) chemotherapyinduced neutropenia in ovarian cancer. Some interventions are becoming a non-pharmaceutical option for cancer patients, while others still require further validation and confirmation. Meanwhile, owing to the rapid development of the field and increased demands from cancer patients, safety issues concerning oncology acupuncture practice have become imperative. Patients with cancer may be at higher risk developing adverse reactions from acupuncture. Practical strategies for enhancing safety measures are discussed and recommended.

Lu, Weidong; Doherty-Gilman, Anne M.; Rosenthal, David S.

2011-01-01

128

Burning mouth syndrome. Evaluation of multiple variables among 85 patients.  

PubMed

The relationship between burning mouth syndrome and 48 variables was investigated in 241 patients, 45 years old and older, who had attended the Oral Medicine Clinic of the Faculty of Dentistry, University of Stellenbosch during a period of 4 years. A total of 85 cases of burning mouth syndrome were diagnosed in 65 women and 20 men. Statistically significant relationships (p < 0.05) were found with self-medication, xerostomia, and other salivary disturbances in both men and women with burning mouth syndrome when compared with their respective controls. Among the women with BMS, significant relationships were also found with anemia, inadequate diet, chronic infection, hormone therapy, ulcerative/erosive lesions, and atrophy. In contrast men with BMS showed statistically significant relationships between taking prescribed medication, central nervous system disturbances, gingivitis, and denture-related problems. In addition, significant associations were related to variables such as psychogenic factors, regurgitation, flatulence, and periodontitis. PMID:8469539

Maresky, L S; van der Bijl, P; Gird, I

1993-03-01

129

Medulloblastoma: Long-term follow-up of patients treated with electron irradiation of the spinal field  

SciTech Connect

Thirty-two patients with posterior fossa medulloblastoma underwent treatment with electron irradiation to the spinal field. The 5- and 10-year actuarial survival rates were 57% and 50%, respectively. Late complications observed in the 15 patients followed up for more than 5 years were short stature (six patients), decreased sitting-standing height ratio (four patients), scoliosis (two patients), poor school performance (seven patients), xerostomia (one patient), esophageal stricture (one patient), pituitary dysfunction (four patients), primary hypothyroidism (one patient), bilateral eighth-nerve deafness (one patient), and carcinoma of the thyroid (one patient). Complications following treatment with electrons to a spinal field are compared with reported complications following treatment with photons to the spinal field. Although short-term reactions were minimal, the authors found no difference in late complications. More sophisticated treatment planning may show such a long-term benefit in the future.

Gaspar, L.E.; Dawson, D.J.; Tilley-Gulliford, S.A.; Banerjee, P. (London Regional Cancer Centre, Ontario (Canada))

1991-09-01

130

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

131

[Side effects of radiotherapy in oral cavity: diagnosis, prevention and treatment guidelines].  

PubMed

To avoid, or at least to reduce complications in patients who require head and neck radiotherapy, adequate oral cavity treatment is necessary before the therapy. Recent management guidelines speak of possibilities of preventing osteoradionecrosis with hyperbaric oxygen, using long-wave ultrasound in stimulating osteoblasts growth, and surgical transfer of submandibular salivary glands to submental area with 99% effectiveness in preventing xerostomia, besides traditional therapy. Preventive measures are naturally the best choice, since late complications treatment is not needed as often, and should draw special attention of physicians and patients. Since wide a spectrum of preventive and curative measures is required, the need exists for standard teams to look after the patients during and after radiotherapy, and which should include, besides radiotherapist, oral or maxillofacial surgeon in cooperation with oral medicine specialist. PMID:20143603

Badzek, Sasa; Tomas, Ilijan; Krajina, Ivan; Pu?o, Katarina; Kelovi?, Vesna Lesko; Krajina, Zdenko; Plestina, Stjepko

2009-01-01

132

Bilateral submandibular gland aplasia with hypertrophy of the sublingual glands of a patient with a cleft lip and palate: case report.  

PubMed

Aplasia of major salivary glands is a rare disorder with only a handful of cases reported in the literature. The cause of congenital absence of the salivary glands has not been determined, but it may be associated with ectodermal defects of the first and second branchial arches. Patients may be asymptomatic or may experience dysphagia, xerostomia, several periodontal disease, or multiple caries. There are few reports of patients with congenital gland aplasia with cleft lip and palate. We document the case of a 41-year-old patient with repaired unilateral cleft lip palate, bilateral submandibular gland aplasia, and compensatory hypertrophy of the sublingual glands. To the best of our knowledge, there are no previous reports that can be found in the literature with a combination of such findings. PMID:24036837

Reija, María Fe García; Gordillo, Diana Patricia Lopez; Palacio, Julia Cayetana Blasco; Abascal, Laura Bermejo; Perea, Belén García-Montesinos

2013-09-01

133

Effect of Amifostine in Head and Neck Cancer Patients Treated with Radiotherapy: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials  

PubMed Central

Background Amifostine is the most clinical used chemical radioprotector, but its effect in patients treated with radiation is not consistent. Methods By searching Medline, CENTRAL, EMBASE, ASCO, ESMO, and CNKI databases, the published randomized controlled trials (RCTs) about the efficacy of amifostine in HNSCC patients treated with radiotherapy were collected. The pooled efficacy and side effects of this drug were calculated by RevMan software. Results Seventeen trials including a total of 1167 patients (604 and 563 each arm) were analyzed in the meta-analysis. The pooled data showed that the use of amifostine significantly reduce the risk of developing Grade3–4 mucositis (relative risk [RR],0.72; 95% confidence interval [CI],0.54–0.95; p<0.00001), Grade 2–4 acute xerostomia (RR,0.70; 95%CI,0.52–0.96; p?=?0.02), or late xerostomia (RR,0.60; 95%CI,0.49–0.74; p<0.00001) and Grade 3–4 dysphagia (RR,0.39; 95%CI,0.17–0.92; p?=?0.03). However, subgroup analysis demonstrated that no statistically significant reduction of Grade3–4 mucositis (RR,0.97; 95% CI,0.74–1.26; p?=?0.80), Grade 2–4 acute xerostomia (RR,0.35; 95%CI,0.02–5.44; p?=?0.45), or late xerostomia (RR,0.40; 95%CI,0.13–1.24; p?=?0.11) and Grade 3–4 dysphagia (RR,0.23; 95%CI,0.01–4.78; p?=?0.35) was observed in patients treated with concomitant chemoradiotherapy. Compared with placebo or observation, amifostine does not show tumor protective effect in complete response (RR,1.02; 95%CI,0.89–1.17; p?=?0.76) and partial response (RR,0.90; 95%CI, 0.56–1.44; p?=?0.66). For the hematologic side effect, no statistical difference of Grade 3–4 leucopenia (RR,0.60; 95%CI,0.35–1.05; p?=?0.07), anemia (RR,0.80; 95%CI, 0.42–1.53; p?=?0.50) and thrombocytopenia (RR,0.43; 95%CI,0.16–1.15; p?=?0.09) were found between amifostine and control groups. The most common amifostine related side effects were nausea, emesis, hypotension and allergic with an average incidence rate (Grade 3–4) of 5%, 6%, 4% and 4% respectively. Conclusion This systematic review showed that amifostine significantly reduce the serious mucositis, acute/late xerastomia and dysphagia without protection of the tumor in HNSCC patients treated with radiotherapy. And the toxicities of amifostine were generally acceptable.

Li, Xuebing; Wu, Hua; Li, Yang; Hua, Feng

2014-01-01

134

Antidepressant-induced Burning Mouth Syndrome: A Unique Case  

PubMed Central

Burning Mouth Syndrome (BMS) is defined as a chronic orofacial pain syndrome, without evidence of mucosal lesions and other clinical signs of disease or laboratory abnormalities. Patients with BMS complain of burning pain in the mouth, xerostomia and taste disturbances. It is more common among women and the median age of occurrence is about 60 years. BMS may be primary or secondary to other diseases. The mainstay in the treatment of BMS includes antidepressants, benzodiazepines, and anticonvulsants. A few cases of BMS caused due to medication have been reported. The causative drugs include angiotensin-converting enzyme inhibitors, anticoagulants, antipsychotics, antiretrovirals, and benzodiazepines. This is a case report of a patient on antidepressants who developed symptoms of BMS thereby causing a dilemma in management.

Puttaswamiah, Rajiv Nidasale; Birur, Praveen N; Ramaswamy, Bhanushree; Sunny, Sumsum P

2014-01-01

135

Antidepressant-induced Burning Mouth Syndrome: A Unique Case.  

PubMed

Burning Mouth Syndrome (BMS) is defined as a chronic orofacial pain syndrome, without evidence of mucosal lesions and other clinical signs of disease or laboratory abnormalities. Patients with BMS complain of burning pain in the mouth, xerostomia and taste disturbances. It is more common among women and the median age of occurrence is about 60 years. BMS may be primary or secondary to other diseases. The mainstay in the treatment of BMS includes antidepressants, benzodiazepines, and anticonvulsants. A few cases of BMS caused due to medication have been reported. The causative drugs include angiotensin-converting enzyme inhibitors, anticoagulants, antipsychotics, antiretrovirals, and benzodiazepines. This is a case report of a patient on antidepressants who developed symptoms of BMS thereby causing a dilemma in management. PMID:25031818

Raghavan, Shubhasini Attavar; Puttaswamiah, Rajiv Nidasale; Birur, Praveen N; Ramaswamy, Bhanushree; Sunny, Sumsum P

2014-07-01

136

Tools for optimal tissue sparing in concomitant chemoradiation of advanced head and neck cancer: subcutaneous amifostine and computed tomography-based target delineation.  

PubMed

Organ preservation in patients with head and neck cancer can be achieved using concomitant chemoradiation protocols. Critical tissues can be spared using highly conformal radiation therapy techniques and/or radiation protectors. With three-dimensional conformal radiation therapy (3DCRT) tight target definitions of the primary tumor and neck nodal levels are mandatory. In 2000, a clinical trial for advanced-stage head and neck squamous cell carcinoma was initiated in Rotterdam, The Netherlands. Patients are treated with paclitaxel administered concomitantly with 3DCRT and randomized to receive subcutaneous (SC) amifostine or no amifostine. Those in the radioprotectant arm received amifostine 500 mg SC before each radiation therapy (RT) fraction. This article presents early findings on toxicity. Acute toxicity is evaluated according to Radiation Therapy Oncology Group criteria. Xerostomia was scored subjectively and by whole saliva measurements. Neck nodal levels were delineated in accordance with previously published computed tomography (CT)-based guidelines developed in Rotterdam. Forty-one patients are the subject of this report. In patients treated with amifostine, mucositis and dysphagia took longer to resolve than with conventional RT schedules. No difference in objective and subjective evaluation of xerostomia was seen between treatment arms. So far in this ongoing study, no advantage of SC amifostine has been detected. This might be because of the toxicity of the concomitant treatment itself, the dose of amifostine, the route of administration, or the insufficient sparing of critical structures by 3DCRT. These early findings and the ongoing development of better tissue-sparing techniques with more accurate CT-based target delineation protocols and intensity-modulated radiation therapy (IMRT) are discussed. PMID:12577248

Braaksma, Marijel; Levendag, Peter

2002-12-01

137

Phase II trial of subcutaneous amifostine in patients undergoing radiation therapy for head and neck cancer.  

PubMed

The availability of subcutaneously (SC) administered amifostine may present an advantage for radioprotectant therapy in head and neck cancer patients. In a randomized phase II trial comparing SC amifostine versus no amifostine in 140 patients undergoing radiation therapy for head and neck, thoracic, or pelvic cancers, amifostine treatment was associated with reductions in mucosal toxicity and delays in radiation therapy among the 19 patients with head and neck cancer, as well as in the thoracic and pelvic cancer groups. A phase II trial of SC amifostine in head and neck cancer was performed in a patient population (n = 54) similar to that studied in a phase III trial of intravenous amifostine to allow comparisons of outcomes. Acute xerostomia grade 2 occurred in 56% with SC amifostine and 51% with intravenous amifostine (78% in the no-amifostine group in phase III trial), with median time to onset being 40 days and 45 days, respectively (30 days with no amifostine), and cumulative radiation dose to onset being 58 Gy and 60 Gy (42 Gy with no amifostine), respectively. Amifostine SC was well tolerated, with three quarters of patients receiving > or =75% of the planned dose. Nausea, vomiting, and hypotension were less severe with SC amifostine, but cutaneous toxicity was more frequent. The reduction in radiation therapy-induced acute xerostomia with SC amifostine is similar to that with intravenous amifostine in patients with head and neck cancer. If cutaneous toxicity is judged an acceptable risk, SC amifostine may represent a second, more convenient option for treating physicians. PMID:12577250

Anné, Pramila Rani

2002-12-01

138

Preliminary data of the GORTEC 2000-02 phase III trial comparing intravenous and subcutaneous administration of amifostine for head and neck tumors treated by external radiotherapy.  

PubMed

A prospective randomized study is comparing intravenous (IV; arm A) versus subcutaneous (SC; arm B) administration of amifostine in patients receiving radiotherapy for head and neck cancer. Main eligibility criteria were newly diagnosed squamous cell head and neck cancer, inclusion of at least 75% of both parotid glands within radiation fields that would receive at least 40 Gy, and no evidence of distant metastasis. Prophylactic use of pilocarpine and concomitant chemotherapy were prohibited. Intravenous administration of amifostine is 200 mg/m2/d in a short 3-minute infusion 15 to 30 minutes before each fraction of radiotherapy. Subcutaneous administration is 500 mg/d in two, slow 1.25-mL injections at two different sites 20 to 60 minutes before each radiotherapy fraction. Antiemetic treatment and blood pressure monitoring are required in both arms. As of April 25, 2002, 111 of the 292 required patients were included. Data are available for the first 54 patients. Acute toxicity included nausea/vomiting (12% for arm A; 13% for arm B), hypotension (6% in arm A; 0% in arm B), skin rash (15% in arm A; 16% in arm B), and asthenia (4% in arm A; 0% in arm B). Compliance with amifostine administration was 70% in arm A (IV) and 80% in arm B (SC). The rate of acute xerostomia (> or = grade 2) was 23% in arm A and 19% in arm B. These preliminary results indicate that tolerance is better with SC than IV administration, particularly because of the absence of hypotension. The absence of hypotension with SC administration facilitates patient monitoring and management in radiotherapy departments. More patients and data are required to assess the long-term efficacy of SC administration on acute and late xerostomia. PMID:12577246

Bardet, Etienne; Martin, Laurent; Calais, Gilles; Tuchais, Claude; Bourhis, Jean; Rhein, Béatrix; Feham, Nouredine; Alphonsi, Marc

2002-12-01

139

Prevalence of Candida Species in the Oral Cavity of Patients Undergoing Head and Neck Radiotherapy  

PubMed Central

Background and aims Candidiasis is a common opportunistic infection in immunocompromised patients. Radiation to the head and neck affects the oral mucous membrane and produces xerostomia. Xerostomia alters the oral mucosa and predisposes them to colonization by Candida species. The aim of this study was evaluation of Candida species before and after radiotherapy. Materials and methods Twenty patients undergoing radiation therapy were selected. None of the patients had taken any antibiotics and antifungals during the 3-month period prior to the study and did not take any during the study; in addition, they did not have any systemic conditions predisposing them to Candida infections. Swabs were collected from all the patients for Candida species culturing procedures 3±1 days before treatment and 2 and 4 weeks after radiotherapy. Swabs were inoculated on 2% Sabouraud’s dextrose agar. Different types of Candida species are specified by colony color. Analysis of variance was used to assess the difference between the periods before and after treatment. Results Mean age of the patients were 59.4 years. Ten patients were Candida-positive before the initiation of radiotherapy. Eighteen and 20 patients were Candida-positive after two and four weeks of radiotherapy, respectively. The most frequent type of Candida in this study was Candida albicans both before and after radiotherapy. Conclusion The present study suggests that patients undergoing head and neck radiotherapy should take antifungal agents, especially sugar-free agents, topical fluoride and salivary substitutes. The most commonly found Candida in this study was Candida albicans, which might be attributed to its high pathogenecity.

Azizi, Arash; Rezaei, Masood

2009-01-01

140

Short-term hazards of low-dose radioiodine ablation therapy in postsurgical thyroid cancer patients.  

PubMed

During the last two decades, there has been a trend to use low-dose I-131 ablation therapy in patients with thyroid carcinoma without metastases. However, information regarding the incidence of acute adverse reactions in patients after low-dose radioiodine therapy has not been reported. In this study, the acute radiation effects after low-dose radioiodine ablation therapy in postsurgical differentiated thyroid cancer patients was evaluated. Fifty-six patients with differentiated thyroid cancer were prospectively evaluated. None of these patients had evidence of a distant metastasis. All patients received 40 mCi (1480 MBq) I-131 MIBG orally and were evaluated for symptoms and signs by a physician on the second and seventh days after therapy. Xerostomia and nausea were the most common complaints with the same incidence rate of 5.35%. Gastralgia occurred at a frequency of 3.57%. Pain in the thyroid bed, tenderness over a parotid gland, submandibular glands, change in taste, and vomiting all were found at a frequency of 1.78%. Maximum reactions generally occurred 24-48 hours after therapy. All the symptoms except for xerostomia resolved completely in most patients within a week. In comparison with high-dose ablation therapy published in the literature, the incidence of radiation reactions in low-dose radioiodine therapy was much lower. It was concluded that in patients without lymph node or distant metastases, low-dose I-131 MIBG therapy may be recommended to avoid the high incidence of local complications after high-dose treatment. PMID:8896926

Lin, W Y; Shen, Y Y; Wang, S J

1996-10-01

141

Long-term results of ipsilateral radiotherapy for tonsil cancer  

PubMed Central

Purpose We evaluated the effectiveness and safety of ipsilateral radiotherapy for the patient with well lateralized tonsil cancer: not cross midline and <1 cm of tumor invasion into the soft palate or base of tongue. Materials and Methods From 2003 to 2011, twenty patients with well lateralized tonsil cancer underwent ipsilateral radiotherapy. Nineteen patients had T1-T2 tumors, and one patient had T3 tumor; twelve patients had N0-N2a disease and eight patients had N2b disease. Primary surgery followed by radiotherapy was performed in fourteen patients: four of these patients received chemotherapy. Four patients underwent induction chemotherapy followed by concurrent chemoradiotherapy (CCRT). The remaining two patients received induction chemotherapy followed by radiotherapy and definitive CCRT, respectively. No patient underwent radiotherapy alone. We analyzed the pattern of failure and complications. Results The median follow-up time was 64 months (range, 11 to 106 months) for surviving patients. One patient had local failure at tumor bed. There was no regional failure in contralateral neck, even in N2b disease. At five-year, local progression-free survival, distant metastasis-free survival, and progression-free survival rates were 95%, 100%, and 95%, respectively. One patient with treatment failure died, and the five-year overall survival rate was 95%. Radiation Therapy Oncology Group grade 2 xerostomia was found in one patient at least 6 months after the completion of radiotherapy. Conclusion Ipsilateral radiotherapy is a reasonable treatment option for well lateralized tonsil cancer. Low rate of chronic xerostomia can be expected by sparing contralateral major salivary glands.

Koo, Tae Ryool

2013-01-01

142

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

143

Total lymphoid irradiation for multiple sclerosis  

SciTech Connect

Although chemical immunosuppression has been shown to benefit patients with chronic progressive multiple sclerosis (MS), it appears that chemotherapy has an appreciable oncogenic potential in patients with multiple sclerosis. Accordingly, we developed a modified total lymphoid irradiation (TLI) regimen designed to reduce toxicity and applied it to a randomized double blind trial of TLI or sham irradiation in MS. Standard TLI regimens were modified to reduce dose to 1,980 rad, lowering the superior mantle margin to midway between the thyroid cartilage and angle of the mandible (to avert xerostomia) and the lower margin of the mantle field to the inferior margin of L1 (to reduce gastrointestinal toxicity by dividing abdominal radiation between mantle and inverted Y), limiting spinal cord dose to 1,000 rad by custom-made spine blocks in the mantle and upper 2 cm of inverted Y fields, and also protecting the left kidney even if part of the spleen were shielded. Clinical efficacy was documented by the less frequent functional scale deterioration of 20 TLI treated patients with chronic progressive MS compared to to 20 sham-irradiated progressive MS patients after 12 months (16% versus 55%, p less than 0.03), 18 months (28% versus 63%, p less than 0.03), and 24 months (44% versus 74%, N.S.). Therapeutic benefit during 3 years follow-up was related to the reduction in lymphocyte count 3 months post-irradiation (p less than 0.02). Toxicity was generally mild and transient, with no instance of xerostomia, pericarditis, herpes zoster, or need to terminate treatment in TLI patients. However, menopause was induced in 2 patients and staphylococcal pneumonia in one.

Devereux, C.K.; Vidaver, R.; Hafstein, M.P.; Zito, G.; Troiano, R.; Dowling, P.C.; Cook, S.D.

1988-01-01

144

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

145

TAT-Mediated Delivery of Tousled Protein to Salivary Glands Protects Against Radiation-Induced Hypofunction  

SciTech Connect

Purpose: Patients treated with radiotherapy for head-and-neck cancer invariably suffer its deleterious side effect, xerostomia. Salivary hypofunction ensuing from the irreversible destruction of glands is the most common and debilitating oral complication affecting patients undergoing regional radiotherapy. Given that the current management of xerostomia is palliative and ineffective, efforts are now directed toward preventive measures to preserve gland function. The human homolog of Tousled protein, TLK1B, facilitates chromatin remodeling at DNA repair sites and improves cell survival against ionizing radiation (IR). Therefore, we wanted to determine whether a direct transfer of TLK1B protein to rat salivary glands could protect against IR-induced salivary hypofunction. Methods: The cell-permeable TAT-TLK1B fusion protein was generated. Rat acinar cell line and rat salivary glands were pretreated with TAT peptide or TAT-TLK1B before IR. The acinar cell survival in vitro and salivary function in vivo were assessed after radiation. Results: We demonstrated that rat acinar cells transduced with TAT-TLK1B were more resistant to radiation (D{sub 0} = 4.13 {+-} 1.0 Gy; {alpha}/{beta} = 0 Gy) compared with cells transduced with the TAT peptide (D{sub 0} = 4.91 {+-} 1.0 Gy; {alpha}/{beta} = 20.2 Gy). Correspondingly, retroductal instillation of TAT-TLK1B in rat submandibular glands better preserved salivary flow after IR (89%) compared with animals pretreated with Opti-MEM or TAT peptide (31% and 39%, respectively; p < 0.01). Conclusions: The results demonstrate that a direct transfer of TLK1B protein to the salivary glands effectively attenuates radiation-mediated gland dysfunction. Prophylactic TLK1B-protein therapy could benefit patients undergoing radiotherapy for head-and-neck cancer.

Sunavala-Dossabhoy, Gulshan, E-mail: gsunav@lsuhsc.edu [Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, LA (United States)] [Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, LA (United States); Palaniyandi, Senthilnathan; Richardson, Charles; De Benedetti, Arrigo [Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, LA (United States)] [Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, LA (United States); Schrott, Lisa [Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA (United States)] [Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA (United States); Caldito, Gloria [Department of Bioinformatics and Computational Biology, Louisiana State University Health Sciences Center, Shreveport, LA (United States)] [Department of Bioinformatics and Computational Biology, Louisiana State University Health Sciences Center, Shreveport, LA (United States)

2012-09-01

146

Oral hygiene products and acidic medicines.  

PubMed

Acidic or EDTA-containing oral hygiene products and acidic medicines have the potential to soften dental hard tissues. The low pH of oral care products increases the chemical stability of some fluoride compounds, favors the incorporation of fluoride ions in the lattice of hydroxyapatite and the precipitation of calcium fluoride on the tooth surface. This layer has some protective effect against an erosive attack. However, when the pH is too low or when no fluoride is present these protecting effects are replaced by direct softening of the tooth surface. Xerostomia or oral dryness can occur as a consequence of medication such as tranquilizers, anti-histamines, anti-emetics and anti-parkinsonian medicaments or of salivary gland dysfunction e.g. due to radiotherapy of the oral cavity and the head and neck region. Above all, these patients should be aware of the potential demineralization effects of oral hygiene products with low pH and high titratable acids. Acetyl salicylic acid taken regularly in the form of multiple chewable tablets or in the form of headache powder as well chewing hydrochloric acids tablets for treatment of stomach disorders can cause erosion. There is most probably no direct association between asthmatic drugs and erosion on the population level. Consumers, patients and health professionals should be aware of the potential of tooth damage not only by oral hygiene products and salivary substitutes but also by chewable and effervescent tablets. Additionally, it can be assumed that patients suffering from xerostomia should be aware of the potential effects of oral hygiene products with low pH and high titratable acids. PMID:16687890

Hellwig, E; Lussi, A

2006-01-01

147

Clinical and Histological Findings of Denture Stomatitis as Related to Intraoral Colonization Patterns of C. albicans, Salivary Flow, and Dry Mouth  

PubMed Central

Purpose Multifactorial etiological factors contribute to denture stomatitis (DS), a type of oral candidiasis; however, unlike other oral candidiasis, DS can occur in a healthy person wearing a denture. In this study, we therefore attempt to explore the association between candida, denture, and mucosal tissue using 1) exfoliative cytology, 2) the candidal levels present in saliva, on mucosal tissues and on denture surfaces, and 3) the salivary flow rate and xerostomic symptoms. Materials and Methods A cross-sectional study enrolled 32 edentulous participants, 17 without DS as controls and 15 with DS (Newton’s classification type II and III). Participants with systemic or other known oral conditions were excluded. Participants completed a xerostomia questionnaire, and salivary flow rates were measured. Samples of unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. UWS was used for fungal culturing. Periodic acid-Schiff (PAS) stain and quantitative exfoliative cytology were performed on samples from affected and unaffected mucosa from each participant. Levels of Candida species (albicans and non-albicans) were determined in salivary samples (expressed as colony-forming units, CFU), as well as from swab samples obtained from denture fitting surfaces, in addition to affected and unaffected mucosa. Results There were no significant differences in salivary flow rates, mucosal wetness, or frequency of reported dry mouth comparing participants with and without DS. Exfoliative cytology of mucosal smears demonstrated significantly higher (P = 0.02) inflammatory cell counts in DS patients, as compared with smears of healthy denture-wearers. C. albicans was significantly more prevalent in saliva (P = 0.03) and on denture surfaces (P = 0.002) of DS participants, whereas mucosal candidal counts and the presence of cytological hyphae did not show significant difference comparing DS to healthy participants. Conclusions In this investigation, we presented a unique group of healthy edentulous patients. This population may reflect the general DS population without systemic or other oral diseases. The prominent etiological factor for DS in this population is the presence of candida in denture and saliva. We found that other factors such as saliva flow/xerostomia, fitting of the denture, and the presence of candida in the mucosa, are less important in this population. Therefore, DS treatments in healthy patients should first focus on sanitization of an existing denture and/or fabrication of a new denture.

AlTarawneh, Sandra; Bencharit, Sompop; Mendoza, Luisito; Curran, Alice; Barrow, David; Barros, Silvana; Preisser, John; Loewy, Zvi G.; Gendreau, Linda; Offenbacher, Steven

2012-01-01

148

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

149

[3D-CRT and intensity modulated radiation therapy (IMRT)].  

PubMed

Three-dimensional conformal radiation therapy (3D-CRT) conforms a high dose region closer to the target volume than does 2D radiation therapy. IMRT is the advanced form of 3D-CRT. With IMRT technique, using multiple intensity modulated beams, one can deliver a high dose of radiation to the target and a low dose to the surrounding normal structures. IMRT planning provides improved tumor target coverage when compared to 3D-CRT treatment planning. There is significant sparing of critical structures and other normal tissues. IMRT also produces dose distributions capable of delivering different dose prescriptions to multiple targets, providing a new opportunity for differential dose painting to increase the dose selectively to specific image-defined regions. Preliminary findings indicate that IMRT is a new clinically feasible tool in radiation oncology. The initial results of clinical studies demonstrate reduced xerostomia in head and neck cancer and also effectively reduced acute and late occurring toxicities, improving the QOL of patients treated for prostate cancer. According to these studies, IMRT will allow dose escalation, leading to better tumor control without normal tissue damage. On the other hand, there are some problems for IMRT in Japan: There are few medical physicists, which results in radiation technologists playing most clinical technological roles, including some dosimetrical and physical activities. Social recognition and economical and legal support for medical physicists should be established in providing better patient care services. PMID:14712764

Hatano, Kazuo; Narita, Yuichiro; Araki, Hiroshi; Sakai, Mitsuhiro

2003-12-01

150

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

151

A pilot study on the effect of radiation on calmodulin in rat submandibular salivary glands.  

PubMed

Xerostomia and loss of salivary gland secretion is one of the most common complications of the radiation treatment of head-and-neck malignancies. The secretory mechanism in the salivary glands can be modulated by the concentration of intracellular Ca2+. Calmodulin is a calcium-binding protein that is widely distributed in nature and is involved in regulating intracellular calcium. In this study the effect of radiation on the concentration of calmodulin in rat salivary glands was investigated. Fourteen rats were divided into three groups: R1 (n = 4) and R2 (n = 5) received a single dose of 15 Gy and group C (n = 5) received no radiation. R1 and R2 animals were killed at weeks 2 and 10 post-irradiation, respectively. The submandibular glands were removed, homogenized and their total calmodulin was determined. The mean calmodulin concentrations were 6.4+/-1.1 microg/gland for controls, 14.1+/-3.7 microg/gland for R1 and 68.2+/-14.4 microg/gland for R2. Kruskal-Wallis ANOVA revealed a significant increase in the concentration of calmodulin following irradiation (p = 0.003). The relationship between this increase and the loss of salivary gland function is not yet clear. PMID:10391495

Haghighat, N; Al-Hashimi, I

1999-05-01

152

Antagonism of the effects of clonidine by the alpha 2-adrenoceptor antagonist, fluparoxan.  

PubMed Central

1. The effects of fluparoxan, an alpha 2-adrenoceptor antagonist, on the pharmacodynamic changes induced by clonidine were investigated in this placebo-controlled, double-blind, two-period, cross-over study in 16 healthy male volunteers (aged 19 to 44 years). 2. Subjects received either fluparoxan or placebo, twice-daily for 5 1/2 days (11 doses). One hour after the first and last dose of each treatment period, clonidine (200 micrograms) was infused intravenously over 5 min. 3. Indices of clonidine-mediated pharmacodynamic responses (growth hormone secretion, bradycardia, hypotension, xerostomia and sedation) were taken before and after clonidine infusion. Growth hormone secretion was assessed by quantifying serum growth hormone concentrations; sedation was assessed by both visual analogue scales (VAS) and by a visual psychomotor response meter, measuring critical flicker fusion (CFF). 4. The majority of subjects reported minor adverse events such as lethargy, headache and dry mouth following clonidine infusion. All adverse events were likely to be related to clonidine, as they occurred consistently between treatment groups. Fluparoxan has, however, in previous studies been reported to cause headache and light-headedness. 5. Prior to the clonidine infusion, fluparoxan caused small but statistically significant increases in systolic blood pressure (4 mm Hg) and salivary flow (approximately 30%) after both single and repeated doses. A small increase in heart rate (2 beats min-1) was seen after a single dose which was also statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Johnson, M A; Blackwell, C P; Smith, J

1995-01-01

153

Complementary strategies for the management of radiation therapy side effects.  

PubMed

Patients with cancer utilize complementary and alternative medicine (CAM) for a variety of purposes, one of which is the reduction of side effects of conventional treatment. With a large number of their patients using CAM, it is important for advanced practitioners in oncology to have an understanding of these therapies to better guide their patients. Side effects of radiation therapy that may have dose-limiting poten-tial include diarrhea, mucositis, skin toxicity, and xerostomia. A com-mon side effect that is not necessarily dose-limiting but considerably troublesome to patients is cancer- and treatment-related fatigue. The CAM therapies that may alleviate some of the side effects of radiation therapy include probiotics, psyllium, exercise, melatonin, honey, acu-puncture, and calendula. Therapies that require more research or have been shown to be ineffective include aloe vera, glutamine, and deglyc-yrrhizinated licorice. This article provides an overview of these thera-pies as well as related research and analysis. PMID:25032003

Stubbe, Christine E; Valero, Meighan

2013-07-01

154

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

155

Alternate delivery route for amifostine as a radio-/chemo-protecting agent.  

PubMed

Amifostine (ethiofos, WR-2721) is an organic thiophosphate prodrug that serves as an antineoplastic adjunct and cytoprotective agent useful in cancer chemotherapy and radiotherapy. The selective protection of certain tissues of the body is believed to be due to higher alkaline phosphatase activity, higher pH and vascular permeation of normal tissues. Amifostine is conventionally administered intravenously before chemotherapy or radiotherapy. It is approved by the Food and Drug Administration (FDA) to reduce cumulative renal toxicity associated with repeated administration of cisplatin in patients with advanced ovarian cancer. It was originally indicated to reduce the cumulative renal toxicity from cisplatin in non-small cell lung cancer although this indication was withdrawn in 2005. Amifostine is also FDA approved for patients with head and neck cancer to reduce the incidence of moderate to severe xerostomia in patients who are undergoing postoperative radiation treatment where the radiation port includes a substantial portion of the parotid glands. The potential of amifostine as a cytoprotective agent is unlikely to be fully realized if the method of administration is restricted to intravenous administration. Attempts have been made to develop non-invasive methods of delivery such as transdermal patches, pulmonary inhalers, and oral sustained-release microspheres. It is the goal of this article to explore non-intravenous routes of administration associated with better efficacy of the drug. This review will primarily focus on the variety of more recently studied (2002 and later) alternative modes for amifostine administration, including subcutaneous, intrarectal and oral routes. PMID:18549666

Praetorius, Natalie P; Mandal, Tarun K

2008-07-01

156

Superficial parotid lobe-sparing delineation approach: a better method of dose optimization to protect the parotid gland in intensity-modulated radiotherapy for nasopharyngeal carcinoma  

PubMed Central

Purpose We used a superficial parotid lobe–sparing delineation approach for dose optimization with better protection for the parotid glands in intensity-modulated radiotherapy (imrt) for nasopharyngeal carcinoma (npc) patients. Methods Compared with traditional contouring of the entire parotid glands as organs at risk (oars) in imrt for npc, we used a superficial parotid lobe–sparing delineation approach of contouring the superficial parotid lobes as oars. Changes in dose to the parotid glands, the targets, and other oars were evaluated. Results The mean dose to the parotid glands overall decreased by more than 4 Gy in the test plans. Impressively, the mean dose to the superficial parotid lobes in the test plans was not more than 30 Gy, regardless of clinical stage. In T1–3 npc patients, the dose distributions for targets were not significantly different in the control plans and the test plans. However, for some T4 patients, the dose distributions for targets and brainstem in the test plans could not meet clinical requirements. Conclusions The superficial parotid lobe–sparing delineation approach can significantly lower the mean dose to the entire parotid and to the superficial parotid lobe in T1–3 npc patients, which would be expected to result in less xerostomia and better quality of life for those patients.

Zhang, H.B.; Lu, X.; Huang, S.M.; Wang, L.; Zhao, C.; Xia, W.X.; Li, S.W.; Wang, F.L.; Zhu, Y.L.; Guo, X.; Xiang, Y.Q.

2013-01-01

157

Late effects after treatment of twenty children with soft tissue sarcomas of the head and neck. Experience at a single institution with a review of the literature  

SciTech Connect

Twenty children with soft tissue sarcomas of the head and neck, treated at the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania from 1972 to 1981, were evaluated for the late deleterious effects of treatment. All patients received radiation therapy and combination chemotherapy with vincristine, dactinomycin, and cyclophosphamide; certain patients also received Adriamycin (doxorubicin). All had ophthalmologic, otologic, growth, and cosmetic evaluations; 15 also had dental and maxillofacial examinations. The median age at diagnosis was 6 years (range, 7 months-13 years). Median follow-up from time of diagnosis was 5.5 years with a minimum of 3 years in all but four patients. The major problems encountered were related to the eyes (xerophthalmia and cataracts), ears (hearing loss), teeth (maleruption and caries), glandular structures (xerostomia, hypopituitarism), and development (craniofacial deformity). It is concluded that children treated for soft tissue sarcomas of the head and neck with combined modality therapy, including radiation enhancers, may show a variety of late treatment-related adversities. These children require close multidisciplinary follow-up for detection of late effects in order that appropriate prophylactic or symptomatic treatment can be instituted to minimize their consequences.

Fromm, M.; Littman, P.; Raney, R.B.; Nelson, L.; Handler, S.; Diamond, G.; Stanley, C.

1986-05-15

158

Identification of risk groups for oropharyngeal dysphagia in hospitalized patients in a university hospital.  

PubMed

Purpose: To identify risk groups for oropharyngeal dysphagia in hospitalized patients in a university hospital. Methods: The study was design as an exploratory cross-sectional with quantitative data analysis. The researched population consisted of 32 patients admitted to the medical clinic at the university hospital. Patient history data were collected, followed by a universal swallowing screening which included functional feeding assessment, to observe clinical signs and symptoms of dysphagia, and assessment of nutritional status through anthropometric data and laboratory tests. Results: Of the total sample, the majority of patients was male over 60 years. The most common comorbidities related to patients with signs and symptoms of dysphagia were chronic obstructive pulmonary disease, systemic arterial hypertension, congestive heart failure, diabetes mellitus and acute myocardial infarction. The food consistency that showed higher presence of clinical signs of aspiration was pudding and the predominant sign was wet voice. Conclusion: There is a high incidence of risk for oropharyngeal dysphagia in hospitalized patients and an even higher rate of hospitalized patients with nutritional deficits or already malnourished. Hospitalized patients with respiratory diseases, chronic obstructive pulmonary disease, congestive heart failure and patients with xerostomia were indicated as risk group for oropharyngeal dysphagia. PMID:24714855

Bassi, Daiane; Furkim, Ana Maria; Silva, Cristiane Alves; Coelho, Mara Sérgia Pacheco Honório; Rolim, Maria Rita Pimenta; de Alencar, Maria Luiza Aires; Machado, Marcos José

2014-01-01

159

The Potential of Helical Tomotherapy in the Treatment of Head and Neck Cancer  

PubMed Central

A decade after its first introduction into the clinic, little is known about the clinical impact of helical tomotherapy (HT) on head and neck cancer (HNC) treatment. Therefore, we analyzed the basics of this technique and reviewed the literature regarding HT's potential benefit in HNC. The past two decades have been characterized by a huge technological evolution in photon beam radiotherapy (RT). In HNC, static beam intensity-modulated radiotherapy (IMRT) has shown superiority over three-dimensional conformal RT in terms of xerostomia and is considered the standard of care. However, the next-generation IMRT, the rotational IMRT, has been introduced into the clinic without any evidence of superiority over static beam IMRT other than being substantially faster. Of these rotational techniques, HT is the first system especially developed for IMRT in combination with image-guided RT. HT is particularly promising for the treatment of HNC because its sharp dose gradients maximally spare the many radiosensitive organs at risk nearby. In addition, HT's integrated computed tomography scan assures a very precise dose administration and allows for some adaptive RT. Because HT is specifically developed for IMRT in combination with (integrated) image-guidance, it allows for precise dose distribution (“dose painting”), patient setup, and dose delivery. As such, it is an excellent tool for difficult HNC irradiation. The literature on the clinical results of HT in HNC all show excellent short-term (?2 years) results with acceptable toxicity profiles. However, properly designed trials are still warranted to further substantiate these results.

Verellen, Dirk; Van De Voorde, Lien; de Ost, Bie; De Kerf, Geert; Vanderveken, Olivier; Van Laer, Carl; Van den Weyngaert, Danielle; Vermorken, Jan B.; Gregoire, Vincent

2013-01-01

160

Aging and secretory reserve capacity of major salivary glands.  

PubMed

A loss of acinar cells occurs with aging, while salivary production remains age-stable in healthy adults. It is hypothesized that a secretory reserve exists to preserve function despite a loss of acinar cells in normal aging. The purpose of this double-blind, placebo-controlled, crossover study was to determine age-related differences in salivary response to an anti-sialogogue (glycopyrrolate). Thirty-six healthy subjects (18 young--20-38 yrs; 18 older--60-77 yrs) received 4.0 microg/kg i.v. glycopyrrolate. Parotid and submandibular/sublingual saliva samples and xerostomia questionnaire responses were collected. Variables calculated for each subject were: times to initial and maximum suppression and xerostomic complaint; time to recovery; and durations of suppression and complaint. Salivary function was more adversely affected in older persons. There were no consistent age-associated questionnaire response differences. These findings suggest that salivary gland output is more adversely affected by an anti-sialogogue in healthy older vs. younger adults, supporting the secretory reserve hypothesis of salivary function. PMID:14514768

Ghezzi, E M; Ship, J A

2003-10-01

161

Frequency of rheumatic diseases in patients with autoimmune thyroid disease.  

PubMed

We aimed to investigate the frequency of rheumatic diseases in patients suffering from autoimmune thyroid diseases (ATD). Sixty-five patients (56 F, 9 M), who were followed by diagnosis of ATD, were questioned and examined for the presence of rheumatic disease. Basic laboratory tests and antithyroid antibodies, antinuclear antibody and rheumatoid factor (RF) levels were also measured by appropriate methods. Various rheumatic diseases were detected in 40 (62%) of patients with ATD. The most frequent rheumatic conditions were fibromyalgia, recurrent aphthous stomatitis, osteoarthritis, keratoconjunctivitis sicca and xerostomia and carpal tunnel syndrome which were detected in 20 (31%), 13 (20%), 10 (15%), 9 (14%) and 8 (12%) of patients, respectively. Autoimmune diseases, except Sjogren's syndrome, which were detected in ten patients with ATD, are as follows-vitiligo: two; autoimmune hepatitis: two; oral lichen planus: one, ulcerative colitis: one, inflammatory arthritis in four patients (two of them had rheumatoid arthritis, one had psoriasis and psoriatic arthritis and one had mixed collagen tissue disease). RF was positive in two patients, one of them had rheumatoid arthritis and FANA was positive in six (9%) patients; all of them had hypothyroidism. The frequency of rheumatic diseases seems to be higher in patients suffering from ATD. Initial evaluation and a regular checking for rheumatic diseases in patients suffering from ATD were recommended. PMID:17102943

Soy, Mehmet; Guldiken, Sibel; Arikan, Ender; Altun, Betul Ugur; Tugrul, Armagan

2007-04-01

162

Weak association between subjective symptoms of and objective testing for dry eyes and dry mouth: results from a population based study  

PubMed Central

OBJECTIVES—To determine associations between symptoms of dry eyes and dry mouth and objective evidence of lacrimal and salivary gland dysfunction in a population based sample. To determine associations between these elements and the presence of autoantibodies.?METHODS—A cross sectional population based survey. Subjects were interviewed and examined (Schirmer-1 test and unstimulated salivary flow) for the presence of dry eyes and mouth. Antibodies (anti-Ro [SS-A], anti-La [SS-B], rheumatoid factor, antinuclear antibody) were measured.?RESULTS—341 subjects were examined. Twenty four per cent had dry eye symptoms, 29% dry mouth symptoms, and 14% both. There was only a weak association between the presence of oral or ocular symptoms and their respective test results. Associations were strongest between dry mouth symptoms and positive test results, and in subjects under 55 years of age. There was no association between the presence of autoantibodies and either symptoms or signs of dry eyes or dry mouth.?CONCLUSION—Only weak associations were found between self reported symptoms of dry eyes and dry mouth and objective measures said to define Sjögrens syndrome in the general population. The clinical significance of these symptoms in the community needs reappraisal.?? Keywords: Sjögrens syndrome; Schirmer's test; keratoconjunctivitis sicca; xerostomia

Hay, E.; Thomas, E; Pal, B; Hajeer, A.; Chambers, H; Silman, A

1998-01-01

163

Emerging treatment options for nasopharyngeal carcinoma  

PubMed Central

Nasopharyngeal carcinoma is endemic in Asia and is etiologically associated with Epstein–Barr virus. Radiotherapy is the primary treatment modality. The role of systemic therapy has become more prominent. Based on multiple phase III studies and meta-analyses, concurrent cisplatin-based chemoradiotherapy is the current standard of care for locally advanced disease (American Joint Committee on Cancer manual [7th edition] stages II–IVb). The reported failure-free survival rates from phase II trials are encouraging for induction + concurrent chemoradiotherapy. Data from ongoing phase III trials comparing induction + concurrent chemoradiotherapy with concurrent chemoradiotherapy will validate the results of these phase II studies. Intensity-modulated radiotherapy techniques are recommended if the resources are available. Locoregional control exceeding 90% and reduced xerostomia-related toxicities can now be achieved using intensity-modulated radiotherapy, although distant control remains the most pressing research problem. The promising results of targeted therapy and Epstein–Barr virus-specific immunotherapy from early clinical trials should be validated in phase III clinical trials. New technology, more effective and less toxic chemotherapy regimens, and targeted therapy offer new opportunities for treating nasopharyngeal carcinoma.

Zhang, Lu; Chen, Qiu-Yan; Liu, Huai; Tang, Lin-Quan; Mai, Hai-Qiang

2013-01-01

164

Function of the membrane water channel aquaporin-5 in the salivary gland.  

PubMed

The process of saliva production in the salivary glands requires transepithelial water transfer from the interstitium to the acinar lumen. There are two transepithelial pathways: the transcellular and paracellular. In the transcellular pathway, the aquaporin water channels induce passive water diffusion across the membrane lipid bilayer. It is well known that aquaporin-5 (AQP5) is expressed in the salivary glands, in which it is mainly localized at the apical membrane of the acinar cells. This suggests the physiological importance of AQP5 in transcellular water transfer. Reduced saliva secretion under pilocarpine stimulation in AQP5-null mice compared with normal mice further indicates the importance of AQP5 in this process, at least in stimulated saliva secretion. Questions remain therefore regarding the role and importance of AQP5 in basal saliva secretion. It has been speculated that there would be some short-term regulation of AQP5 such as a trafficking mechanism to regulate saliva secretion. However, no histochemical evidence of AQP5-trafficking has been found, although some of biochemical analyses suggested that it may occur. There are no reports of human disease caused by AQP5 mutations, but some studies have revealed an abnormal subcellular distribution of AQP5 in patients or animals with xerostomia caused by Sjögren's syndrome and X-irradiation. These findings suggest the possible pathophysiological importance of AQP5 in the salivary glands. PMID:23209334

Matsuzaki, Toshiyuki; Susa, Taketo; Shimizu, Kinue; Sawai, Nobuhiko; Suzuki, Takeshi; Aoki, Takeo; Yokoo, Satoshi; Takata, Kuniaki

2012-10-31

165

Function of the Membrane Water Channel Aquaporin-5 in the Salivary Gland  

PubMed Central

The process of saliva production in the salivary glands requires transepithelial water transfer from the interstitium to the acinar lumen. There are two transepithelial pathways: the transcellular and paracellular. In the transcellular pathway, the aquaporin water channels induce passive water diffusion across the membrane lipid bilayer. It is well known that aquaporin-5 (AQP5) is expressed in the salivary glands, in which it is mainly localized at the apical membrane of the acinar cells. This suggests the physiological importance of AQP5 in transcellular water transfer. Reduced saliva secretion under pilocarpine stimulation in AQP5-null mice compared with normal mice further indicates the importance of AQP5 in this process, at least in stimulated saliva secretion. Questions remain therefore regarding the role and importance of AQP5 in basal saliva secretion. It has been speculated that there would be some short-term regulation of AQP5 such as a trafficking mechanism to regulate saliva secretion. However, no histochemical evidence of AQP5-trafficking has been found, although some of biochemical analyses suggested that it may occur. There are no reports of human disease caused by AQP5 mutations, but some studies have revealed an abnormal subcellular distribution of AQP5 in patients or animals with xerostomia caused by Sjögren’s syndrome and X-irradiation. These findings suggest the possible pathophysiological importance of AQP5 in the salivary glands.

Matsuzaki, Toshiyuki; Susa, Taketo; Shimizu, Kinue; Sawai, Nobuhiko; Suzuki, Takeshi; Aoki, Takeo; Yokoo, Satoshi; Takata, Kuniaki

2012-01-01

166

[Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3)].  

PubMed

The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for (131)I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative (131)I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC < or =1 cm (131)I ablation may be helpful in an individual constellation. Preparation for (131)I ablation requires low iodine diet for two weeks and TSH-stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lower blood activity) and the advantages of endogenous TSH-stimulation (necessary for (131)I-therapy in patients with metastases, higher sensitivity of (131)I whole-body scan) are discussed. In most centers standard activities are used for (131)I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of (131)I should not exceed 1-10 MBq, alternative tracers are (123)I or (124)I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene. PMID:17938757

Dietlein, M; Dressler, J; Eschner, W; Grünwald, F; Lassmann, M; Leisner, B; Luster, M; Moser, E; Reiners, Chr; Schicha, H; Schober, O

2007-01-01

167

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

2013-10-01

168

Oral findings in postmenopausal women attending dental hospital in Western part of India  

PubMed Central

Objectives: To know the nature, incidence and severity of oral manifestations occurring in postmenopausal women. Study design: Oral changes were observed in 365 postmenopausal women and 365 age matched male individuals attending the department of Oral Medicine and Radiology. The patients were asked about complaints of dry mouth, taste and breath changes, mucosal and facial pain and were examined for oral changes such as ulceration, white and red lesions. The results obtained from the study were then correlated with various other similar studies. Results: The important oral findings in postmenopausal women were mucosal burning/pain (25.8%), dry mouth (27.1%), altered taste (3.6%), altered breath (6.3%) and facial pain (3.6%). Oral submucous fibrosis (OSMF) was significantly more common in males (5.5%) as compared to postmenopausal females (1.9%). Conclusion: Results from the present study reveal that oral symptoms are common problems in postmenopausal women. Postmenopausal patients showed significantly more oral changes than the control. These changes could be related to the hormone alterations. Therefore, dentists need to refer postmenopausal women with oral symptoms to a gynaecologist for more careful examinations and medical interventions if necessary. Key words:Menopause; postmenopause; xerostomia; pallor; oral changes.

Nidhi, Sinha; Sumita, Kaswan; Farzan, Rahman; Bharati, Doni; Ashok, KP

2013-01-01

169

Burning mouth syndrome.  

PubMed

Burning mouth syndrome is a debilitating medical condition affecting nearly 1.3 million of Americans. Its common features include a burning painful sensation in the mouth, often associated with dysgeusia and xerostomia, despite normal salivation. Classically, symptoms are better in the morning, worsen during the day and typically subside at night. Its etiology is largely multifactorial, and associated medical conditions may include gastrointestinal, urogenital, psychiatric, neurologic and metabolic disorders, as well as drug reactions. BMS has clear predisposition to peri-/post menopausal females. Its pathophysiology has not been fully elucidated and involves peripheral and central neuropathic pathways. Clinical diagnosis relies on careful history taking, physical examination and laboratory analysis. Treatment is often tedious and is aimed at correction of underlying medical conditions, supportive therapy, and behavioral feedback. Drug therapy with alpha lipoic acid, clonazepam, capsaicin, and antidepressants may provide symptom relief. Psychotherapy may be helpful. Short term follow up data is promising, however, long term prognosis with treatment is lacking. BMS remains an important medical condition which often places a recognizable burden on the patient and health care system and requires appropriate recognition and treatment. PMID:23429751

Gurvits, Grigoriy E; Tan, Amy

2013-02-01

170

Evaluation of salivary calcium and salivary parathyroid levels in postmenopausal women with and without oral dryness  

PubMed Central

Objective: The primary objective of this study is to estimate and secondary objective is to compare the salivary calcium levels, salivary parathyroid hormone (PTH) levels in postmenopausal women with and without oral dryness (OD). Materials and Methods: A case-control study was carried out on 80 selected postmenopausal women. Salivary calcium concentrations were assessed through Semi Autoanalyzer by Arsenazo III reaction. The salivary PTH concentration was measured by the enzyme linked immunosorbent assay. Severity of OD was assessed by a questionnaire through which the xerostomia inventory (XI) score could be measured. Statistical analysis of Student's t-test, Mann-Whitney test and Pearson's correlation was used. Results: There was a significant difference in mean values of both salivary calcium concentration and XI score in postmenopausal women with/without OD (P < 0.001). No statistically significant difference (P > 0.05) was found in salivary parathyroid levels in postmenopausal women in both groups. A positive correlation was found between the salivary calcium concentration and XI score in both case and control groups (P < 0.05). Conclusion: Severity of OD in postmenopausal women is associated with the high levels of salivary calcium. However, the correlation of severity of OD with PTH could not be established.

Singh, Balwinder; Sheikh, Soheyl; Pallagatti, Shambulingappa; Kaur, Kirandeep; Sohi, Ravinder

2013-01-01

171

[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

2013-01-01

172

Burning mouth syndrome  

PubMed Central

Burning mouth syndrome is a debilitating medical condition affecting nearly 1.3 million of Americans. Its common features include a burning painful sensation in the mouth, often associated with dysgeusia and xerostomia, despite normal salivation. Classically, symptoms are better in the morning, worsen during the day and typically subside at night. Its etiology is largely multifactorial, and associated medical conditions may include gastrointestinal, urogenital, psychiatric, neurologic and metabolic disorders, as well as drug reactions. BMS has clear predisposition to peri-/post menopausal females. Its pathophysiology has not been fully elucidated and involves peripheral and central neuropathic pathways. Clinical diagnosis relies on careful history taking, physical examination and laboratory analysis. Treatment is often tedious and is aimed at correction of underlying medical conditions, supportive therapy, and behavioral feedback. Drug therapy with alpha lipoic acid, clonazepam, capsaicin, and antidepressants may provide symptom relief. Psychotherapy may be helpful. Short term follow up data is promising, however, long term prognosis with treatment is lacking. BMS remains an important medical condition which often places a recognizable burden on the patient and health care system and requires appropriate recognition and treatment.

Gurvits, Grigoriy E; Tan, Amy

2013-01-01

173

Changes in functioning of rat submandibular salivary gland under streptozotocin-induced diabetes are associated with alterations of Ca2+ signaling and Ca2+ transporting pumps.  

PubMed

Xerostomia and pathological thirst are troublesome complications of diabetes mellitus associated with impaired functioning of salivary glands; however, their cellular mechanisms are not yet determined. Isolated acinar cells were loaded with Ca2+ indicators fura-2/AM for measuring cytosolic Ca2+ concentration ([Ca2+]i) or mag-fura-2/AM-inside the endoplasmic reticulum (ER). We found a dramatic decrease in pilocarpine-stimulated saliva flow, protein content and amylase activity in rats after 6 weeks of diabetes vs. healthy animals. This was accompanied with rise in resting [Ca2+]i and increased potency of acetylcholine (ACh) and carbachol (CCh) but not norepinephrine (NE) to induce [Ca2+]i transients in acinar cells from diabetic animals. However, [Ca2+]i transients mediated by Ca2+ release from ER stores (induced by application of either ACh, CCh, NE, or ionomycin in Ca2+-free extracellular medium) were decreased under diabetes. Application of inositol-1,4,5-trisphosphate led to smaller Ca2+ release from ER under the diabetes. Both plasmalemma and ER Ca2+-ATPases activity was reduced and the latter showed the increased affinity to ATP under the diabetes. We conclude that the diabetes caused impairment of salivary cells functions that, on the cellular level, associates with Ca2+ overload, increased Ca2+-mobilizing ability of muscarinic but not adrenergic receptors, decreased Ca2+-ATPases activity and ER Ca2+ content. PMID:16443349

Fedirko, N V; Kruglikov, I A; Kopach, O V; Vats, J A; Kostyuk, P G; Voitenko, N V

2006-03-01

174

[AIDS--mucous membrane manifestations].  

PubMed

In the course of the infection with the human immunodeficiency virus (HIV), we frequently observe disorders of the mucous membranes and, occasionally, they present the first manifestation of HIV-induced immunodeficiency. Like in other organs, opportunistic infections and malignant tumors prevail as a result of the impaired immune system. Opportunistic infections are characterized by frequency (candidiasis), aggressive expansion, persistence, frequent recurrences, and resistance to therapy (gingivitis, parodontitis, herpes simplex, warts). Oral hairy leucoplakia is considered a specific lesion of HIV infection. Malignant tumors, such as Kaposi's sarcoma, non-Hodgkin's lymphoma, and squamous cell carcinoma, may cause marked morbidity in AIDS patients; occasionally, the clinical picture of Kaposi's sarcoma and non-Hodgkin's lymphoma is rather uncharacteristic. Other manifestations on the mucous membranes may arise in association with systemic reactions, such as drug eruptions, thrombocytopenic purpura, or acute HIV infection. The etiology of still other lesions of the mucous membranes (e.g. chronic recurrent ulcers, xerostomia, disorders of pigmentation) is incompletely understood. The awareness of these disorders of the mucous membranes in HIV infection is of diagnostic, therapeutic and epidemiological importance. PMID:2205062

Pichler, E; Zangerle, R; Puelacher, W; Waldhart, E; Hintner, H; Fritsch, P

1990-07-01

175

Oral health status in haemodialysis patients.  

PubMed

Objective: To assess the oral and dental manifestations in non- diabetic and diabetic uraemic patients who were undergoing haemodialysis and to estimate and compare the salivary pH in these two groups. Material and Methods: Ninety Seven uraemic patients who were undergoing maintenance haemodialysis were included in the study. Subjective and objective findings were evaluated and recorded in a specially designed proforma. Predialytic unstimulated whole salivary pH was recorded by using pH-measuring strips. Dental health assessment consisted of DMFT and CPITN indices. Results: A subjective oral manifestation of dysguesia was found to be more significant in non-diabetic patients (p<0.008). Statistically, a high significance was observed with mucosal petechiae in 31.9% patients of diabetic group .The overall DMFT score was significantly higher in diabetic group. A moderate significance was found with a CPI score of 5 (p<0.015). The pH of saliva was significantly higher among diabetic patients. Conclusion: The diabetic subjects who were on haemodialysis were at a high risk for developing periodontal disease and they exhibited a potential threat for dental decay and xerostomia. A lower salivary pH and a poor glycaemic control may affect their oral health. Further research is required to clarify the combined influence of diabetic nephropathy on oral health. PMID:24179940

Swapna, Lingam Amara; Reddy, Reddy Sudhakara; Ramesh, Tatapudi; Reddy, Reddy Lavanya; Vijayalaxmi, Nimma; Karmakar, Partha; Pradeep, Koppolu

2013-09-01

176

Complementary Strategies for the Management of Radiation Therapy Side Effects  

PubMed Central

Patients with cancer utilize complementary and alternative medicine (CAM) for a variety of purposes, one of which is the reduction of side effects of conventional treatment. With a large number of their patients using CAM, it is important for advanced practitioners in oncology to have an understanding of these therapies to better guide their patients. Side effects of radiation therapy that may have dose-limiting poten­tial include diarrhea, mucositis, skin toxicity, and xerostomia. A com­mon side effect that is not necessarily dose-limiting but considerably troublesome to patients is cancer- and treatment-related fatigue. The CAM therapies that may alleviate some of the side effects of radiation therapy include probiotics, psyllium, exercise, melatonin, honey, acu­puncture, and calendula. Therapies that require more research or have been shown to be ineffective include aloe vera, glutamine, and deglyc­yrrhizinated licorice. This article provides an overview of these thera­pies as well as related research and analysis.

Stubbe, Christine E.; Valero, Meighan

2013-01-01

177

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

178

[Safety of radioiodine therapy in patients with thyroid carcinoma younger than 21 years].  

PubMed

We studied 20 patients with differentiated thyroid carcinoma undergoing radioiodine therapy (> or = 100 mCi dose) before the age of 21: 10 patients without distant metastases received a mean dose of 145 mCi and 10 with lung involvement received 270 mCi. One or more years after ablative therapy, xerostomia was present in two patients but was not accompanied by more severe complications such as oral ulcers or fissures, and 99mTcO4- scintigraphy confirmed salivary dysfunction. One patient showed keratoconjunctivitis sicca. Blood counts did not reveal abnormalities caused by radioiodine therapy. FSH was normal in 18 patients. Patients with elevated levels had received radioiodine just over a year ago and repetition of the exam after 6 months showed that FSH had returned to normal. The 6 male patients had normal LH and testosterone levels. Analysis did not reveal signs of pulmonary fibrosis secondary to treatment in the 10 cases with iodine-accumulating metastases in this organ. Our data suggest that ablative therapy employing a dose of 100 to 300 mCi is safe in young individuals, but persistent complications such as salivary dysfunction and conjunctivitis may occur. PMID:16184252

Rosário, Pedro Weslley S; Cardoso, Ludmilla David; Barroso, Alvaro Luís; Padrão, Eduardo L; Rezende, Leonardo Lamego; Purisch, Saulo

2005-04-01

179

Loss of TRPM2 function protects against irradiation-induced salivary gland dysfunction  

PubMed Central

Xerostomia as a result of salivary gland damage is a permanent and debilitating side effect of radiotherapy for head and neck cancers. Effective treatments for protecting, or restoring, salivary gland function are not available. Here we report that irradiation treatment leads to activation of the calcium-permeable channel, transient potential melastatin-like 2 (TRPM2), via stimulation of poly-ADP-ribose polymerase. Importantly, irradiation induced an irreversible loss of salivary gland fluid secretion in TRPM2+/+ mice while a transient loss was seen in TRPM2?/? mice with >60% recovery by 30 days after irradiation. Treatment of TRPM2+/+ mice with the free radical scavenger Tempol or the PARP1 inhibitor 3-aminobenzamide attenuated irradiation-induced activation of TRPM2 and induced significant recovery of salivary fluid secretion. Furthermore, TPL (4-hydroxy-2,2,6,6-tetramethylpiperidine- N-oxyl) induced complete recovery of function in irradiated TRPM2?/? mice. These novel data demonstrate that TRPM2 is activated by irradiation, via PARP1 activation, and contributes to irreversible loss of salivary gland function.

Liu, Xibao; Cotrim, Ana; Teos, Leyla; Zheng, Changyu; Swaim, William; Mitchell, James; Mori, Yasuo; Ambudkar, Indu

2014-01-01

180

Interventions for edentate elders--what is the evidence?  

PubMed

Demographic developments indicate an increasing proportion of elderly persons in the population as well as longer life expectancies. Furthermore, the prevalence of edentulism is decreasing, and natural teeth are being retained until later in life. Geriatric patients are more frequently fragile with multiple co-morbidities, including frequent medication-related side effects such as xerostomia. Cognitive impairment also increases with age and presents a considerable challenge to oral hygiene and dental treatment. Edentulous patients present a particular challenge, as muscle skill and the ability to adapt to a new denture diminish with age. Duplication techniques reduce the adaptation of replacement dentures, and implants are increasingly used to stabilise lower complete dentures, significantly improving chewing efficiency and preventing peri-implant bone loss. Implant overdentures may reverse some of the functional, psychological and psychosocial effects of tooth loss and thus increase the oral health-related quality of life until late in life. Evidence from RCTs exists on the 10-year survival of implants and implant overdentures, but few studies have investigated the problems and survival rates when the patient loses autonomy. The standard of care in geriatric patients has to be adapted to the patient's motivation, functional and cognitive impairment, and medical condition as well as his/her socio-economic context. PMID:24446979

Müller, Frauke

2014-02-01

181

Systemic anaplastic large cell lymphoma presenting with cutaneous manifestations in a young man: a case report.  

PubMed

Skin lesions can be a sign of internal disease. When they are associated with persisting systemic signs, the possibility of an internal malignancy should always be considered. We describe a 25-year-old man who presented with weight loss, fatigue, subpyrexia, xerostomia and skin rash of 6 months duration. Physical examination showed a dry red skin, most prominent in the face, the palms of the hands and the soles of the feet. Laboratory investigations revealed signs of inflammation and a high level of antinuclear antibodies. Retroperitoneal lymph nodes were visualized on a CT scan of the abdomen. CT-guided biopsy of an abdominal lymph node revealed the presence of an anaplastic large cell lymphoma (ALCL), ALK-positive. A biopsy of the skin showed non-specific signs of inflammation.The patient underwent 8 cycles of chemotherapy according to the CHOP protocol. A complete remission was obtained. Non-Hodgkin lymphoma can indeed be associated with skin lesions. They result from direct invasion by malignant cells or are of paraneoplastic origin, as was the case in this patient. PMID:22712169

Vande Walle, N; Van den Enden, E; Fostier, K; De Coninck, A; Nieboer, K; Velkeniers, B; Lacor, P

2012-01-01

182

[Oral health in the EpiFloripa: a prospective study of adult health in Southern Brazil].  

PubMed

Objective: To describe methods and challenges of oral health studies nested in a prospective cohort study of adults. Methods: A sample of 2,016 adults was investigated in 2009. Household visits were performed in order to apply a questionnaire on socioeconomic, demographic, health related variables, medicine consumption, blood donation, domestic violence and a set of questions related to women's health. Oral health data included self-reported oral health, number of remaining teeth, dental services use, perception of dental treatment needs, occurrence, intensity and impact of dental pain on daily life, xerostomia and chewing impairment due to poor oral health. In addition, participants' blood pressure, weight, height and waist circumference were measured. The second wave of the study was carried out in 2012. A questionnaire on socioeconomic factors, quality of life, discriminatory experiences, 24-hour dietary recall and oral health aspects (the same used in 2009) was applied. In addition, blood pressure, weight, and waist circumference were measured and clinical oral health status was assessed (dental caries, tooth loss, and periodontal outcomes). Results: Participation rate was 85.3% (n = 1,720) in 2009 and, among those, 1,222 (71.1%) were followed up in 2012. Conclusions: The follow-up of this population will contribute in the elucidation of the potentially causal associations between oral outcomes and general chronic diseases. PMID:24918424

Peres, Marco Aurelio; Peres, Karen Glazer; Boing, Antonio Fernando; Bastos, João Luiz; Silva, Diego Augusto; González-Chica, David Alejandro

2014-06-01

183

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

184

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

185

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

PubMed

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. PMID:6609705

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

186

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

187

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

188

[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

2013-08-01

189

Perlecan Domain IV Peptide Stimulates Salivary Gland Cell Assembly In Vitro  

PubMed Central

Treatment of xerostomia would benefit from development of a functional implantable artificial salivary gland. Salivary gland tissue from surgical patients was assessed by histology and immunohistochemistry to establish the phenotype of normal salivary gland cells including the native basement membranes. Ductal and acinar cells were identified in tissue and cultured cells from dispersed tissue. High levels of laminin and perlecan/HSPG2 (heparan sulfate proteoglycan 2) 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™ or a bioactive peptide derived from domain IV of perlecan. On either matrix, large acini-like lobular structures grew and formed connections between the lobes. ?-Amylase secretion was confirmed by staining and activity assay. Biomarkers, including tight junction protein E-cadherin and water channel protein aquaporin 5 found in tissue, were expressed in cultured acinar cells. Cells cultured on Matrigel or domain IV of perlecan peptide organized stress fibers and activated focal adhesion kinase. We report a novel technique to isolate acinar cells from human salivary gland and identify a human peptide sequence in perlecan that triggers differentiation of salivary gland cells into self-assembling acini-like structures that express essential biomarkers and which secrete ?-amylase.

Pradhan, Swati; Zhang, Chu; Jia, Xinqiao; Carson, Daniel D.; Witt, Robert

2009-01-01

190

Radioprotective Effect of Lidocaine on Function and Ultrastructure of Salivary Glands Receiving Fractionated Radiation  

SciTech Connect

Purpose: Radiation-induced xerostomia still represents a common side effect after radiotherapy for head-and-neck malignancies. The aim of the present study was to examine the radioprotective effect of lidocaine hydrochloride during fractionated radiation in an experimental animal model. Methods and Materials: To evaluate the influence of different radiation doses on salivary gland function and the radioprotective effect of lidocaine, rabbits were irradiated with 15, 25, 30, and 35 Gy (equivalent doses in 2-Gy fractions equivalent to 24, 40, 48, and 56 Gy, respectively). Lidocaine hydrochloride (10 and 12 mg/kg) was administered before every radiation fraction in the treatment groups. Salivary gland function was assessed by flow sialometry and sialoscintigraphy, and the morphologic changes were evaluated using transmission electron microscopy. Results: Functional impairment was first observed after 35 Gy and pretreatment with lidocaine improved radiation tolerance of both parotid and submandibular glands. The use of 12 mg/kg lidocaine was superior and displayed significant radioprotection with regard to flow sialometry and sialoscintigraphy. The ultrastructure was largely preserved after pretreatment with both lidocaine doses. Conclusions: Lidocaine represents an effective radioprotective agent and a promising approach for clinical application to avoid radiation-induced functional impairment of salivary glands.

Hakim, Samer George, E-mail: samer.hakim@mkg-chir.mu-luebeck.de [Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck (Germany); Benedek, Geza Attila [Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck (Germany); Su Yuxiong [Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck (Germany); Department of Oral and Maxillofacial Surgery, Sun Yat-Sen University, Guanghua School of Stomatology, Guanghua (China); Jacobsen, Hans Christian [Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck (Germany); Klinger, Matthias [Institute of Anatomy, University of Luebeck, Luebeck (Germany); Dendorfer, Andreas [Institute of Experimental and Clinical Pharmacology and Toxicology, University of Luebeck, Luebeck (Germany); Hemmelmann, Claudia [Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck (Germany); Meller, Birgit [Department of Radiology and Nuclear Medicine, University of Luebeck, Luebeck (Germany); Nadrowitz, Roger; Rades, Dirk [Department of Radiation Oncology, University of Luebeck, Luebeck (Germany); Sieg, Peter [Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck (Germany)

2012-03-15

191

Oral lichen planus - retrospective study of 563 Croatian patients.  

PubMed

Objectives: To investigate the epidemiological and clinical characteristics of oral lichen planus (OLP) in a group of Croatian patients seen between 2006 and 2012. Study Design: A group of 563 patients with a diagnosis of OLP was retrospectively reviewed in our clinic. Data regarding age, gender, medical history, drugs, smoking, alcohol, chief complaint, clinical type, localization, histology, treatment and malignant transformation were registered. Results: Of the 563 patients, 414 were females and 149 were males. The average age at the diagnosis was 58 (range 11-94). The most common site was buccal mucosa (82.4%). Most of our patients did not smoke (72.5%) or consume alcohol (69.6%). Patients reported oral soreness (43.3%), mucosal roughness (7%), xerostomia (3%), gingival bleeding (2%) and altered taste (0.5%) as the chief complaint, while almost half of them were asymptomatic (44.2%). The most common types of OLP were reticular (64.8%) and erosive (22.9%). Plaque-like (5.7%) atrophic/erythemtous (4.3%) and bullous (2.3%) type were also observed. Malignant transformation rate of 0.7% was recorded. Conclusions: OLP mostly affects non-smoking middle-aged women. Buccal mucosa is the most commonly affected site. In almost half of the cases patients are asymptomatic. In spite of the small risk for malignant transformation all patients should be regularly monitored. PMID:24608217

Budimir, V; Richter, I; Andabak-Rogulj, A; Vu?i?evi?-Boras, V; Budimir, J; Brailo, V

2014-01-01

192

Oral lichen planus - retrospective study of 563 Croatian patients  

PubMed Central

Objectives: To investigate the epidemiological and clinical characteristics of oral lichen planus (OLP) in a group of Croatian patients seen between 2006 and 2012. Study Design: A group of 563 patients with a diagnosis of OLP was retrospectively reviewed in our clinic. Data regarding age, gender, medical history, drugs, smoking, alcohol, chief complaint, clinical type, localization, histology, treatment and malignant transformation were registered. Results: Of the 563 patients, 414 were females and 149 were males. The average age at the diagnosis was 58 (range 11-94). The most common site was buccal mucosa (82.4%). Most of our patients did not smoke (72.5%) or consume alcohol (69.6%). Patients reported oral soreness (43.3%), mucosal roughness (7%), xerostomia (3%), gingival bleeding (2%) and altered taste (0.5%) as the chief complaint, while almost half of them were asymptomatic (44.2%). The most common types of OLP were reticular (64.8%) and erosive (22.9%). Plaque-like (5.7%) atrophic/erythemtous (4.3%) and bullous (2.3%) type were also observed. Malignant transformation rate of 0.7% was recorded. Conclusions: OLP mostly affects non-smoking middle-aged women. Buccal mucosa is the most commonly affected site. In almost half of the cases patients are asymptomatic. In spite of the small risk for malignant transformation all patients should be regularly monitored. Key words:Oral lichen planus, malignant transformation, epidemiology, retrospective study.

Budimir, Vice; Richter, Ivica; Andabak-Rogulj, Ana; Vucicevic-Boras, Vanja

2014-01-01

193

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

194

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

195

Dietetic management in gastrointestinal complications from antimalignant chemotherapy.  

PubMed

Antineoplastic chemotherapy (CT) represents the systemic treatment of malignant tumors. It can be used alone or combined with surgery and / or radiotherapy. The cytotoxic agents used in chemotherapy work on both cancerous cells and noncancerous cells of the body, generally resulting in high toxicity. The biological aggressiveness of chemotherapy particularly affects rapidly replicating cells, such as those of the digestive tract, resulting in adverse effects that impair food intake, leading to compromised nutritional status and which may lead to cachexia. The main toxic effects of chemotherapy in the gastrointestinal tract include nausea, vomiting -these are the most frequent- constipation, diarrhea, xerostomia, mucositis, dysphagia and anorexia. Given the high frequency of such effects, nutritional intervention should be an integral part of cancer treatment, to maintain and/or improve the patient's nutritional status and reduce or minimize the side effects caused by treatment. Accordingly, the goal of this study is to review dietetic conduct in the process of caring for patients undergoing cancer chemotherapy. PMID:22566305

Calixto-Lima, L; Martins de Andrade, E; Gomes, A P; Geller, M; Siqueira-Batista, R

2012-01-01

196

Sicca symptoms and their impact on quality of life among very long-term survivors after hematopoietic SCT.  

PubMed

The objective of this prospective cross-sectional case-control study was to examine the prevalence of dryness symptoms and its impact on quality of life (QoL) among very long-term survivors after hematopoietic SCT (HSCT) in comparison with their respective sibling donors. Forty-four allogeneic HSCT recipients with a long-term survival (median: 17.5; range: 11-26 years) were included. Their respective, HLA-identical sibling donors served as controls. Clinical examinations included saliva flow rates (SFR) and the Schirmer's test. The presence of sicca symptoms of mouth, eyes and skin were inquired. The social functioning (SF)-36 questionnaire was applied. Recipients had lower (P<0.01) unstimulated and stimulated mean SFR than donors. Schirmer's test results <5 mm was found in 45% of the recipients in comparison with 27% of the donors (P = 0.07). Xerostomia (34 vs 4 subjects), xerophtalmia (23 vs 3) and dry skin (32 vs 12) were reported more often by the recipients than donors (P<0.001). Sicca symptoms and their objective findings correlated with QoL. The mean SF-36 scores of the donors were significantly higher than those of the recipients for physical component summary. In conclusion, sicca symptoms are common amongst long-term survivors of HSCT and affect remarkably the QoL. PMID:23292241

Daikeler, T; Mauramo, M; Rovó, A; Stern, M; Halter, J; Buser, A; Tyndall, A; Häusermann, P; Gratwohl, A; Tichelli, A; Brennan, M T; Waltimo, T

2013-07-01

197

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

198

Mature Results of a Randomized Trial of Accelerated Hyperfractionated Versus Conventional Radiotherapy in Head-and-Neck Cancer  

SciTech Connect

Purpose: To evaluate long-term late adverse events and treatment outcome of a randomized, multicenter Phase III trial of continuous, hyperfractionated, accelerated radiotherapy (CHART) compared with conventional radiotherapy (CRT) in 918 patients with advanced squamous cell carcinomas of the head and neck. Methods and Materials: Survival estimates were obtained for locoregional relapse-free survival, local relapse-free survival, overall survival, disease-specific survival, disease-free survival and for late adverse events. Results: The 10-year estimates (+-1 standard error) for locoregional relapse-free survival, overall survival, disease-free survival, and disease-specific survival were 43% +- 2% for CHART and 50% +- 3% with CRT (log-rank p = 0.2); 26% +- 2% and 29% +- 3% (p = 0.4), respectively; 41% +- 2% and 46% +- 3% (p = 0.3), respectively; and 56% +- 3% and 58% +- 3% (p = 0.5), respectively. There was a small but significant reduction in the incidence of slight or worse and moderate or worse epidermal adverse events with CHART (p = 0.002 to 0.05). Severe xerostomia, laryngeal edema, and mucosal necrosis were also significantly lower with CHART (p = 0.02 to 0.05). Conclusions: Despite the reduction in total dose from 66 Gy to 54 Gy, control of locoregional disease and survival with CHART were similar to those with CRT. These findings, together with the low incidence of long-term severe adverse events, suggest that CHART is a treatment option for patients with low-risk disease and for those unable to withstand the toxicity of concurrent chemoradiotherapy.

Saunders, Michele I. [Marie Curie Research Wing, Mount Vernon Hospital, Northwood (United Kingdom); Academic Department of Oncology, University College Hospital, London (United Kingdom); Rojas, Ana M., E-mail: arc03@btconnect.co [Marie Curie Research Wing, Mount Vernon Hospital, Northwood (United Kingdom); Parmar, Mahesh K.B. [Medical Research Council Clinical Trials Office, London (United Kingdom); Dische, Stanley [Marie Curie Research Wing, Mount Vernon Hospital, Northwood (United Kingdom)

2010-05-01

199

Prevalence of Oral Mucosal Lesions in an Adult Iranian Population  

PubMed Central

Background Nowadays the importance of oral health to life quality is not obvious to anyone in our world. Oral lesions can interfere with daily social activities in involved patients through impacts on mastication, swallowing and speech and symptoms like xerostomia, halitosis or dysesthesia. Objectives To assess the prevalence and types of oral lesions in a general population in Rasht, Northern Province of Iran. Patients and Methods 1581 people aged > 30 years old who were inhabitant of Rasht, Iran, enrolled in a cross-sectional study. For each individual a detailed questionnaire based on the world health organization (WHO) guidelines in order to diagnosis of the lesions was filled and it contained all the required data. Participants were divided into two groups with and without oral mucosal lesions and oral mucosal lesions were divided into two groups with and without. Demographic characteristics and clinical information including age, sex, smoking (cigarette and tobacco), opium consumption, medication and oral and dental hygiene were collected and compared between these two groups. Results The prevalence of mucosal lesions in our study was 19.4%. Our data demonstrated higher prevalence of oral mucosal lesions in males and young adults (30-40 years). The most common mucosal lesion among our participants was Fissured tongue(4%), followed by Fordyce granules(2.8%), geographic tongue(2.6%) , Pigmentation(2.5%), Candida(1.8%), Smoker Plate(1.6%), lingual Varices(1.5%), Petechiae(1.4%) and lingual labial(1.4%) . Leukoplakia was observed only in two people (0.1%).No case of malignant lesions was detected. No statistically significant difference was confirmed between the two groups regarding smoking, opium consumption, medication and oral and dental hygiene. Conclusions Our data has provided baseline information about epidemiologic aspects of oral mucosal lesions which can be valuable in organized national program targeting on oral health and hygiene in the society.

Mansour Ghanaei, Fariborz; Joukar, Farahnaz; Rabiei, Maryam; Dadashzadeh, Alireza; Kord Valeshabad, Ali

2013-01-01

200

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

201

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

PubMed Central

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/m2. 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.

Eldeeb, Hany; Hamed, Rasha Hamdy

2012-01-01

202

Pilocarpine modulates the cellular electrical properties of mammalian hearts by activating a cardiac M3 receptor and a K+ current  

PubMed Central

Pilocarpine, a muscarinic acetylcholine receptor (mAChR) agonist, is widely used for treatment of xerostomia and glaucoma. It can also cause many other cellular responses by activating different subtypes of mAChRs in different tissues. However, the potential role of pilocarpine in modulating cardiac function remained unstudied.We found that pilocarpine produced concentration-dependent (0.1–10??M) decrease in sinus rhythm and action potential duration, and hyperpolarization of membrane potential in guinea-pig hearts. The effects were nearly completely reversed by 1??M atropine or 2?nM 4DAMP methiodide (an M3-selective antagonist).Patch-clamp recordings in dispersed myocytes from guinea-pig and canine atria revealed that pilocarpine induces a novel K+ current with delayed rectifying properties. The current was suppressed by low concentrations of M3-selective antagonists 4DAMP methiodide (2–10?nM), 4DAMP mustard (4–20?nM, an ackylating agent) and p-F-HHSiD (20–200?nM). Antagonists towards other subtypes (M1, M2 or M4) all failed to alter the current.The affinity of pilocarpine (KD) at mAChRs derived from displacement binding of [3H]-NMS in the homogenates from dog atria was 2.2??M (65% of the total binding) and that of 4DAMP methiodide was 2.8?nM (70% of total binding), consistent with the concentration of pilocarpine needed for the current induction and for the modulation of the cardiac electrical activity and the concentration of 4DAMP to block pilocarpine effects.Our data indicate, for the first time, that pilocarpine modulates the cellular electrical properties of the hearts, likely by activating a K+ current mediated by M3 receptors.

Wang, Huizhen; Shi, Hong; Lu, Yanjie; Yang, Baofeng; Wang, Zhiguo

1999-01-01

203

Early Hyperbaric Oxygen Therapy for Reducing Radiotherapy Side Effects: Early Results of a Randomized Trial in Oropharyngeal and Nasopharyngeal Cancer  

SciTech Connect

Purpose: Comparison of quality of life (QoL) and side effects in a randomized trial for early hyperbaric oxygen therapy (HBOT) after radiotherapy (RT). Methods and Materials: From 2006, 19 patients with tumor originating from the tonsillar fossa and/or soft palate (15), base of tongue (1), and nasopharynx (3) were randomized to receive HBOT or not. HBOT consisted of 30 sessions at 2.5 ATA (15 msw) with oxygen breathing for 90 min daily, 5 days per week, applied shortly after the RT treatment was completed. As of 2005, all patients received validated questionnaires (i.e., the European Organization for Research and Treatment of Cancer [EORTC] QLQ-C30, EORTC QLQ Head and Neck Cancer Module (H and N35), Performance Status Scale): before treatment; at the start of RT treatment; after 46 Gy; at the end of RT treatment; and 2, 4, and 6 weeks and 3, 6, 12, and 18 months after follow-up. Results: On all QoL items, better scores were obtained in patients treated with hyperbaric oxygen. The difference between HBOT vs. non-HBOT was significant for all parameters: EORTC H and N35 Swallowing (p = 0.011), EORTC H and N35 Dry Mouth (p = 0.009), EORTC H and N35, Sticky Saliva (p = 0.01), PSS Eating in Public (p = 0.027), and Pain in Mouth (visual analogue scale; p < 0.0001). Conclusions: Patients randomized for receiving hyperbaric oxygen after the RT had better QoL scores for swallowing, sticky saliva, xerostomia, and pain in mouth.

Teguh, David N. [Department of Radiation Oncology, Rotterdam (Netherlands); Levendag, Peter C., E-mail: p.levendag@erasmusmc.n [Department of Radiation Oncology, Rotterdam (Netherlands); Noever, Inge; Voet, Peter; Est, Henrie van der; Rooij, Peter van [Department of Radiation Oncology, Rotterdam (Netherlands); Dumans, Antoine G. [Department of Maxillofacial Surgery, Rotterdam (Netherlands); Boer, Maarten F. de [Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam (Netherlands); Huls, Michiel van der; Sterk, Wouter [Institute for Hyperbaric Medicine, Rotterdam (Netherlands); Schmitz, Paul [Department of Biostatistics of Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

2009-11-01

204

Impact of Radiotherapy Dose on Dentition Breakdown in Head and Neck Cancer Patients  

PubMed Central

Purpose To evaluate the severity of post-radiation dental lesions and possible correlation with radiation dose to the teeth in patients treated for head and neck cancers. Methods and Materials Data from 93 head and neck radiotherapy patients treated between 1997 and 2008 were analyzed retrospectively. The main effect, radiation dose to the individual teeth, was evaluated with covariates of elapsed time after radiation, xerostomia, topical fluoride use, and oral hygiene status included. Patients’ radiotherapy plans were used to calculate cumulative exposure for each tooth. Patients’ teeth were evaluated using a validated index and then categorized as having none/slight or moderate/severe post-radiation damage. Results Patients (31 females, 62 males) ranged in age from 18–82 yrs (mean=57). The number of teeth/patient ranged from 3–30 (mean=20) with a total of 1873 teeth evaluated. Overall, 51% of teeth had moderate/severe damage, with the remaining having little or none. Using odds ratios and 95% confidence intervals, the odds for moderate/severe damage were 2–3x greater for teeth exposed to between 30–60 Gy as compared to no radiation. However, for teeth exposed to ?60 Gy as compared to no radiation the odds of moderate/severe tooth damage was greater by a magnitude of 10 times. Conclusions The results indicate that there is minimal tooth damage below 30 Gy (salivary gland threshold), a greater than 1:1 increased dose-response between 30–60y likely related to salivary gland damage, and a critical threshold of ?60Gy which may be linked to direct effects of radiation on tooth structure. These findings suggest that care should be taken during the treatment planning process to limit tooth dose, and when clinically possible to limit tooth dose to less than 60 Gy.

Walker, Mary P.; Wichman, Brian; Cheng, An-Lin; Coster, James; Williams, Karen B.

2011-01-01

205

Intensity-Modulated Radiotherapy for Head-and-Neck Cancer in the Community Setting  

SciTech Connect

Purpose: To review outcomes with intensity-modulated radiation therapy (IMRT) in the community setting for the treatment of nasopharyngeal and oropharyngeal cancer. Methods and Materials: Between April 2003 and April 2007, 69 patients with histologically confirmed cancer of the nasopharynx and oropharynx underwent IMRT in our practice. The primary sites included nasopharynx (11), base of tongue (18), and tonsil (40). The disease stage distribution was as follows: 2 Stage I, 11 Stage II, 16 Stage III, and 40 Stage IV. All were treated with a simultaneous integrated boost IMRT technique. The median prescribed doses were 70 Gy to the planning target volume, 59.4 Gy to the high-risk subclinical volume, and 54 Gy to the low-risk subclinical volume. Forty-five patients (65%) received concurrent chemotherapy. Toxicity was graded according to the Radiation Therapy Oncology Group toxicity criteria. Progression-free and overall survival rates were estimated with the Kaplan-Meier product-limit method. Results: Median duration of follow-up was 18 months. The estimated 2-year local control, regional control, distant control, and overall survival rates were 98%, 100%, 98%, and 90%, respectively. The most common acute toxicities were dermatitis (32 Grade 1, 32 Grade 2, 5 Grade 3), mucositis (8 Grade 1, 33 Grade 2, 28 Grade 3), and xerostomia (0 Grade 1, 29 Grade 2, 40 Grade 3). Conclusions: Intensity-modulated radiotherapy in the community setting can be accomplished safely and effectively. Systematic internal review systems are recommended for quality control until sufficient experience develops.

Seung, Steven [Division of Radiation Oncology, Oregon Clinic, Portland, OR (United States); Earle A. Chiles Research Institute, Providence Health System, Portland, OR (United States)], E-mail: steven.seung@providence.org; Bae, Joseph [Lewis and Clark College, Portland, OR (United States); Solhjem, Matthew; Bader, Stephen; Gannett, David; Hansen, Eric K.; Louie, Jeannie; Underhill, Kelly Cha Christine [Division of Radiation Oncology, Oregon Clinic, Portland, OR (United States)

2008-11-15

206

Ipsilateral Irradiation for Oral and Oropharyngeal Carcinoma Treated With Primary Surgery and Postoperative Radiotherapy  

SciTech Connect

Purpose: The purpose was to evaluate the contralateral nodal control (CLNC) in postoperative patients with oral and oropharyngeal cancer treated with ipsilateral irradiation of the neck and primary site. Late radiation-induced morbidity was also evaluated. Methods and Materials: The study included 123 patients with well-lateralized squamous cell carcinomas treated with surgery and unilateral postoperative irradiation. Most patients had tumors of the gingiva (41%) or buccal mucosa (21%). The majority of patients underwent surgery of the ipsilateral neck (n = 102 [83%]). The N classification was N0 in 73 cases (59%), N1 or N2a in 23 (19%), and N2b in 27 cases (22%). Results: Contralateral metastases developed in 7 patients (6%). The 5-year actuarial CLNC was 92%. The number of lymph node metastases was the only significant prognostic factor with regard to CLNC. The 5-year CLNC was 99% in N0 cases, 88% in N1 or N2a cases, and 73% in N2b cases (p = 0.008). Borderline significance (p = 0.06) was found for extranodal spread. Successful salvage could be performed in 71% of patients with contralateral metastases. The prevalence of Grade 2 or higher xerostomia was 2.6% at 5 years. Conclusions: Selected patients with oral or oropharyngeal carcinoma treated with primary surgery and postoperative ipsilateral radiotherapy have a very high CLNC with a high probability of successful salvage in case of contralateral metastases. However, bilateral irradiation should be applied in case of multiple lymph node metastases in the ipsilateral neck, particularly in the presence of extranodal spread. The incidence of radiation-induced morbidity is considerably lower as observed after bilateral irradiation.

Vergeer, Marije R., E-mail: mr.vergeer@vumc.n [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Doornaert, Patricia [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Jonkman, Anja [Department of Radiation Oncology, University Medical Center Groningen, Groningen (Netherlands); Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands); Ende, Piet L.A. van den [MAASTRO Clinic, Maastricht (Netherlands); Jong, Martin A. de [Department of Radiation Oncology, Leiden University Medical Center, Leiden (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)

2010-11-01

207

Freedom From Local and Regional Failure of Contralateral Neck With Ipsilateral Neck Radiotherapy for Node-Positive Tonsil Cancer: Results of a Prospective Management Approach  

SciTech Connect

Purpose: To review the outcomes of a prospective management approach using ipsilateral neck radiotherapy in the treatment of node-positive squamous cell carcinoma of the tonsil with a well-lateralized primary lesion. Methods and Materials: Between August 2003 and June 2007, 20 patients who presented with squamous cell carcinoma of the tonsil, without involvement of the base of the tongue or midline soft palate, and with Stage N1-N2b disease were prospectively treated with radiotherapy to the primary site and ipsilateral neck. In addition, 18 patients received concurrent chemotherapy. The actuarial freedom from contralateral nodal and in-field progression was determined. Acute and late toxicity were prospectively evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3, and Radiation Therapy Oncology Group criteria. Results: The nodal disease was Stage N1 in 4 patients, N2a in 3 patients, and N2b in 13 patients. At a median follow-up 19 months (range, 12-40), no in-field or contralateral nodal recurrences had been observed. The 2-year freedom from distant metastasis rate was 87.4%. The actuarial 2-year disease-free and overall survival rates were both 79.5%. Late Radiation Therapy Oncology Group grade 2 xerostomia occurred in 1 patient (5%). No late Grade 3 or greater toxicity was observed. No patient was feeding tube dependent at their last follow-up visit. Conclusion: In carefully selected patients with node-positive, lateralized tonsillar cancer, treatment of the ipsilateral neck and primary site does not appear to increase the risk of contralateral nodal failure and reduces late morbidity compared with historical controls. Although the outcomes with ipsilateral radiotherapy in the present series were promising, these findings require longer follow-up and validation in a larger patient cohort.

Rusthoven, Kyle E. [Department of Radiation Oncology, University of Colorado Health Sciences Center, Denver, Colorado (United States)], E-mail: kyle.rusthoven@uchsc.edu; Raben, David [Department of Radiation Oncology, University of Colorado Health Sciences Center, Denver, Colorado (United States); Schneider, Charles; Witt, Robert; Sammons, Sarah; Raben, Adam [Helen Graham Cancer Center, Head and Neck Multidisciplinary Group, Wilmington, Delaware (United States)

2009-08-01

208

Salivary gland cell differentiation and organization on micropatterned PLGA nanofiber craters.  

PubMed

There is a need for an artificial salivary gland as a long-term remedy for patients suffering from salivary hypofunction, a leading cause of chronic xerostomia (dry mouth). Current salivary gland tissue engineering approaches are limited in that they either lack sufficient physical cues and surface area needed to facilitate epithelial cell differentiation, or they fail to provide a mechanism for assembling an interconnected branched network of cells. We have developed highly-ordered arrays of curved hemispherical "craters" in polydimethylsiloxane (PDMS) using wafer-level integrated circuit (IC) fabrication processes, and lined them with electrospun poly-lactic-co-glycolic acid (PLGA) nanofibers, designed to mimic the three-dimensional (3-D) in vivo architecture of the basement membrane surrounding spherical acini of salivary gland epithelial cells. These micropatterned scaffolds provide a method for engineering increased surface area and were additionally investigated for their ability to promote cell polarization. Two immortalized salivary gland cell lines (SIMS, ductal and Par-C10, acinar) were cultured on fibrous crater arrays of various radii and compared with those grown on flat PLGA nanofiber substrates, and in 3-D Matrigel. It was found that by increasing crater curvature, the average height of the cell monolayer of SIMS cells and to a lesser extent, Par-C10 cells, increased to a maximum similar to that seen in cells grown in 3-D Matrigel. Increasing curvature resulted in higher expression levels of tight junction protein occludin in both cell lines, but did not induce a change in expression of adherens junction protein E-cadherin. Additionally, increasing curvature promoted polarity of both cell lines, as a greater apical localization of occludin was seen in cells on substrates of higher curvature. Lastly, substrate curvature increased expression of the water channel protein aquaporin-5 (Aqp-5) in Par-C10 cells, suggesting that curved nanofiber substrates are more suitable for promoting differentiation of salivary gland cells. PMID:23777914

Soscia, David A; Sequeira, Sharon J; Schramm, Robert A; Jayarathanam, Kavitha; Cantara, Shraddha I; Larsen, Melinda; Castracane, James

2013-09-01

209

Comparison of Oral Lesion Prevalence Between Renal Transplant Patients and Dialysis Patients  

PubMed Central

Objective: Renal transplantation is performed in patients with end stage renal disease as the best treatment plan. However, different complications may occur in these patients due to the direct consequences of the renal disease or drug-induced suppression of the body immune system. The main objective of the present study was to compare different oral lesions in patients receiving renal transplantation with the patients undergoing dialysis referred to two hospitals in Tehran, Iran. Materials and Methods: In this cross-sectional study, 93 renal transplant patients who had received renal transplant at least 6 months prior to our study, were selected from their records at the hospitals. Furthermore, 93 candidates of renal transplantation were selected as the control group. The patients in both case and control groups underwent oral examinations and the results were analyzed by chi-square test and Spearman correlation coefficient. Results: At least one oral lesion was found in 30 (32.2%) patients in the renal transplant group and 8 (8.6%) patents in the control subjects. The difference between the two groups was statistically significant (p<0.0001). The most prevalent lesion was xerostomia observed in 20 patients of the renal transplant group and 4 patients in the control group. The odds ratio of cyclosporine and amlodipine and the effect of these in increasing the risk of oral lesions was 1.21 and 1.02, respectively in renal transplant recipients. Conclusion: The results of the study showed that renal transplantation significantly increases the risk of related oral lesions. Therefore, renal transplant recipients must undergo regular oral examinations in order to find any suspicious lesion(s) as soon as possible to treat them.

Mansourian, Arash; Manouchehri, Amin; Shirazian, Shiva; Moslemi, Elham; Haghpanah, Golnaz

2013-01-01

210

Systematic Review of Acupuncture in Cancer Care: A Synthesis of the Evidence  

PubMed Central

Purpose Many cancer centers offer acupuncture services. To date, a comprehensive systematic review of acupuncture in cancer care has not been conducted. The purpose of this review was to evaluate the efficacy of acupuncture for symptom management in patients with cancer. Methods Medline, Embase, CINAHL, Cochrane (all databases), Scopus, and PubMed were searched from inception through December 2011 for prospective randomized clinical trials (RCT) evaluating acupuncture for symptom management in cancer care. Only studies involving needle insertion into acupuncture points were included. No language limitations were applied. Studies were assessed for risk of bias (ROB) according to Cochrane criteria. Outcomes by symptom were designated as positive, negative, or unclear. Results A total of 2,151 publications were screened. Of those, 41 RCTs involving eight symptoms (pain, nausea, hot flashes, fatigue, radiation-induced xerostomia, prolonged postoperative ileus, anxiety/mood disorders, and sleep disturbance) met all inclusion criteria. One positive trial of acupuncture for chemotherapy-induced nausea and vomiting had low ROB. Of the remaining studies, eight had unclear ROB (four positive, three negative, and one with unclear outcomes). Thirty-three studies had high ROB (19 positive, 11 negative, and three with both positive and negative outcomes depending on the symptom). Conclusion Acupuncture is an appropriate adjunctive treatment for chemotherapy-induced nausea/vomiting, but additional studies are needed. For other symptoms, efficacy remains undetermined owing to high ROB among studies. Future research should focus on standardizing comparison groups and treatment methods, be at least single-blinded, assess biologic mechanisms, have adequate statistical power, and involve multiple acupuncturists.

Garcia, M. Kay; McQuade, Jennifer; Haddad, Robin; Patel, Sonya; Lee, Richard; Yang, Peiying; Palmer, J. Lynn; Cohen, Lorenzo

2013-01-01

211

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

212

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

PubMed Central

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.

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

2011-01-01

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

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

2009-06-01

215

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

216

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

217

Complete denture biofilm after brushing with specific denture paste, neutral soap and artificial saliva.  

PubMed

This study compared the levels of biofilm in maxillary and mandibular complete dentures and evaluated the number of colony-forming units (cfu) of yeasts, after using auxiliary brushing agents and artificial saliva. Twenty-three denture wearers with hyposalivation and xerostomia were instructed to brush the dentures 3 times a day during 3 weeks with the following products: Corega Brite denture dentifrice, neutral liquid soap, Corega Brite combined with Oral Balance (artificial saliva) or tap water. For biofilm quantification, the internal surfaces of the dentures were disclosed, photographed and measured using a software. For microbiological analysis, the biofilm was scrapped off, and the harvested material was diluted, sown in CHROMagar™ Candida and incubated at 37°C for 48?h. Data were analyzed statistically by two-way ANOVA and Tukey's test (?=0.05). Mandibular dentures presented a mean biofilm percentage (µ=26.90 ± 21.10) significantly greater than the maxillary ones (µ=18.0 ± 15.0) (p<0.05). Brushing using Corega Brite combined with Oral Balance (µ=15.87 ± 18.47) was more effective (p<0.05) than using the denture dentifrice (µ=19.47 ± 17.24), neutral soap (µ=23.90 ± 18.63) or tap water (control; µ=32.50 ± 20.68). For the microbiological analysis, the chi-square test did not indicate significant difference between the hygiene products for either type of denture. The more frequently isolated species of yeasts were C. albicans, C. tropicalis and C. glabrata. In conclusion, mandibular dentures had more biofilm formation than maxillary ones. Denture brushing with Corega Brite dentifrice combined with the use of Oral Balance was the most effective method for reduction of biofilm levels, but the use of products did not show difference in yeast cfu counts. PMID:23657413

Paranhos, Helena de Freitas Oliveira; Salles, Antônio Eduardo Sparça; Macedo, Leandro Dorigan de; Silva-Lovato, Cláudia Helena da; Pagnano, Valéria Oliveira; Watanabe, Evandro

2013-01-01

218

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

219

Multi-Institutional Trial of Accelerated Hypofractionated Intensity-Modulated Radiation Therapy for Early-Stage Oropharyngeal Cancer (RTOG 00-22)  

SciTech Connect

Purpose: To assess the results of a multi-institutional study of intensity-modulated radiation therapy (IMRT) for early oropharyngeal cancer. Patients and Methods: Patients with oropharyngeal carcinoma Stage T1-2, N0-1, M0 requiring treatment of the bilateral neck were eligible. Chemotherapy was not permitted. Prescribed planning target volumes (PTVs) doses to primary tumor and involved nodes was 66 Gy at 2.2 Gy/fraction over 6 weeks. Subclinical PTVs received simultaneously 54-60 Gy at 1.8-2.0 Gy/fraction. Participating institutions were preapproved for IMRT, and quality assurance review was performed by the Image-Guided Therapy Center. Results: 69 patients were accrued from 14 institutions. At median follow-up for surviving patients (2.8 years), the 2-year estimated local-regional failure (LRF) rate was 9%. 2/4 patients (50%) with major underdose deviations had LRF compared with 3/49 (6%) without such deviations (p = 0.04). All cases of LRF, metastasis, or second primary cancer occurred among patients who were current/former smokers, and none among patients who never smoked. Maximal late toxicities Grade >=2 were skin 12%, mucosa 24%, salivary 67%, esophagus 19%, osteoradionecrosis 6%. Longer follow-up revealed reduced late toxicity in all categories. Xerostomia Grade >=2 was observed in 55% of patients at 6 months but reduced to 25% and 16% at 12 and 24 months, respectively. In contrast, salivary output did not recover over time. Conclusions: Moderately accelerated hypofractionatd IMRT without chemotherapy for early oropharyngeal cancer is feasible, achieving high tumor control rates and reduced salivary toxicity compared with similar patients in previous Radiation Therapy Oncology Group studies. Major target underdose deviations were associated with higher LRF rate.

Eisbruch, Avraham, E-mail: eisbruch@umich.ed [University of Michigan, Ann Arbor, MI (United States); Harris, Jonathan [Department of Statistics, American College of Radiology (United States); Garden, Adam S.; Chao, Clifford K.S. [M.D. Anderson Cancer Center, Houston, TX (United States); Straube, William [Image-Guided Therapy Center at Washington University, St. Louis, MO (United States); Harari, Paul M. [University of Wisconsin, Madison, WI (United States); Sanguineti, Giuseppe [University of Texas Medical Branch, Galveston, TX (United States); Jones, Christopher U. [Radiation Oncology Center, Sacramento, CA (United States); Bosch, Walter R. [Image-Guided Therapy Center at Washington University, St. Louis, MO (United States); Ang, K. Kian [M.D. Anderson Cancer Center, Houston, TX (United States)

2010-04-15

220

Common and Specific Associations of Anti-SSA/Ro60 and Anti-Ro52/TRIM21 Antibodies in Systemic Lupus Erythematosus  

PubMed Central

Little information exists about the association of anti-SSA/Ro60 and anti-Ro52/TRIM21 with systemic lupus erytematosus (SLE) features. In this work, we analysed the associations of both anti-Ro reactivities with clinical and immunological manifestations in 141 SLE patients. Photosensitivity and xerophtalmia/xerostomia were found to be positively associated with both anti-SSA/Ro60 (P = 0.024 and P = 0.019, resp.) and anti-Ro52/TRIM21 (P = 0.026 and P = 0.022, resp.). In contrast, a negative association was detected regarding anti-phospholipid antibodies, anti-SSA/Ro60 having a stronger effect (P = 0.014) than anti-Ro52/TRIM21. Anti-SSA/Ro60 showed a specific positive association with hypocomplementemia (P = 0.041), mainly with low C4 levels (P = 0.008), whereas anti-Ro52/TRIM21 was found to be positively associated with Raynaud's phenomenon (P = 0.026) and cytopenia (P = 0.048) and negatively associated with anti-dsDNA (P = 0.013). Lymphocytes are involved in the relationship between anti-Ro52/TRIM21 and cytopenia since positive patients showed lower cell levels than negative patients (P = 0.036). In conclusion, anti-SSA/Ro60 and anti-Ro52/TRIM21 showed both common and specific associations in SLE. These data thus increase evidence of the different associations of the two anti-Ro specificities even in a particular disease.

Menendez, Aurora; Gomez, Jesus; Caminal-Montero, Luis; Diaz-Lopez, Jose Bernardino; Cabezas-Rodriguez, Ivan; Mozo, Lourdes

2013-01-01

221

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

222

Intensity Modulated Radiotherapy Improves Target Coverage and Parotid Gland Sparing When Delivering Total Mucosal Irradiation in Patients With Squamous Cell Carcinoma of Head and Neck of Unknown Primary Site  

SciTech Connect

Head and neck squamous cell carcinoma with occult primary site represents a controversial clinical problem. Conventional total mucosal irradiation (TMI) maximizes local control, but at the expense of xerostomia. IMRT has been shown to spare salivary tissue in head and cancer patients. This study has been performed to investigate the potential of IMRT to perform nodal and TMI and also allow parotid gland sparing in this patient group. Conventional radiotherapy (CRT) and IMRT plans were produced for six patients to treat the ipsilateral (involved) post-operative neck (PTV1) and the un-operated contralateral neck and mucosal axis (PTV2). Plans were produced with and without the inclusion of nasopharynx in the PTV2. The potential to improve target coverage and spare the parotid glands was investigated for the IMRT plans. There was no significant difference in the mean doses to the PTV1 using CRT and IMRT (59.7 and 60.0 respectively, p = 0.5). The maximum doses to PTV1 and PTV2 were lower for the IMRT technique as compared to CRT (P = 0.008 and P < 0.0001), respectively, and the minimum doses to PTV1 and PTV2 were significantly higher for IMRT as compared to CRT (P = 0.001 and P = 0.001), respectively, illustrating better dose homogeneity with IMRT. The mean dose to the parotid gland contralateral to PTV1 was significantly lower for IMRT (23.21 {+-} 0.7) as compared to CRT (50.5 {+-} 5.8) (P < 0.0001). There was a significant difference in parotid dose between plans with and without the inclusion of the nasopharynx. IMRT offers improved dose homogeneity in PTV1 and PTV2 and allows for parotid sparing.

Bhide, Shreerang [Department of Oncology-Head and Neck, Royal Marsden Hopsital, London (United Kingdom)], E-mail: sabhide@yahoo.com; Clark, Catherine; Harrington, Kevin; Nutting, Christopher M. [Department of Oncology-Head and Neck, Royal Marsden Hopsital, London (United Kingdom)

2007-10-01

223

Predicting radiotherapy outcomes using statistical learning techniques  

NASA Astrophysics Data System (ADS)

Radiotherapy outcomes are determined by complex interactions between treatment, anatomical and patient-related variables. A common obstacle to building maximally predictive outcome models for clinical practice is the failure to capture potential complexity of heterogeneous variable interactions and applicability beyond institutional data. We describe a statistical learning methodology that can automatically screen for nonlinear relations among prognostic variables and generalize to unseen data before. In this work, several types of linear and nonlinear kernels to generate interaction terms and approximate the treatment-response function are evaluated. Examples of institutional datasets of esophagitis, pneumonitis and xerostomia endpoints were used. Furthermore, an independent RTOG dataset was used for 'generalizabilty' validation. We formulated the discrimination between risk groups as a supervised learning problem. The distribution of patient groups was initially analyzed using principle components analysis (PCA) to uncover potential nonlinear behavior. The performance of the different methods was evaluated using bivariate correlations and actuarial analysis. Over-fitting was controlled via cross-validation resampling. Our results suggest that a modified support vector machine (SVM) kernel method provided superior performance on leave-one-out testing compared to logistic regression and neural networks in cases where the data exhibited nonlinear behavior on PCA. For instance, in prediction of esophagitis and pneumonitis endpoints, which exhibited nonlinear behavior on PCA, the method provided 21% and 60% improvements, respectively. Furthermore, evaluation on the independent pneumonitis RTOG dataset demonstrated good generalizabilty beyond institutional data in contrast with other models. This indicates that the prediction of treatment response can be improved by utilizing nonlinear kernel methods for discovering important nonlinear interactions among model variables. These models have the capacity to predict on unseen data. Part of this work was first presented at the Seventh International Conference on Machine Learning and Applications, San Diego, CA, USA, 11-13 December 2008.

El Naqa, Issam; Bradley, Jeffrey D.; Lindsay, Patricia E.; Hope, Andrew J.; Deasy, Joseph O.

2009-09-01

224

Intensity-modulated radiotherapy for nasopharyngeal carcinoma: improvement of the therapeutic ratio with helical tomotherapy vs segmental multileaf collimator-based techniques  

PubMed Central

Objectives The aim of the study was to compare differences in dosimetric, clinical and quality-of-life end points among patients treated with helical tomotherapy (HT) and segmental multileaf collimator (SMLC)-based intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma. Methods From June 2005 to August 2009, 30 consecutive patients were treated with IMRT for nasopharyngeal carcinoma to a dose of 70 Gy. 14 patients (47%) were treated using HT and 16 (53%) were treated using SMLC-based IMRT. 28 patients (93%) received concurrent chemotherapy. The patients were evenly balanced between the two radiotherapy groups with respect to clinical and pathological characteristics. Median follow-up was 30 months (range, 6–62 months). Results The 2-year estimates of overall survival, local–regional control and progression-free survival were 81%, 87% and 82%, respectively. There were no significant differences in any of these end points with respect to IMRT technique (p>0.05 for all). Dosimetric analysis revealed that patients treated by HT had significantly improved salivary sparing with respect to mean dose (27.3 vs 34.1 Gy, p=0.03) and volume receiving greater than or equal to 30 Gy (31.7% vs 47.3%, p=0.01) to the contralateral (spared) parotid gland. The incidence of Grade 3+ late xerostomia was 13 and 7% among patients treated with SMLC-based IMRT and HT, respectively (p=0.62). The corresponding proportion of patients who subjectively reported “too little” or “no” saliva at final follow-up was 38% and 7%, respectively (p=0.04). Conclusion The superior dosimetric outcome observed with HT appeared to translate into moderately improved clinical outcomes with respect to salivary sparing. Prospective trials are needed to validate this gain in the therapeutic ratio.

Chen, A M; Yang, C C; Marsano, J; Liu, T; Purdy, J A

2012-01-01

225

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

226

Bidirectional Relationship between Chronic Kidney Disease & Periodontal Disease  

PubMed Central

Non communicable diseases (NCDs) affect the life of an individual in terms of mortality, morbidity and financial crises. Main NCDs are diabetes mellitus (DM), cardiovascular diseases (CVD), pulmonary diseases, osteoporosis and chronic kidney diseases (CKD). About 40% of the total deaths can be controlled by eliminating the risk factors for NCDs. Periodontitis have recently been labeled as an important potential risk factor for NCDs. CKD affect the oral health status of patients by inducing gingival hyperplasia, xerostomia, calcification of root canals and delayed eruption of teeth. Periodontitis increases systemic inflammatory burden leading to worsening of CKD which in turn has been has been found to negatively affect CKD of patients on hemodialysis therapy by altering their serum albumin and C-reactive protein levels. As hypoalbuminemia leads to increased mortality in CKD patients, it needs to be avoided by reducing systemic inflammatory burden in patients receiving HD therapy. Treating periodontal disease could be one factor that might decrease the systemic inflammatory burden and thereby improve quality of life of these patients. Sources of Data: Data from descriptive, cross sectional and longitudinal studies published between 2000 and 2012 were included. Data searches based on human studies only. Data Extraction: The key words, periodontitis, chronic kidney disease and hemodialysis, on MEDLINE, approximately 120 studies were identified. 35 of them were relevant to all three keywords. Most of them were cross sectional studies and total 7 clinical trials were identified regarding checking of serum levels after periodontal therapy with variable results. Conclusion: Patients with CKD have higher prevalence of periodontal disease while non-surgical periodontal therapy has been indicated to decrease the systemic inflammatory burden in patients with CKD specially those undergoing HD therapy.

Wahid, Arsalan; Chaudhry, Saima; Ehsan, Afifa; Butt, Sidra; Ali Khan, Ayyaz

2013-01-01

227

Clinical observation and quality of life in terms of nasal sinusitis after radiotherapy for nasopharyngeal carcinoma: long-term results from different nasal irrigation techniques.  

PubMed

Objective: The aim of our study was to investigate the relationship between nasal irrigation techniques (NIT) and the survival rate and the quality of life (QOL) in patients with nasal sinusitis (NS). Methods: We studied data from 1134 patients with nasopharyngeal carcinoma (NPC) who received radical radiotherapy, which were randomly divided into three groups (A, B and C). Group A used nasal irrigator; Group B used homemade nasal irrigation (NI) connector combined with enemator; and Group C used nasal sprayer. The clinical effects, 5-year overall survival (OS) and progression-free survival (PFS) were observed. Furthermore, the QOL in patients with NS was evaluated using the Sino-Nasal Outcome Test 20. Results: The median follow-up time was 69 months. The 5-year OS and PFS were 80.5% and 73.2%, respectively, for all patients. There was no significant difference in OS, PFS, xerostomia and neck skin toxicity grade 3 and greater among groups. There was no difference among groups. The incidence of NS was the highest in group C. Conclusion: The symptoms of NS seriously affected the QOL period of 1 year. Group C showed no improvement during the follow-up period, which for A and B, by contrast, had after 1 year. Although the exact mechanism remains to be explored in NIT, our findings suggest that patients with NPC should nasal irrigate for 2 years after radiotherapy. Advances in knowledge: Our study shows that a nasal irrigator is necessary for patients with NPC for a high QOL in terms of NS. PMID:24814695

Luo, H-H; Fu, Z-C; Cheng, H-H; Liao, S-G; Li, D-S; Cheng, L-P

2014-07-01

228

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

229

Oral Health-Related Complications of Breast Cancer Treatment: Assessing Dental Hygienists' Knowledge and Professional Practice  

PubMed Central

Objective Approximately 200,000 women are diagnosed with breast cancer in the U.S. every year. These patients commonly suffer from oral complications of their cancer therapy. The purpose of this study was to assess dental hygienists’ knowledge and professional practice related to providing care for breast cancer patients. Methods A pre-tested 43-item survey was mailed to a random sample of 10% of all licensed dental hygienists in the State of Michigan (N=962). The survey assessed the respondents’ knowledge of potential oral complications of breast cancer treatments as well as their professional practices when treating patients with breast cancer. After two mailings, the response rate was 37% (N=331). Descriptive and inferential analyses were conducted using SAS. Results Many dental hygienists were unaware of the recommended clinical guidelines for treating breast cancer patients and lacked specific knowledge pertaining to the commonly prescribed anti-estrogen medications for pre-and postmenopausal breast cancer patients. Over 70% of the respondents indicated they were unfamiliar with the AI class of medications. Only 13% of dental hygienists correctly identified the mechanism of action of anti-estrogen therapy. Dental hygienists reported increased gingival inflammation, gingival bleeding, periodontal pocketing, xerostomia and burning tissues in patients receiving anti-estrogen therapies. Less than 10% believed that their knowledge of breast cancer treatments and the oral side effects is up to date. Conclusions Results indicate a need for more education about the potential oral effects of breast cancer therapies and about providing the best possible care for patients undergoing breast cancer treatment.

Taichman, L. Susan; Gomez, Grace; Inglehart, Marita Rohr

2014-01-01

230

Clinical and laboratorial profile and histological features on minor salivary glands from patients under investigation for Sj?gren's syndrome  

PubMed Central

Diagnosis of Sjögren’s syndrome (SS) is complex and the usefulness of labial minor salivary glands biopsy in this process remains controversial. Objectives: to evaluate the clinical and laboratorial profile and histological features on labial minor salivary glands from patients under investigation of SS. Study Design: clinical charts from 38 patients under suspicion of SS and submitted to labial minor salivary glands biopsies were reviewed. Clinical and laboratorial data were retrieved from the clinical files and the HE-stained histological slides were reviewed under light microscopy. Results: mean age of the patients was 56.5 years and 97% were females; histological analysis showed that 42% of the cases showed ductal dilatation, lymphocytic foci were found in 52.6% and, from this group, 80% of the cases presented a foci/lobules ratio above 0.8. Acinar/ductal ratio was considered diminished in 39.5% of the samples. Thirty six (95%) and 32 (84%) patients, respectively, complained about xerostomia and xerophthalmia. A study of the time interval of the symptoms that led to SS investigation showed a mean of 116 months. Moreover, sixty-six percent of the patients had already been submitted to immunosuppressive therapy prior to the labial minor salivary gland biopsy. Age of the patients, scintigraphic alterations on salivary function, antinuclear factor (ANF), anti-Ro and anti-La did not show statistical significant association with the histological features. Lobules/foci ratio above 0.8 was the only histological parameter statistically associated with Sjögren’s syndrome diagnosis (p<0.0001). Conclusions: in the studied sample, lymphocytic foci on salivary glands were the only histological parameter associated to the diagnosis of SS. Early indication of labial minor salivary gland biopsy to patients under investigation of SS could limit the effects of immunosuppressive therapy on the histological features associated with the evolution of salivary gland involvement in SS. Key words:Sjögren syndrome, minor salivary glands, biopsy, lymphocytic foci.

Pereira, Debora L.; Vilela, Veronica S.; dos-Santos, Teresa C R B.

2014-01-01

231

Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer.  

PubMed

The objective of the study was the assessment of the results of a prospective clinical trial with two preventive swallowing rehabilitation programs on the long-term side effects of chemoradiotherapy (CCRT) in advanced head and neck cancer patients. The study cohort consisted of 29 patients, randomized in two exercise groups: a standard (S) group receiving routine swallowing exercises (N = 14), and an experimental (E) group receiving swallowing exercises based on the TheraBite® Jaw Motion Rehabilitation System™ (N = 15). Assessment of functional changes was carried out with multidimensional outcome measures (e.g., videofluoroscopy, study-specific questionnaires) at four time points (pre-treatment, at 10 weeks, 1 year, and 2 years post-treatment). Overall, in the first year post-treatment many initial tumor- and treatment-related problems diminished significantly, except xerostomia (59 %). The only additional improvement at 2 years was that the overall weight significantly further increased (p = 0.000), however, without regaining baseline value. In the subgroup analysis according to exercise group, this difference was significant in the E-group only (p = 0.002). The same was the case for the subgroup analysis according to site of disease, with a significant weight gain in the 'below the hyoid bone' group only. This study shows that the overall functional problems at 1 and 2 years post-CCRT are limited. Both rehabilitation programs produce similar results, with a slight but significant benefit for the E-group in weight gain at 2 years, as also seen in the 'below the hyoid bone' group. Both rehabilitation programs applied are feasible and show good compliance despite the burdensome CCRT. PMID:23892729

van der Molen, Lisette; van Rossum, Maya A; Rasch, Coen R N; Smeele, Ludi E; Hilgers, Frans J M

2014-05-01

232

Predicting radiotherapy outcomes using statistical learning techniques*  

PubMed Central

Radiotherapy outcomes are determined by complex interactions between treatment, anatomical and patient-related variables. A common obstacle to building maximally predictive outcome models for clinical practice is the failure to capture potential complexity of heterogeneous variable interactions and applicability beyond institutional data. We describe a statistical learning methodology that can automatically screen for nonlinear relations among prognostic variables and generalize to unseen data before. In this work, several types of linear and nonlinear kernels to generate interaction terms and approximate the treatment-response function are evaluated. Examples of institutional datasets of esophagitis, pneumonitis and xerostomia endpoints were used. Furthermore, an independent RTOG dataset was used for ‘generalizabilty’ validation. We formulated the discrimination between risk groups as a supervised learning problem. The distribution of patient groups was initially analyzed using principle components analysis (PCA) to uncover potential nonlinear behavior. The performance of the different methods was evaluated using bivariate correlations and actuarial analysis. Over-fitting was controlled via cross-validation resampling. Our results suggest that a modified support vector machine (SVM) kernel method provided superior performance on leave-one-out testing compared to logistic regression and neural networks in cases where the data exhibited nonlinear behavior on PCA. For instance, in prediction of esophagitis and pneumonitis endpoints, which exhibited nonlinear behavior on PCA, the method provided 21% and 60% improvements, respectively. Furthermore, evaluation on the independent pneumonitis RTOG dataset demonstrated good generalizabilty beyond institutional data in contrast with other models. This indicates that the prediction of treatment response can be improved by utilizing nonlinear kernel methods for discovering important nonlinear interactions among model variables. These models have the capacity to predict on unseen data.

El Naqa, Issam; Bradley, Jeffrey D; Lindsay, Patricia E; Hope, Andrew J; Deasy, Joseph O

2013-01-01

233

[Sjögren's syndrome].  

PubMed

This paper consists the theorical review and the current concepts of the subject and the second includes the casuistry of the Stomatology Department of the Pulido Valente Hospital. From April 1989 to 1991 (2 years), a study was made on Sjögren Syndrome (Primary and Secondary) of multiple character with the particular co-operation of the Portuguese Institute of Rheumatology. With this paper we wish to point out the importance of the oral evaluation of the study of the plurisystemic diseases as well as to establish criterions of diagnosis for the Portuguese population. Eighty cases of suspected Sjögren's Syndrome have been assessed, 66 of which have been fully. The reason for the consultation was dry mouth, dry eyes and enlargement of parotid glands. The symptoms were isolated or in association with other pathologies after other causes had been excluded. We had to establish the salivary reference values for the Portuguese population in 22 healthy volunteers. The xerostomia was evaluated by the Sialochemistry, Sialography, Cintigraphy and biopsies of the lower lip and of the sublingual gland. The ophthalmologic examination took place in the Ophthalmology Department of Santo António dos Capuchos Hospital by means of Shirmer test, Rosa Bengala and B.U.T. In spite of Sjögren's Syndrome being, up to now, so remotely determined in connection with the treatment, these patients need medical care and Stomatology plays a fundamental role as far as the diagnosis and the therapeutic points of view are concerned. We maintain the notion that the Syndrome is not as infrequent as one would believe and the evaluation of the oral field is important to establish the degree of the disease and its treatment. PMID:7856465

Brito, A; Figueirinhas, J; Ramos, M; Soares, A L; Neves, L R; Lobo, J; Faro, L S

1994-10-01

234

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

235

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

236

Malnutrition and the role of nutritional support for radiation therapy patients.  

PubMed

The nutritional status of a tumor patient can be negatively influenced by the local and systemic effects of the malignant tumor (tumor cachexia, anorexia, difficult oral food intake), by the effects of the various antitumoral therapy modalities (surgery, radiotherapy, chemotherapy), and by the complications associated with such modalities (anorexia, nausea, vomiting, mucositis, xerostomia, alterations of the smell and taste sensations, odynophagia, dysphagia, maldigestion, malabsorption, diarrhea, steatorrhea, conditioned aversions, radiogenic late effects), as well as by the psychological reactions of the patient to the real or feared existence of his tumor. The radiation-induced nutritional disorders depend on the tumor localization, the region irradiated, the dose and length of radiotherapy, the fractionation, the volume irradiated, and the combination with other therapeutic modalities ("combined modality therapy"). The acute radiation-induced reactions are usually of limited duration and for this reason tend to interfere with the nutritional status to a lesser extent than the permanent chronic consequences of irradiation. Weight loss and malnutrition tend to develop particularly in patients in whom segments of the gastrointestinal tract are subjected to irradiation. The incidence and severity of deficient nutrition depend not only on the region irradiated (head-neck region, thorax, abdomen, pelvis) but also, and most particularly, on the volume of the digestive tract irradiated. Chemotherapy and radiotherapy combined act very strongly on rapidly proliferating cell populations (skin, mucosa, epithelium of the gastrointestinal tract). In this context, actinomycin D and adriamycin act like real sensitizers, whereas the majority of the other drugs are likely to produce only an additive effect. The first named cytostatics give rise to the so-called recall phenomenon, i.e., the reactivation of latent radiation effects in response to the subsequent administration of the drug. Malnutrition impairs organ function and ultimately results in increased morbidity and mortality. For this reason it has proven mandatory and reasonable that the organism of all tumor patients suffering from malnutrition is provided with the missing essential nutrients (especially amino acids for protein synthesis). This tends to clearly improve the Karnofsky performance status, with a positive effect on response rates, toxicity, and survival rates in retrospective studies.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3140323

Thiel, H J; Fietkau, R; Sauer, R

1988-01-01

237

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

238

Boron Neutron Capture Therapy in the Treatment of Locally Recurred Head-and-Neck Cancer: Final Analysis of a Phase I/II Trial  

SciTech Connect

Purpose: To investigate the efficacy and safety of boron neutron capture therapy (BNCT) in the treatment of inoperable head-and-neck cancers that recur locally after conventional photon radiation therapy. Methods and Materials: In this prospective, single-center Phase I/II study, 30 patients with inoperable, locally recurred head-and-neck cancer (29 carcinomas and 1 sarcoma) were treated with BNCT. Prior treatments consisted of surgery and conventionally fractionated photon irradiation to a cumulative dose of 50 to 98 Gy administered with or without concomitant chemotherapy. Tumor responses were assessed by use of the RECIST (Response Evaluation Criteria in Solid Tumors) and adverse effects by use of the National Cancer Institute common terminology criteria version 3.0. Intravenously administered L-boronophenylalanine-fructose (400 mg/kg) was administered as the boron carrier. Each patient was scheduled to be treated twice with BNCT. Results: Twenty-six patients received BNCT twice; four were treated once. Of the 29 evaluable patients, 22 (76%) responded to BNCT, 6 (21%) had tumor growth stabilization for 5.1 and 20.3 months, and 1 (3%) progressed. The median progression-free survival time was 7.5 months (95% confidence interval, 5.4-9.6 months). Two-year progression-free survival and overall survival were 20% and 30%, respectively, and 27% of the patients survived for 2 years without locoregional recurrence. The most common acute Grade 3 adverse effects were mucositis (54% of patients), oral pain (54%), and fatigue (32%). Three patients were diagnosed with osteoradionecrosis (each Grade 3) and one patient with soft-tissue necrosis (Grade 4). Late Grade 3 xerostomia was present in 3 of the 15 evaluable patients (20%). Conclusions: Most patients who have inoperable, locally advanced head-and-neck carcinoma that has recurred at a previously irradiated site respond to boronophenylalanine-mediated BNCT, but cancer recurrence after BNCT remains frequent. Toxicity was acceptable. Further research on novel modifications of the method is warranted.

Kankaanranta, Leena [Department of Oncology, Helsinki University Central Hospital, Helsinki (Finland); Seppaelae, Tiina; Koivunoro, Hanna [Department of Physics, University of Helsinki, Helsinki (Finland); Boneca Corporation, Helsinki (Finland); Saarilahti, Kauko [Department of Oncology, Helsinki University Central Hospital, Helsinki (Finland); Atula, Timo [Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki (Finland); Collan, Juhani [Department of Oncology, Helsinki University Central Hospital, Helsinki (Finland); Salli, Eero; Kortesniemi, Mika [Helsinki and Uusimaa Hospital District Medical Imaging Center, Helsinki University Central Hospital, Helsinki (Finland); Uusi-Simola, Jouni [Department of Physics, University of Helsinki, Helsinki (Finland); Helsinki and Uusimaa Hospital District Medical Imaging Center, Helsinki University Central Hospital, Helsinki (Finland); Vaelimaeki, Petteri [Department of Physics, University of Helsinki, Helsinki (Finland); Boneca Corporation, Helsinki (Finland); Maekitie, Antti [Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki (Finland); Seppaenen, Marko [Turku PET Centre, Turku University Hospital, Turku (Finland); Minn, Heikki [Department of Oncology, Turku University Central Hospital, Turku (Finland); Revitzer, Hannu [Aalto University School of Science and Technology, Esopo (Finland); Kouri, Mauri [Department of Oncology, Helsinki University Central Hospital, Helsinki (Finland); Kotiluoto, Petri; Seren, Tom; Auterinen, Iiro [VTT Technical Research Centre of Finland, Espoo (Finland); Savolainen, Sauli [Department of Physics, University of Helsinki, Helsinki (Finland); Helsinki and Uusimaa Hospital District Medical Imaging Center, Helsinki University Central Hospital, Helsinki (Finland); Joensuu, Heikki, E-mail: heikki.joensuu@hus.fi [Department of Oncology, Helsinki University Central Hospital, Helsinki (Finland)

2012-01-01

239

Tissue engineering in otorhinolaryngology.  

PubMed

Tissue engineering is a field of research with interdisciplinary cooperation between clinicians, cell biologists, and materials research scientists. Many medical specialties apply tissue engineering techniques for the development of artificial replacement tissue. Stages of development extend from basic research and preclinical studies to clinical application. Despite numerous established tissue replacement methods in otorhinolaryngology, head and neck surgery, tissue engineering techniques opens up new ways for cell and tissue repair in this medical field. Autologous cartilage still remains the gold standard in plastic reconstructive surgery of the nose and external ear. The limited amount of patient cartilage obtainable for reconstructive head and neck surgery have rendered cartilage one of the most important targets for tissue engineering in head and neck surgery. Although successful in vitro generation of bioartificial cartilage is possible today, these transplants are affected by resorption after implantation into the patient. Replacement of bone in the facial or cranial region may be necessary after tumor resections, traumas, inflammations or in cases of malformations. Tissue engineering of bone could combine the advantages of autologous bone grafts with a minimal requirement for second interventions. Three different approaches are currently available for treating bone defects with the aid of tissue engineering: (1) matrix-based therapy, (2) factor-based therapy, and (3) cell-based therapy. All three treatment strategies can be used either alone or in combination for reconstruction or regeneration of bone. The use of respiratory epithelium generated in vitro is mainly indicated in reconstructive surgery of the trachea and larynx. Bioartificial respiratory epithelium could be used for functionalizing tracheal prostheses as well as direct epithelial coverage for scar prophylaxis after laser surgery of shorter stenoses. Before clinical application animal experiments have to prove feasability and safety of the different experimental protocols. All diseases accompanied by permanently reduced salivation are possible treatment targets for tissue engineering. Radiogenic xerostomia after radiotherapy of malignant head and neck tumors is of particular importance here due to the high number of affected patients. The number of new diseases is estimated to be over 500,000 cases worldwide. Causal treatment options for radiation-induced salivary gland damage are not yet available; thus, various study groups are currently investigating whether cell therapy concepts can be developed with tissue engineering methods. Tissue engineering opens up new ways to generate vital and functional transplants. Various basic problems have still to be solved before clinically applying in vitro fabricated tissue. Only a fraction of all somatic organ-specific cell types can be grown in sufficient amounts in vitro. The inadequate in vitro oxygen and nutrition supply is another limiting factor for the fabrication of complex tissues or organ systems. Tissue survival is doubtful after implantation, if its supply is not ensured by a capillary network. PMID:14577908

Bücheler, M; Haisch, A

2003-09-01

240

Accelerated hyperfractionation (AHF) compared to conventional fractionation (CF) in the postoperative radiotherapy of locally advanced head and neck cancer: influence of proliferation.  

PubMed

Based on the assumption that an accelerated proliferation process prevails in tumour cell residues after surgery, the possibility that treatment acceleration would offer a therapeutic advantage in postoperative radiotherapy of locally advanced head and neck cancer was investigated. The value of T(pot) in predicting the treatment outcome and in selecting patients for accelerated fractionation was tested. Seventy patients with (T2/N1-N2) or (T3-4/any N) squamous cell carcinoma of the oral cavity, larynx and hypopharynx who underwent radical surgery, were randomized to either (a) accelerated hyperfractionation: 46.2 Gy per 12 days, 1.4 Gy per fraction, three fractions per day with 6 h interfraction interval, treating 6 days per week or (b) Conventional fractionation: 60 Gy per 6 weeks, 2 Gy per fraction, treating 5 days per week. The 3-year locoregional control rate was significantly better in the accelerated hyperfractionation (88 +/- 4%) than in the CF (57+/- 9%) group, P=0.01 (and this was confirmed by multivariate analysis), but the difference in survival (60 +/- 10% vs 46 +/- 9%) was not significant (P=0.29). The favourable influence of a short treatment time was further substantiated by demonstrating the importance of the gap between surgery and radiotherapy and the overall treatment time between surgery and end of radiotherapy. Early mucositis progressed more rapidly and was more severe in the accelerated hyperfractionation group; reflecting a faster rate of dose accumulation. Xerostomia was experienced by all patients with a tendency to be more severe after accelerated hyperfractionation. Fibrosis and oedema also tended to be more frequent after accelerated hyperfractionation and probably represent consequential reactions. T(pot) showed a correlation with disease-free survival in a univariate analysis but did not prove to be an independent factor. Moreover, the use of the minimum and corrected P-values did not identify a significant cut-off. Compared to conventional fractionation, accelerated hyperfractionation did not seem to offer a survival advantage in fast tumours though a better local control rate was noted. This limits the use of T(pot) as a guide for selecting patients for accelerated hyperfractionation. For slowly growing tumours, tumour control and survival probabilities were not significantly different in the conventional fractionation and accelerated hyperfractionation groups. A rapid tumour growth was associated with a higher risk of distant metastases (P=0.01). In conclusion, tumour cell repopulation seems to be an important determinant of postoperative radiotherapy of locally advanced head and neck cancer despite lack of a definite association between T(pot) and treatment outcome. In fast growing tumours accelerated hyperfractionation provided an improved local control but without a survival advantage. To gain a full benefit from treatment acceleration, the surgery-radiotherapy gap and the overall treatment time should not exceed 6 and 10 weeks respectively. PMID:11870530

Awwad, H K; Lotayef, M; Shouman, T; Begg, A C; Wilson, G; Bentzen, S M; Abd El-Moneim, H; Eissa, S

2002-02-12

241

Assessment of oral mucositis in adult and pediatric oncology patients: an evidence-based approach.  

PubMed

Oral mucositis is a frequent side effect of cancer treatment and can lead to delayed treatment, reduced treatment dosage, altered nutrition, dehydration, infections, xerostomia, pain, and higher healthcare costs. Mucositis is defined as "inflammatory lesions of the oral and/or gastrointestinal tract caused by high-dose cancer therapies. Alimentary tract mucositis refers to the expression of mucosal injury across the continuum of oral and gastrointestinal mucosa, from the mouth to the anus" (Peterson, Bensadoun, & Roila, 2008, p. ii122). Evidence demonstrates that oral mucositis is quite distressing for patients. In addition, the majority of oncology nurses are unaware of available guidelines related to the care of oral mucositis. A multidisciplinary Oral Mucositis Committee was formed by the University of Iowa Hospitals and Clinics to develop evidence-based prevention and treatment strategies for adult and pediatric oncology patients experiencing oral mucositis. The first step was implementing an evidence-based nursing oral assessment. The Iowa Model was used to guide this evidence-based practice initiative. The Oral Assessment Guide (OAG) is reliable and valid, feasible, and sensitive to changing conditions. The OAG was piloted on an Adult Leukemia and Bone Marrow Transplant Unit leading to modification and adaptation. The pilot evaluation found 87% of patients had an abnormal oral assessment involving all categories in the tool. Nursing questionnaires showed that staff (8/23; 35% response) felt they were able to identify at risk patients using the OAG (3.3; 1-4 scale), and the tool accurately identifies mucosal changes (2.9; 1-4 scale). A knowledge assessment found nurses correctly identified OAG components 63% of the time. Unlike results from a national survey, most University of Iowa Hospitals and Clinics nurses (63%) were aware of national guidelines for prevention and treatment of oral mucositis. Developing an evidence-based nursing policy and updating documentation systems was done before implementation occurred. Computer-based and printed educational materials were developed for nursing staff caring for oncology patients. Team members were responsible for facilitating adoption in clinical areas. After organizational roll out, the nursing assessment was documented in all patients 87% of the time, and 99% for inpatients. The highest risk population, head and neck cancer patients receiving radiation, had documentation in 88% of audited visits. Other clinics required further work. Changing the system to the electronic medical record created an additional need for integration of the evidence-based practice with housewide documentation of oral assessment being completed 60.9% of the time. Use of an evidence-based assessment is the first step in a comprehensive program to reduce a common and highly distressing side effect of cancer treatment. Nursing documentation of oral assessment is well integrated on inpatient units. Opportunities for improvement remain in ambulatory care. Multidisciplinary team collaborations to expand evidence-based assessment and research questions generated from this work will be shared. PMID:20863028

Farrington, Michele; Cullen, Laura; Dawson, Cindy

2010-01-01