RESUMO
Radiotherapy in patients with head and neck cancer fairly leads to xerostomia, profoundly affecting their quality of life. With limited effective preventive and therapeutic methods, attention has turned to exploring alternatives. This article outlines how intraglandular injection of mitochondria-boosting agents can serve as a potential strategy to reduce salivary acinar damage. This method can contribute to the thoughtful development of study protocols or medications to reduce radiation-induced salivary glands damage.
Assuntos
Neoplasias de Cabeça e Pescoço , Mitocôndrias , Glândulas Salivares , Xerostomia , Xerostomia/etiologia , Xerostomia/prevenção & controle , Humanos , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/efeitos da radiação , Neoplasias de Cabeça e Pescoço/radioterapia , Glândulas Salivares/efeitos da radiação , Glândulas Salivares/efeitos dos fármacos , Glândulas Salivares/patologia , Lesões por Radiação/prevenção & controle , Lesões por Radiação/etiologia , Animais , Radioterapia/efeitos adversos , Radioterapia/métodos , Qualidade de VidaRESUMO
BACKGROUND AND PURPOSE: We performed a cost-effectiveness analysis (CEA) comparing an adaptive radiotherapy (ART) strategy, based on weekly replanning, aiming to correct the parotid gland overdose during treatment and expecting therefore to decrease xerostomia, when compared to a standard IMRT. MATERIALS AND METHODS: We conducted the ARTIX trial, a randomized, parallel-group, multicentric study comparing a systematic weekly replanning ART to a standard IMRT. The primary endpoint was the frequency of xerostomia at 12 months, measured by stimulating salivary flow with paraffin. The CEA was designed alongside the ARTIX trial which was linked to the French national health data system (SNDS). For each patient, healthcare consumptions and costs were provided by the SNDS. The reference case analysis was based on the primary endpoint of the trial. Sensitivity and scenario analyses were performed. RESULTS: Of the 129 patients randomly assigned between 2013 and 2018, only 2 records were not linked to the SNDS, which provides a linkage proportion of 98.4%. All of the other 127 records were linked with good to very good robustness. On the intent-to-treat population at 12 months, mean total costs per patient were 41,564 (SD 23,624) and 33,063 (SD 16,886) for ART and standard IMRT arms, respectively (p = 0.033). Incremental cost effectiveness ratio (ICER) was 162,444 per xerostomia avoided. At 24 months, ICER was 194,521 per xerostomia avoided. For both progression-free and overall survival, ART was dominated by standard IMRT. CONCLUSION: The ART strategy was deemed to be not cost-effective compared with standard IMRT for patients with locally advanced oropharyngeal cancer.
Assuntos
Neoplasias de Cabeça e Pescoço , Radioterapia de Intensidade Modulada , Xerostomia , Humanos , Análise de Custo-Efetividade , Radioterapia de Intensidade Modulada/efeitos adversos , Análise Custo-Benefício , Neoplasias de Cabeça e Pescoço/radioterapia , Xerostomia/etiologia , Xerostomia/prevenção & controle , Xerostomia/epidemiologia , Glândula Parótida , Dosagem RadioterapêuticaRESUMO
PURPOSE: Despite the availability of various prevention methods, dental caries continue to be diagnosed in patients receiving head and neck radiotherapy (RT). Since conventional approaches do not evaluate posttreatment alterations in dietary behaviors, we aimed to assess the influence of radiation-induced xerostomia on post-RT cariogenic dietary habits in patients. METHODS: Fifty-seven patients completed the Xerostomia Questionnaire (XQ) and answered questions regarding daily cariogenic food and beverage (CFB) intake, daily tooth brushing, fluoride application, and subjective total taste acuity (STTA). They also underwent evaluations to determine the Simplified Oral Hygiene Index (OHI-S) score, Saxon test score, number of decayed-missing-filled teeth (DMFT), and proportion of DMFT to the test teeth (DMFT rate). Clinical records were searched for information regarding RT modalities, including the median of the mean dose to the parotid glands, days after the completion of RT, submandibular gland resection, whole-neck irradiation, and the DMFT value and rate before RT. The patients were divided into low and high XQ score groups based on the median XQ score of 47.5 for the two sample tests. Univariable and multivariable regression analyses were used to identify independent factors for frequent CFB intake. RESULTS: Higher XQ scores were associated with a significantly greater frequency of CFB intake (p = 0.028*). Regression analysis also identified a higher XQ score (p = 0.017*) as an independent risk factor for frequent CFB intake. CONCLUSION: Radiation-induced xerostomia increased the frequency of CFB intake.
Assuntos
Cárie Dentária , Úlceras Orais , Radioterapia (Especialidade) , Xerostomia , Humanos , Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Xerostomia/epidemiologia , Xerostomia/etiologia , Xerostomia/prevenção & controle , Comportamento AlimentarRESUMO
Sjögren's syndrome (SS) is an autoimmune disorder characterized by oral dryness that is primarily attributed to tumor necrosis factor alpha (TNF-α)-mediated reduction in saliva production. In traditional Chinese medicine, goji berries are recognized for their hydrating effect and are considered suitable to address oral dryness associated with Yin deficiency. In the present study, we used goji berry juice (GBJ) to investigate the potential preventive effect of goji berries on oral dryness caused by SS. Pretreatment of human salivary gland cells with GBJ effectively prevented the decrease in aquaporin-5 (AQP-5) mRNA and protein levels induced by TNF-α. GBJ also inhibited histone H4 deacetylation and suppressed the generation of intracellular reactive oxygen species (ROS). Furthermore, GBJ pretreatment reserved mitochondrial membrane potential and suppressed the upregulation of Bax and caspase-3, indicating that GBJ exerted an antiapoptotic effect. These findings suggest that GBJ provides protection against TNF-α in human salivary gland cells and prevents the reduction of AQP-5 expression on the cell membrane. Altogether, these results highlight the potential role of GBJ in preventing oral dryness caused by SS.
Assuntos
Lycium , Síndrome de Sjogren , Xerostomia , Humanos , Fator de Necrose Tumoral alfa/metabolismo , Lycium/metabolismo , Glândulas Salivares/metabolismo , Glândulas Salivares/patologia , Xerostomia/induzido quimicamente , Xerostomia/prevenção & controle , Xerostomia/complicações , Síndrome de Sjogren/complicações , Síndrome de Sjogren/metabolismo , Síndrome de Sjogren/patologia , Aquaporina 5/genéticaRESUMO
PURPOSE: The objective of this study was to compare clinical outcomes of intensity-modulated radiation therapy (IMRT) alone versus IMRT + brachytherapy (BT) in patients with T1-T2N0M0 oropharyngeal squamous cell cancers (OPSCC). METHODS AND MATERIALS: This open-label randomized controlled trial was conducted at Tata Memorial Hospital, Mumbai, India. Patients with stage I and II OPSCC were considered for IMRT to a dose of 50 Gy/25 fractions/5 weeks in phase I followed by randomization (1:1) to further treatment with IMRT (20 Gy/10 fractions/2 weeks) or BT (192Ir high dose rate, 21 Gy/7 fractions/2 fractions per day). The primary endpoint of the trial was the reduction in xerostomia at 6 months evaluated using 99mTc salivary scintigraphy. Severe salivary toxicity (xerostomia) was defined as posttreatment salivary excretion fraction ratio <45%. Secondary endpoints were local control, disease-free survival, and overall survival. RESULTS: Between November 2010 and February 2020, 90 patients were randomized to IMRT (n = 46) alone or IMRT + BT (n = 44). Eleven patients (8 residual/recurrent disease, 2 lost to follow-up, 1 second primary) in the IMRT arm and 9 patients (8 residual/recurrence, 1 lost to follow-up) in the BT arm were not evaluable at 6 months for the primary endpoint. At 6 months, xerostomia rates using salivary scintigraphy were 14% (5/35: 95% CI, 5%-30%) in the BT arm while it was seen in 44% (14/32: 95% CI, 26%-62%) in the IMRT arm (P = .008). Physician-rated Radiation Therapy Oncology Group grade ≥2 xerostomia at any time point was observed in 30% of patients (9/30) in the IMRT arm and 6.7% (2/30) in the BT arm (P = .02). At a median follow-up of 42.5 months, the 3-year local control in the IMRT arm was 56.4% (95% CI, 43%-73%) while it was 66.2% (95% CI, 53%-82%) in the BT arm (P = .24). CONCLUSIONS: The addition of BT to IMRT for T1-T2N0M0 OPSCC results in a significant reduction in xerostomia. This strongly supports the addition of BT to IMRT in suitable cases.
Assuntos
Braquiterapia , Neoplasias de Cabeça e Pescoço , Neoplasias Orofaríngeas , Radioterapia de Intensidade Modulada , Xerostomia , Humanos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Braquiterapia/efeitos adversos , Braquiterapia/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço , Xerostomia/etiologia , Xerostomia/prevenção & controle , Neoplasias Orofaríngeas/radioterapiaRESUMO
BACKGROUND: The aim of this pilot, supplement study was the evaluation of primary, idiopathic mucosal mouth dryness (xerostomia or dry mouth) in subjects without systemic diseases. METHODS: Subjects with xerostomia were managed either with standard management (SM) or with SM and a Pycnogenol® mouth spray (Hankintatukku Oy, Karkkila, Finland), at the dosage of 60 mg/day in 30 spurts, for 2 weeks. RESULTS: A total of 50 subjects were included in the study: 25 controls using only standard management (SM) and 25 subjects using the Pycnogenol® mouth spray. No side effects and no tolerability problems were observed with the Pycnogenol® mouth spray. The groups were comparable for characteristics and symptoms at baseline. These otherwise healthy subjects had a BMI<26. After 2 weeks, salivary flow and salivary oxidative stress (in Carr Units) were improved significantly with Pycnogenol® mouth spray as compared to controls (P<0.05), whereas minimal improvements in salivary flow were seen with SM. The subjective symptomatic dry mouth score and the number of mucosal breaks and ulcerations (all minimal, <1 mm in length or diameter) were significantly decreased with the Pycnogenol® mouth spray supplement compared to SM controls (P<0.05). The Pycnogenol® mouth spray led to significant improvement in salivary lysozyme levels, compared to controls (P<0.05). CONCLUSIONS: Based on these preliminary results, Pycnogenol® mouth spray could be a new supplementary option for the management of primary xerostomia.
Assuntos
Flavonoides , Extratos Vegetais , Xerostomia , Humanos , Projetos Piloto , Extratos Vegetais/uso terapêutico , Extratos Vegetais/efeitos adversos , Xerostomia/tratamento farmacológico , Xerostomia/prevenção & controle , Xerostomia/induzido quimicamenteRESUMO
ABSTRACT Objective: To determine the occurrence of hyposalivation in Brazilian adults and its association with individual determinants, such as the use of medications, systemic conditions, smoking, and alcohol consumption. Material and Methods: A cross-sectional study with 402 adults was developed. Information was collected on sociodemographic and general health characteristics, and sialometry was performed with stimulated salivary flow. It indicated low salivary flow when ≤ 0.7 mL/min. Bivariate and multivariate analyses were conducted using a decision tree (p<0.05). Results: The sample was comprised predominantly of women (68.2%) aged ≤ 29 years (25.4%). Most participants did not use medication (56.7%). Among systemic diseases, the most cited was hypertension (25.1%). More than a third of the participants presented hyposalivation (40.3%), being associated with the following variables: age between 50 to 59 years (p=0.011), female sex (p<0.001), menopause (p=0.001), use of alcohol (p=0.033), systemic disease (p=0.002) and medication use (p<0.001). In multivariate analysis, in addition to sex (p<0.001) and hypertension (p=0.005), an association was also found between hyposalivation and diabetes (p=0.014). Conclusion: Factors associated with hyposalivation in adults were sex and the presence of hypertension or diabetes.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Salivação , Xerostomia/prevenção & controle , Fatores de Risco , Distribuição de Qui-QuadradoRESUMO
INTRODUCTION: Radiotherapy-induced xerostomia (RIX) is one of the most common adverse effects of radiotherapy (RT) in head and neck cancer patients (HNC) and a major determinant of survivors' quality of life. The primary objective was to evaluate the reduction of patients' xerostomia symptoms after the utilisation of a sodium-hyaluronate mouthwash compared to a placebo solution. The secondary objectives were to evaluate the improvement of quality of life and to evaluate the patients' satisfaction. METHODS: The protocol was approved by the ethical committee (Ref. 50,053/19) and registered at ClinicalTrials.gov (ID: NCT05103124). The study was a double-blind randomised clinical trial (RCT) with a crossover design and was conducted at the Fondazione Policlinico Universitario A. Gemelli, Rome. RESULTS: Thirty-two patients completed the study protocol. Lower values of the modified Xerostomia Questionnaire (XQ) were retrieved when comparing the baseline scores to the ones after the treatment, when compared with placebo (Mann-Whitney U test = 0.01); higher values of patients' satisfaction (Likert scale) and modified XQ were retrieved for the sodium-hyaluronate mouthwash (Mann-Whitney U test = 0.001). CONCLUSIONS: This RCT highlights the advantages of treating RIX with the sodium-hyaluronate mouthwash since it seems to be clinically effective in reducing its symptoms, without any reported adverse events. CLINICALTRIALS: gov: NCT05103124 in 17/10/2021.
Assuntos
Neoplasias de Cabeça e Pescoço , Radioterapia (Especialidade) , Xerostomia , Humanos , Antissépticos Bucais/uso terapêutico , Ácido Hialurônico/uso terapêutico , Xerostomia/tratamento farmacológico , Xerostomia/etiologia , Xerostomia/prevenção & controle , Sódio/uso terapêutico , Neoplasias de Cabeça e Pescoço/radioterapia , Qualidade de VidaRESUMO
Salivary gland damage caused by ionizing radiation (IR) severely affects the patient quality of life and influences the efficacy of radiotherapy. Most current treatment modalities are palliative, so effective prevention of damage caused by IR is essential. Melatonin (MLT) is an antioxidant that has been reported to prevent IR-induced damage in a range of systems, including the hematopoietic system and gastrointestinal tract. In this study, we explored the effects of MLT on whole-neck irradiation (WNI)-induced salivary gland damage in mice. The results revealed that by protecting the channel protein AQP-5, MLT not only alleviates salivary gland dysfunction and maintains salivary flow rate, but also protects salivary gland structure and inhibits the WNI-induced reduction in mucin production and degree of fibrosis. Compared with WNI-treated mice, in those receiving MLT, we observed a modulation of oxidative stress in salivary glands via its effects on 8-OHdG and SOD2, as well as an inhibition of DNA damage and apoptosis. With respect to its radioprotective mechanism, we found that MLT may alleviate WNI-induced xerostomia partly by regulating RPL18A. In vitro, we demonstrated that MLT has radioprotective effects on salivary gland stem cells (SGSCs). In conclusion, our data this study indicate that MLT can effectively alleviate radiation-induced damage in salivary glands, thereby providing a new candidate for the prevention of WNI-induced xerostomia.
Assuntos
Melatonina , Xerostomia , Camundongos , Animais , Melatonina/farmacologia , Melatonina/uso terapêutico , Melatonina/metabolismo , Qualidade de Vida , Glândulas Salivares/metabolismo , Glândulas Salivares/efeitos da radiação , Xerostomia/tratamento farmacológico , Xerostomia/etiologia , Xerostomia/prevenção & controle , Radiação IonizanteRESUMO
BACKGROUND: To determine the safety of Botox and its potential effect on alleviating radiation therapy (RT)-induced sialadenitis in head and neck cancer patients. METHODS: Twenty patients with stage III/IV head and neck cancer were randomized to receive Botox or saline injections into both submandibular glands (SMG). There were three visits: one before RT (V1); 1 week after RT (V2); and 6 weeks after RT (V3), each of which included saliva collection, a 24-h dietary recall, and a quality-of-life survey. RESULTS: No adverse events were observed. While the control group was much older, the Botox group more commonly underwent induction chemotherapy compared with controls. From V1 to V2, salivary flow decreased in both groups, but only in the control group from V1 to V3. CXCL-1 (GRO), a neutrophil chemoattractant, was lower in the Botox group compared with the control group at V3. CONCLUSION: Botox can be safely administered to the salivary glands prior to external beam radiation without observed complications or side-effects. After an initial reduction in salivary flow following RT, the Botox group showed lack of further flow reduction compared with controls. The inflammatory marker CXCL 1, which was reduced in the in Botox group at V3, may be a candidate for further studies of radiation-induced sialadenitis.
Assuntos
Toxinas Botulínicas Tipo A , Neoplasias de Cabeça e Pescoço , Sialadenite , Xerostomia , Humanos , Toxinas Botulínicas Tipo A/uso terapêutico , Projetos Piloto , Xerostomia/etiologia , Xerostomia/prevenção & controle , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/complicações , Sialadenite/etiologia , Sialadenite/prevenção & controleRESUMO
BACKGROUND AND PORPUSE: Salivary glands sustain collateral damage following radiotherapy (RT) to treat cancers of the head and neck, leading to complications, including xerostomia and hyposalivation. This systematic review (SR) with meta-analysis was performed to determine the effectiveness of bethanechol chloride in preventing salivary gland dysfunction in this context. MATERIALS AND METHODS: Medline/Pubmed, Embase, Scopus, LILACS via Portal Regional BVS and Web of Science were searched electronically in accordance with the Cochrane manual and reported PRISMA guidelines. RESULTS: 170 patients from three studies were included. Results from the meta-analysis suggest that bethanechol chloride is associated with increases in: whole stimulating saliva (WSS) after RT (Std. MD 0.66, 95% CI 0.28 to 1.03, P < 0.001); whole resting saliva (WRS) during RT (Std. MD 0.4, 95% CI 0.04 to 0.76, P = 0.03); and WRS after RT (Std. MD 0.45, 95% CI 0.04 to 0.86, P = 0.03). CONCLUSION: The present study suggests that bethanechol chloride therapy may be effective in patients with xerostomia and hyposalivation.
Assuntos
Betanecol , Lesões por Radiação , Xerostomia , Humanos , Betanecol/uso terapêutico , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Lesões por Radiação/tratamento farmacológico , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Glândulas Salivares , Xerostomia/tratamento farmacológico , Xerostomia/etiologia , Xerostomia/prevenção & controleRESUMO
Radiotherapy (RT) continues to play a key role in the management of head and neck cancer (HNC). Xerostomia remains a principal detriment to the quality of life (QoL) for 80 % of surviving patients receiving head and neck radiation. Radiation-induced injury to the salivary glands is dose-dependent, and thus efforts have been focused on decreasing radiation to the salivary glands. Decreased saliva production reduces both short-term and long-term quality of life in head and neck survivors by impacting on taste and contributing to dysphagia. Several radioprotective agents to the salivary gland have been investigated. Although not widely practiced, surgical transfer of the submandibular gland prior to RT is the mainstay of surgical options in preventing xerostomia. This review focuses on the strategies to improve xerostomia following radiation therapy in head and neck cancers.
Assuntos
Neoplasias de Cabeça e Pescoço , Xerostomia , Humanos , Xerostomia/etiologia , Xerostomia/prevenção & controle , Qualidade de Vida , Glândulas Salivares , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/radioterapia , Glândula SubmandibularAssuntos
Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Xerostomia , Humanos , Radioterapia de Intensidade Modulada/efeitos adversos , Carcinoma Nasofaríngeo/radioterapia , Estudos Prospectivos , Xerostomia/etiologia , Xerostomia/prevenção & controle , Glândula Parótida/patologia , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/patologia , Dosagem RadioterapêuticaAssuntos
Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Xerostomia , Humanos , Radioterapia de Intensidade Modulada/efeitos adversos , Carcinoma Nasofaríngeo/radioterapia , Estudos Prospectivos , Xerostomia/etiologia , Xerostomia/prevenção & controle , Glândula Parótida/patologia , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/patologiaRESUMO
The saliva secreted from submandibular gland (SMG) accounts for 60%-65%. It plays an important role in maintaining the human function of swallow, digestion, testing, speech, protection of oral mucosa, and prevention from dental carries. The SMG is frequently resected during the treatment for various kinds of oral and maxillofacial diseases, resulting in xerostomia and decreased quality of life. During the past 15 years, Research Center of Salivary Gland Diseases in Peking University School and Hospital of Stomatology conducted a series of studies on new techniques for preservation of SMG and achieved remarkable results. The clinicopathologic and imaging characteristics of IgG4-related sialadenitis (IgG4-RS) were clarified based on systematic studies. The results of studies on the pathogenesis of IgG4-RS showed that unbalance of inflammatory factors mediated the abnormality of secretion of SMG. IL-4 participates in occurring and development of glandular fibrosis of SMG. Regulation of tumor necrosis factor α (TNF-α) and cleaning of senescent cells might be taken as the targets for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents showed effective results for treating IgG4-RS, clinical remission was achieved in all the patients, serum IgG4 levels decreased, and salivary gland secretion significantly increased. Sialoendoscopy-assisted sialolithectomy was applied in the treatment of about 1 000 cases with submandibular hilar calculi with a success rate of more than 90%. Transfer of SMG was used for prevention from radiation-induced xerostomia in the patients with head and neck carcinoma. SMG was transferred to the submental region before radiotherapy and was kept away from the ra-diation field. The results of prospective clinical controlled study showed this technique could effectively preserve the function of SMG and prevent from xerostomia. Based on the micro-anatomical study on the blood vessels and ducts of SMG, partial sialoadenectomy was applied for treatment of benign tumors in the SMG. A clinical controlled study confirmed its safety for control of the tumors and its advantage of preservation of SMG function. The studies on the involvement of SMG in oral squamous cell carcinoma (OSCC) provided the anatomical and histopathological basis for preservation of SMG during neck dissection for early cases with OSCC. A innovated surgical modality "four preservations including SMG" was used during the neck dissection for the early cases with OSCC. A prospective randomized clinical controlled study confirmed its safety, feasibility, effectiveness for control of the carcinoma, and advantages of preservation of SMG function.
Assuntos
Carcinoma de Células Escamosas , Neoplasias Bucais , Sialadenite , Xerostomia , Humanos , Carcinoma de Células Escamosas/patologia , Glucocorticoides , Imunoglobulina G , Interleucina-4 , Neoplasias Bucais/patologia , Estudos Prospectivos , Qualidade de Vida , Sialadenite/prevenção & controle , Sialadenite/cirurgia , Glândula Submandibular/cirurgia , Fator de Necrose Tumoral alfa , Xerostomia/etiologia , Xerostomia/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PURPOSE: To assess the prevalence of oral manifestations in a group of allogenic liver, kidney or haematopoietic stem cell transplantation recipients and patients, and analyze the possible oral manifestations associated with the use of 4 immunosuppressive drugs. METHODS: One hundred and eighteen patients submitted to liver, kidney and hematopoietic stem cell transplantation who used tacrolimusï¼ sirolimusï¼cyclosporine or mycophenolate mofetil were enrolled. Through a questionnaire survey and oral examination, their oral manifestations were recorded, and the possible statistical associations with immunosuppressive drugs were analyzed using SPSS 21.0 software package. RESULTS: The prevalence of oral lichenoid lesions and cheilitis for the group of patients using tacrolimus after transplantation was significantly lower than the group of patients who did not used the agent(Pï¼0.01). The prevalence of oral lichenoid lesions for the group of patients who used cyclosporine was significantly higher than the group of patients who did not used the drug(Pï¼0.05), and the prevalence of cheilitis for the group of patients who used cyclosporine was significantly higher than the group of patients who did not used the drug(Pï¼0.01). The prevalence of oral lichenoid lesions and cheilitis for the group of patients who used tacrolimus was significantly lower than the group of patients who used cyclosporine(Pï¼0.01). The group of patients who used mycophenolate mofetil after transplantation had a significantly lower prevalence of dry mouth than the group of patients who did not used the drug(Pï¼0.01). The prevalence of oral manifestations in patients with sirolimus after transplantation was not significantly reduced. CONCLUSIONS: The use of tacrolimus improved the symptoms of oral lichenoid lesions and cheilitis and the effect was better than cyclosporine after transplantation. The use of mycophenolate mofetil improved dry mouth after organ transplantation.
Assuntos
Queilite , Imunossupressores , Transplante de Órgãos , Xerostomia , Queilite/prevenção & controle , Ciclosporina/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Ácido Micofenólico/uso terapêutico , Sirolimo , Tacrolimo/uso terapêutico , Xerostomia/prevenção & controleRESUMO
PURPOSE: To compare the incidence of xerostomia in nasopharyngeal carcinoma (NPC) patients treated with superficial parotid lobe-sparing intensity-modulated radiation therapy (SPLS-IMRT) and conventional IMRT (C-IMRT). METHODS: Patients with histologically confirmed NPC who met the eligibility criteria were randomly assigned to receive either SPLS-IMRT or C-IMRT. The primary endpoint was the incidence of xerostomia at 12 months post-IMRT. The secondary endpoints included the xerostomia questionnaire (XQ) score, unstimulated salivary flow rate (USFR), stimulated salivary flow rate (SSFR), and survival outcomes. RESULTS: Ninety patients were enrolled. Eighty-two patients were included for xerostomia analysis (42 in the SPLS-IMRT group and 40 in the C-IMRT group). At 12 months post-IMRT, the incidence of xerostomia in the SPLS-IMRT group was significantly lower than that in the C-IMRT group (83.4% vs 95.0%; P = 0.007), especially the grade 3 xerostomia (0% vs 12.5%; P < 0.001). The median change in XQ score was similar between the two groups (11.9 points vs 14.1 points; P = 0.194). There was a significantly higher median fractional USFR (0.67 vs 0.35; P = 0.024) and SSFR (0.66 vs 0.32; P = 0.021) in the SPLS-IMRT group than the C-IMRT group. The 3-year LRRFS, DMFS, and OS in the SPLS-IMRT and C-IMRT groups were 92.5% vs 90.9%, 83.8% vs 81.7%, and 88.9% vs 88.2% (all P > 0.05). CONCLUSION: SPLS-IMRT significantly reduced the incidence of xerostomia at 12 months post-IMRT in NPC by recovering parotid gland function earlier than C-IMRT, without compromising survivals. Phase III clinical trials are warranted. (ClinicalTrials.gov, number NCT05020067).
Assuntos
Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Xerostomia , Humanos , Radioterapia de Intensidade Modulada/efeitos adversos , Glândula Parótida , Carcinoma Nasofaríngeo , Estudos Prospectivos , Xerostomia/epidemiologia , Xerostomia/etiologia , Xerostomia/prevenção & controle , Neoplasias Nasofaríngeas/radioterapiaRESUMO
OBJECTIVE: The aim of the study was to investigate clinical evidence for defining the indications of prophylactic level IB radiotherapy (RT) in nasopharyngeal carcinoma (NPC). METHODS: We conducted a phase 2 prospective study in 116 newly diagnosed patients with NPC treated by intensity-modulated RT. Whether level IB was irradiated is based on the risk score model (RSM). Two groups based on RSM were obtained: low risk and high risk. Omission of level IB irradiation was conducted in the low-risk group, otherwise level IB was contoured as part of the treatment target. Grade 2 or worse xerostomia at 12 months was assessed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-H&N35 questionnaire. RESULTS: At a median follow-up of 16 months (range, 1-26 months), none of the patients developed failures at level IB. The 1-year overall survival, locoregional recurrence-free survival, and distant metastasis-free survival rates were 98.3%, 97.2%, and 95.8%, respectively. At 12 months xerostomia side-effects were reported in 90 of 116 alive patients; grade 2 or worse xerostomia at 12 months was significantly lower in the low-risk group than in the high-risk group. CONCLUSION: Omission of level IB irradiation was feasible for patients with low-risk IB lymph nodes metastasis.
Assuntos
Carcinoma , Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Xerostomia , Carcinoma/patologia , Carcinoma/radioterapia , Humanos , Linfonodos/patologia , Carcinoma Nasofaríngeo/etiologia , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/radioterapia , Estudos Prospectivos , Radioterapia de Intensidade Modulada/efeitos adversos , Fatores de Risco , Xerostomia/etiologia , Xerostomia/prevenção & controleRESUMO
PURPOSE: Avasopasem manganese (GC4419), an investigational selective dismutase mimetic radioprotector, reduced duration, incidence, and severity of severe oral mucositis (World Health Organization grade 3-4) in a phase 2b, randomized, double-blind trial of patients receiving concurrent cisplatin (cis) and radiation therapy (RT) for head and neck cancer. We report the secondary endpoints of final 1- and 2-year tumor outcomes and exploratory data on trismus and xerostomia. METHODS AND MATERIALS: Patients with locally advanced oral cavity or oropharynx cancer to be treated with definitive or postop cis and RT were randomized to 1 of 3 arms: 30 mg avasopasem, 90 mg avasopasem, or placebo. Pairwise comparisons of Kaplan-Meier estimates (each active arm separately vs placebo) were made for overall survival, progression-free survival, locoregional control, and distant metastasis-free survival. Xerostomia and trismus data were collected at each follow-up visit and analyzed for trends by post-RT timepoint and treatment group. RESULTS: At a median follow-up for the entire cohort of 25.5 months (25th-75th percentile, 24.6-26.2 months; range, 0.2-31.9 months), Kaplan-Meier estimates of 1- and 2-year overall survival, progression-free survival, locoregional control, and distant metastasis-free survival were not statistically different. No trends were apparent in xerostomia or trismus data. CONCLUSIONS: Avasopasem does not lead to statistically different tumor control outcomes when used concurrently with cis and RT for head and neck cancer. There was no detectable effect on trismus or xerostomia.
Assuntos
Neoplasias de Cabeça e Pescoço , Estomatite , Xerostomia , Cisplatino/efeitos adversos , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Compostos Organometálicos , Estomatite/etiologia , Estomatite/prevenção & controle , Trismo/etiologia , Trismo/prevenção & controle , Xerostomia/etiologia , Xerostomia/prevenção & controleRESUMO
PURPOSE: To identify the clinical significance of sparing submandibular glands (SMG) for the amelioration of acute xerostomia using diffusion kurtosis imaging (DKI) in nasopharyngeal carcinoma (NPC) patients treated with helical tomotherapy (HT). MATERIALS AND METHODS: The prospective study enrolled 42 participants treated with HT. All patients underwent five times of DKI scans before HT (pre-HT), in the middle of the HT course (mid-HT), immediately after HT (post-HT), and 1 months (1m-HT), 3 months post-HT(3m-HT). Mean diffusion (MD) and mean kurtosis (MK) of SMG, parotid glands (PG) and sublingual glands (SLG), saliva flow rate measures under resting (uSFR) and stimulated condition (sSFR), and xerostomia questionnaire scores (XQ) were recorded. Comparisons between the SMG-spared and -unspared groups were analyzed using two-factor repeated-measures ANOVA for the group as the inter-subject factor and the time as the intra-subject factor. RESULTS: When sparing SMG, the dose of spared-SMG and ipsilateral SLG was lower compared to that of unspared glands (p < 0.001). MD of spared-SMG and ipsilateral SLG in SMG-spared group were lower than that of SMG-unspared group (the simple effect for the group, p-value at mid-HT, post-HT, 1m- and 3m-HT was 0.014, 0.011, 0.000 and 0.000, respectively), MK of spared-SMG was higher conversely (the main effect for the group, p < 0.001), while uSFR and sSFR were significantly lower in SMG-unspared group (the main effect for the group, p = 0.002, and p = 0.045, respectively). No significant differences were detected in MK of SLG, MD/MK of PG, and XQ between the two groups (the main effect for the group, p values were 0.9, 0.37, 0.15, 0.86, respectively). There were significant differences in the effect of the time for all MD/MK of the salivary glands and for uSFR, sSFR, and XQ between the SMG-spared and -unspared groups (p values were all <0.001). CONCLUSION: Sparing SMG is of great clinical significance in alleviating acute xerostomia for NPC patients treated by helical tomotherapy as evaluated by diffusion kurtosis imaging and saliva flow rate.