Surface mould brachytherapy in oral and oropharyngeal cancers.

INTRODUCTION: There are insufficient data on surface mold brachytherapy (SMB) in treating oral cancers. We reviewed our institutional experience to investigate the efficacy and toxicity of this treatment modality. MATERIAL AND METHODS: We retrospectively reviewed all the patients treated between 1989 and 2018 with high-dose-rate iridium-192 SMB for oral and oropharyngeal squamous cell carcinomas at our institution. Surface mold brachytherapy was delivered via an acrylic surface mold with 1-5 inserted catheters spaced 1 cm apart fabricated by our dental oncologist. The Kaplan-Meier product estimator was used to assess local control (LC), locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS). Cox proportional hazards regression analysis was used to assess the relationship of various variables and patient outcomes. RESULTS: Eighteen patients met the inclusion criteria and were evaluated. Indications for treatment were primary tumor (n = 13), local recurrence (2), locoregional recurrence (1), and oligometastatic disease (1). Ten patients received SMB alone and 8 received external beam radiotherapy with an SMB boost. The acute toxicity outcomes were as follows: no toxicity (n = 1), grade 1 (7), grade 2 (9), and grade 3 (1). Late effects were rare, only occurring in 3 patients. The one- and two-year LC were 81% and 68%, LRC 77% and 64%, DMFS 81% and 81%, and OS 77% and 46%. CONCLUSIONS: Surface mold brachytherapy is a viable modality as either primary or boost treatment for superficial oral cancers. In our patients, this treatment method has a low toxicity profile and resulted in reasonable LC.

A direct technique to fabricate an intraoral shield for unilateral head and neck radiation.

A radiation oncologist may ask the prosthodontist to fabricate an intraoral shield when ipsilateral fields are used for patients with head and neck cancer. A technique for its fabrication is described that can be accomplished with materials and equipment that are readily available in the dental office. Baseplate wax is used intraorally to fabricate a pattern, which is duplicated with irreversible hydrocolloid material. Autopolymerizing acrylic resin is then used to make the shield. This simple technique can be completed in a single visit.

Squamous Cell and Adenoid Cystic Carcinoma Collision Tumor of the Soft Palate Treated with Surface Mold Brachytherapy.

Simultaneous primary cancers are rare in the oropharynx. This report describes the first reported case of a collision tumor of squamous cell and adenoid cystic carcinoma in the soft palate. The patient was immunosuppressed with a history of liver transplantation, smoking and heavy alcohol drinking. He was treated with wide local excision followed by adjuvant radiotherapy with surface acrylic mold brachytherapy. This technique was used instead of external beam radiotherapy in order to minimize toxicity. The patient tolerated the treatment well and with the only acute grade two mucositis at the soft palate and minimal late toxicity. There is no evidence of disease recurrence and the patient continues to maintain excellent quality of speech and swallowing 14 months after treatment completion.

Systematic review of literature: functional outcomes of implant-prosthetic treatment in patients with surgical resection for oral cavity tumors.

The current systematic review was performed to assess the functional outcomes of implant-prosthetic treatment on patients who have had surgical resection of oral cavity tumors. The assessment of function, satisfaction, or quality of life (QoL) were the major outcomes that evaluated preoperative and/or before and after implant-prosthetic treatment. Only eight published studies fulfilled the inclusion criteria. Three publications evaluated chewing ability, masticatory performance, and neuromuscular function, and the other five publications used questionnaire as a method of assessment. These publications mainly reported on implant-prosthetic treatment in mandibulectomy patients. It was found that implant-retained prosthesis had a beneficial effect on masticatory performance and masseter muscle activity on the defect side, but not on the non-defect side. Swallowing threshold performance and jaw movement parameters showed no significant differences between non-implant-retained prosthesis and implant-retained prosthesis. Significant improvement in prosthesis and patients' satisfaction with implant-retained prosthesis compared to non-implant-retained prosthesis was observed. However, general improvement in patients' QoL was not observed after implant-prosthetic treatment. Patients with intraoral resection might benefit from implant-retained prosthesis with regard to masticatory function and satisfaction. However, future clinical trials with an adequate sample size are needed to identify the group of patients who are likely to benefit from the implant-prosthetic treatment modality.

Prevalence of carotid and pulp calcifications: a correlation using digital panoramic radiographs.

OBJECTIVE: To compare the prevalence of pulp calcification with that of carotid calcification using digital panoramic dental radiographs. STUDY DESIGN: Digital panoramic radiographs of patients at a dental oncology clinic were included if (1) the carotid artery bifurcation region was visible bilaterally and (2) the patient had non-restored or minimally restored molars and/or canines. An endodontist evaluated the images for pulpal calcifications in the selected teeth. An oral and maxillofacial radiologist independently evaluated the same images for calcifications in the carotid bifurcation region. Odds-ratio and Pearson chi(2) were used for data analysis. Presence of pulpal calcification was also evaluated as a screening test for the presence of carotid calcification. RESULTS: A total of 247 panoramic radiographs were evaluated. 32% (n = 80) had pulpal calcifications and 25% (n = 61) had carotid calcifications with 12% (n = 29) having both carotid and pulp calcifications. A significantly higher prevalence of both pulp and carotid calcification was found in subjects older than age 60 years compared to younger age groups. Accuracy of pulpal calcification in screening for carotid calcification was 66.4%. CONCLUSIONS: Both pulp and carotid calcifications were more prevalent in older individuals. The presence of pulp calcification was not a strong predictor for the presence of carotid calcification.

Correlation between carotid area calcifications and periodontitis: a retrospective study of digital panoramic radiographic findings in pretreatment cancer patients.

OBJECTIVES: The objective of this study was to examine the prevalence of carotid area calcifications retrospectively detected on digital panoramic radiographs of pretreatment cancer subjects, and to correlate the finding of such calcifications with radiographic evidence of periodontal bone loss in the same subjects. STUDY DESIGN: Digital panoramic radiographs of 201 subjects were evaluated for calcifications projected in the carotid artery bifurcation area as well as for alveolar bone loss as a result of periodontal disease. Inclusion criteria were unobscured carotid artery bifurcation regions bilaterally and sufficient index teeth present with a definable cemento-enamel junction and alveolar crest. Radiographs were independently observed for carotid area calcifications and for periodontal status. Image enhancements permitted for detection of calcifications projected in the carotid area included window/level, inverse, and emboss. Periodontal measurements were made on index teeth using proprietary imaging software and a mouse-driven measurement algorithm. A 3-factor analysis of variance was performed with 3 between-subjects comparisons. Percentage of bone loss was the dependent variable. Independent variables were age, subject sex, and the presence or absence of carotid area calcifications. RESULTS: Differences measured in percentage of bone loss between sexes were not statistically significant. While bone loss did increase with age, comparison of the mean bone loss of each age category revealed no statistical significance. There was a highly significant correlation between carotid artery area calcifications visible on panoramic radiographs and percent alveolar bone loss. Radiographs showing unilateral and bilateral calcifications had a mean percent bone loss of 24.2% +/- 12.6% and 25.7% +/- 13.0% respectively, compared to those with no calcification at 10.4% +/- 9.9%. CONCLUSIONS: Nearly 1 in 4 subjects in this study evidenced calcifications projected in the carotid bifurcation region. The finding of such calcifications was significantly related to the calculated percentage of alveolar bone loss.

The influence of water storage on durometer hardness of 5 soft denture liners over time.

PURPOSE: This laboratory study investigated the influence of water storage on the durometer hardness of 2 RTV and 3 HTV soft denture liners over a 1-year period. MATERIALS AND METHODS: Five soft denture liners were used: 2 HTV silicone rubber (Luci-Sof and Molloplast-B), 1 RTV silicone rubber (Tokuyama), 1 HTV polyphosphazene (Novus), and an RTV plasticized acrylic (PermaSoft) that uses a surface sealer. They were processed following manufacturers' instructions, cured, and stored in tap water at 37 degrees C. The water was changed every 2 weeks. Five durometer A hardness measurements were made at logarithmically spaced intervals of 16.7 minutes, 27.8 hours, 11.6 days, 34.7 days, 115 days, and 347 days. Repeated measures analysis of variance (MANOVA), one-way analysis of variance (ANOVA), Pillai trace statistic, the difference scores (last-first) among the groups, and the Tamhane T2 multiple comparison test were used to compare the groups over time, all on SPSS V. 7.5 and 9.0. RESULTS: The order of highest initial indentation hardness was Luci-Sof, Molloplast-B, Novus (H(D)= 38 to 33). Tokuyama and PermaSoft as a group were softer (H(D)= 18 to 22). Tokuyama Soft Relining changed the least over 347 days, followed by Luci-Sof, Novus, Molloplast-B, and PermaSoft in that order (p < or = 0.05). Within the PermaSoft group, sealer applied only once changed the least over 347 days, followed by no sealer, and then sealer applied every month (p < 0.0005). CONCLUSIONS: After 347 days of water storage, Tokuyama had the lowest indentation hardness changes, followed by Luci-Sof, Novus, PermaSoft with sealer applied once; Molloplast-B, PermaSoft without sealer; and PermaSoft with sealer applied every month. All HTV soft denture liners had higher indentation hardness than RTV liners initially. After 347 days, PermaSoft without sealer and with sealer every month became the hardest.