ABSTRACT
PURPOSE: To verify the immediate effects of photobiomodulation on the production of salivary flow and the correlation of demographic, anthropometric and medication use data. METHODS: The study included 100 healthy individuals, aged between 18 and 76 years (mean 27.2 years), randomly split into an experimental group and a placebo group. Assessments of anthropometric measurements, self-perception of saliva production and sialometry were performed. Next, LASER irradiation was carried out at an infrared wavelength (808 nanometers) with 100 milliwatts (mw) of power at five intraoral points: on the sublingual glands and bilaterally on the submandibular and parotid glands, at doses of 9, 18 and 24 joules (J). Sialometry was repeated after each application. The control group received the same procedures with placebo equipment. RESULTS: There was a statistical association in the self-perception of reduced saliva in the experimental group for the 24J dose and in sialometry and in the reduction in salivary flow for the 18J and 24J doses and an increase to 9J, in both groups. There was no association when comparing the experimental and placebo groups. Multiple multinomial regression analysis revealed that the reduction or increase in salivary flow is independent of demographic, anthropometric and medication use variables. CONCLUSION: The bioinhibitory action of photobiomodulation on healthy salivary glands occurred at a dose of 18J and 24J, while the biostimulant action happened at a dose of 9J, regardless of demographic, anthropometric variables and medication use. The self-perception of reduced salivary flow occurred at 24J.
OBJETIVO: Verificar os efeitos imediatos da fotobiomodulação na produção do fluxo salivar e a correlação dos dados demográficos, antropométricos e de uso de medicamentos. MÉTODO: Participaram do estudo 100 indivíduos saudáveis, com idade entre 18 e 76 anos (média 27,2 anos), divididos de forma randomizada em grupo experimental e grupo placebo. Foram realizadas as avaliações das medidas antropométricas, autopercepção da produção de saliva e a sialometria. Na sequência, realizou-se a irradiação do LASER no comprimento de onda infravermelho (808 nanômetros) com 100 miliwatts (mw) de potência em cinco pontos intraorais: nas glândulas sublingual e bilateralmente nas submandibulares e parótidas, nas doses 9, 18 e 24 joules (J). A sialometria foi repetida após cada aplicação. O grupo controle recebeu os mesmos procedimentos com equipamento placebo. RESULTADOS: Houve associação estatística na autopercepção de redução da saliva no grupo experimental para a dose de 24J e na sialometria e na redução do fluxo salivar para as doses 18J e 24J e aumento para 9J, em ambos os grupos. Não houve associação quando comparado entre os grupos experimental e placebo. A análise de regressão multinomial múltipla revelou que a redução ou o aumento do fluxo salivar independe das variáveis demográficas, antropométricas e uso de medicamentos. CONCLUSÃO: A ação bioinibitória da fotobiomodulação sobre as glândulas salivares saudáveis ocorreu em dose de 18J e 24J, já ação bioestimulante na dose 9J, independe das variáveis demográficas, antropométricas e uso de medicamentos. A autopercepção da redução do fluxo salivar ocorreu em 24J.
Subject(s)
Low-Level Light Therapy , Saliva , Humans , Adult , Low-Level Light Therapy/methods , Middle Aged , Adolescent , Young Adult , Male , Female , Saliva/chemistry , Saliva/metabolism , Aged , Salivation/radiation effects , Salivation/physiology , Salivary Glands/radiation effectsABSTRACT
BACKGROUND: Arterial hypertension is a systemic condition that affects about 35% of the world population. The drugs that are used for its control can produce hyposalivation. This work evaluated the effect of photobiomodulation on salivary flow rate, salivary pH, total protein concentration, and calcium concentration in individuals using antihypertensive medications. MATERIAL AND METHODS: 41 subjects were randomly allocated in one of two groups: control (placebo) and photobiomodulation. The subjects had their salivary glands (20 sites) irradiated with a laser emitting at 808 nm, 4J/site once a week for 4 weeks and had their salivary flow measured before and after the whole treatment. RESULTS: The intragroup analysis (before and after treatment) shows a significant difference for both non-stimulated and stimulated salivary flow in the photobiomodulation group (p = 0.0007 and p = 0.0001, respectively). Comparing the placebo with the photobiomodulation group, significant differences were found for both non-stimulated (p = 0.0441) and stimulated salivary flow (p = 0.0441) after the treatment. No significant differences were found in pH, total protein concentration, calcium concentration. CONCLUSION: Despite the usage of drugs that influence the nervous system and typically result in a reduction of saliva production, photobiomodulation demonstrated a remarkable ability to enhance saliva production by a significant 75%.
Subject(s)
Antihypertensive Agents , Low-Level Light Therapy , Saliva , Xerostomia , Humans , Low-Level Light Therapy/methods , Female , Male , Xerostomia/etiology , Xerostomia/drug therapy , Xerostomia/therapy , Middle Aged , Antihypertensive Agents/pharmacology , Antihypertensive Agents/therapeutic use , Saliva/metabolism , Adult , Calcium/metabolism , Aged , Hypertension/drug therapy , Hypertension/therapy , Hydrogen-Ion Concentration , Salivary Glands/drug effects , Salivary Glands/radiation effects , Salivary Glands/metabolism , Salivation/drug effects , Salivation/radiation effectsABSTRACT
PURPOSE: Radiotherapy is one of the main strategies used in the treatment of cancer patients and it can cause early or late xerostomia and/or hyposalivation. Therapeutic management of xerostomia includes oral hygiene, sialogenic agents among others. METHODS: This study reviews the use of extra-oral salivary glands photobiomodulation in treating xerostomia and/or hyposalivation after radiotherapy and performs a meta-analysis of this data. RESULTS: After a broad search of the literature, eight clinical studies were selected. DISCUSSION: In a safe way, the studies found that extra-oral stimulation of the salivary glands has benefits in the hyposalivation and changes in salivary flow resulting from lesions by radiotherapy. A meta-analysis found significant values in pain comparing the pre- and post-treatment moments (MD - 3.02, I2 95%, IC - 5.56; - 0.48) and for stimulated salivary flow at 30 days after the end of radiotherapy (MD 2.90, I2 95%, IC 1.96; 3.84). CONCLUSION: The most promising parameters comprise wavelengths between 630 and 830 nm, radiant exposure from 2 to 10 J/cm2, two-to-three times a week, before the radiotherapy damage, and homogeneously in the glands. Therefore, Light-Emitting Diode (LED) stimulation of larger areas than the punctual stimulation of small millimeters of the Low-Level Laser Therapy (LLLT) appears to be promising.
Subject(s)
Low-Level Light Therapy , Salivary Glands , Xerostomia , Humans , Low-Level Light Therapy/methods , Xerostomia/etiology , Salivary Glands/radiation effectsABSTRACT
This randomized placebo-controlled trial evaluates the impact of photobiomodulation (PBMT) on the salivary flow and biochemistry of patients with chronic kidney disease (CKD) on hemodialysis. Forty-four patients on hemodialysis self-responded two questionnaires for oral health and salivary gland function perception. The subjects were evaluated for function of salivary glands and randomly allocated to two groups: PBMT group (three irradiations at 808 nm, 100 mW, 142 J/cm2, and 4 J per site); and placebo group. Patients were submitted to non-stimulated and stimulated sialometry and after the treatment at baseline and 14 days. Salivary volume and biochemical of the saliva were analyzed. At baseline, most subjects had self-perception of poor oral health (52.6%) and salivary dysfunction (63.1%). Clinical exam revealed that 47.3% of subjects presented dry mucosa. PBMT promoted increase of the non-stimulated (p = 0.027) and stimulated saliva (p = 0.014) and decrease of urea levels in both non-stimulated (p = 0.0001) and stimulated saliva (p = 0.0001). No alteration was detected in total proteins and calcium analysis. Patients with kidney disease can present alteration in flow, concentrations, and composition of saliva, affecting oral health, but our findings suggest that PBMT is effective to improve hyposalivation and urea levels in saliva of patients with CKD.
Subject(s)
Low-Level Light Therapy , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic/therapy , Salivary Glands/radiation effects , Humans , Renal Insufficiency, Chronic/metabolism , Renal Insufficiency, Chronic/physiopathology , Salivary Glands/metabolism , Salivary Glands/physiopathologyABSTRACT
Background: An important side effect of radioactive iodine (RAI) therapy in patients treated for papillary thyroid cancer (PTC) is chronic sialadenitis. Neck ultrasonography (US) easily recognizes radioiodine-induced salivary gland abnormalities. The objectives of this study were to determine the prevalence of US-detected sialadenitis caused by RAI and to identify the risk factors associated with this damage. Methods: This nonconcurrent cohort study includes all PTC-operated patients who were treated with RAI between 2007 and 2017 and were systematically evaluated with preoperative and follow-up neck US that included targeted exploration of the major salivary glands. Patients with pre-existing salivary gland diseases were excluded. The anatomical damage (diminished glandular volume, wavy contours, hypoechogenicity, and heterogeneity) was qualitatively assessed and compared with the preoperative study. RAI activity, sex, age, and preparation method were evaluated as risk factors using univariate and multivariate analyses with logistic regression. Results: Enrolled in this study were 570 patients who received a median RAI activity of 3700 MBq (100 mCi). On US, we found 143 patients (25.1%) with damage in at least one of their salivary glands: all had parotid damage (77 bilaterally) and 14 (9.8%) also had submandibular gland damage (7 of them bilaterally). The multivariate analysis indicated that the risk of sialadenitis was significantly (p < 0.01) correlated with both RAI activity and sex (14.1% of males vs. 28.5% of females). However, the main risk factor was RAI activity; no injury was detected in 156 patients who received 1110 MBq (30 mCi) and 1850 MBq (50 mCi) of RAI. In the groups of patients receiving 3700 MBq (100 mCi), 5550 MBq (150 mCi) and ≥7400 MBq (≥200 mCi), atrophy was found in 21%, 46.9%, and 77.7% of patients, respectively. Age and preparation method were not related to an increased risk of atrophy in this study. Conclusions: Chronic sialadenitis is common and affects approximately one fourth of patients who receive 3700 MBq (100 mCi) or higher RAI activity. The main risk factor for this injury is the total RAI activity administered. By using the lowest effective activity possible, irreversible anatomical damage in salivary glands can be minimized. US is an excellent tool to diagnose post-RAI atrophy.
Subject(s)
Iodine Radioisotopes/adverse effects , Salivary Glands/diagnostic imaging , Salivary Glands/radiation effects , Thyroid Cancer, Papillary/diagnostic imaging , Thyroid Cancer, Papillary/radiotherapy , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/radiotherapy , Ultrasonography/methods , Adolescent , Adult , Aged , Aged, 80 and over , Atrophy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neck/diagnostic imaging , Observer Variation , Parotid Gland/diagnostic imaging , Quality of Life , Radiotherapy/adverse effects , Risk , Risk Factors , Salivary Glands/physiopathology , Submandibular Gland/diagnostic imaging , Thyroid Cancer, Papillary/surgery , Thyroid Neoplasms/surgery , Young AdultABSTRACT
To date, there is no compilation of evidence-based information associating photobiomodulation effect and salivary glands. This systematic review aims to assess photobiomodulation effect of low intensity laser on salivary glands in the presence of systemic diseases. MEDLINE databases were searched in duplicate through December 2018. In vivo studies and clinical trials were included if photobiomodulation was performed in salivary glands of animal (rat or mice) or human in the presence of systemic disease. The methodological quality was assessed in duplicate using the modified Newcastle-Ottawa scale (NOS). Search strategy identified 483 potentially eligible articles, and 449 were included. The Boolean search naturally leads to a high amount of works the majority of which were excluded because the analysis of the title and abstract demonstrated it was not focusing on PBM. Only 34 studies were selected for the full-text analysis, of which 5 were excluded due to non-use of photobiomodulation, 4 due to lack of control group, 2 because they were studies of cell cultures and 1 because they did not have the total of animals used. Thus, 21 papers were included for the critical evaluation of the impact of photobiomodulation on the major salivary glands; the studies used rats (n = 10) and humans (n = 11). Although studies reported an increase in the salivary rate, decrease in pain, and increase in quality of life after the PBM, the lack of standards for the application of light and reporting of the parameters, make it hard to reproduce the results. This topic is still in need for further research.
Subject(s)
Low-Level Light Therapy , Salivary Glands/radiation effects , Animals , Clinical Trials as Topic , Humans , Mice , Pain/radiotherapy , Quality of Life , RatsABSTRACT
Las glándulas salivales humanas pueden ser gravemente lesionadas por la radioterapia utilizada contra neoplasias de cabeza y cuello, produciendo hiposialia y xerostomía, las cuales afectan la salud oral y sistémica, mermando la calidad de vida de la persona. Los tratamientos convencionales actuales están diseñados para disminuir los síntomas, sin actuar sobre los cambios fisiopatológicos que se dan a nivel glandular. Esta revisión intenta analizar aquellas terapias preventivas y/o curativas que están desarrollándose en el campo biomolecular y que tienen un futuro prometedor por sus características innovadoras: terapia génica, terapia con células madre y terapia con factores de crecimiento. Se evidencia un aporte adicional de la nanotecnología, la cual está mejorando las vías de aplicación de los tratamientos.
Human salivary glands can be seriously injured by the radiotherapy used against head and neck neoplasms, producing hyposialia and xerostomy, which affect oral and systemic health, diminishing the person's quality of life. Current conventional treatments are designed to reduce symptoms, without acting on the pathophysiological changes that occur at the glandular level. This review attempts to analyze those preventive and /or curative therapies that are developing in the biomolecular field and that have a promising future due to their innovative features: Gene therapy, stem cell therapy and growth factor therapy. An additional contribution of nanotechnology is evident, which is improving the routes of treatment application.
Subject(s)
Humans , Radiotherapy/adverse effects , Salivary Gland Diseases/prevention & control , Stem Cells/physiology , Genetic Therapy/methods , Intercellular Signaling Peptides and Proteins/therapeutic use , Radiation Injuries/prevention & control , Radiation-Protective Agents/therapeutic use , Salivary Gland Diseases/therapy , Salivary Glands/radiation effects , Xerostomia/prevention & control , NanotechnologyABSTRACT
In the aim to support treatments and diagnostics in Dentistry the most common radiographies are the periapical radiography and the dental panoramic. In the dental panoramic the X-ray beam is addressed into a large zone of the face obtaining the image of the upper and lower jaw. In this procedure part of the X-rays are scattered reaching some other parts of the patient body. In this work the absorbed dose in the eye lens, thyroid, salivary glands, mammary glands, and gonads, was measured in patients undergoing a dental orthopantomography. Measurements were carried out with thermolmuminiscent dosimeters. With the absorbed doses the Effective dose were calculated. The highest dose was obtained in the salivary glands (30.4⯵Sv) and the lowest dose was obtained in thyroid (3.8⯵Sv).
Subject(s)
Radiography, Panoramic/adverse effects , Female , Gonads/radiation effects , Humans , Lens, Crystalline/radiation effects , Male , Mammary Glands, Human/radiation effects , Radiation Dosage , Salivary Glands/radiation effects , Scattering, Radiation , Thermoluminescent Dosimetry , Thyroid Gland/radiation effectsABSTRACT
BACKGROUND: Oral mucositis (OM) is the most frequent and debilitating acute side effect associated with head and neck cancer (HNC) treatment. When present, severe OM negatively impacts the quality of life of patients undergoing HNC treatment. Photobiomodulation is a well-consolidated and effective therapy for the treatment and prevention of severe OM, and is associated with a cost reduction of the cancer treatment. Although an increase in the quality of life and a reduction in the severity of OM are well described, there is no study on cost-effectiveness for this approach considering the quality of life as a primary outcome. In addition, little is known about the photobiomodulation effects on salivary inflammatory mediators. Thus, this study aimed to assess the cost-effectiveness of the photobiomodulation therapy for the prevention and control of severe OM and its influence on the salivary inflammatory mediators. METHODS/DESIGN: This randomized, double-blind clinical trial will include 50 HNC patients undergoing radiotherapy or chemoradiotherapy. The participants will be randomized into two groups: intervention group (photobiomodulation) and control group (preventive oral care protocol). OM (clinical assessment), saliva (assessment of collected samples) and quality of life (Oral Health Impact Profile-14 and Patient-Reported Oral Mucositis Symptoms questionnaires) will be assessed at the 1st, 7th, 14th, 21st and 30th radiotherapy sessions. Oxidative stress and inflammatory cytokine levels will be measured in the saliva samples of all participants. The costs are identified, measured and evaluated considering the radiotherapy time interval. The incremental cost-effectiveness ratio will be estimated. The study will be conducted according to the Brazilian public health system perspective. DISCUSSION: Photobiomodulation is an effective therapy that reduces the cost associated with OM treatment. However, little is known about its cost-effectiveness, mainly when quality of life is the effectiveness measure. Additionally, this therapy is not supported by the Brazilian public health system. Therefore, this study widens the knowledge about the safety of and strengthens evidence for the use of photobiomodulation therapy, providing information for public policy-makers and also for dental care professionals. This study is strongly encouraged due to its clinical relevance and the possibility of incorporating new technology into public health systems. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials-ReBEC, RBR-5h4y4n . Registered on 13 June 2017.
Subject(s)
Chemoradiotherapy/adverse effects , Cranial Irradiation/adverse effects , Head and Neck Neoplasms/radiotherapy , Low-Level Light Therapy/methods , Radiation Injuries/prevention & control , Salivary Glands/radiation effects , Stomatitis/prevention & control , Biomarkers/metabolism , Brazil , Chemoradiotherapy/economics , Cost-Benefit Analysis , Cranial Irradiation/economics , Cytokines/metabolism , Double-Blind Method , Head and Neck Neoplasms/economics , Health Care Costs , Humans , Inflammation Mediators/metabolism , Low-Level Light Therapy/adverse effects , Low-Level Light Therapy/economics , Oxidative Stress , Radiation Injuries/economics , Radiation Injuries/etiology , Radiation Injuries/metabolism , Randomized Controlled Trials as Topic , Risk Factors , Saliva/metabolism , Salivary Glands/metabolism , Severity of Illness Index , Stomatitis/economics , Stomatitis/etiology , Stomatitis/metabolism , Time Factors , Treatment OutcomeABSTRACT
PURPOSE: To verify the acute effect of electrostimulation on the salivary flow of patients with hyposalivation. METHODS: Uncontrolled clinical trial evaluating 15 patients with hyposalivation induced by radiotherapy (RT) used for head and neck cancer treatment. Mean age of the patients was 56.8 ± 6.46 years. Males outnumbered females (73%). Transcutaneous Electrical Nerve Stimulation (TENS) was adjusted with 50Hz of frequency and 250µs of pulse width. Intensity was adjusted over a 20-minute period according to maximum tolerance. The electrodes were attached bilaterally on the region of the salivary glands. Evaluation of the salivary flow was performed through sialometry before and immediately after application of TENS. RESULTS: The most prevalent region for RT was the oropharynx (80.0% of cases). The mean dose used in RT was 64.6 ± 7.27 Gy. After TENS, salivary flow increased significantly (p = 0.0051) from 0.05 (0.00; 0.40) mL/min to 0.10 (0.07: 0.40) mL/min. The response to TENS was directly correlated with the intensity of the tolerated electric current (r = 0.553; p = 0.032) and the dose used in RT (r = -0.514; p = 0.050). CONCLUSION: TENS was able to increase the salivary flow rate of patients with RT-induced hyposalivation.
OBJETIVO: Verificar o efeito agudo da eletroestimulação sobre o fluxo salivar de pacientes com hipossalivação. MÉTODO: Ensaio clínico não controlado que avaliou o efeito de uma única aplicação da Transcutaneous Electric Nerve Stimulation (TENS) sobre o fluxo salivar de 15 pacientes com hipossalivação induzida por radioterapia (RT), utilizada no tratamento de câncer de cabeça e pescoço. A média de idade dos pacientes foi de 56,8 ± 6,46 anos e o gênero masculino foi predominante (73%). A TENS foi programada com 50Hz de frequência, 250µs de largura de pulso e a intensidade foi ajustada ao longo dos 20 minutos conforme máxima tolerância. Os eletrodos foram fixados bilateralmente sobre a região das glândulas salivares. A avaliação do fluxo salivar foi realizada por meio de sialometria estimulada, antes e imediatamente após a aplicação da TENS. RESULTADOS: Em 80% dos casos, o tratamento oncológico incluiu quimioterapia. A RT foi aplicada em 80% dos casos na região e orofaringe, com intensidade média de 64,6 ± 7,27 Gy. Após a TENS, o fluxo salivar aumentou significativamente (p = 0,0051), passando de 0,05 (0,00; 0,40) mL/min para 0,10 (0,07;0,40) mL/min. A resposta à TENS foi diretamente correlacionada à intensidade da corrente elétrica tolerada (r = 0,553; p = 0,032) e à dose utilizada na RT (r = -0,514; p = 0,050). CONCLUSÃO: A TENS aumentou significativamente o fluxo salivar de pacientes com hipossalivação induzida pela RT.
Subject(s)
Head and Neck Neoplasms/radiotherapy , Salivary Glands/radiation effects , Transcutaneous Electric Nerve Stimulation , Xerostomia/therapy , Female , Humans , Male , Middle Aged , Radiation Dosage , Radiotherapy/adverse effects , Radiotherapy, Intensity-Modulated , Saliva/metabolism , Salivation/radiation effects , Xerostomia/etiologyABSTRACT
BACKGROUND AND OBJECTIVE: radioiodine treatment (I131) used to treat thyroid carcinomas produces side effects (sialadenitis, xerostomia, dysphagia and caries susceptibility) reflecting in a poor patient quality of life. This study aimed to evaluate the effect of I131 on salivary function and possible oral impairment. MATERIAL AND METHODS: Thirty-seven patients undergoing I131 were submitted to oral examination, answer questions regarding xerostomia/hyposalivation and collect saliva at three moments (M1: 30-45 days before I131, M2: 1-2 days after I131 and M3: 7-10 days after treatment). Saliva was assayed for flow rate and calcium/phosphate concentrations. RESULTS AND CONCLUSIONS: significant difference in calcium/phosphate concentration was shown between M1 and M2, with evident decrease at M2. Flow rate reduced right after treatment with 41% of patients returning to previous rate at M3 (no statistical difference). A higher number of patients related xerostomia and difficulty in swallowing food at M2. The results showed that xerostomia/hyposalivation, dysphagia and calcium/phosphate concentration decrease may be considered early radioiodine side effects.
Subject(s)
Carcinoma, Papillary/radiotherapy , Iodine Radioisotopes/adverse effects , Saliva/radiation effects , Salivary Glands/radiation effects , Thyroid Neoplasms/radiotherapy , Adult , Aged , Deglutition Disorders/physiopathology , Female , Humans , Male , Middle Aged , Quality of Life , Salivary Glands/drug effects , Sialadenitis/etiology , Xerostomia/chemically induced , Xerostomia/etiologyABSTRACT
RESUMO Objetivo Verificar o efeito agudo da eletroestimulação sobre o fluxo salivar de pacientes com hipossalivação. Método Ensaio clínico não controlado que avaliou o efeito de uma única aplicação da Transcutaneous Electric Nerve Stimulation (TENS) sobre o fluxo salivar de 15 pacientes com hipossalivação induzida por radioterapia (RT), utilizada no tratamento de câncer de cabeça e pescoço. A média de idade dos pacientes foi de 56,8 ± 6,46 anos e o gênero masculino foi predominante (73%). A TENS foi programada com 50Hz de frequência, 250μs de largura de pulso e a intensidade foi ajustada ao longo dos 20 minutos conforme máxima tolerância. Os eletrodos foram fixados bilateralmente sobre a região das glândulas salivares. A avaliação do fluxo salivar foi realizada por meio de sialometria estimulada, antes e imediatamente após a aplicação da TENS. Resultados Em 80% dos casos, o tratamento oncológico incluiu quimioterapia. A RT foi aplicada em 80% dos casos na região e orofaringe, com intensidade média de 64,6 ± 7,27 Gy. Após a TENS, o fluxo salivar aumentou significativamente (p = 0,0051), passando de 0,05 (0,00; 0,40) mL/min para 0,10 (0,07;0,40) mL/min. A resposta à TENS foi diretamente correlacionada à intensidade da corrente elétrica tolerada (r = 0,553; p = 0,032) e à dose utilizada na RT (r = -0,514; p = 0,050). Conclusão A TENS aumentou significativamente o fluxo salivar de pacientes com hipossalivação induzida pela RT.
ABSTRACT Purpose To verify the acute effect of electrostimulation on the salivary flow of patients with hyposalivation. Methods Uncontrolled clinical trial evaluating 15 patients with hyposalivation induced by radiotherapy (RT) used for head and neck cancer treatment. Mean age of the patients was 56.8 ± 6.46 years. Males outnumbered females (73%). Transcutaneous Electrical Nerve Stimulation (TENS) was adjusted with 50Hz of frequency and 250μs of pulse width. Intensity was adjusted over a 20-minute period according to maximum tolerance. The electrodes were attached bilaterally on the region of the salivary glands. Evaluation of the salivary flow was performed through sialometry before and immediately after application of TENS. Results The most prevalent region for RT was the oropharynx (80.0% of cases). The mean dose used in RT was 64.6 ± 7.27 Gy. After TENS, salivary flow increased significantly (p = 0.0051) from 0.05 (0.00; 0.40) mL/min to 0.10 (0.07: 0.40) mL/min. The response to TENS was directly correlated with the intensity of the tolerated electric current (r = 0.553; p = 0.032) and the dose used in RT (r = -0.514; p = 0.050). Conclusion TENS was able to increase the salivary flow rate of patients with RT-induced hyposalivation.
Subject(s)
Humans , Male , Female , Salivary Glands/radiation effects , Xerostomia/therapy , Transcutaneous Electric Nerve Stimulation , Head and Neck Neoplasms/radiotherapy , Radiation Dosage , Radiotherapy/adverse effects , Saliva/metabolism , Salivation/radiation effects , Xerostomia/etiology , Radiotherapy, Intensity-Modulated , Middle AgedABSTRACT
BACKGROUND: Some complications of radioiodine therapy have been reported, but the involvement of the eyes and adnexa is rarely discussed. The purpose of this study was to determine the correlation among ocular surface changes, xerostomia, and changes in the nasal mucosa associated with radioiodine therapy. METHODS: Patients subjected to radioiodine therapy (group 1) or not subjected (group 2) were prospectively evaluated by examinations of the ocular surface and tear film, saliva production, and nasal endoscopy. Ocular and nasal symptoms and xerostomia were evaluated using questionnaires. RESULTS: Evaluation of the ocular surface did not indicate significant differences between the groups. Nasal endoscopy revealed higher mucosal pallor in group 1 and worsening of the endoscopic appearance. Worsening of ocular symptoms and nasal symptoms, xerostomia, and a significant decrease in salivary production was also observed in group 1. CONCLUSION: Subjective worsening of xerostomia, xerophthalmia, nasal symptoms, and changes in the nasal mucosa in group 1 was observed.
Subject(s)
Adenocarcinoma, Follicular/radiotherapy , Iodine Radioisotopes/adverse effects , Organs at Risk/radiation effects , Thyroid Neoplasms/radiotherapy , Xerostomia/etiology , Adenocarcinoma, Follicular/pathology , Adult , Aged , Cohort Studies , Female , Follow-Up Studies , Humans , Iodine Radioisotopes/therapeutic use , Lacrimal Apparatus/radiation effects , Male , Middle Aged , Nasal Mucosa/radiation effects , Prospective Studies , Radiation Injuries/diagnosis , Radiation Injuries/epidemiology , Risk Assessment , Salivary Glands/radiation effects , Thyroid Neoplasms/pathology , Xerophthalmia/etiology , Xerophthalmia/physiopathology , Xerostomia/physiopathologyABSTRACT
Low-power laser irradiation (LPLI) has been extensively employed to modulate inflammation in vitro and in vivo. Previous reports from our group indicated that LPLI might regulate glycemia in diabetic animals. Diabetes results in chronic hyperglycemia and therefore chronic inflammation by upregulation of inflammatory markers such as the high mobility group box 1 (HMGB1) protein. Thus this study aimed to analyze the LPLI effects upon blood glucose levels, plasma insulin and HMGB1 concentrations in a diabetes experimental rat model. Streptozotocin-induced diabetic rats were irradiated in the salivary glands area with a diode laser applied at 660 nm, 70 mW, 20 J/cm2 , 22.4 J, with a spot area of 0.028 cm2 and its effects were evaluated. LPLI significantly reduced diabetic rat hyperglycemia, without changing insulin or HMGB1 plasma levels, but possibly by ameliorating the insulin resistance in these animals. These findings suggest that LPLI might have a systemic effect, but more studies are necessary to better understand its mechanisms. Fasting blood glucose measured by peroxidase-glucose oxidase (PGO) method (A), showing a reduction of diabetic animals glycemia after LPLI. LPLI probably reduced the hyperglycemia in diabetes by improving the insulin resistance in these animals (B). C n = 10, CL n = 10, D n = 7 and DL n = 8. Data are expressed as mean ± SD; * P < 0.05 vs. respective control group; # P < 0.05 vs. D group.
Subject(s)
Diabetes Mellitus, Experimental/radiotherapy , Low-Level Light Therapy , Salivary Glands/radiation effects , Animals , Blood Glucose/analysis , Female , HMGB1 Protein/blood , Insulin/blood , Insulin Resistance , Rats , StreptozocinABSTRACT
PURPOSE: This review addressed the structural changes observed in salivary glands and pathogenic mechanisms resulting from oxidative stress caused by radiotherapy. The preventive and regenerative therapies for altered acinar morphology and glandular function were also reviewed. Among acute and late microscopic alterations in glandular tissue, there are particularly changes indicative of cell death, hypovascularization, formation of fibrous tissue and edema. A critical role was identified for the Akt-MDM2-p53 pathway in the suppression of DNA damage-induced apoptosis in acinar cells. Prophylactic treatment with pilocarpine, cevilemine, bethanechol and isoproterenol has shown a positive effect on salivary flow, but lasting results have not been observed. Growth factors, histamine and lidocaine, have also demonstrated radioprotective effects on the salivary glands. Stem cell preservation and transplantation may be an alternative to maintain tissue homeostasis and thus allow glandular regeneration. CONCLUSION: Knowledge of the structural changes observed in the salivary glands contributes to proving the short- and long-term efficacy of the therapies investigated. It is important to know the mechanisms involved in radiation-induced damage, since the control of the pathogenic mechanisms can inhibit the initial process of tissue degeneration. The challenge for investigators is to protect normal cells selectively, without promoting tumor growth.
Subject(s)
Head and Neck Neoplasms/radiotherapy , Salivary Gland Diseases/etiology , Salivary Gland Diseases/therapy , Salivary Glands/radiation effects , Apoptosis/drug effects , Apoptosis/radiation effects , DNA Damage/drug effects , DNA Damage/radiation effects , Humans , Oxidative Stress , Radiation-Protective Agents/therapeutic use , Salivary Glands/drug effects , Stem Cell TransplantationABSTRACT
Background: The radioactive iodine therapy for differentiated thyroid cancer can produce severe and frequent salivary symptoms, during the treatment or later. Aim: To analyze the incidence, severity and charactheristics of the salivary signs and symptoms in these patients. Patients and Method: Retrospective and descriptive analisis of 106 patients with confirmed diagnosis of differentiated thyroid cancer, treated with surgery and radioactive iodine, that completed a telephonic survey for the evaluation of salivary symptoms. Results: 26 (24.52 percent) patients presented with salivary symptoms or signs after the radioactive iodine therapy (mean 5 months). The average doses of I 131 was 128,5 mCi. Xerostomy, pain, xeroftalmy, inflammation, sialoadenitis and dysgeusia, were the most frequent clinical symptoms. Conclusions: After radioactive iodine therapy the salivary symptoms and signs incidence is high. We conclude that the indication for this treatment must be selective, but in accordance with the oncological risk of each patient.
Introducción: El tratamiento con yodo radioactivo en el tratamiento del cáncer diferenciado de tiroides puede originar síntomas alejados de origen salival. Éstos pueden llegar a ser intensos y frecuentes. Objetivo: Conocer la incidencia, características e intensidad de dichos síntomas. Material y Método: Revisión retrospectiva y análisis descriptivo de 106 pacientes con diagnóstico definitivo y anatomopatológico de cáncer diferenciado de tiroides, tratados con yodo radioactivo, que contestaron una encuesta telefónica especialmente diseñada para evaluación de patología salival. Resultados: Veintiséis (24,52 por ciento) pacientes presentaron y consultaron por síntomas y/o signos alejados (promedio 5 meses) de la terapia ablativa, de origen salival. La dosis promedio fue de 128,5 mCi de I 131. Los síntomas más frecuentes fueron xerostomía, dolor, xeroftalmia, inflamación, sialoadenitis y alteración del gusto. Discusión: La incidencia de signos y síntomas salivales alejados en pacientes tratados con I 131 es alta y justificaría a nuestro juicio su indicación selectiva, de acuerdo a los riesgos de recurrencia tumoral de cada paciente.
Subject(s)
Humans , Male , Adult , Female , Young Adult , Middle Aged , Salivary Gland Diseases/epidemiology , Salivary Gland Diseases/etiology , Thyroid Neoplasms/radiotherapy , Iodine Radioisotopes/adverse effects , Epidemiology, Descriptive , Salivary Glands/radiation effects , Incidence , Retrospective Studies , Iodine Radioisotopes/administration & dosage , Radiotherapy, Adjuvant/adverse effectsABSTRACT
OBJECTIVE: The present pilot study aimed to assess the effect of low-level laser therapy (LLLT) on hyposalivation and xerostomia as a consequence of head and neck radiotherapy. BACKGROUND DATA: The benefits of LLLT in salivary flow have been shown; however, there are no studies investigating its effects on patients who have already undergone radiotherapy and present hyposalivation and xerostomia as a sequela. METHODS: Twenty-three patients with a history of head and neck malignancy, who were treated by fractioned teletherapy (dosimetry ranging from 45 to 70 Gy) in the cervicofacial region were selected. They all presented with xerostomia and severe hyposalivation. Patients were randomly distributed into a laser group (n=12) and a control group (n=11). A GaAlAs laser (830 nm, 100 mW, illuminated area 0.028 cm2, 3.57 W/cm2, 20 sec, 2.0 J, 71 J/cm2) was used punctually in the major salivary glands, twice a week for 6 weeks, with a 12 session total. Stimulated and unstimulated salivary flow rate (SFR) were assessed, as well as the xerostomia and quality of life related to oral health (QLROH). RESULTS: The analysis did not show any significant difference between the groups with regards to the SFR and xerostomia, and the QLROH. However, at the end of the treatment, the xerostomia and the QLROH showed significant improvement in both groups compared with assessments performed at baseline, highlighting the importance of advice given to the irradiated patients, and their follow-up. CONCLUSIONS: With the parameters used, LLLT was not able to increase SFR or decrease xerostomia. The results may be associated with the late effects of radiotherapy on glandular structure, such as fibrosis and acinar atrophy.
Subject(s)
Low-Level Light Therapy , Radiation Injuries/radiotherapy , Salivary Glands/radiation effects , Salivation/radiation effects , Xerostomia/radiotherapy , Adult , Aged , Female , Head and Neck Neoplasms/radiotherapy , Humans , Male , Middle Aged , Pilot Projects , Radiation Injuries/etiology , Treatment Outcome , Xerostomia/etiologyABSTRACT
There is controversy concerning the effect of pilocarpine in the reversal of radio-induced xerostomia; however, the tests are usually performed at the end of radiotherapy. The present study evaluated the radioprotective effects of pilocarpine when ingested during radiation treatment. Eleven patients (recently diagnosed with head and neck cancer who were not undergoing radiotherapy) were divided into two groups: the control group (saline solution intake n=6) and the pilocarpine-treated (5 mg pilocarpine three times daily, n=5) group, in a prospective and double-blinded study. For five weeks, oral conditions, unstimulated salivary flow and stimulated saliva flow were collected weekly, with the first collection occurring prior to radiation therapy. As early as the second week, the control group exhibited oral complications and greater reduction in salivary flow rate. At the end of the study, the pilocarpine-treated group presented mean values of salivary flow greater than those of the control group. Pilocarpine intake applied simultaneously with radiotherapy demonstrated encouraging results with regard to lowering salivary flow reduction and incidence of xerostomia, as well as of oral complications.
Subject(s)
Pilocarpine/administration & dosage , Radiation-Protective Agents/administration & dosage , Radiotherapy/adverse effects , Salivary Glands/drug effects , Salivary Glands/radiation effects , Administration, Oral , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/radiotherapy , Humans , Pilocarpine/therapeutic use , Radiation-Protective Agents/therapeutic use , Treatment Outcome , Xerostomia/etiologyABSTRACT
Based on previous data on the histamine radioprotective effect on highly radiosensitive tissues, in the present work we aimed at investigating the radioprotective potential of the H4R ligand, JNJ7777120, on ionizing radiation-induced injury and genotoxic damage in small intestine, salivary glands and hematopoietic tissue. For that purpose, rats were divided into 4 groups. JNJ7777120 and JNJ7777120-irradiated groups received a daily subcutaneous JNJ7777120 injection (10 mg/kg) starting 24 h before irradiation. Irradiated groups received a single dose of 5 Gy on whole-body using Cesium-137 source and were sacrificed 3 or 30 days after irradiation. Tissues were removed, fixed, stained with hematoxylin and eosin or PAS staining and histological characteristics were evaluated. Proliferative and apoptotic markers were studied by immunohistochemistry, while micronucleus assay was performed to evaluate DNA damage. Submandibular gland (SMG) function was evaluated by methacholine-induced salivation. Results indicate that JNJ7777120 treatment diminished mucosal atrophy and preserved villi and the number of crypts after radiation exposure (240±8 vs. 165±10, P<0.01). This effect was associated to a reduced apoptosis and DNA damage in intestinal crypts. JNJ7777120 reduced radiation-induced aplasia, preserving medullar components and reducing formation of micronucleus and also it accelerated bone marrow repopulation. Furthermore, it reduced micronucleus frequency in peripheral blood (27±8 vs. 149±22, in 1,000 erythrocytes, P<0.01). JNJ7777120 completely reversed radiation-induced reduced salivation, conserving glandular mass with normal histological appearance and reducing apoptosis and atrophy of SMG. JNJ7777120 exhibits radioprotective effects against radiation-induced cytotoxic and genotoxic damages in small intestine, SMG and hematopoietic tissues and, thus, could be of clinical value for patients undergoing radiotherapy.
Subject(s)
Hematopoietic System/drug effects , Indoles/pharmacology , Intestine, Small/drug effects , Piperazines/pharmacology , Radiation-Protective Agents/pharmacology , Receptors, G-Protein-Coupled/metabolism , Receptors, Histamine/metabolism , Salivary Glands/drug effects , Animals , Bone Marrow/drug effects , Bone Marrow/pathology , Bone Marrow/radiation effects , Breast Neoplasms/pathology , Cell Line, Tumor , Cell Proliferation/drug effects , Female , Hematopoietic System/pathology , Hematopoietic System/radiation effects , Humans , Intestine, Small/pathology , Intestine, Small/radiation effects , Ligands , Male , Mutagens/toxicity , Rats , Rats, Sprague-Dawley , Receptors, Histamine H4 , Salivary Glands/pathology , Salivary Glands/radiation effects , Sulfhydryl Compounds/metabolism , Thiobarbituric Acid Reactive Substances/metabolism , Whole-Body IrradiationABSTRACT
INTRODUCTION: Radiotherapy (RT) of head and neck neoplasms often damages the salivary glands. AIM: To examine the pattern of morphologic changes resulting from RT of the head and neck region in minipig parotid glands in a clinical and experimental research setting. METHODS: Twelve 18-month-old male Brazilian minipigs weighing 30-40 kg were selected. Eight minipigs were assigned to the experimental group (group 1) and 4 to the control group (group 2). The RT was performed under general anesthesia at Erasto Gaertner Hospital, Curitiba, Brazil, using an á/â ratio of 2.5. The minipigs from group 1 underwent 3 sessions of irradiation with Cobalt 60 of the head and neck, bilaterally, with 3 exposures of 8 Gy each at 7-day intervals for a total dose of 24 Gy. The animals were sacrificed 12 weeks post-RT. RESULTS: The irradiated parotid glands displayed reductions in the size and number of acini as well as loss of secretory granules. The presence of fibrosis and loss of parenchyma relative to non-irradiated glands were observed, with an average reduction in volume of 54%. CONCLUSIONS: Our results demonstrate that this model for parotid gland damage resulting from an RT regimen appears to be useful for preclinical large animal studies of RT-induced damage and testing novel potential treatment options. Although recent advances in radiation therapy, such as intensity-modulated radiation therapy, have reduced the dose and limited the field of radiation, considerable salivary gland injury still occurs and can greatly impact the patient's quality of life after cancer treatment.