Photobiomodulation Therapy for Cancer Treatment-Related Salivary Gland Dysfunction: A Systematic Review.

Objective: Symptoms and clinical signs of decreased saliva secretion are a common after cancer therapy. The goal of this research is to systematically review the evidence about the efficacy of photobiomodulation therapy (PBMT) for the management of cancer treatment-related xerostomia or salivary hypofunction. Methods: PubMed was searched for articles investigating the clinical effects of PBMT on cancer therapy-related xerostomia or hyposalivation. The publications that met the eligibility criteria were evaluated for the quality of the study design, physical parameter setting reproducibility, specifics of the treatment protocol, clinical outcomes, and adverse effects. The strongest evidence was given a heavier weight in the overall conclusions. Results: A total of 314 articles were identified, and 5 controlled trials were included in this systematic review. Most of the studies were in head and neck cancer patients treated with radiotherapy (RT) or radiochemotherapy (RT-CT), and one study was in dry mouth associated with hematopoietic stem cell transplantation (HSCT). Data showed conflicting results for either prevention or treatment of RT- or RT-CT-induced dry mouth or hyposalivation. The data for HSCT-related dry mouth were positive. Conclusions: Despite positive preliminary outcomes in most of the trials, it is too early to confidently determine the efficacy of PBM for cancer therapy-related hyposalivation or xerostomia.

Efficacy of Radiation Therapy for the Treatment of Sialocele in Dogs.

BACKGROUND: Sialocele is a collection of saliva that has leaked from a damaged salivary gland or duct and is surrounded by granulation tissue. Surgery is the recognized first-line treatment. Recurrence rate after surgery is 5-14%. Salivary gland tissue is very sensitive to radiation therapy (RT). HYPOTHESIS/OBJECTIVES: Radiation therapy will be useful for the treatment of sialocele. The aims were to characterize response rate and clinical course of dogs with sialocele treated with RT and to determine a starting dose for clinical use. ANIMALS: Eleven dogs with sialocele. METHODS: Retrospective study of response and outcome after RT. RESULTS: All dogs had cervical sialocele. Seven dogs (63.6%) were treated with 3 weekly fractions of 4 Gray (Gy); (total dose, 12 Gy). Three dogs (27.3%) received 4 fractions of 4 Gy (16 Gy) and 1 dog received 5 fractions of 4 Gy (20 Gy) on a Monday-Wednesday-Friday schedule. Six dogs (54%) achieved a complete response (CR), and 5 dogs (45%) achieved a partial response (PR). Three dogs had progression of their sialocele 2, 3, and 9 months after RT; all three had received 12 Gy initially and 2 received 2 additional fractions of 4 Gy (cumulative total dose, 20 Gy) and subsequently achieved remission for >2 years. CONCLUSIONS AND CLINICAL IMPORTANCE: Radiation therapy is useful for the treatment of recurrent sialocele refractory to surgical management and a minimum total dose of 16 or 20 Gy in 4 Gy fractions appears effective.

Isolation and characterization of human salivary gland cells for stem cell transplantation to reduce radiation-induced hyposalivation.

BACKGROUND: Recently, we showed that transplantation of 100-300 c-Kit(+) stem cells isolated from cultured salispheres ameliorates radiation-damage in murine salivary glands. The aim of this study is to optimize and translate these findings from mice to man. METHODS: Mouse and human non-malignant parotid and submandibular salivary gland tissue was collected and enzymatically digested. The remaining cell suspension was cultured according to our salisphere culture method optimized for murine salispheres. Salisphere cells were tested using 3D matrix culturing for their in vitro stem cell characteristics such as the potential to differentiate into tissue specific cell types. Several potential mouse and human salivary gland stem cells were selected using FACS. RESULTS: In human salivary gland, c-Kit(+) cells were only detected in excretory ducts as shown previously in mice. From both human parotid and submandibular gland cell suspensions salispheres could be grown, which when placed in 3D culture developed ductal structures and mucin-expressing acinar-like cells. Moreover, cells dispersed from primary salispheres were able to form secondary spheres in matrigel, a procedure that could be repeated for at least seven passages. Approximately 3000 c-Kit+ cells could be isolated from primary human salispheres per biopsy. CONCLUSION: Human salivary glands contain a similar 'putative' stem cell population as rodents, expressing c-kit and capable of in vitro differentiation and self-renewal. In the future, these cells may have the potential to reduce radiotherapy-induced salivary gland dysfunction in patients.

Uso combinado de la sialografía y el ultrasonido en las enfermedades de las glándulas salivares mayores / Combined use of sialography and ultrasound in diseases of major salivary glands

Se realizó un estudio descriptivo retrospectivo de seis años de trabajo del departamento de Imagenología del Hospital Universitario Camilo Cienfuegos de Sancti Spíritus desde julio de 1998 hasta junio del 2004, para correlacionar los resultados de la sialografía y la ultrasonografía con el diagnóstico anatomopatológico de las lesiones que afectan las glándulas salivares mayores. Se conformó una serie de 70 pacientes con los requisitos para el estudio, 45 masculinos y 25 femeninos, con un rango de edades entre 15 y 82 años. La muestra la constituyeron 36 masas intraglandulares, 22 procesos inflamatorios crónicos no obstructivos, 10 procesos inflamatorios crónicos obstructivos y 2 abscesos simples, los que se clasificaron mediante la observación y análisis de las imágenes en 5 patrones sialográficos y 9 ultrasonográficos que permitieron agrupar las afecciones obtenidas en la muestra. En los resultados obtenidos se encontró asociación de los patrones sialográficos II y ultrasonográfico F en el 50 por ciento de los tumores, de los patrones sialográficos III y ultrasonográfico B en alrededor del 70 por ciento de los procesos inflamatorios crónicos no obstructivos y de los patrones sialográficos V y ultrasonográfico I en el 80 por ciento de las sialolitiasis, por lo que el estudio orienta que ambas técnicas se complementan(AU)

A retrospective/descriptive study of six years of work at the Imagenology Department of the Camilo Cienfuegos University Hospital of Sancti Spíritus from July of 1998 to June of 2004 was carried out to correlate the results of a sialography and an ultrasonography with the anatomopathological diagnosis of lesions that affect the major salivary glands. A series of 70 patients with the requirements for the study, 45 males and 25 females was made up, with an age range between 15 and 82 years. The sample was made up of 36 intraglandular masses , 22 chronic non-obstructive inflammatory processes, 10 chronic obstructive inflammatory processes and 2 simple abscesses, which were classified by observing and analyzing images in 5 sialographic and 9 ultrasonographic patterns that allowed to group the affections obtained in the sample. In the results obtained, an association was found of the sialographic II and ultrasonographic F patterns in 50 percent of the tumors, of the sialographic III and ultrasonographic B patterns in around 70 percent of the chronic non-obstructive inflammatory processes, and of the sialographic V and ultrasonographic I patterns in 80 percent of the sialolithiases, therefore the study indicates that both techniques complement each othe(AU)

[The role of radiotherapy in the management of benign lymphoepithelial lesions]. / Rola radioterapii w leczeniu benign lymphoepithelial lesion.

Benign lymphoepithelial lesion (BLL) is observed as a diffuse or nodular enlargement of major salivary gland. In 80% it appears in woman in the sixth and seventh decade. The histopathologic appearance consist of a triad of parenchymatous atrophy, interstitial lymphocytic infiltration and epimyoepithelial islands. This disease co-exists in 50% of cases with connective tissue disorders. In patients with BLL the risk of the development of a malignant lymphoma may be as high as 40:1 in comparison to the control group. From 1960 to 1991 ten women with BLL in salivary glands were treated in Oncology Centre in Kraków. The disease was localized in parotid glands (8 pts), in submandibular glands (1 pt) and in parotid and submandibular gland (1 pt). In this group 3 patients were treated for the rheumatoid arthritis and in 1 women presented symptoms of Sjögren' syndrome. Exclusive surgical treatment was performed in 2 patients, 7 patients were treated with irradiation, and 1 patient received combined therapy: surgery and radiotherapy. The doses of irradiation were from 12 to 36 Gy given in 6 to 18 fractions. Complete remission was observed in 2 patients who received only surgical treatment. In group of 8 patients treated with irradiation and surgery and irradiation we have observed local control in six women after 1 series and in two women after 2 series of irradiation. During the observation malignancies developed in 4 patients between 11 to 39 months after radiotherapy. One patient developed cancer of salivary gland. In remaining 3 patients it was observed malignant lymphomas. Our results of therapy of BLL in salivary gland are similar to presented by the other authors and indicate the efficiency of local (surgical or irradiation) treatment.

Low-dose radiation therapy for benign salivary disorders.

Two patients, one with a persistent salivary fistula after surgery for a skin tumor overlying the parotid region, and the other with a ranula recurrent after surgery, were treated with low-dose irradiation. Both problems resolved after a total dose of less than 30 Gy, and neither patient experienced xerostomia. In selected patients, low-dose radiation therapy offers a solution to persistent salivary flow refractory to surgical management.

[Treatment of inflammatory salivary gland diseases by using intraductal UV irradiation]. / Lechenie vospalitel'nykh zabolevanii sliunnykh zhelez s pomoshch'iu intrakanal'nogo UF-oblucheniia.

A novel technique is offered for treatment of sialadenitis. Ultraviolet irradiation conductors are inserted into the gland via its major duct for subsequent intracorporeal UV therapy of the gland. The results of the treatment are analyzed in 57 cases of sialadenitis observed during 1 to 2.5 years. The technique proved effective enough to be recommended for practical application.