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1.
Medicine (Baltimore) ; 99(24): e20658, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541507

RESUMO

BACKGROUND: With the number of cancer patients growing, radiotherapy and chemotherapy have been a necessary treatment. Unfortunately, there are many side effects after radiation and chemotherapy, one of which is xerostomia that always harasses patients. Although there are many ways of treatment of xerostomia, they have many disadvantages. With the rare side effects and the excellent effect, acupuncture has been widely applied to dry mouth after radiotherapy, but it has not been recognized as the standard treatment. Because acupuncture prescription is mostly different and the sample size of studies is small, we need more high-quality meta-analysis to provide relatively reliable evidence for the treatment of radiation-induced xerostomia. The objective of this study is to assess the curative effect of acupuncture treatment of cancer patients after radiotherapy and provide more reliable evidence for acupuncture treatment of xerostomia after radiotherapy for cancer patients. METHODS: We will search the following databases: CENTRAL (The Cochrane Central Register of Controlled Trials), MEDLINE, EMBASE, PubMed, CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), Wan Fang Data Knowledge Service Platform. At any rate, 2 review authors will assess all randomized controlled trials (RCTs), seemingly conformance to the inclusion criteria, to confirm qualification, determine the risk of bias and extract data using a running data extraction form. The revolution of disagreements is a discussion. We will use the approach recommended by Cochrane reviews to assess the bias in studies. Risk ratios (RR) and 95% confidence intervals (CIs) will be used to assess the treatment effects of an intervention for dichotomous results. We will use mean differences (MD) and standard deviation (SD) to aggregate the data of every trial for continuous results. The heterogeneity test of Cochran and quantification of the I statistic will be used to assess the variation of treatment effects. Only if there are studies of semblable comparisons reporting the same results, we will conduct a meta-analysis. RESULTS: From the study, we will evaluate the efficacy of acupuncture for xerostomia patients who has cancer and been treated by radiation. CONCLUSION: The conclusion of this study will be the evidence, which can ensure the efficacy of acupuncture for cancer patients with radiation-evoked xerostomia among and provide guidance for the treatment of xerostomia. INPLASY REGISTRATION NUMBER: INPLASY202040211.


Assuntos
Terapia por Acupuntura , Metanálise como Assunto , Neoplasias/radioterapia , Lesões por Radiação/terapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Xerostomia/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Xerostomia/etiologia
2.
Br J Radiol ; 93(1107): 20190955, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31971818

RESUMO

Patients with squamous cell carcinoma of the oropharynx are generally treated with (chemo) radiation. Patients with oropharyngeal cancer have better survival than patients with squamous cell carcinoma of other head and neck subsites, especially when related to human papillomavirus. However, radiotherapy results in a substantial percentage of survivors suffering from significant treatment-related side-effects. Late radiation-induced side-effects are mostly irreversible and may even be progressive, and particularly xerostomia and dysphagia affect health-related quality of life. As the risk of radiation-induced side-effects highly depends on dose to healthy normal tissues, prevention of radiation-induced xerostomia and dysphagia and subsequent improvement of health-relatedquality of life can be obtained by applying proton therapy, which offers the opportunity to reduce the dose to both the salivary glands and anatomic structures involved in swallowing.This review describes the results of the first cohort studies demonstrating that proton therapy results in lower dose levels in multiple organs at risk, which translates into reduced acute toxicity (i.e. up to 3 months after radiotherapy), while preserving tumour control. Next to reducing mucositis, tube feeding, xerostomia and distortion of the sense of taste, protons can improve general well-being by decreasing fatigue and nausea. Proton therapy results in decreased rates of tube feeding dependency and severe weight loss up to 1 year after radiotherapy, and may decrease the risk of radionecrosis of the mandible. Also, the model-based approach for selecting patients for proton therapy in the Netherlands is described in this review and future perspectives are discussed.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Transtornos de Deglutição/prevenção & controle , Neoplasias Orofaríngeas/radioterapia , Terapia com Prótons/métodos , Lesões por Radiação/prevenção & controle , Xerostomia/prevenção & controle , Idoso , Transtornos de Deglutição/etiologia , Nutrição Enteral/estatística & dados numéricos , Humanos , Mandíbula/efeitos da radiação , Pessoa de Meia-Idade , Países Baixos , Órgãos em Risco/efeitos da radiação , Qualidade de Vida , Glândulas Salivares/efeitos da radiação , Xerostomia/etiologia
3.
Int J Radiat Oncol Biol Phys ; 106(1): 167-173, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586664

RESUMO

PURPOSE: The adenoid cystic carcinoma (ACC), Erbitux, and Particle Therapy (ACCEPT) phase 1/2 trial (NCT01192087) evaluated a combined-modality approach (concurrent cetuximab and intensity modulated radiation therapy with carbon ion boost) for newly diagnosed nonmetastatic head and neck ACC. METHODS AND MATERIALS: Twenty-three patients with ACC were enrolled between June 2012 and June 2017 after initial diagnosis or postoperatively. All received a 400 mg/m2 cetuximab loading dose a week before radiation therapy, followed by weekly 250 mg/m2 doses starting on the first day of radiation therapy. The carbon ion radiation therapy boost was 24 Gy (relative biological effectiveness) in 8 daily fractions, followed by intensity modulated radiation therapy (54 Gy). The primary endpoint was safety and feasibility (defined based on Common Terminology Criteria for Adverse Events grade ≥3 events). Secondary endpoints included local and distant relapse, disease-free survival, and overall survival. RESULTS: Disease was most commonly in the paranasal sinuses (30%), palate (17%), and nasopharynx (17%). Nine (39%) patients underwent surgery (R1: 22%, R2: 78%). Median follow-up was 38.5 months. No patients experienced grade 4 to 5 events. Rates of grade 3 rash and radiation dermatitis were 17% and 22%, respectively. Grade 2 and 3 mucositis and dysgeusia occurred in 43% and 48% and in 9% and 0%, respectively. Grade 2 to 3 dysphagia and xerostomia were present in 43% and 4% and in 26% and 0%, respectively. At last follow-up, 5 (22%) patients experienced in-field relapse and 6 (26%) developed distant metastases. The 3-year disease-free survival was 67%, and median overall survival was 54 months. CONCLUSIONS: Outcomes of this trial were satisfactory. Although the trial did not meet the predefined criteria of feasibility owing to the comparatively high rates of grade 3 dermatitis, numbers are comparable to existing data on cetuximab + radiation therapy.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Carcinoma Adenoide Cístico/terapia , Cetuximab/uso terapêutico , Quimiorradioterapia/métodos , Neoplasias de Cabeça e Pescoço/terapia , Radioterapia com Íons Pesados , Radioterapia de Intensidade Modulada , Antineoplásicos Imunológicos/administração & dosagem , Carcinoma Adenoide Cístico/patologia , Cetuximab/administração & dosagem , Quimiorradioterapia/efeitos adversos , Terapia Combinada/métodos , Transtornos de Deglutição/etiologia , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Esquema de Medicação , Estudos de Viabilidade , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Radiodermatite/etiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Eficiência Biológica Relativa , Xerostomia/etiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-31731594

RESUMO

Oral complications of cancer therapy, such as oral dryness, dysphagia, and taste alteration, are associated with a negative impact in the quality of life of the patients. Few supportive care measures are available for such complications. This case series reveals the effectiveness of the photobiomodulation (PBM) therapy when used in a specific protocol and parameters, in the management of oral complications related to cancer therapy. Dysphagia was measured using the functional outcome swallowing scale for staging oropharyngeal dysphagia (FOSS). Oral mucositis was measured according to the National Cancer Institute scale. The quantity of the whole resting and stimulated saliva was measured in order to assess the oral dryness. In addition, the taste alteration was measured according to a protocol suggested by the International Standards organization (ISO). Sensation of burning mouth was measured using a visual analogue scale. These measurements were made before treatment, during, and at the end of the treatment. Diode laser 635 nm was used in 3 J/cm2. Five sessions interleaved with 24 h breaks were conducted for the dysphagia and oral dryness, and 10 sessions were conducted for the taste alteration and burning mouth sensation. Regardless of the limitations of this case series, PBM can be considered safe, time saving, and a promising approach for the management of the oral complications due to cancer therapy and the quality of life of cancer patients.


Assuntos
Transtornos de Deglutição/radioterapia , Terapia com Luz de Baixa Intensidade , Neoplasias/terapia , Estomatite/radioterapia , Xerostomia/radioterapia , Adulto , Transtornos de Deglutição/etiologia , Humanos , Lasers Semicondutores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Saliva , Estomatite/etiologia , Paladar , Xerostomia/etiologia
5.
Ned Tijdschr Tandheelkd ; 126(10): 507-511, 2019 Oct.
Artigo em Holandês | MEDLINE | ID: mdl-31613279

RESUMO

A side effect of radiotherapy in the head and neck area is a reduction of the capillary blood flow and with it, a reduction in local defenses. Depending on the duration and intensity of the radiation, hypoxia, hypocellularity and hypovascularity, may occur, resulting in an increased risk of infection. Hyposalivation, a commonly occurring phenomenon after radiotherapy, leads to a higher caries sensitivity. To keep oral health at an acceptable level as much as possible, teeth are checked by a dentist prior to radiotherapy. Non-essential teeth and teeth with pathology are extracted, in order to prevent future problems. Dental treatment in the area treated with radiation will nevertheless sometimes be necessary after radiotherapy. Because the risk of infection is high and may result in the loss of part of the jaw, antibiotic prophylaxis is started prior to invasive treatment. In general, amoxicillin 500 mg 3dd 1 is chosen for 14 days. After treatment, wound healing should be checked by the specialist.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Cárie Dentária/prevenção & controle , Neoplasias de Cabeça e Pescoço , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Xerostomia/etiologia
6.
Medicine (Baltimore) ; 98(36): e17030, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490391

RESUMO

To identify predictors for improvement of xerostomia in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).Patients diagnosed with stage I-IVb NPC (according to the 7th edition of the American Joint Committee on Cancer) between September 2015 and March 2016 were retrospectively analyzed. All the patients received IMRT. Predictors for improvement of xerostomia were analyzed using logistic regression analysis. Receiver operating characteristic curve analysis was used to identify the most appropriate cut-off values for predicting factors.This study included 195 patients: xerostomia improved in 109 patients and xerostomia remained unchanged in 86 patients. Volume of the parotid gland ≤52.2 cm was a risk factor for xerostomia improvement (odds ratio [OR] = 3.506, 95% confidence interval [CI]: 1.932-6.362, P = .001). The mean dose of <39 Gy to the ipsilateral parotid gland was a protective factor (OR = 0.417, 95% CI: 0.271-0.641, P = .001). V30 of the contralateral parotid gland ≤52% was a protective factor (OR = 0.593, 95% CI: 0.462-0.760, P = .001).Volume of the parotid gland, the mean dose of the ipsilateral parotid gland, and V30 of the contralateral parotid gland were independent predictors for improvement of xerostomia.


Assuntos
Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Xerostomia/etiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
7.
Codas ; 31(4): e20180176, 2019 Sep 02.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31483040

RESUMO

PURPOSE: To analyze the effects of electrical stimulation on the salivary flow of head and neck cancer patients with radiotherapy-induced hyposalivation. RESEARCH STRATEGIES: Searches were made in the Medline (via Pubmed), Cochrane Library, Scopus and Lilacs databases. SELECTION CRITERIA: Selection included clinical trials that evaluated salivary flow objectively, published in the last 10 years in either Portuguese, English or Spanish. DATA ANALYSIS: The PEDro scale was used for the methodological evaluation of the studies. RESULTS: The search strategy resulted in 21 publications, 17 of which were excluded, hence there were 4 articles left. The included studies had a total of 212 participants, all of whom had an increase in salivary flow, both through the electroacupuncture method and direct application on the salivary glands. The score obtained through the PEDRo scale was low, evidencing questionable methodological quality and risk of bias. CONCLUSION: The included studies demonstrate the clinical potential of TENS to increase the salivary flow of head and neck cancer patients treated with RT.


Assuntos
Estimulação Elétrica , Radioterapia/efeitos adversos , Xerostomia/terapia , Ensaios Clínicos como Assunto , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Xerostomia/etiologia
8.
Mayo Clin Proc ; 94(9): 1814-1824, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31405750

RESUMO

OBJECTIVE: To determine whether N-acetylcysteine rinse was safe and could improve thickened secretions and dry mouth during and after radiotherapy. PATIENTS AND METHODS: We designed a prospective pilot double-blind, placebo-controlled randomized clinical trial (Alliance MC13C2). Adult patients (age ≥18 years) were enrolled if they underwent chemoradiotherapy (≥60 Gy). Patients initiated testing rinse within 3 days of starting radiotherapy. With swish-and-spit, they received 10% N-acetylcysteine (2500 mg daily) or placebo rinse solution 5 times daily during radiotherapy and 2 weeks postradiotherapy. The primary aim was to evaluate N-acetylcysteine in improvement of saliva viscosity with the Groningen Radiotherapy-Induced Xerostomia questionnaire. Secondary aims included evaluating xerostomia improvement by the same questionnaire and with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck-35 Questions survey and adverse-event profiles. The type I error rate was 20%. RESULTS: Thirty-two patients undergoing chemoradiotherapy were enrolled. Baseline characteristics were balanced for placebo (n=17) and N-acetylcysteine (n=15). N-acetylcysteine was better for improving sticky saliva (area under curve, P=.12). Scores of multiple secondary end points favored N-acetylcysteine, including sticky saliva daytime (P=.04), daytime and total xerostomia (both P=.02), pain (P=.18), and trouble with social eating (P=.15). Repeated measures models confirmed the findings. Taste was a major dissatisifer for N-acetylcysteine rinse; however, both testing rinses were safe and well tolerated overall. CONCLUSION: Our pilot data showed that N-acetylcysteine rinse was safe and provided strong evidence of potential efficacy for improving thickened saliva and xerostomia by patient-reported outcome. A confirmatory phase 3 trial is required. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02123511.


Assuntos
Acetilcisteína/uso terapêutico , Quimiorradioterapia/efeitos adversos , Neoplasias de Cabeça e Pescoço/terapia , Antissépticos Bucais/farmacologia , Mucosite/terapia , Xerostomia/tratamento farmacológico , Idoso , Quimiorradioterapia/métodos , Método Duplo-Cego , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/efeitos dos fármacos , Mucosite/etiologia , Medidas de Resultados Relatados pelo Paciente , Segurança do Paciente , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Valores de Referência , Medição de Risco , Resultado do Tratamento , Xerostomia/etiologia
9.
Radiat Oncol ; 14(1): 131, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31358029

RESUMO

PURPOSE: To analyze baseline CT/MR-based image features of salivary glands to predict radiation-induced xerostomia 3-months after head-and-neck cancer (HNC) radiotherapy. METHODS: A retrospective analysis was performed on 266 HNC patients who were treated using radiotherapy at our institution between 2009 and 2018. CT and T1 post-contrast MR images along with NCI-CTCAE xerostomia grade (3-month follow-up) were prospectively collected at our institution. CT and MR images were registered on which parotid/submandibular glands were contoured. Image features were extracted for ipsilateral/contralateral parotid and submandibular glands relative to the location of the primary tumor. Dose-volume-histogram (DVH) parameters were also acquired. Features were pre-selected based on Spearman correlation before modelling by examining the correlation with xerostomia (p < 0.05). A shrinkage regression analysis of the pre-selected features was performed using LASSO. The internal validity of the variable selection was estimated by repeating the entire variable selection procedure using a leave-one-out-cross-validation. The most frequently selected variables were considered in the final model. A generalized linear regression with repeated ten-fold cross-validation was developed to predict radiation-induced xerostomia at 3-months after radiotherapy. This model was tested in an independent dataset (n = 50) of patients who were treated at the same institution in 2017-2018. We compared the prediction performances under eight conditions (DVH-only, CT-only, MR-only, CT + MR, DVH + CT, DVH + CT + MR, Clinical+CT + MR, and Clinical+DVH + CT + MR) using the area under the receiver operating characteristic curve (ROC-AUC). RESULTS: Among extracted features, 7 CT, 5 MR, and 2 DVH features were selected. The internal cohort (n = 216) ROC-AUC values for DVH, CT, MR, and Clinical+DVH + CT + MR features were 0.73 ± 0.01, 0.69 ± 0.01, 0.70 ± 0.01, and 0.79 ± 0.01, respectively. The validation cohort (n = 50) ROC-AUC values for DVH, CT, MR, and Clinical+DVH + CT + MR features were 0.63, 0.57, 0.66, and 0.68, respectively. The DVH-ROC was not significantly different than the CT-ROC (p = 0.8) or MR-ROC (p = 0.4). However, the CT + MR-ROC was significantly different than the CT-ROC (p = 0.03), but not the Clinical+DVH + CT + MR model (p = 0.5). CONCLUSION: Our results suggest that baseline CT and MR image features may reflect baseline salivary gland function and potential risk for radiation injury. The integration of baseline image features into prediction models has the potential to improve xerostomia risk stratification with the ultimate goal of truly personalized HNC radiotherapy.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Imagem por Ressonância Magnética/métodos , Glândula Parótida/patologia , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Glândula Submandibular/patologia , Tomografia Computadorizada por Raios X/métodos , Xerostomia/diagnóstico , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Glândula Parótida/diagnóstico por imagem , Glândula Parótida/efeitos da radiação , Prognóstico , Dosagem Radioterapêutica , Estudos Retrospectivos , Glândula Submandibular/diagnóstico por imagem , Glândula Submandibular/efeitos da radiação , Xerostomia/diagnóstico por imagem , Xerostomia/etiologia
10.
Cancer Radiother ; 23(5): 439-448, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31358445

RESUMO

Intensity-modulated radiation therapy (IMRT) is presently the recommended technique for the treatment of locally advanced head and neck carcinomas. Proton therapy would allow to reduce the volume of irradiated normal tissue and, thus, to decrease the risk of late dysphagia, xerostomia, dysgeusia and hypothyroidism. An exhaustive research was performed with the search engine PubMed by focusing on the papers about the physical difficulties that slow down use of proton therapy for head and neck carcinomas. Range uncertainties in proton therapy (±3 %) paradoxically limit the use of the steep dose gradient in distality. Calibration uncertainties can be important in the treatment of head and neck cancer in the presence of materials of uncertain stoichiometric composition (such as with metal implants, dental filling, etc.) and complex heterogeneities. Dental management for example may be different with IMRT or proton therapy. Some uncertainties can be somewhat minimized at the time of optimization. Inter- and intrafractional variations and uncertainties in Hounsfield units/stopping power can be integrated in a robust optimization process. Additional changes in patient's anatomy (tumour shrinkage, changes in skin folds in the beam patch, large weight loss or gain) require rescanning. Dosimetric and small clinical studies comparing photon and proton therapy have well shown the interest of proton therapy for head and neck cancers. Intensity-modulated proton therapy is a promising treatment as it can reduce the substantial toxicity burden of patients with head and neck squamous cell carcinoma compared to IMRT. Robust optimization will allow to perform an optimal treatment and to use proton therapy in current clinical practice.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Física Sanitária , Terapia com Prótons , Lesões por Radiação/prevenção & controle , Radioterapia (Especialidade) , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Pesquisa Médica Translacional , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/prevenção & controle , Disgeusia/etiologia , Disgeusia/prevenção & controle , Humanos , Hipotireoidismo/etiologia , Hipotireoidismo/prevenção & controle , Modelos Teóricos , Órgãos em Risco , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia Guiada por Imagem , Radioterapia de Intensidade Modulada/efeitos adversos , Incerteza , Xerostomia/etiologia , Xerostomia/prevenção & controle
11.
Int J Mol Sci ; 20(13)2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31261876

RESUMO

The chronic sensation of a dry mouth is a disease condition called xerostomia and affects a large part of the population. Xerostomia is associated with decreased secretion, or more often, qualitative changes in saliva proteins and immunoglobulin concentrations that develop as a result of salivary gland dysfunction. Several reasons causing dry mouth were described, and usually, they include taking medications, diseases or radiotherapy. In some situations, when it is difficult to use salivary stimulants or salivary gland damage is irreversible, the only option might seem to be saliva substitutes. The paper presents the most important aspects considering saliva preparations. The rheological and lubricating properties and the reconstruction of the complex saliva structure has been the main purpose of research. The biological properties of saliva preparations were also widely discussed. As part of the work, the antimicrobial effect of three commercial saliva preparations was tested. Finally, inadequate antimicrobial properties against the strains isolated from the oral cavity were demonstrated. The development of salivary substitutes, in particular, the improvement of antimicrobial properties, can be achieved using nanotechnology, including drug delivery systems containing nanocarriers.


Assuntos
Materiais Biomiméticos/química , Saliva/química , Xerostomia/tratamento farmacológico , Animais , Anti-Infecciosos/química , Anti-Infecciosos/uso terapêutico , Materiais Biomiméticos/uso terapêutico , Humanos , Microfluídica/métodos , Viscosidade , Xerostomia/etiologia
12.
BMC Res Notes ; 12(1): 376, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262359

RESUMO

OBJECTIVE: Drugs for managing mental disorders can cause adverse drug reactions (ADRs) that have negative impacts on patients yet, in Malawi, epidemiological data on the drug-related problems are limited. This study assessed the prevalence and severity of ADRs in out-patients at Zomba Mental Hospital. RESULTS: Twenty-six of forty patients (65.0%) were taking haloperidol and 14 (35.0%) chlorpromazine. The commonest diagnosis was schizophrenia (n = 23, 57.5%) followed by epileptic psychosis (n = 4, 10.0%) and general psychosis (n = 4, 10.0%) with one of psychotic depression and one psychosis secondary to general medical condition. Comorbidities were also found with epilepsy being the commonest (n = 4, 10.0%). All patients reported at least one ADR of varying severity (mild, moderate and severe). Polydipsia was the most prevalent (24, 60.0%) followed by weight gain (20, 50.0%), spasm (15, 37.5%) and xerostomia (15, 37.5%). Some ADRs were gender specific and these included impotence (6/27, 29.6%) for males and menstrual changes (3/14, 21.4%) for females. Severe ADRs were more common in the older aged group (> 35 years 8.3% vs 7.1%), in males (11.1% vs 0.0%) and on chlorpromazine (14.3% vs 3.8%). Patients taking chlorpromazine and haloperidol are at risk of experiencing a wide range of ADRs with varying degrees of severity.


Assuntos
Antipsicóticos/efeitos adversos , Clorpromazina/efeitos adversos , Disfunção Erétil/diagnóstico , Haloperidol/efeitos adversos , Distúrbios Menstruais/diagnóstico , Polidipsia/diagnóstico , Espasmo/diagnóstico , Xerostomia/diagnóstico , Adolescente , Adulto , Antipsicóticos/administração & dosagem , Clorpromazina/administração & dosagem , Estudos Transversais , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Feminino , Haloperidol/administração & dosagem , Hospitais Psiquiátricos , Humanos , Malaui , Masculino , Distúrbios Menstruais/etiologia , Distúrbios Menstruais/fisiopatologia , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Polidipsia/etiologia , Polidipsia/fisiopatologia , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/tratamento farmacológico , Esquizofrenia/fisiopatologia , Convulsões/tratamento farmacológico , Convulsões/fisiopatologia , Espasmo/etiologia , Espasmo/fisiopatologia , Ganho de Peso/efeitos dos fármacos , Xerostomia/etiologia , Xerostomia/fisiopatologia
13.
Oral Dis ; 25(7): 1798-1808, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31257663

RESUMO

OBJECTIVES: To evaluate (a) oral colonization of Candida species, especially for non-albicans Candida species (NACS), in xerostomic postradiotherapy head and neck cancer patients and (b) risk factors affecting their colonization. MATERIALS AND METHODS: Subjective and objective dry mouth scores, stimulated salivary flow rates, pH and buffering capacity were measured in 72 xerostomic postradiotherapy head and neck cancer patients. Candida counts and species identification were performed using oral rinse samples cultured in Candida Chromagar, followed by polymerase chain reaction and API 20C AUX system. RESULTS: Candida colonization was observed in 87.5% of subjects, with 80.6% and 48.6% of study population colonized by C. albicans and NACS, respectively. NACS was associated with high objective dry mouth scores, denture use, and females (p = .006, .009, and .036, respectively). In addition, Candida glabrata was detected more in females (p = .018) and denture wearers (p = .026), while Candida tropicalis was associated with high objective dry mouth scores (p = .022) and females (p = .027). Quantity of Candida colonization correlated positively with objective dry mouth scores (r = 0.599, p < .001) and negatively with salivary flow rates (r = -0.258, p = .041) and pH (r = -0.290, p = .022). CONCLUSION: NACS colonization was common in xerostomic head and neck cancer patients. Increased signs of dry mouth, female and dental prostheses may promote NACS colonization.


Assuntos
Candida/efeitos da radiação , Candidíase Bucal/epidemiologia , Neoplasias de Cabeça e Pescoço/radioterapia , Boca/efeitos da radiação , Saliva/efeitos da radiação , Xerostomia/radioterapia , Adulto , Idoso , Candida/efeitos dos fármacos , Candida/crescimento & desenvolvimento , Candida albicans/efeitos dos fármacos , Candida albicans/crescimento & desenvolvimento , Candidíase Bucal/diagnóstico , Contagem de Colônia Microbiana , Feminino , Humanos , Pessoa de Meia-Idade , Boca/microbiologia , Saliva/metabolismo , Saliva/microbiologia , Glândulas Salivares/efeitos da radiação , Taxa Secretória/efeitos da radiação , Xerostomia/etiologia
14.
Int J Radiat Oncol Biol Phys ; 105(4): 765-772, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31351194

RESUMO

PURPOSE: Dry eye is not typically considered a toxicity of whole brain radiation therapy (WBRT). We analyzed dry eye syndrome as part of a prospective study of patient-reported outcomes after WBRT. METHODS AND MATERIALS: Patients receiving WBRT to 25 to 40 Gy were enrolled on a study with dry mouth as the primary endpoint and dry eye syndrome as a secondary endpoint. Patients received 3-dimensional WBRT using opposed lateral fields. Per standard practice, lacrimal glands were not prospectively delineated. Patients completed the Subjective Evaluation of Symptom of Dryness (SESoD, scored 0-4, with higher scores representing worse dry eye symptoms) at baseline, immediately after WBRT (EndRT), and at 1 month (1M), 3 months, and 6 months. Patients with baseline SESoD ≥3 (moderate dry eye) were excluded. The endpoints analyzed were ≥1-point and ≥2-point increase in SESoD score at 1M. Lacrimal glands were retrospectively delineated with fused magnetic resonance imaging scans. RESULTS: One hundred patients were enrolled, 70 were eligible for analysis, and 54 were evaluable at 1M. Median bilateral lacrimal V20Gy was 79%. At 1M, 17 patients (32%) had a ≥1-point increase in SESoD score, and 13 (24%) a ≥2-point increase. Lacrimal doses appeared to be associated with an increase in SESoD score of both ≥1 point (V10Gy: P = .042, odds ratio [OR] 1.09/%; V20Gy: P = .071, OR 1.03/%) and ≥2 points (V10Gy: P = .038, OR 1.15/%; V20Gy: P = .063, OR 1.04/%). The proportion with increase in dry eye symptoms at 1M for lacrimal V20Gy ≥79% versus <79% was 46% versus 15%, respectively, for ≥1 point SESoD increase (P = .02) and 36% versus 12%, respectively, for ≥2 point SESoD increase (P = .056). CONCLUSIONS: Dry eye appears to be a relatively common, dose/volume-dependent acute toxicity of WBRT. Minimization of lacrimal gland dose may reduce this toxicity, and patients should be counseled regarding the existence of this potential side effect and treatments for dry eye.


Assuntos
Neoplasias Encefálicas/radioterapia , Irradiação Craniana/efeitos adversos , Síndromes do Olho Seco/etiologia , Aparelho Lacrimal/efeitos da radiação , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Irradiação Craniana/métodos , Síndromes do Olho Seco/prevenção & controle , Feminino , Humanos , Aparelho Lacrimal/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dosagem Radioterapêutica , Xerostomia/etiologia , Adulto Jovem
15.
Oral Dis ; 25(7): 1744-1750, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295368

RESUMO

OBJECTIVES: Though xerostomia is a frequent oral symptom, there is no validated disease-specific questionnaire in German. The purpose of this study was to translate and validate versions of the Xerostomia Inventory and the Summated Xerostomia Inventory in a German-speaking population. PARTICIPANTS AND METHODS: Thirty-nine patients including 18 patients suffering from radiation-induced xerostomia enrolled in this study. Both questionnaires were translated into German language according to international accepted guidelines. For validation, we evaluated reliability, validity, and responsiveness using the COSMIN manual for cross-cultural adaptation. RESULTS: Cronbach's α was 0.92 for XI and 0.91 for SXI, showing both high internal consistency. Patients suffering from xerostomia showed significantly higher average scores demonstrating its discriminant validity. Confirmatory factor analysis showed excellent "goodness-of-fit" values for SXI and good to moderate values for XI, confirming the assumed factor structures. The Xerostomia Inventory and its summated version both showed excellent test-retest reliability in the non-xerostomia group (ICC = 0.85 and 0.84). CONCLUSIONS: The XI and SXI in their cross-cultural adapted versions are the first validated self-report assessments for xerostomia in German language. They are characterized by practical design and can be easily interpreted by the treating physician.


Assuntos
Saúde Bucal , Psicometria/métodos , Qualidade de Vida , Lesões por Radiação/diagnóstico , Inquéritos e Questionários/normas , Traduções , Xerostomia/diagnóstico , Endoscopia , Feminino , Humanos , Idioma , Masculino , Psicometria/estatística & dados numéricos , Lesões por Radiação/etiologia , Reprodutibilidade dos Testes , Xerostomia/etiologia , Xerostomia/psicologia
16.
Paraguay Oral Research ; 8(1): 35-40, julio 2019.
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-1021606

RESUMO

La xerostomía, síndrome de boca seca o síndrome de Sjögren se define como la disminución del flujo salival en condiciones de reposo. El origen de esta endad clínica es mulcausal, pudiendo ser el resultado de una alteración localizada sobre las glándulas productoras de la saliva, o bien el resultado de un desequilibrio o alteración de índole sistémica. La evaluación del grado de disfunción de las glándulas salivares ha constuido un objevo básico por ello el propósito de este estudio fue determinar frecuencia del síndrome de Sjögren en pacientes con lupus eritematoso del hospital central del Instuto de Previsión Social en el año 2017 que acuden a tratamiento odontológico. Se realizó un descripción observacional retrospecvo para lo cual se recurrió a la historial clínico previo permiso del jefe de reumatología para acceder a los datos . Como conclusión general se obtuvo que existe una predominancia de pacientes de entre 46 a 50 años de edad representada por el 39% y de sexo femenino en el 83% de los casos. Se demuestra la frecuencia mencionando que acudieron 74 pacientes y de los cuales 18 (24%) personas presentan lupus eritematoso y síndrome de Sjögren, y entre estos el 78% acude a tratamiento odontológico.


Xerostomia, dry mouth syndrome or Sjögren's syndrome is defined as decreased salivary flow under resng condions. The origin of this clinical enty is mulcausal, and may be the result of an alteraon located on the glands producing saliva, or the result of an imbalance or alteraon of a systemic nature. The evaluaon of the degree of dysfuncon of the salivary glands has been a basic objecve and therefore the purpose of this study was to determine the frequency of Sjögren syndrome in paents with lupus erythematosus from the central hospital of the Social Welfare Instute in 2017 who seek dental treatment. A retrospecve observaonal descripon was made, for which the clinical history was used with the prior permission of the head of rheumatology to access the data. The general conclusion was that there is a predominance of paents between 46 and 50 years of age represented by 39% and female in 83% of cases. The frequency is demonstrated by menoning that 74 paents aended and of which 18 (24%) people present with lupus erythematosus and Sjögren's syndrome, of which 78% aend dental treatment


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Síndrome de Sjogren/complicações , Síndrome de Sjogren/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Xerostomia/etiologia , Transtornos de Deglutição/etiologia , Prevalência , Estudos Retrospectivos , Assistência Odontológica
17.
Eur J Haematol ; 103(4): 300-306, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31240771

RESUMO

OBJECTIVES: Haematopoietic stem cell transplantation (HSCT) recipients are at risk of side effects within the oral cavity. The purpose of this study was to examine progression of common oral diseases and hyposalivation and their associations with survival in allogeneic HSCT recipients. METHODS: Two hundred and sixty nine adult HSCT recipients treated with HSCT between 2008 and 2016 were included in this study. The associations of caries, decayed, missing, filled teeth (DMFT) index, radiological attachment loss and stimulated salivary flow rate with 6-month survival and the progression of the oral disorders within 2 years were examined. RESULTS: Forty HSCT recipients (14.8%) deceased within 6 months post-HSCT. Among the deceased recipients, hyposalivation and caries were more common pre-HSCT than in recipients who survived over 6 months (P < 0.05). HSCT recipients with hyposalivation pre-HSCT had higher risk of death (HR: 1.90, 95% CI:1.00-3.60; P = 0.044) within 6 months post-HSCT compared with recipients without hyposalivation. Hyposalivation pre-HSCT was associated with a higher DMFT index score (P < 0.05) and a smaller number of teeth (P < 0.005) 24 months post-HSCT in comparison with those without hyposalivation. CONCLUSIONS: Hyposalivation and caries were associated with a lower rate of survival in HSCT recipients. Additionally, hyposalivation predisposed to deterioration of oral health post-HSCT.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Doenças da Boca/epidemiologia , Doenças da Boca/etiologia , Xerostomia/epidemiologia , Xerostomia/etiologia , Adulto , Idoso , Feminino , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças da Boca/diagnóstico , Prognóstico , Taxa de Sobrevida , Resultado do Tratamento , Xerostomia/diagnóstico , Adulto Jovem
18.
Acta Oncol ; 58(10): 1366-1372, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31241381

RESUMO

Introduction: Xerostomia is a frequent complication after curative intended radiotherapy (RT) for head and neck squamous cell carcinoma (HNSCC). Assessment of xerostomia is commonly done by the physician. The aim of this study is to investigate the relation between patient and physician-rated xerostomia and to predict the degree of xerostomia from patients with self-reported xerostomia based on delivered doses to the oral cavity, parotid, and submandibular glands. Material and methods: During a 2-year period, consecutive HNSCC patients attending the follow-up clinic were included. All included patients had self-reported xerostomia, and completed the disease-specific EORTC QLQ-H&N35 questionnaire. The physician assessed the degree of xerostomia with the DAHANCA toxicity scale and was blinded for the EORTC score. Oral cavity, parotid, and submandibular glands (OAR) were delineated on the planning CT according to international guidelines. DVH were extracted from treatment plans. Logistic regression tested the relation between mean doses, patient characteristics, and xerostomia scores. Differences between DVH values and scoring of xerostomia were analyzed with a Kruskal-Wallis test. The relation between xerostomia and dose distributions was further investigated using principal component analysis (PCA). Results: In total, 109 patients were included in the study. A weak correlation was seen between patient and physician-rated toxicity (p = .001), however, in general patients reported more toxicity than physicians. For EORTC score ≥2, the multi-variable analysis was significant for doses to the oral cavity, tobacco status and use of xerogenic medication. Neither the DVH analysis nor the PCA found any clear distinction between xerostomia scores for EORTC or DAHANCA and investigated OARs. Conclusion: Patients tended to report higher scores of xerostomia than the physician. PCA indicated a complex relation between doses to the OAR and xerostomia scores, showing e.g., that reducing doses in one organ was on the expense of increased dose to another organ.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Lesões por Radiação/diagnóstico , Planejamento da Radioterapia Assistida por Computador/efeitos adversos , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Xerostomia/diagnóstico , Adulto , Idoso , Goma de Mascar , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Boca/diagnóstico por imagem , Boca/efeitos da radiação , Órgãos em Risco/efeitos da radiação , Análise de Componente Principal , Estudos Prospectivos , Doses de Radiação , Lesões por Radiação/etiologia , Lesões por Radiação/terapia , Glândulas Salivares/diagnóstico por imagem , Glândulas Salivares/efeitos da radiação , Índice de Gravidade de Doença , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Inquéritos e Questionários , Tomografia Computadorizada por Raios X , Xerostomia/etiologia , Xerostomia/terapia , Adulto Jovem
19.
Int J Radiat Oncol Biol Phys ; 105(2): 440-447, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31201897

RESUMO

PURPOSE: Xerostomia commonly occurs in patients who undergo head and neck radiation therapy and can seriously affect patients' quality of life. In this study, we developed a xerostomia prediction model with radiation treatment data using a 3-dimensional (3D) residual convolutional neural network (rCNN). The model can be used to guide radiation therapy to reduce toxicity. METHODS AND MATERIALS: A total of 784 patients with head and neck squamous cell carcinoma enrolled in the Radiation Therapy Oncology Group 0522 clinical trial were included in this study. Late xerostomia is defined as xerostomia of grade ≥2 occurring in the 12th month of radiation therapy. The computed tomography (CT) planning images, 3D dose distributions, and contours of the parotid and submandibular glands were included as 3D rCNN inputs. Comparative experiments were performed for the 3D rCNN model without 1 of the 3 inputs and for the logistic regression model. Accuracy, sensitivity, specificity, F-score, and area under the receiver operator characteristic curve were evaluated. RESULTS: The proposed model achieved promising prediction results. The performance metrics for 3D rCNN model with contour, CT images, and radiation therapy dose; 3D rCNN without contour; 3D rCNN without CT images; 3D rCNN without the dose; logistic regression with the dose and clinical parameters; and logistic regression without clinical parameters were as follows: accuracy: 0.76, 0.74, 0.73, 0.65, 0.64, and 0.56; sensitivity: 0.76, 0.72, 0.77, 0.59, 0.72, and 0.75; specificity: 0.76, 0.76, 0.71, 0.69, 0.59, and 0.43; F-score: 0.70, 0.68, 0.69, 0.56, 0.60, and 0.57; and area under the receiver operator characteristic curve: 0.84, 0.82, 0.78, 0.70, 0.74, and 0.68, respectively. CONCLUSIONS: The proposed model uses 3D rCNN filters to extract low- and high-level spatial features and to achieve promising performance. This is a potentially effective model for predicting objective toxicity for supporting clinical decision making.


Assuntos
Aprendizado Profundo , Neoplasias Laríngeas/radioterapia , Neoplasias Faríngeas/radioterapia , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Xerostomia/etiologia , Área Sob a Curva , Humanos , Neoplasias Hipofaríngeas/diagnóstico por imagem , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Laríngeas/diagnóstico por imagem , Modelos Logísticos , Neoplasias Orofaríngeas/diagnóstico por imagem , Neoplasias Orofaríngeas/radioterapia , Glândula Parótida/diagnóstico por imagem , Glândula Parótida/efeitos da radiação , Neoplasias Faríngeas/diagnóstico por imagem , Curva ROC , Planejamento da Radioterapia Assistida por Computador , Radioterapia Conformacional , Radioterapia Guiada por Imagem , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Glândula Submandibular/diagnóstico por imagem , Glândula Submandibular/efeitos da radiação , Tomografia Computadorizada por Raios X , Xerostomia/prevenção & controle
20.
Otolaryngol Pol ; 73(3): 26-31, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-31249150

RESUMO

PURPOSE: The aim of this retrospective study was to present the prevalence of early and late radiation-induced reaction and factors affecting its formation and severity in patients after adjuvant radio- or radiochemotherapy in salivary gland cancer. MATERIAL AND METHODS: A total of 113 patients with early and 91 with late radiation-induced reaction, irradiated in 2006-2016 were enrolled in the study. The frequency of acute mucosal radiation-induced reaction, time of onset, intensity, healing time, as well as the incidence of late radiation-induced reaction from the skin and subcutaneous tissue were analyzed. Factors that could influence the development and intensity of reaction were identified. RESULTS: Acute severity and the presence of late radiation-induced reaction do not affect overall survival. Dosage in the tumor bed site, as well as the dosage in the nodal region, affect the severity of the acute radiation-induced mucosal reaction. The severity of the early radiation-induced reaction is higher in men, more advanced patients (higher T and N+ in TNM classification), irradiated into a larger area, and those in whom two-dimensional planning and complementary chemoradiotherapy were applied. The late reaction of the skin and subcutaneous tissue was dominated by patients irradiated in the nodal regions and those with a higher intensity of early radiation-induced reaction. CONCLUSIONS: Supplementary radiotherapy or radiochemotherapy in salivary gland cancer is associated with acceptable toxicity which has no effect on overall survival.


Assuntos
Antineoplásicos/uso terapêutico , Quimiorradioterapia/métodos , Neoplasias das Glândulas Salivares/terapia , Adulto , Antineoplásicos/efeitos adversos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Dosagem Radioterapêutica , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Neoplasias das Glândulas Salivares/patologia , Xerostomia/etiologia
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