Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients

Effect of Photobiomodulation on Salivary Nitrite in Patients with Chemotherapy-Induced Oral Mucositis: A Randomized Clinical Trial

Background: Oral mucositis (OM) is a severe inflammatory and ulcerative condition of the oral mucosa commonly induced by chemotherapy. Photobiomodulation (PBM) therapy has been proposed for preventing and treating OM. However, the understanding of light interaction with biological tissues and the variability in light sources and protocols limit its widespread application. This study aimed to evaluate the impact of PBM on salivary nitrite levels, a marker of oxidative stress associated with inflammation and tissue damage. Materials and Methods: This prospective, randomized, double-blind clinical trial included 45 patients, evenly divided into three age- and sex-matched groups. Group 1 received basic oral care instructions prior to chemotherapy. Group 2 received these instructions plus PBM using a 650 nm intraoral diode laser. Group 3 received basic oral care instructions combined with PBM using both a 650 nm intraoral diode laser and a 980 nm extraoral diode laser. OM severity was assessed using World Health Organization criteria, and salivary nitrite levels were measured using the Griess reagent kit (Biotium®) according to the manufacturer's instructions 1 and 2 weeks after the first chemotherapy session. Results: Our study included 45 patients who were evenly distributed into three groups, matched for age, sex, tumor type, and type of chemotherapy. Significant differences in OM severity were observed among the groups at both 1 and 2 weeks (p = 0.000). Salivary nitrite levels also showed significant differences between groups at these time points (p = 0.00). Significant differences were found between the control group and both laser treatment groups, but no significant difference was noted between the two laser treatment groups. Conclusions: PBM effectively reduces OM severity, whether used intraorally alone or combined with extraoral application. This effect is likely due to PBM's ability to lower salivary nitrite levels, indicating reduced oxidative stress and inflammation.

Tritrichomonas muris sensitizes the intestinal epithelium to doxorubicin-induced apoptosis

Doxorubicin (DXR) is a widely used chemotherapy drug that can induce severe intestinal mucositis. Although the influence of gut bacteria on DXR-induced damage has been documented, the role of eukaryotic commensals remains unexplored. We discovered Tritrichomonas muris (Tmu) in one of our mouse colonies exhibiting abnormal tuft cell hyperplasia, prompting an investigation into its impact on DXR-induced intestinal injury. Mice from Tmu-colonized and Tmu-excluded facilities were injected with DXR. Tissue morphology and gene expression were evaluated at acute injury (6 h) and regenerative (72 h and 120 h) phases. Changes to crypt and villus morphology were more subtle than previously reported and region-specific, with significantly shorter jejunal villi in Tmu+ mice at 72 h post-DXR compared with Tmu- controls. Most notably, we observed elevated rates of DXR-induced apoptosis, measured by cleaved caspase 3 (CC3) staining, in Tmu+ intestinal crypts at 6 h post-DXR. Tmu+ mice also exhibited reduced expression of active intestinal stem cell (aISC) marker Lgr5 and facultative ISC (fISC) marker Ly6a at 6 h post-DXR compared with Tmu- controls. Tmu, but not DXR, was associated with increased inflammation and expression of type 2 cytokines IL-5 and IL-13. Tmu+ mice also exhibited a decreased fecal abundance of Lactobacillus, which promotes gut barrier integrity, and reduced claudin expression, indicating potential barrier dysfunction that could explain the increase in DXR-induced apoptosis. These findings highlight the significant influence of commensal microbiota, particularly eukaryotic organisms like Tmu, on intestinal biology and response to chemotherapy, underscoring the complexity of gut microbiota interactions in drug-induced mucositis.NEW & NOTEWORTHY Our study found that the eukaryotic commensal Tritrichomonas muris (Tmu) significantly increases DXR-induced intestinal apoptosis in mice. Tmu also reduces Lgr5 expression post-DXR injury and elevates inflammation and type 2 cytokine expression in the absence of injury. 16S sequencing identifies decreased abundance of protective Lactobacillus in Tmu colonized mice, as well as decreased expression of barrier-forming claudins, which may explain increased apoptosis. These findings emphasize the complex role of microbiota in drug-induced intestinal damage.

The Trajectory of Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy and its Influencing Factors

BACKGROUND

Oral mucositis (OM) is a common and severe side effect of radiotherapy in head and neck cancer (HNC). The study aimed to investigate the longitudinal changes in OM and its influencing factors in patients with HNC during radiotherapy.

METHODS

This was a retrospective longitudinal observational study. From July 2022 to March 2023, patients with HNC undergoing radiation therapy were enrolled. OM, oral hygiene, oral infections, oral pain, feeding route, and laboratory indicators were measured at 7 times. The influencing factors of OM were analyzed using generalized estimation equations (GEEs).

RESULTS

A total of 160 patients were included in this study. The prevalence of severe OM at T0, T1, T2, T3, T4, T5, and T6 was 0, 0, 2.5%, 9.4%, 26.9%, 24.4%, and 26.9%, respectively. The prevalence of grade 1-2 OM at T0, T1, T2, T3, T4, T5, and T6 was 0, 16.3%, 53.1%, 65.1%, 61.9%, 70.7%, and 71.3%, respectively. Duration of diagnosis, clinical stage, N stage, M stage, surgery, diabetes, radiotherapy dose, oral hygiene, oral infection, oral pain, feeding route, and lymphocyte impacted OM significantly in the GEEs multivariate model.

CONCLUSIONS

OM occurs in almost all patients with HNC who undergo radiotherapy. Changes in the severity of OM are a dynamic process, with the severity increasing with the cumulative radiotherapy dose. Specialist oral evaluation and oral care are needed to alleviate the severity of OM in HNC patients.

Safety, effectiveness and pharmacokinetics of high-dose propylene glycol-free melphalan (EVOMELA) with a prolonged infusion as myeloablative conditioning in Chinese multiple myeloma patients undergoing autologous stem cell transplantation: A prospective phase iv study

BackgroundMelphalan formulated with modified cyclodextrin (β-cyclodextrin sulfobutyl ether sodium [BSES]) is widely used before autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM) because of its favorable solubility and stability versus conventional melphalan, but the efficacy and safety data on Chinese patients with MM who subsequently underwent ASCT are still limited.MethodsIn this prospective, open-label, non-randomized, interventional study, a total of 67 MM patients who were eligible for ASCT were enrolled and assigned to receive 200 mg/m2 of Melphalan in two divided doses of 100 mg/m2 on Days -3 and -2 before ASCT on Day 0. We evaluated the efficacy, safety and pharmacokinetics (PK) of a prolonged infusion of high-dose BSES-melphalan as the conditioning treatment in the patients.ResultsOverall, 67 patients received melphalan with the median infusion time of 136 min. All patients achieved myeloablation with a median time of 5 days. Median time to neutrophil and platelet engraftments was 11 and 12 days after ASCT, respectively. Within the 65 evaluable patients, 18 patients (27.7%) achieved stringent complete response, 21 (32.3%) achieved complete response, 18 (27.7%) achieved very good partial response, and 3 (4.6%) achieved partial response. No treatment-related mortality (TRM) or adverse events leading to study withdrawal were identified. Prolonged infusion resulted in a lower Cmax but comparable AUCs.ConclusionsHigh-dose BSES-melphalan as a conditioning medicine is effective and safe in Chinese patients with MM before ASCT. Prolonging infusion duration may improve the safety without compromising efficacy.

Full-Mouth Digital Dental Rehabilitation Under General Anesthesia in a Post-Treatment Intraoral Squamous Cell Carcinoma Patient: A Case Report

Background: The treatment of head and neck cancer primarily involves surgical tumor removal combined with radiotherapy and/or chemotherapy. It often leads to significant side effects, impacting the anatomical structures of the oral cavity and resulting in major functional, esthetic, and socio-relational alterations. Case presentation: This clinical report aims to demonstrate the effectiveness of a hospital-based approach incorporating general anesthesia (GA) and computer-aided design and manufacturing (CAD/CAM) technology in the oral rehabilitation of a 58-year-old woman in remission from intraoral squamous cell carcinoma of the mandibular symphysis. The patient presented with oral pain, radiation-induced caries, reduced occlusal vertical dimension, and severely compromised teeth. Treatment Approach: The treatment plan included the removal of two non-restorable teeth, root canal treatment for the remaining teeth, and the placement of ceramic crowns and a partial removable prosthesis. Due to the complexity of the case and the patient's limitations, the treatment was performed under GA, allowing for a staged approach. Digital technologies, including intraoral scanning and CAD-CAM, enhanced precision and patient comfort. This approach facilitated tooth preservation and minimized the number of extractions while achieving satisfactory functional and esthetic outcomes. Conclusion: The case highlights the value of GA and digital techniques in managing special-needs patients with a history of irradiated head and neck cancer.

Effects of Omega-3 Fatty Acids on Oral Mucositis Induced by Anticancer Therapy: A Meta-Analysis

Oral mucositis (OM) is a serious complication of anticancer therapy that can substantially affect patient quality of life and treatment outcomes. This meta-analysis evaluated the efficacy of omega-3 fatty acids in the prevention and treatment of OM in patients diagnosed with cancer undergoing anticancer therapy. A systematic literature search of the PubMed, Embase, Web of Science, Cochrane Library, CNKI, and Wanfang databases for relevant studies, published up to September 24, 2024, was performed. Risk ratio (RR) or standardized mean difference (SMD) with corresponding 95% confidence interval (CIs) were calculated using Review Manager version 5.3. Five studies, including 337 patients, were included in this meta-analysis. Results of analysis revealed that, although omega-3 fatty acids did not significantly reduce the overall incidence of OM (RR 0.50, 95% CI 0.25-1.01), it significantly reduced the incidence of severe OM (RR 0.31, 95% CI 0.17-0.56), with no heterogeneity was observed (p = 0.96; I2= 0%). Furthermore, omega-3 fatty acids were found to significantly alleviate OM-associated pain (SMD -1.61, 95% CI -2.79 to -0.43), with no heterogeneity was detected (p = 0.32; I2 = 0%). Omega-3 fatty acids effectively reduced the incidence of severe OM and alleviated OM-related pain in patients undergoing anticancer therapy.

Chemotherapy-Induced Mucositis in Pediatric Oncology: Experience From 145 Cases at the Mohammed VI University Hospital, Oujda

Introduction Chemotherapy-induced mucositis is a common and debilitating complication in pediatric oncology patients, characterized by painful inflammation of the oral and gastrointestinal mucosal membranes. It commonly contributes to a decline in the quality of life, an elevated risk of infections, and prolonged durations of hospitalization. Management involves both preventive and therapeutic measures intended to reduce symptoms and prevent the onset of complications. This study aims to evaluate the clinical characteristics, associated risk factors, and the effectiveness of therapeutic strategies in managing chemotherapy-induced mucositis in children treated at the Pediatric Oncology Unit of Mohammed VI University Hospital in Oujda. Materials and methods This retrospective study was conducted over 14 months, from July 2022 to August 2023, at the Pediatric Oncology Unit of Centre Hospitalier Universitaire Mohammed VI, Oujda. One hundred and forty-five pediatric patients receiving chemotherapy were included in the study. Data were systematically collected and recorded in an Excel file to document relevant clinical, demographic, laboratory, and treatment information. Results The age of the patients ranged from three to 16 years, with a male predominance of 66% (96 cases). In 51% of the patients (74 cases), a history of oral mucositis episodes was reported. Common hematologic malignancies observed were leukemia (41.3%; 60 cases), followed by lymphoma (20.6%; 30 cases), neuroblastoma (13.7%; 20 cases), bone tumor (10.3%; 15 cases), retinoblastoma (7.6%; 11 cases) and other tumors (6.2%; 9 cases). Psychological distress, including anxiety, was present in 66% of patients. Almost all patients exhibited anorexia and refused to eat. The intensity of pain, evaluated using the Visual Analog Scale (VAS), ranged from 4 to 9/10, necessitating opioid analgesia in certain cases. Laboratory findings revealed neutropenia in 80% (116 cases), lymphopenia in 33% (48 cases), and an elevated C-reactive protein (CRP) in 79% (114 cases) of the patients. The treatment approach involved the administration of topical antifungal agents and meticulous oral hygiene, which included the use of bicarbonate mouthwashes. In severe cases, intravenous antibiotic therapy was initiated along with multimodal analgesic management. Conclusion Oral mucositis is a frequent and severe side effect of chemotherapy, associated with considerable morbidity and a decline in quality of life, underscoring the importance of prompt diagnosis and intervention.

Oral Mucositis in Head and Neck Cancer Patients

Oral mucositis (OM) is a common side effect of radiation therapy for head and neck cancer (HNC). Despite the medical advances in cancer therapy, OM is still virtually inevitable in patients being irradiated for neoplasms of the head and neck. The initial signs of oral mucositis typically manifest after cumulative doses between 15 and 20 Gy, with ulceration formation by 30 Gy and reaching peak severity in the week after radiation treatment completion (generally 60-72 Gy in management of HNC), then resolving over the 3-4 weeks following treatment completion. Severe oral mucositis (SOM), defined as WHO grade 3 and grade 4, occurs in 65-70% of patients receiving concurrent cisplatin and radiation therapy for locoregionally advanced HNC. WHO grade 3 or 4 oral mucositis leads to risk of systemic infection, severe pain, reduced oral intake which can lead to dehydration, significant weight loss and malnutrition, need for feeding tube placement and hospitalization. The clinical and economic impact, not to mention the impact on patient quality of life from oral mucositis has been well studied. As mucositis is commonly the dose-limiting factor leading to disruption or delay in cancer therapy, establishment of evidence-based guidelines has been paramount in supportive care management of these patients. Improvements in the prevention and treatment of oral mucositis remain essential to better patient outcomes. Here we review the current standard of care, recent successes and failures in development of therapies to mitigate OM, share patient and provider educational resources, and describe on-going and future directions of research in this area.

Mechanisms of photobiomodulation therapy in treating and preventing antineoplastic-induced oral mucositis: a systematic review

PURPOSE

To conduct a systematic review of the mechanisms of photobiomodulation therapy (PBMT) for treating or preventing oral mucositis (OM) caused by antineoplastic therapy.

METHODS

Following PRISMA 2020 guidelines, a search was conducted in Medline, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), and Bibliografia Brasileira de Odontologia from August to September 2023 using descriptors related to OM and laser therapy. Studies on the mechanisms of photobiomodulation in OM were included. Randomized (RCTs) or non-randomized trials from the past 10 years were reviewed. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools.

RESULTS

A total of 355 studies was identified. After the screening, seven met the eligibility criteria. The RCTs showed a low risk of bias. PBMT reduced OM incidence in patients undergoing chemotherapy/radiotherapy. PBMT decreased pro-inflammatory cytokines (interleukin-6, tumor necrosis factor-α) and increased anti-inflammatory cytokines (interleukin-4, interleukin-10). It also modulated inflammatory mediators, enhancing the antioxidant enzyme superoxide dismutase and overexpressing genes for keratinocyte differentiation, aiding injury repair.

CONCLUSION

The findings suggested that the mechanism of action of PBMT in OM involves modulation of the inflammatory response, balancing oxygen reactive species generation, and expression of factors related to healing or repair. Further studies are needed to elucidate these mechanisms and optimize treatment protocols.

Dental health, conditioning and oral mucositis in allogeneic hematopoietic stem cell transplantation: a single-center study

Oral mucositis (OM) is a severe adverse effect of conditioning treatments preceding allogeneic hematopoietic stem cell transplantation (allo-HSCT). Despite the high incidence of OM in transplant recipients, there is a lack of effective strategies for risk assessment. The aim of this study was to identify risk factors for OM development and evaluate the significance of oral health prior to allo-HSCT. A retrospective analysis of 242 adult patients receiving allo-HSCT was conducted, grading OM occurrence and severity using the World Health Organization scale. Furthermore, a radiographic assessment score was introduced to measure dental damage and restoration status in patients undergoing HSCT. In this cohort, 51.24% of patients developed clinically significant OM, with a mean grade of 1.1 (±1.3 standard deviation). Additionally, OM severity correlated with the total body irradiation dose (P < 0.0001). Among the 61 patients evaluated for dental treatment before HSCT, a significantly higher proportion developed OM (93.2%; P < 0.0001). Moreover, we observed that higher pretransplant dental damage was associated with more severe OM (P = 0.039). These findings provide a rationale for a detailed pretransplant dental examination to assess OM risk in HSCT recipients.

Mitigation of Methotrexate-Induced Intestinal Mucositis in Male Wistar Rats by Gallic Acid: The Role of HGF and C-Met Genes

Purpose: Gastrointestinal mucositis (GI-M) is the most common adverse effect of methotrexate (MTX). Gallic acid (GA) is a polyphenolic component rich in green tea, gall nuts, hops, grapes, and oak bark and has anti-inflammatory and antioxidant properties. The aim was to investigate the impact of GA on proinflammatory cytokines, expression level of hepatocyte growth factor (HGF) and C-met genes, and histopathological alterations of MTX-induced GI-M in rats. Methods: Twenty-four male Wistar rats were randomly divided into four groups: control, GA, MTX, and MTX + GA. Mucositis was induced in the experimental groups (MTX and MTX + GA) through three intradermal injections (the third to fifth days) of 2.5 mg/kg MTX in the suprascapular region. The GA group received 100 mg/kg GA via gavage, while the control group received normal saline by gavage (7 continuous days) and via intradermal injection (the third to fifth days) in the suprascapular region. The intestinal jejunal tissue and serum were analyzed for HGF and C-met mRNA expression, as well as levels of tumor necrosis factor-α (TNF-α) and interleukin-1 β (IL-1β). In addition, a histopathological study was to eperformedvaluate the villi of mucosa and fibrosis of submucosal layers. Results: Decreased levels of HGF and C-met gene expression in the MTX group were significantly increased by GA administration (p < 0.05). GA administration decreased the elevated levels of TNF-α and IL-1β (p < 0.001) in the MTX group. Histopathological findings showed an adverse effect of MTX in mucosa which was relatively ameliorated in the MTX + GA ones. Conclusion: GA could increase HGF and C-met expression, decrease inflammatory cytokines, and improve histological injuries, affected by MTX, indicating a beneficial role for GA following GI-M.

Modeling the Acute Mucosal Toxicity of Fractionated Radiotherapy Combined with the ATM Inhibitor WSD0628

Ataxia Telangiectasia-mutated (ATM) inhibitors are being developed as radiosensitizers to improve the antitumor effects of radiotherapy, but ATM inhibition can also radiosensitize normal tissues. Therefore, understanding the elevated risk of normal tissue toxicities is critical for radiosensitizer development. This study focused on modeling the relationship between acute mucosal toxicity, radiation dose, fractionation schedule, and radiosensitizer exposure. The ATM inhibitor WSD0628 was combined with single or fractionated doses of radiation delivered to the oral cavity or esophagus of Friend Leukemia virus B (FVB) mice. The potentiation by WSD0628 was quantified by a sensitizer enhancement ratio (SER), which describes the changes in radiation tolerance for radiation combined with WSD0628 relative to radiation-only regimens. WSD0628 profoundly enhanced radiation-induced acute oral and esophageal toxicities. For oral mucosal toxicity, the enhancement by WSD0628 with 3 fractions of radiation resulted in an SER ranging from 1.3 (0.25 mg/kg) to 3.1 (7.5 mg/kg). For the 7.5 mg/kg combination, the SER increased with increasing number of fractions from 2.2 (1 fraction) to 4.3 (7 fractions) for oral toxicity and from 2.2 (1 fraction) to 3.6 (3 fractions) for esophageal toxicity, which reflects a loss of the normal tissue sparing benefit of fractionated radiation. These findings were used to develop a modified biologically effective dose model to determine alternative radiation schedules with or without WSD0628 that result in similar levels of toxicity. Successful radiosensitizer dose escalation to a maximally effective therapeutic dose will require careful deliberation of tumor site and reduction of radiation dose volume limits for organs at risk.

Effectiveness of Aloe vera in the treatment of oral mucositis: a systematic review and meta-analysis of randomized controlled trials

Oral mucositis (OM) is a common complication of cancer patients. A systematic review and meta-analysis assessed the effectiveness of Aloe vera (AV) in the treatment of OM. The population included cancer patients undergoing radiotherapy or chemotherapy, treated for OM with AV. A search following the PICOS strategy, with specific keywords, identified randomized controlled trials (RCTs) published up to September 2024. Seven RCTs involving 355 participants, 170 in the intervention (AV) groups (mean age 39.7 years, standard deviation 23.9 years) and 185 in control groups (mean age 39.0 years, standard deviation 23.5 years), were included. A significant difference in the improvement of severe mucositis cases (grades 3 and 4) was observed with the use of AV compared to control (placebo, sodium bicarbonate, or benzydamine) (odds ratio 0.32, 95% confidence interval 0.15-0.70, P = 0.004). Considering the moderate heterogeneity observed (I2 = 36%, P = 0.15), a subgroup analysis was conducted. A subgroup analysis showed significant improvement in grade 3 and 4 OM for AV versus placebo (odds ratio 0.22, 95% CI 0.11-0.44, P < 0.001), but not compared with sodium bicarbonate or benzydamine. The results suggest that AV may be beneficial for cancer patients undergoing radiotherapy or chemotherapy, leading to improvements in the more severe stages of OM.

Stomatitis Healing via Hydrogels Comprising Proline, Carboxyvinyl Polymer, and Water

Chemotherapy using anticancer agents and radiotherapy of cancers frequently induce the development of stomatitis as a side effect. In the present study, hydrogels for effective stomatitis healing under anticancer drug administration were developed using three components, namely proline, carboxyvinyl polymer, and water (denoted proline gels). Characterization including tilting, Fourier transform infrared spectra, and viscoelasticity measurements indicated that proline gels with proline concentrations over 300 μmol/g could retain water on the tongue of mice. The degradation and release behavior of proline gels in serological environments were evaluated, revealing that proline gels were degraded by serological salt concentrations, and the cumulative amount of proline released from proline gels depended on the concentration of proline in the gel. Proline gels were applied to the stomatitis area on the tongue of mice under anticancer drug administration, with subsequent reduction in the stomatitis area and regeneration of the mucosal epithelium layer, demonstrating effective stomatitis healing by proline gels with proline concentrations over 500 μmol/g. Other control samples including the carboxyvinyl polymer or proline alone did not reduce the stomatitis area in model mice. These results suggested that the proline gel is promising for the mucosa regeneration of anticancer drug-induced stomatitis.

Effective Treatment of Methotrexate Induced Oral Mucositis With a Morphine Mouthwash Solution: A Case Report

Introduction: Methotrexate (MTX) is a common medication used to treat rheumatoid arthritis (RA). MTX inhibits rapid cell turnover throughout the body which can lead to significant side effects. Patients who present with oral lesions may have suffered severe acute toxicity from MTX. Supportive pain treatment includes magic mouthwash solution and/or oral viscous lidocaine to manage pain and allow for healing. We report a case of MTX induced oral mucositis that did not respond to magic mouthwash but did improve with a morphine mouthwash solution. Case: A 67-year-old female with RA presented with worsening oral lesions over 2 weeks. She reported non-compliance with folic acid for 2 weeks while on MTX. Physical exam revealed ulcerating oral lesions on the mucous membranes consistent with mucositis. Pain treatment was initiated with magic mouthwash, but her pain was not well controlled after 24 hours, and still unable to swallow. An oral morphine mouthwash solution was initiated, and patient reported improved pain control over the next 48 hours. She was on the morphine mouthwash for 6 days during which improvement in the lesions was noted. Discussion: Pain management is imperative for oral mucositis. When traditional therapies do not provide adequate control, morphine mouthwash can be considered. It is a safer alternative to systemic opioids and topical opioids may influence cell proliferation and migration, which can positively impact healing of oral lesions. Conclusion: A morphine mouthwash solution can provide effective pain management for oral mucositis lesions in patients who do not respond adequately to magic mouthwash.

Potentiality of Curcumin Against Radio-Chemotherapy Induced Oral Mucositis: A Review

In recent era, cancer is a major global health hazard and is mostly treated with either radio or chemotherapy. The above treatment procedure induces a secondary concern named as oral mucositis (OM). The disorder OM is specifically associated with oral mucosa and leads to bleeding, pain, difficulty in swallowing of solids, as well as fluids and speech difficulty. Curcumin is explored for prevention as well as treatment of OM. The article was organized via collection of enormous literatures by using the keywords like oral mucositis, chemotherapy, anti-inflammatory, curcumin, and clinical trials from search engines of different domains like Scopus, PubMed/MEDLINE, Science Direct, and Google Scholar with an increasing order of their year of publications. A numerous antineoplastic therapies resulted OM, as a devastating side effect. Moreover, the expanded pathogenesis of the disease permits a sound predictability over the patient's risk, thereby directing its adaptability and management protocols towards the achievement of novel therapeutics. An augmented interest towards curcumin as a potential therapeutic emerged because of its easy accessibility, antioxidant, anti-inflammatory, antiulcer, antimicrobial, and wound-healing abilities along with reduced side effects. Curcumin can potentially alter OM and OM-induced weight loss but showed a great heterogeneity.

Graphical Abstract

Metagenomic Profiling of Oral Microbiome Dynamics During Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma Patients

BACKGROUND

We explored the interaction between the oral microbiome and the development of radiation-induced mucositis in patients with head and neck squamous cell cancer (HNSCC) undergoing chemoradiotherapy (CRT). We prospectively studied the oral microbiome and compared it to healthy controls. Additionally, we compared patients with low-grade (LGM) vs. high-grade mucositis (HGM).

METHODS

Ten HNSCC patients scheduled for CRT were included. Saliva samples were characterized prior to, during, and nine months after CRT using metagenomic sequencing. We similarly characterized samples from seven healthy controls. We assessed alpha and beta diversity and examined abundances at different taxonomic levels between (sub)groups.

RESULTS

Patients exhibited significantly reduced alpha diversity compared to controls at all times (p ⟨ 0.05). Differential abundance of taxa between patients and controls was observed at baseline. In patients, the relative abundance of Staphylococcus aureus and Escherichia coli increased significantly during CRT. Capnocytophaga spp. was associated with the definitive CRT patients' subgroup. At baseline, two fungal families (Melampsoraceae and Herpotrichiellaceaea) were more abundant in patients who later developed HGM. No differentially abundant taxa were found between LGM vs. HGM during irradiation.

CONCLUSION

Our findings support the hypothesis that CRT, as well as HNSCC itself, influences the composition of the oral microbiome. Microbial markers found in patients who later developed HGM should be evaluated using independent cohorts to qualify their specific biomarker potential.

Benefit of Avasopasem Manganese on Severe Oral Mucositis in Head and Neck Cancer in the ROMAN Trial: Unplanned Secondary Analysis

Purpose

Oral mucositis (OM) is a debilitating side effect of cisplatin and intensity-modulated radiation therapy (IMRT) in patients with head and neck cancer. The phase 3 ROMAN trial showed avasopasem manganese (AVA) significantly decreased individual endpoints of incidence and duration of severe oral mucositis (SOM, World Health Organization [WHO] grade 3-4), with nominal decrease in severity (WHO grade 4) and significant increase in the delay in onset of SOM. We sought to determine the Net Treatment Benefit (NTB) of AVA versus placebo (PBO) using the generalized pairwise comparisons (GPC) method.

Methods and Materials

GPC is a statistical method that permits simultaneous analysis of several prioritized outcomes, comparing all possible pairs of a patient in the active (ie, AVA) group and a patient from the control (ie, PBO) group. NTB is the net benefit across all the outcomes for AVA compared to PBO. Key clinically relevant outcomes from ROMAN were prioritized: (1) WHO grade 4 OM incidence; (2) SOM incidence; (3) days of SOM; (4) days to SOM onset, with 7 days difference defined as the clinical relevance threshold for SOM days and SOM onset.

Results

GPC analysis of 407 patients (AVA = 241, placebo = 166) stratified by cisplatin schedule and treatment setting resulted in 13,969 pairwise comparisons. AVA showed statistically significant net benefit on all 4 key outcomes with a 53.9% probability that AVA would benefit patients versus a 35.0% probability that PBO would; the difference between these probabilities was a NTB of 18.9% (P = .0012), translating to an AVA number needed to treat of 5.3 patients. All outcomes contributed to NTB, reflecting improvements in SOM incidence, onset and duration, and in grade 4 OM incidence seen in the original ROMAN analysis.

Conclusions

This GPC analysis shows compelling evidence from the ROMAN trial of AVA's clinical benefit across key parameters of SOM burden.

Cross-Cultural Adaptation and Validation of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Oral Health 15 into Hindi Version for Cancer Patients

Objectives

The multidimensional concept of quality of life (QoL) has become vital in cancer care, and research and is crucial for epidemiological investigations. The primary objective of the research was to translate and culturally adapt the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Oral Health15 (EORTC QLQ OH15) questionnaire into Hindi, assessing its reliability and validity for implementation among cancer patients of Aligarh.

Materials and Methods

This study was carried out from June 2019 to May 2021. Permissions were obtained from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) group for cross-cultural adaptation and translation of the Quality of Life Questionnaire-Oral Health15 (QLQ-OH15) and ethical clearance was secured from the Institutional Ethical Review Board at Aligarh Muslim University. Informed consent was provided by participating patients. The translation and cultural adaptation of the QLQ-OH15 followed an eight-phase procedure in compliance with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire translation manual, ensuring consistency. Psychometric properties were evaluated using the Statistical Program for the Social Sciences 20, assessing content validity, convergent and discriminant validity, criterion validity, construct validity, reliability and test-retest reproducibility.

Results

The content validity ratio exceeded 0.75, with Cronbach's alpha values above 0.70 for each scale, confirming reliability. Factor analysis identified five factors: 'Pain and discomfort,' 'Information,' 'Soreness,' 'Denture' and 'Xerostomia.' Every item in every scale had its item convergent validity validated; all values were over 0.4 and there were no scaling mistakes observed. All of the items' correlation coefficients for the other scales were lower than their scales, indicating discriminant validity. There were statistically significant associations between Hindi EORTC QLQ-OH15 scores and three proxy measures: Perceived oral health (P = 0.000), perceived satisfaction with the mouth (P = 0.000) and perceived dental treatment need (P = 0.001).

Conclusion

The Hindi version of the QLQ-OH15 is a valid and reliable tool for assessing oral health-related quality of life in Indian cancer patients. This adaptation facilitates better symptom management and improved QoL in this population, emphasising the importance of oral health in comprehensive cancer care.

Prophylactic trimethoprim-sulfamethoxazole is safe in adult patients with primary central nervous system lymphoma receiving high-dose methotrexate

This retrospective study investigated the potential drug-drug interactions between trimethoprim-sulfamethoxazole (TMP-SMZ) and high-dose methotrexate (HD-MTX) in adult patients with primary central nervous system lymphoma (PCNSL). A total of 143 Chinese adult patients with PCNSL who received 498 cycles of MTX were included. Differences in the pharmacokinetics of MTX, including Cmax, clearance (CL) and AUC0-48 h with and without co-administration of TMP-SMZ were assessed. The incidence of MTX-related acute kidney injury (AKI), hepatotoxicity, myelosuppression, and delayed MTX elimination at 48 and 72 h were also compared. Patients were divided into two cohorts for analysis: 146 cycles with TMP-SMZ exposure and 352 cycles without TMP-SMZ exposure. Patients who received TMP-SMZ concurrently with HD-MTX exhibited a 1.13-fold increase in Cmax, a 1.12-fold increase in AUC0-48 h and a reduction in CL by 0.87-fold for MTX. There was no significant difference in the incidence of MTX-related AKI, hepatotoxicity, myelosuppression, or delayed MTX elimination between the two cohorts. Prophylactic TMP-SMZ might lead to increased MTX exposure but has no impact on the incidence of myelosuppression, AKI, and hepatotoxicity. These results suggested that prophylactic TMP-SMZ is safe for adult patients with PCNSL receiving HD-MTX.

Interventions for preventing oral mucositis in people receiving cancer treatment: photobiomodulation

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of photobiomodulation for the prevention of oral mucositis in people undergoing treatment for head and neck cancers, other solid cancers, and haematological cancers.

Vinpocetine attenuates 5-fluorouracil-induced intestinal injury: role of the Keap1/Nrf2/HO-1, NF-κB/TLR4/SOCS3 and RIPK1/RIPK3/MLKL signals

OBJECTIVES

5-Fluorouracil (5-FU) is a chemotherapy drug commonly prescribed in cancer management. Unfortunately, intestinal mucositis restricts 5-FU clinical use. Vinpocetine (VNP) is a synthetic alkaloid that is derived from vincamine. Our study was conducted to elucidate the intestinal protective effects of VNP on 5-FU intestinal injury in rats and explore the underlying mechanisms.

MATERIALS AND METHODS

5-FU was injected i.p. for five days, while VNP was given P.O (5 and 10 mg/kg).

RESULTS

VNP effectively mitigates oxidative stress by a significant increase in GSH and SOD and decreasing MDA content mediated by Nrf2, HO-1 upregulation, and significant Keap1 downregulation. VNP mitigated inflammatory perturbations by decreasing MPO, TNF-α, IL-1β, and IL-6 facilitated by downregulating NF-κB and TLR4 and upregulating SOCS3 levels. In addition, the RIPK1, RIPK3, MLKL, and caspase-8 expression levels were significantly decreased, evidenced improvement of intestinal necroptosis by VNP.

CONCLUSION

Hence, VNP potently prevents intestinal injury induced by 5-FU by modulating Keap1/Nrf2/HO-1, NF-κB/TLR4/SOCS3, and RIPK1/RIPK3/MLKL signals.

Xiao-Ban-Xia Decoction Alleviates Chemotherapy-Induced Nausea and Vomiting by Inhibiting Ferroptosis via Activation of The Nrf2/SLC7A11/GPX4 Pathway

Chemotherapy-induced nausea and vomiting (CINV) represents the common gastrointestinal side effect for cancer patients. Xiao-Ban-Xia decoction (XBXD), a classical anti-emetic traditional Chinese medicine formula, is frequently used for the clinical treatment of CINV. This study used a cisplatin-induced rat pica model to explore whether the anti-emetic mechanism of XBXD in treating CINV is related to ferroptosis. The inflammatory damage of the gastrointestinal tract is evaluated by HE staining and ELISA. The degree of ferroptosis are validated by the iron deposition, the levels of ROS, MDA, and GSH, and the ultrastructure of mitochondria in the gastric antrum and ileum. The potential ferroptosis-related targets of XBXD against CINV are screened by network pharmacology and further assessed by Western blot. XBXD significantly decreased the kaolin consumption in rats, and improved the inflammatory pathological damage, with decreased levels of HMGB1, IL-1β, and TNF-α. Furthermore, XBXD significantly suppressed ferroptosis, as indicated by the improvement of iron deposition, mitochondrial abnormalities, and oxidative stress. The network pharmacology and Western blot results indicated that XBXD activated the Nrf2/SLC7A11/GPX4 signaling pathway. This study proved that XBXD activates the Nrf2/SLC7A11/GPX4 signaling pathway, thereby inhibiting ferroptosis, which represents a critical anti-emetic mechanism of XBXD in combatting CINV.

Influence of Tryptophan Metabolism on the Protective Effect of Weissella paramesenteroides WpK4 in a Murine Model of Chemotherapy-Induced Intestinal Mucositis

Dysbiosis is a notable marker of intestinal mucositis, an inflammatory condition induced by antineoplastic chemotherapy. Scientific evidence supports the effectiveness of probiotics in managing dysbiosis associated with intestinal mucositis. It is known that tryptophan metabolism is a regulatory component in the multifactorial phenomenon of mucosal homeostasis. In the face of that, we aimed to investigate if oral administration of Weissella paramesenteroides WpK4, a probiotic candidate strain, has a protective effect in a murine model of intestinal mucositis induced by 5-fluorouracil (5-FU) and if tryptophan metabolism plays any role in this effect. Gavage with viable cells of W. paramesenteroides WpK4 increased intestinal mucus production, regeneration of villi, as well as control of dysbiosis in mice submitted to 5-FU chemotherapy, and resulted in 100% survival, unlike the control saline-treated group, which resulted in 60% survival of mice after mucositis induction. Weissella paramesenteroides WpK4 genome harbors sequences encoding enzymes for tryptophan production and catabolism and can synthesize tryptophan, tryptamine, and indole acetic acid in vitro. Besides, oral administration of WpK4 induced increased expression of molecules involved in tryptophan metabolism in mouse ileum and serum. Notably, simultaneous treatment with alfa-naphthoflavone, an aryl hydrocarbon receptor (AhR) inhibitor, abolished the protective effects exerted by W. paramesenteroides Wpk4, as manifested by a significant decline in body weight, suggesting that treatment with the probiotic strain modulates AhR activation. Our results suggest that tryptophan metabolism is potentially involved in the protective effects caused by oral administration of W. paramesenteroides WpK4 to mice during gut inflammatory conditions induced by 5-FU.

Sex Differences in Health-Related Quality of Life in Patients With Head and Neck Cancer-A Prospective Study

OBJECTIVE

To analyse sex differences in health-related quality of life (HRQL) before, during and up to 3 months posttreatment of head and neck cancer, and to examine the importance of salivary secretion rate for HRQL posttreatment.

METHODS

Patients were recruited before starting curative oncologic treatment. Clinical examinations were performed including determination of the stimulated salivary secretion rate. HRQL (EORTC C30 and HN35) was reported at baseline, weeks 2, 4 and 6 during treatment and 3 months after treatment.

RESULTS

A total of 56 men and 19 women were included. During treatment, men reported more problems with pain and sexuality, a higher use of painkillers and need for nutritional support during oncologic treatment, while women reported more problems with weight loss and dry mouth. At 3 months posttreatment, women reported more problems and symptoms than men with the highest scores noted for dry mouth, weight loss and sticky saliva. Patients with hyposalivation (≤ 0.7 mL/min) posttreatment reported more problems and symptoms compared with those with a secretion rate of > 0.7 mL/min, especially regarding dry mouth, sticky saliva and social eating (p < 0.001 for all three).

CONCLUSION

Problems and symptoms during and postoncologic treatment seem to differ between women and men, which must be taken into consideration by healthcare and dental professionals. Patients with hyposalivation posttreatment have more problems and symptoms and are therefore in greater need of supportive care.

Molecular mechanisms underlying methotrexate-induced intestinal injury and protective strategies

Methotrexate (MTX) is a folic acid reductase inhibitor that manages various malignancies as well as immune-mediated inflammatory chronic diseases. Despite being frequently prescribed, MTX's severe multiple toxicities can occasionally limit its therapeutic potential. Intestinal toxicity is a severe adverse effect associated with the administration of MTX, and patients are significantly burdened by MTX-provoked intestinal mucositis. However, the mechanism of such intestinal toxicity is not entirely understood, mechanistic studies demonstrated oxidative stress and inflammatory reactions as key factors that lead to the development of MTX-induced intestinal injury. Besides, MTX causes intestinal cells to express pro-inflammatory cytokines like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), which activate nuclear factor-kappa B (NF-κB). This is followed by the activation of the Janus kinase/signal transducer and activator of the transcription3 (JAK/STAT3) signaling pathway. Moreover, because of its dual anti-inflammatory and antioxidative properties, nuclear factor erythroid-2-related factor 2/heme oxygenase-1 (Nrf2/HO-1) has been considered a critical signaling pathway that counteracts oxidative stress in MTX-induced intestinal injury. Several agents have potential protective effects in counteracting MTX-provoked intestinal injury such as omega-3 polyunsaturated fatty acids, taurine, umbelliferone, vinpocetine, perindopril, rutin, hesperidin, lycopene, quercetin, apocynin, lactobacillus, berberine, zinc, and nifuroxazide. This review aims to summarize the potential redox molecular mechanisms of MTX-induced intestinal injury and how they can be alleviated. In conclusion, studying these molecular pathways might open the way for early alleviation of the intestinal damage and the development of various agent plans to attenuate MTX-mediated intestinal injury.

Cost-effectiveness of expanding national health insurance coverage for composite resin restorations in cancer patients in South Korea

OBJECTIVES

Cancer patients often have compromised oral health, making them vulnerable to severe dental caries and restoration failures. Due to the nature of cervical or anterior caries in cancer patients, the use of adequate restorative materials is important. However, public dental insurance coverage for composite treatments varies among countries and only glass ionomer cements (GICs) are covered in all age groups in South Korea. This study examined the cost-effectiveness of expanding national health insurance coverage to include resin composite (RC) restorations as compared with GIC in cancer patients.

METHODS

Data from cancer patients who received direct restoration using GIC were identified from the National Health Screening Cohort. The relative effect of RC compared to GIC was determined through a meta-analysis, which was then utilized in calculating corresponding transition probabilities within a multi-state model. A Markov-chain Monte Carlo microsimulation was performed to estimate useful life-years and total treatment costs at the tooth level. The incremental cost-effectiveness ratio (ICER) of RC versus GIC was calculated, considering scenarios with and without expanded national health insurance coverage. The robustness of the results was confirmed through various sensitivity analyses.

RESULTS

Between the two materials, RC resulted in a 0.4-year longer useful life. From a limited societal perspective, it cost $9.6 less with expanded coverage but $24.3 more without expansion, resulting in an ICER of -$25.2 and $63.9 per tooth-year, respectively. From a patient's perspective, the ICER values were -$72.7 versus $138.8 per tooth-year, respectively, translating into $200 more in savings with the expansion. Various sensitivity analyses consistently demonstrated a smaller ICER when insurance coverage was expanded.

CONCLUSIONS

The expansion of national health insurance coverage to include RC restorations for cancer patients appears to be clearly cost-effective. This emphasizes the need for further policy considerations to ensure access to dental care for cancer patients.

CLINICAL SIGNIFICANCE

Timely management of dental caries is crucial for cancer patients, as untreated caries can escalate into severe oral conditions, negatively impacting treatment outcomes and increasing care costs. Expanding a national health insurance coverage for cancer patients in the treatment of early dental lesions is necessary to prevent advanced dental diseases.

Interventions to reduce the risk of side-effects of cancer treatments in childhood

INTRODUCTION

Childhood cancers as a group affect around 1 in 500 children but each individual diagnosis is a rare disease. While research largely focuses on improving cure rates, the management of side effects of treatment are high priority for clinicians, families and children and young people.

AREAS COVERED

The prevention and efficient management of infectious complications, oral mucositis, nausea and vomiting and graft-vs-host disease illustrated with examples of implementation research, translation of engineering to care, advances in statistical methodologies, and traditional bench-to-patient development. The reviews draw from existing systematic reviews and well conducted clinical practice guidelines.

EXPERT OPINION

The four areas are driven from patient and family priorities. Some of the problems outlined are ready for proven interventions, others require us to develop new technologies. Advancement needs us to make the best use of new methods of applied health research and clinical trial methodologies. Some of the greatest challenges may be those we're not fully aware of, as new therapies move from their use in adult oncological practice into children. This will need us to continue our collaborative, multi-professional, multi-disciplinary and eclectic approach.

The role of colonization with resistant Gram-negative bacteria in the treatment of febrile neutropenia after stem cell transplantation

BACKGROUND

Febrile neutropenia (FN) is a common complication of stem cell transplantation.

AIM

To evaluate the frequency of sepsis in patients with FN colonized with resistant Gram-negative bacteria (extended-spectrum β-lactamase (ESBL)-positive, multidrug-resistant (MDR) Pseudomonas aeruginosa) and the choice of primary antibiotic in colonized patients.

METHODS

This retrospective study analysed data from patients undergoing haematopoietic stem cell transplantation from January 2018 to September 2022. Data were extracted from the hospital information system.

FINDINGS

Carbapenem as the primary antibiotic of choice was chosen in 10.9% of non-colonized +/-AmpC patients, 31.5% of ESBL+ patients, and 0% of MDR P. aeruginosa patients. Patients with FN and MDR P. aeruginosa colonization had a high prevalence of sepsis (namely 100%, P = 0.0197). The spectrum of sepsis appeared to be different, with Gram-negative bacilli predominating in the ESBL+ group (OR: 5.39; 95% CI: 1.55-18.76; P = 0.0123). Colonizer sepsis was present in 100% of sepsis with MDR P. aeruginosa colonization (P = 0.002), all in allogeneic transplantation (P = 0.0003), with a mortality rate of 33.3% (P = 0.0384). The incidence of sepsis in patients with ESBL+ colonization was 25.9% (P = 0.0197), with colonizer sepsis in 50% of sepsis cases (P = 0.0002), most in allogeneic transplantation (P = 0.0003).

CONCLUSION

The results show a significant risk of sepsis in FN with MDR P. aeruginosa colonization, a condition almost exclusively caused by the colonizer. At the same time, a higher risk of Gram-negative sepsis has been demonstrated in patients colonized with ESBL+ bacteria.

Clinical Features of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Induced by Immune Checkpoint Inhibitor versus Non-Immune Checkpoint Inhibitor Drugs in China: A Cross-Sectional Study and Literature Review

Purpose

Immune checkpoint inhibitors (ICIs) can cause life-threatening Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Large-scale original research on ICI-induced SJS/TEN is limited. This study aimed to explore the unique clinical characteristics and potential pathophysiological mechanisms of SJS/TEN induced by ICIs.

Methods

This cross-sectional study compared the clinical features of SJS/TEN induced by ICIs and non-ICIs, and reviewed the case characteristics of ICI-induced SJS/TEN. Clinical features were analyzed using independent t-tests, Mann-Whitney U-tests, and multivariable regression models.

Results

This study enrolled 41 cases of ICI-induced SJS/TEN and 107 non-ICI-induced cases from January 22, 2015, to May 28, 2024. ICI-induced SJS/TEN patients exhibited a trend towards a longer latency period (β: 17, 95% CI: -1.49 to 35.48), a smaller affected body surface area (BSA) (β: -40.68, 95% CI: -71.59 to -9.77), and milder oral and ocular mucositis than non-ICI-induced cases. A literature review identified PD-1 inhibitors as the primary ICIs involved and systemic corticosteroids as the most frequent intervention. No statistically significant difference in mortality rate was observed between patients treated with systemic corticosteroids alone and those receiving combination therapies (P= 0.85). The mortality rate for ICI-induced SJS/TEN was 24.5%.

Conclusion

This study offered the largest comparative analysis to date, highlighting the unique clinical features of ICI-induced SJS/TEN, including a smaller affected BSA, a prolonged latency period trend, and milder oral and ocular mucositis. We described the epidemiology, clinical presentation, and therapeutic strategies for ICI-induced SJS/TEN. These findings not only contribute to a deeper understanding of the complex immune-inflammatory pathways in severe immune-related cutaneous adverse events (ircAEs) but also may inform the development of more targeted and effective treatments.

Semaglutide treatment for PRevention Of Toxicity in high-dosE Chemotherapy with autologous haematopoietic stem-cell Transplantation (PROTECT): study protocol for a randomised, double-blind, placebo-controlled, investigator-initiated study

INTRODUCTION

Cancer treatment with high-dose chemotherapy damages the mucosal barrier of the gastrointestinal (GI) tract and is associated with severe toxicity involving mucositis, severe inflammation and organ dysfunction. Currently, there is no effective prophylaxis against this. Glucagon-like peptide 1 (GLP-1), a well-known regulator of blood glucose, has been suggested in mouse studies to possess trophic effects on gut epithelial cells as well as anti-inflammatory properties. In line with this, endogenous GLP-1 levels have been shown to be inversely correlated with toxicities after haematopoietic stem cell transplantation (HSCT) and treatment with a GLP-1 receptor agonist (GLP-1RA) was shown to limit chemotherapy-induced mucositis in rodents. This present study investigates the effects of the GLP-1RA semaglutide on GI mucositis severity score in patients with lymphoma undergoing high-dose chemotherapy followed by autologous (auto) HSCT.

METHODS AND ANALYSIS

This is a randomised, double-blind, placebo-controlled, two-centre investigator-initiated clinical study. Forty adult patients with malignant lymphoma referred for auto-HSCT will be randomised in a 1:1 manner to receive either semaglutide or placebo once-weekly for 8 weeks. This includes a run-in period of 3-4 weeks with semaglutide 0.25 mg prior to high-dose chemotherapy treatment followed by a period of 4-5 weeks with semaglutide 0.5 mg including the 1 week of high-dose chemotherapy treatment. Clinical assessment of endpoint measurements and safety will be performed weekly during treatment and in a follow-up period of 10 weeks. The primary endpoint is GI mucositis severity (mean severity grade (0-II) during week 1-4 after auto-HSCT). Secondary endpoints include C-reactive protein increment, quality of life and safety. Fever, bacteraemia, antibiotic use, weight loss, morphine consumption, duration of hospitalisation, use of parenteral nutrition, change in muscle mass and clinical and laboratory evidence of organ toxicities will also be assessed.

ETHICS AND DISSEMINATION

The study complies with Danish and European Union legislation and is approved by the Danish Medicines Agency, the Danish National Medical Research Ethics Committee (EU CT #2022-502139-20-00) and the Danish Data Protection Agency. The study is monitored by the Capital Region of Denmark's good clinical practice unit. All results, positive, negative and inconclusive, will be disseminated at national and international scientific meetings and in peer-reviewed scientific journals.

TRIAL REGISTRATION NUMBER

NCT06449625.

Preventive effect of probiotics on oral mucositis induced by anticancer therapy: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Oral mucositis (OM) is a prevalent and painful complication in patients undergoing anticancer treatment, which significantly impacts patients' quality of life (QoL) and adherence to therapy. The use of oral probiotics as a preventive strategy for OM has shown promise, but the clinical evidence remains inconclusive. This meta-analysis of randomized controlled trials (RCTs) aims to evaluate the efficacy of probiotics in preventing OM caused by radiotherapy and/or chemotherapy.

METHODS

A comprehensive search of PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov was conducted up to January 31, 2024, to identify eligible RCTs. The primary outcomes were the incidences of severe OM and all-grade OM. Secondary outcomes included rates of anticancer treatment completion, clinical response, requirement for enteral nutrition, time course of OM, body weight loss, QoL, and adverse events (AEs). Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.

RESULTS

A total of 12 RCTs involving 1,376 patients were included in the quantitative analysis. Probiotics administration significantly reduced the risk of severe OM (RR = 0.61, 95%CI: 0.53-0.72, P < 0.001) and all-grade OM (RR = 0.90, 95%CI: 0.82-0.98, P = 0.016) compared to the control group. Multi-strain probiotics formulations were more effective than single-strain probiotics in preventing severe OM (P = 0.011). There were no significant differences between the probiotics and control groups regarding anticancer treatment completion (RR = 1.03, 95%CI: 0.98-1.08, P = 0.198), clinical response to therapy (RR = 1.05, 95%CI: 0.94-1.17, P = 0.406), or the need for enteral nutrition (RR = 1.28, 95%CI: 0.49-3.35, P = 0.680). AEs related to probiotics were rare, with no serious AEs attributable to probiotics use.

CONCLUSIONS

Oral probiotics are both safe and effective in preventing and reducing the severity of OM in patients undergoing anticancer therapy. Multi-strain probiotics demonstrate superior efficacy compared to single-strain probiotics. Further research is warranted to confirm these findings and optimize probiotic treatment strategies for cancer patients.

The role of the gut microbiome in neuroinflammation and chemotherapy-induced peripheral neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most debilitating adverse effects caused by chemotherapy drugs such as paclitaxel, oxaliplatin and vincristine. It is untreatable and often leads to the discontinuation of cancer therapy and a decrease in the quality of life of cancer patients. It is well-established that neuroinflammation and the activation of immune and glial cells are among the major drivers of CIPN. However, these processes are still poorly understood, and while many chemotherapy drugs alone can drive the activation of these cells and consequent neuroinflammation, it remains elusive to what extent the gut microbiome influences these processes. In this review, we focus on the peripheral mechanisms driving CIPN, and we address the bidirectional pathways by which the gut microbiome communicates with the immune and nervous systems. Additionally, we critically evaluate literature addressing how chemotherapy-induced dysbiosis and the consequent imbalance in bacterial products may contribute to the activation of immune and glial cells, both of which drive neuroinflammation and possibly CIPN development, and how we could use this knowledge for the development of effective treatment strategies.

Oral mucositis management with photobiomodulation, Bidens pilosa L. (Asteraceae) and Curcuma longa L. (Zingiberaceae), the FITOPROT herbal medicine, and its influence on inflammatory cytokine levels: a randomized clinical trial

PURPOSE

This randomized clinical trial aimed to compare the effects of a mucoadhesive formula, containing curcuminoids from Curcuma longa L. and glycerinated extract of Bidens pilosa L. (FITOPROT), associated with photobiomodulation (PBM), and of PBM exclusively, on the incidence of oral mucositis (OM)-induced by radiotherapy (RT) in the head and neck region, and the salivary expression of inflammatory cytokines, in patients with head neck cancer.

METHODS

Patients were randomly assigned into two intervention groups-FITOPROT + PBM (n = 25) or PBM (n = 27). PBM protocol comprised a wavelength of 660 nm, 25 mW, 0.25 J/point, and daily irradiation from the first until the last day of RT. FITOPROT was gargled twice a day. All patients underwent a preventive oral care program throughout the study. OM degree, salivary concentration of nitrite, and inflammatory (IL-1, TNFα, IL-6, IL-8, and IL-12p70), and anti-inflammatory (IL-10) cytokines were assessed at baseline, and at the 7th, 14th, 21st, and 30th RT sessions.

RESULTS

There were no differences in the OM degree between groups, but the RT dose significantly affected the OM. The RT significantly affected the salivary nitrite, TNFα, IL-1β, and IL-10 concentrations.

CONCLUSION

FITOPROT associated with PBM showed limited effects on preventing the incidence of severe OM compared to PBM alone. However, FITOPROT + PBM may be associated with nitrite and cytokine balance, which may contribute to the occurrence of fewer cases of severe OM.

TRIAL REGISTRATION

Brazilian Clinical Trials database (ReBEC; RBR-9vddmr), registered UTN code: U1111-1193-2066, registered in August 8th, 2017.

Optical coherence tomography: Promising imaging technique for the diagnosis of oral mucosal diseases

OBJECTIVE

This review aims to summarize the latest application of optical coherence tomography (OCT) in oral mucosal diseases, promoting an accurate and earlier diagnosis of such disorders, which are difficult to be differentiated.

SUBJECTIVE AND METHODS

References on the application of OCT in oral mucosal diseases were mainly obtained from PubMed, Embase, Web of Science and Scopus databases, using the keywords: "optical coherence tomography and 'oral mucosa/oral cancers/oral potentially malignant diseases/oral lichen planus/oral leukoplakia/oral erythroplakia/discoid lupus erythematosus/oral autoimmune bullous diseases/oral ulcers/erythema multiforme/oral mucositis'".

RESULTS

It is found that OCT is showing a promising application potential in the early detection, diagnosis, differential diagnosis, monitoring of oral cancer and oral dysplastic lesions, as well as the delineation of tumor margins. OCT is also playing an increasingly important role in the diagnosis of oral potentially malignant disorders, oral mucosal bullous diseases, oral ulcerative diseases, erythema multiforme, and the early detection of oral mucositis.

CONCLUSION

Optical coherence tomography, as a novel optical technique featured by real-time, noninvasive, dynamic and high-resolution imaging, is of great use to serve as an adjunct tool for the diagnosis, differential diagnosis, monitoring and therapy evaluation of oral mucosal diseases.

Changes in AmotL2 Expression in Cells of the Human Enteral Nervous System in Oxaliplatin-Induced Enteric Neuropathy

Gastrointestinal (GI) toxicity is a common side effect in patients undergoing oxaliplatin (OxPt)-based chemotherapy for colorectal cancer (CRC). Frequently, this complication persists in the long term and could affect the efficacy of the treatment and the patient's life quality. This long-term GI toxicity is thought to be related to OxPt-induced enteral neuropathy. AmotL2 is a member of the Angiomotin family of proteins, which play a role in cell survival, neurite outgrowth, synaptic maturation, oxidative stress protection, and inflammation. In order to assess the role of AmotL2 in OxPt-induced enteral neuropathy, we studied the expression of AmotL2 in cells of the enteric nervous system (ENS) of untreated and OxPt-treated CRC patients and its relationship with inflammation, using immunofluorescence confocal microscopy. Our results in human samples show that the total number of neurons and glial cells decreased in OxPt-treated patients, and TNF-α and AmotL2 expression was increased and colocalized in both neurons and glia. AmotL2 differential expression between OxPt-treated and untreated CRC patients shows the involvement of this scaffold protein in the inflammatory component and toxicity by OxPt in the ENS.

Nuclear Receptors and Stress Response Pathways Associated with the Development of Oral Mucositis Induced by Antineoplastic Agents

Oral mucositis (OM) is one of the common adverse events associated with cancer treatment that decreases the quality of life and affects treatment outcomes. However, the medications used to manage OM are generally only palliative, and our knowledge of the syndrome is limited. The etiology of the syndrome is thought to be complex and multifactorial. We investigated the trends and characteristics of OM and estimated molecular initiating events (MIEs) associated with the development of the syndrome using the FDA Adverse Event Reporting System. The study of trends and characteristics suggested that OM is significantly more likely to occur in females and nonelderly patients and is likely to be induced by protein kinase inhibitors such as afatinib and everolimus. Next, we used Toxicity Predictor, an in-house quantitative structure-activity relationship system, to estimate OM-associated MIEs. The results revealed that the agonist activity of the human pregnane X receptor, thyroid-stimulating hormone-releasing hormone receptor, and androgen receptor may be associated with OM development. Our study findings are expected to help avoid the risk of OM induction during the drug discovery process and clinical use of antineoplastic agents.

Tritrichomonas muris sensitizes the intestinal epithelium to doxorubicin-induced apoptosis

Doxorubicin (DXR) is a widely used chemotherapy drug that can induce severe intestinal mucositis. While the influence of gut bacteria on DXR-induced damage has been documented, the role of eukaryotic commensals remains unexplored. We discovered Tritrichomonas muris (Tmu) in one of our mouse colonies exhibiting abnormal tuft cell hyperplasia, prompting an investigation into its impact on DXR-induced intestinal injury. Mice from Tmu-colonized and Tmu-excluded facilities were injected with DXR, and tissue morphology and gene expression were evaluated at acute injury (6 h) and peak regeneration (120 h) phases. Contrary to previous reports, DXR did not significantly alter villus height, crypt depth, or crypt density in any mice. However, we did observe apoptosis, measured by cleaved caspase 3 (CC3) staining, in intestinal crypts at 6 h post-DXR that was significantly higher in mice colonized by Tmu. Interestingly, while DXR did not alter the expression of active and facultative intestinal stem cell (ISC) marker genes in control mice, it significantly reduced their expression in Tmu + mice. Tmu, but not DXR, is also associated with increased inflammation and expression of the type 2 cytokines IL-5 and IL-13. However, pre-treatment of intestinal organoids with these cytokines is not sufficient to drive elevated DXR-induced apoptosis. These findings highlight the significant influence of commensal microbiota, particularly eukaryotic organisms like Tmu, on intestinal biology and response to chemotherapy, underscoring the complexity of gut microbiota interactions in drug-induced mucositis.

Enhancing Standardized Practices for Oral Mucositis Prevention in Pediatric Hematopoietic Stem Cell Transplantation: A Best Practice Implementation Project

Background

Oral mucositis (OM) poses a significant challenge in children undergoing hematopoietic stem cell transplantation (HSCT). There is a gap between clinical practice and the evidence, and nursing practices is not standardized.

Objective

This study aims to evaluate the effectiveness of applying the evidence for preventing HSCT chemotherapy-induced OM in children and to elevate the nurses' compliance to the evidence.

Methods

Following the clinical evidence practice application model of the Joanna Briggs Institute (JBI) evidence-Based Care Center. The process included reviewing literature, extracting evidence, identifying gaps, developing audit criteria, conducting a baseline audit, creating an action plan, implementing evidence-based interventions, and assessing outcomes.

Results

After the evidence implementation, 6 out of 12 audit criteria with poor compliance are significantly improved, with statistically significant differences (P<0.05). The incidence of OM decreases, with a statistically significant difference (66.6% vs 36.7%, P=0.02). The incidence of grade I, II, III, and IV OM also decreases (30% vs 23.3%, 23.3% vs 13.4%, 10% vs 0%, and 3.3% vs 0%). Ultimately, the standardized oral care practice routine and workflows to prevent OM were established.

Conclusion

Bridging the gap between evidence and clinical practice can standardize nurse behavior, decrease the incidence of OM, and lower the OM severity in children undergoing HSCT.

Efficacy of probiotics in the treatment of oral mucositis in head and neck cancer patients: A systematic review and meta-analysis

OBJECTIVES

To assess the effect of probiotics in oral mucositis induced by chemotherapy or radiotherapy on patients with head and neck cancer (HNC).

METHODS

The PubMed, Embase, Cochrane Library, Clinical trials were screened from January 2010 to April 2024. Randomized clinical trials (RCTs) comparing the efficacy of probiotics in treatment of oral mucositis in HNC were eligible. Outcomes of interest were incidence of oral mucositis and severe oral mucositis. The PROSPERO registration number was 42 022 384 685. The Cochrane risk-of-bias tool (RoB2) was used to assess methodological quality of studies and GRADE criteria (GRADEpro) was applied for rating the certainty of evidence. Meta-analysis was performed by using RevMan 5.4.

RESULTS

A total of eight RCTs comprising 691 patients with HNC were included in this meta-analysis. Probiotics administration significantly reduced the incidence of SOM (RR = 0.60, 95%CI: 0.46-0.78, P = 0.0002). However, it showed no distinct advantage in reducing the overall incidence of oral mucositis (RR = 0.88, 95%CI: 0.76-1.02, P = 0.08). Subgroup analysis found more benefit for reducing SOM in multi-bacterial treated group (RR = 0.35, 95%CI: 0.17-0.73, P = 0.005) than mono-bacterial treated group (RR = 0.69, 95%CI: 0.58-0.82, P < 0.0001). In Addition, probiotics could reduce the incidence of SOM in nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (RR = 0.43, 95%CI: 0.26-0.70, P = 0.0006).

CONCLUSION

Probiotics reduced the incidence of SOM caused by chemotherapy or radiotherapy for HNC. The multi-bacterial combination therapy was more efficacious than the mono-bacterial therapy. Moreover, probiotics also reduced the incidence of SOM in nasopharyngeal carcinoma. However, the advantage of probiotics had not been established in the overall incidence of OM.

Benzimidazole Derivative (N-{4-[2-(4-Methoxyphenyl)-1H-Benzimidazole-1-Sulfonyl] Phenyl} Acetamide) Ameliorates Methotrexate-Induced Intestinal Mucositis by Suppressing Oxidative Stress and Inflammatory Markers in Mice

Methotrexate (MTX)-induced intestinal mucositis (IM) is a common side effect in cancer treatment that impairs the immune system and gut microbes, resulting in loss of mucosal integrity and gut barrier dysfunction. The quality of life and outcomes of treatment are compromised by IM. The present study was designed to investigate the mucoprotective potential of the benzimidazole derivative N-{4-[2-(4-methoxyphenyl)-1H-benzimidazole-1-sulfonyl] phenyl} acetamide (B8) on MTX-induced IM in mice. IM was induced by a single dose of MTX in mice and assessed by physical manifestations as well as biochemical, oxidative, histological, and inflammatory parameters. B8 (1, 3, 9 mg/kg) significantly reduced diarrhea score, mitigated weight loss, increased feed intake and, survival rate in a dose-dependent manner. Notably, B8 exhibited a mucoprotective effect evident through the mitigation of villus atrophy, crypt hypoplasia, diminished crypt mitotic figures, mucin depletion, and oxidative stress markers (GSH, SOD, MDA, and catalase concentration). Gene expression analysis revealed that B8 downregulated the mRNA expression of tumor necrosis factor-α (TNF-α), cyclooxygenase-2 (COX-2), interleukin-6 (IL-6), IL-1β, and nuclear factor-κB (NF-κB) and concurrently upregulated IL-10 expression in contrast to the MTX group. Further, B8 significantly improved the luminal microflora profile by augmenting the growth of Lactobacillus spp. and reducing the number of pathogenic bacteria (E. coli). Additionally, the enzyme-linked immunoassay showed that B8 decreased the levels of pro-inflammatory cytokines. Our findings suggest that B8 had mucoprotective effects against MTX-induced IM and could be used as an adjunct in chemotherapy to deter this side effect.

The predictive value of hematological inflammatory markers for severe oral mucositis in patients with nasopharyngeal carcinoma during intensity-modulated radiation therapy: A retrospective cohort study

BACKGROUND

This study aims to investigate the predictive value of the circulating blood cell count, including neutro-philto-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and thesystemic inflammation index (SII) for the development of severe oral mucositis (SOM) induced by radiation in patients undergoing radiotherapy for nasopharyngeal carcinoma (NPC).

METHODS

In this retrospective study, 142 NPC patients were screened, and based on mucositis toxicity grade, they were categorized into two groups: SOM and nonSOM. Peripheral blood cell counts were conducted prior to Intensity-Modulated Radiation Therapy (IMRT). Associations between blood cell count, NLR, PLR, SII, and SOM occurrence were examined.

RESULTS

Revealed elevated NLR and SII levels, along with reduced lymphocyte (LYM), eosinophil (EOS), and basophil (BAS) in patients with SOM. LYM, EOS, BAS, NLR, and SII were effective predictors of the severity of radiation-induced oral mucositis (RIOM) in NPC patients.

CONCLUSIONS

The occurrence of SOM was strongly linked to the hematological status at the start of Radiation Therapy (RT). Integrating BAS count and NLR into comprehensive risk prediction models could prove valuable for predicting SOM in NPC patients.

Exploring heterogeneity: a dive into preclinical models of cancer cachexia

Cancer cachexia (CC) is a multifactorial and complex syndrome experienced by up to 80% of patients with cancer and implicated in ∼40% of cancer-related deaths. Given its significant impact on patients' quality of life and prognosis, there has been a growing emphasis on elucidating the underlying mechanisms of CC using preclinical models. However, the mechanisms of cachexia appear to differ across several variables including tumor type and model and biologic variables such as sex. These differences may be exacerbated by variance in experimental approaches and data reporting. This review examines literature spanning from 2011 to March 2024, focusing on common preclinical models of CC, including Lewis Lung Carcinoma, pancreatic KPC, and colorectal colon-26 and Apcmin/+ models. Our analysis reveals considerable heterogeneity in phenotypic outcomes, and investigated mechanisms within each model, with particular attention to sex differences that may be exacerbated through methodological differences. Although searching for unified mechanisms is critical, we posit that effective treatment approaches are likely to leverage the heterogeneity presented by the tumor and pertinent biological variables to direct specific interventions. In exploring this heterogeneity, it becomes critical to consider methodological and data reporting approaches to best inform further research.

Novel insights into gut health: Cilostazol strengthens gut integrity by adjusting TLR-2/NF-κB/IL-23 and CD44/AKT/GSK-3β/cyclin-D1 trajectories in methotrexate-induced mucositis model

Methotrexate (MTX)-induced gastrointestinal mucositis is a common adverse effect characterized by redox imbalance and overproduction of inflammatory mediators that perturb intestinal integrity. Currently, there is no definitive treatment for this condition and its prevention is still far beyond comprehension. Because of its pleiotropic pharmacological actions, we aimed to explore the potential mechanisms through which cilostazol (CILO) can protect against MTX-induced intestinal mucositis. Wistar rats were allocated into 4 groups, control, CILO (100 mg/kg, p.o for 14 days), MTX (7.5 mg/kg for 4 successive days), and CILO + MTX. The improving effect of CILO on the morphological structure was confirmed by an upturn in the histopathological and transition electron microscope examinations evidenced by the increased jejunal villus height/width and the crypt depth besides the maintenance of tight junctions. These findings were verified biochemically; on the molecular level, CILO reduced the MTX-induced lipid peroxidation, cleaved caspase-3, p53, and the inflammatory parameters (TLR-2, NF-κB, IL-23, TNF-α, IL-1β), while increasing the anti-inflammatory marker IL-10 and the antioxidant enzyme SOD. Moreover, CILO decreased the injurious axis AKT/GSK-3β/cyclin-D1, and CD44+, but increased the immunoexpression of the cell proliferating marker PCNA. CILO also upheld the intestinal barrier by enhancing the tight junction molecules (ZO-1, claudin-4) and the E-cadherin/β-catenin complex while abating the mesenchymal marker vimentin. In conclusion, CILO protected gut integrity by reducing the epithelial-mesenchymal transition process, the MTX-induced oxidative, apoptotic, and inflammatory mediators, and turning off the CD44/AKT/GSK-3β/cyclin D1 trajectory and intensifying the expression of PCNA.

Dasabuvir alleviates 5-fluorouracil-induced intestinal injury through anti-senescence and anti-inflammatory

5-Fluorouracil (5-Fu) is a basic drug that is used to treat colorectal cancer. Patients who receive 5-Fu chemotherapy often experience side effects that affect the digestive system, such as intestinal injury and diarrhoea, which significantly affect patient compliance with anticancer treatment and quality of life. Therefore, identifying approaches to treat or prevent these side effects is urgent. Dasabuvir (DSV) is a hepatitis C virus inhibitor, but its impact on 5-Fu-induced intestinal injury remains unknown. Our study investigated the effects of DSV on 5-Fu-induced intestinal injury in HUVECs, HIECs and male BALB/c mice. We found that 5-Fu caused intestinal damage by inducing senescence, increasing inflammatory factor expression, and generating oxidative stress. Compared with 5-Fu treatment alone, DSV inhibited senescence by reducing senescence-β-galactosidase (SA-β-gal) activity, the senescence-associated secretory phenotype (SASP, including IL-1, IL-6, and TNF-α) and senescence marker expression levels (p16, p21, and p53). Moreover, the anti-senescence effect of DSV was achieved by inhibiting the mTOR signaling pathway. DSV increased antioxidant enzyme levels and alleviated intestinal tissue injury in mice. In addition, DSV suppressed the 5-Fu-induced increase the diarrhoea scores and ameliorated the weight loss, food intake and water intake of the mice. Overall, this study indicated that DSV could be used to treat chemotherapy-induced intestinal damage.

Recent advances in cancer therapy-associated oral mucositis

Oral mucositis (OM) is a common and debilitating toxicity of cancer treatments - chemotherapy, radiotherapy, hematopoietic cell transplant, or combinations. OM is associated with severe oral pain and has negative impacts on patient function and quality of life. Additionally, OM has accompanying systemic complications that may have critical implications. These local and systemic consequences can alter cancer treatment, and add an economic burden. This review covers the clinical presentation and course of OM, differential diagnosis, clinical and economic impacts, pathogenesis, risk factors, assessment measures, biomarkers and prediction of OM, management, research advances in the development of new drugs and treatments, and big data.

In vitro cytoprotective and in vivo anti-oral mucositis effects of melatonin and its derivatives

According to our preliminary study, melatonin and its N-amide derivatives (N-(2-(1-4-bromobenzoyl-5-methoxy-1H-indol-3-yl)ethyl)acetamide (BBM) and 4-bromo-N-(2-(5-methoxy-1H-indol-3-yl)ethyl)benzamide (EBM)) inhibited the marker of acute inflammation in tests in vitro and in vivo. The anti-inflammatory agent is intended for the prevention and treatment of chemotherapy-induced toxicity. In this study aimed to evaluate the effect of melatonin and its derivatives on mechanisms related to chemotherapy-induced oral mucositis by in vitro ROS and 5-FU-induced human keratinocyte cells as well as in vivo oral mucositis model. In in vitro H2O2-induced HaCaT cells, BBM had the highest level of protection (34.57%) at a concentration 50 µM, followed by EBM (26.41%), and melatonin (7.9%). BBM also protected cells against 5-FU-induced to 37.69-27.25% at 12.5-100 µM while EBM was 36.93-29.33% and melatonin was 22.5-11.39%. In in vivo 5-FU-induced oral mucositis in mice, melatonin, BBM, and EBM gel formulations protected tissue damage from 5-FU similar to the standard compound, benzydamine. Moreover, the weight of mice and food consumption recovered more quickly in the BBM group. These findings suggested that it was possible to develop BBM and EBM as new therapeutic agents for the treatment of oral mucositis.

Vitamin C Supplementation in the Treatment of Autoimmune and Onco-Hematological Diseases: From Prophylaxis to Adjuvant Therapy

Vitamin C is a water-soluble vitamin introduced through the diet with anti-inflammatory, immunoregulatory, and antioxidant activities. Today, this vitamin is integrated into the treatment of many inflammatory pathologies. However, there is increasing evidence of possible use in treating autoimmune and neoplastic diseases. We reviewed the literature to delve deeper into the rationale for using vitamin C in treating this type of pathology. There is much evidence in the literature regarding the beneficial effects of vitamin C supplementation for treating autoimmune diseases such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) and neoplasms, particularly hematological neoplastic diseases. Vitamin C integration regulates the cytokines microenvironment, modulates immune response to autoantigens and cancer cells, and regulates oxidative stress. Moreover, integration therapy has an enhanced effect on chemotherapies, ionizing radiation, and target therapy used in treating hematological neoplasm. In the future, integrative therapy will have an increasingly important role in preventing pathologies and as an adjuvant to standard treatments.

Factors influencing radiation induced oral mucositis in head and neck cancer

INTRODUCTION

Radiotherapy alone or in combination with chemotherapy is an effective and standard treatment of head and neck carcinoma. Oral mucositis is an unavoidable consequence of chemoradiation which is seen in almost all the patients. This painful condition leads to deterioration of the quality of life and thus interferes with the overall outcome of cancer therapy. As no study has been conducted in an Indian context, we conducted this study for better identification of factors influencing the occurrence and severity of oral mucositis in this patient population.

OBJECTIVES

Evaluation of the factors influencing the occurrence, severity, and resolution of radiation induced oral mucositis (RIOM) in patients with head and neck cancer. The relationship between RIOM and treatment volume (TV) and mean dose to oral mucosa were also explored.

METHODS

This prospective study was conducted in patients with a histopathological diagnosis of head and neck carcinoma treated with radiation and chemoradiation. The patient, tumor, and treatment-related factors influencing RIOM were evaluated.

RESULTS

Univariate logistic regression analysis of correlated factors with acute radiation oral mucositis revealed TV in phase one (up to 40 Gy) having P value of 0.029 with odds ratio of 1.008. Spearman rank correlation coefficient demonstrated significant positive correlation between oral mucosa dose and TV in all three phases of radiation.

CONCLUSION

Our study concluded that the most important factor influencing RIOM is TV during phase one of radiation. We found positive correlation between TV and oral mucosa dose through all the phases of radiation treatment.

Investigating the relationship between postoperative radiotherapy and intestinal flora in rectal cancer patients: a study on efficacy and radiation enteritis

Objective

This study aimed to investigate the impact of radiation therapy and radiation enteritis on intestinal flora, providing insights for treatment and prevention.

Methods

Fecal samples were collected from 16 patients undergoing pelvic radiotherapy at Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital). Samples were collected before and after radiotherapy (27-30Gy), and analyzed using DNA sequencing and biostatistical methods.

Results

Patients with radiation enteritis showed increased α-diversity and β-diversity of intestinal flora compared to those without radiation enteritis. Differences in flora composition were observed, with higher abundance of secondary pathways such as amino acid metabolism, carbohydrate metabolism, cofactors and vitamins metabolism, and lipid metabolism.

Conclusion

The study revealed that patients developing radiation enteritis during pelvic radiation therapy had increased diversity and abundance of intestinal flora compared to those who did not develop radiation enteritis. Additionally, patients without radiation enteritis showed significantly higher diversity and abundance of intestinal flora post-radiation compared to pre-radiation.