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Jahanbani Mazraeh E, Sadighi S, Manifar S, Bakhshandeh H, Rajabi M. Assessment of thyme honey oral gel for the prevention of adriamycin and cyclophosphamide chemotherapy-induced oral mucositis in patients with breast cancer. Support Care Cancer 2023; 31:497. [PMID: 37505326 DOI: 10.1007/s00520-023-07943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Oral mucositis (OM) is a common complication of cancer treatment that has an impact on a patient's quality of life and the outcome of cancer therapy. This trial evaluated the effect of thyme honey oral gel for the prevention of chemotherapy-induced OM. METHODS One hundred ten breast cancer patients who received their first cycle of chemotherapy with adriamycin (60 mg/m2) and cyclophosphamide (600 mg/m2) were randomly recruited into two groups: group A were patients who followed general oral hygiene recommendations and rinsing saline 3 times a day, and group B were patients with similar protocol but supplied with our formulated oral gel to be applied 2 to 4 times a day. Patients were assessed by the World Health Organization (WHO) oral mucositis grading scales and self-assessment daily questionnaire. RESULTS The use of thyme honey was associated with diminishing incidence of OM grade ≥ 2 (95% CI, 0.12 to 0.90; P = 0.030), duration of OM (- 3.36 days; 95% CI, - 5.50 to - 1.22; P = 0.037) and delayed occurrence of OM grade ≥ 2 (95% CI, 0.10 to 0.80; P = 0.017). CONCLUSION Thyme honey can be considered as a prophylactic agent for OM and decrease the severity of its symptoms. TRIAL REGISTRATIONS This protocol was registered at the Iranian Registry of Clinical Trials: registration number IRCT201506063106N25, on June 12, 2015; approved by the institutional review board at the Deputy of Research, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran; and approved by the Ethics Committee of Medical Researches of Pharmaceutical Sciences Branch of Islamic Azad University, Tehran, Iran-reference number 5936, on August 17, 2014.
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Affiliation(s)
- Elnaz Jahanbani Mazraeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, P.O. Box 19419, Yasaman St., Yakhchal Ave., Qolhak Ave., Shariati Ave, Tehran, Iran
| | - Sanambar Sadighi
- Department of Hematology/Oncology, Cancer Institute of Iran, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Manifar
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Hooman Bakhshandeh
- Department of Epidemiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rajabi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, P.O. Box 19419, Yasaman St., Yakhchal Ave., Qolhak Ave., Shariati Ave, Tehran, Iran.
- Department of Clinical Pharmacy, University Hospitals of North Midlands NHS Trust, Stoke-On-Trent, ST4 6QG, UK.
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Yaghoobi N, Khozeimeh F, Dehghan P, Maheronnaghsh M, Bazazzadeh M, Noorbakhsh S. Effect of nystatin and licorice on yeasts isolated from the oral lesions of patients with cancer under chemotherapy ( in vitro study). Dent Res J (Isfahan) 2022. [DOI: 10.4103/1735-3327.353830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Agbele AT, Hejazi SM, Dehpour AR, Mohammad Jafari R, Elyassi A, Bagheri M, Seydi M. Treatment Parameters of Photobiomodulation in the Prevention of Non-surgical Cancer Treatment-Induced Oral Mucositis: A Review of Preclinical Studies. J Lasers Med Sci 2021; 12:e54. [DOI: 10.34172/jlms.2021.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 03/06/2021] [Indexed: 01/03/2023]
Abstract
Introduction: The most important side effect after non-surgery cancer treatment (NSCT) is oral mucositis (OM) which degrades the quality of life. Using photobiomodulation (PBM), formerly known as low-level laser therapy (LLLT), in the prevention of NSCT-induced OM was widely studied. Hence, this review evaluates the efficacy of optical treatment parameters behind the working process of PBM in preventing NSCT-induced OM in preclinical studies. Methods: Using the PubMed, Scopus and Embase databases, the present study systematically reviewed existing preclinical studies for optical treatment parameters of PBM in preventing NSCT-induced OM in experimental models without restriction on the year of publication. Results: In total, 51 articles were recognized during the search of the literature, and only 16 research papers were included in this review, taking into consideration the inclusion as well as exclusion benchmarks. The reviewed studies showed that a consensus has yet to be reached on the optimal PBM treatment parameters in preventing NSCT-induced OM. However, a wavelength of 660 nm, a power density of 40 mW as well as fluence which ranged between 2 and 6 J/cm2 were mostly utilized in the included studies. Furthermore, the severity of NSCT-induced OM was reduced following PBM application with no reported severe side effects. Conclusion: The efficacy of PBM with the associated optical parameters is a promising strategy in preventing NSCT-induced OM. However, the optimal parameters of PBM need to be investigated.
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Affiliation(s)
- Alaba Tolulope Agbele
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, 1417613151, Tehran, Iran
- Department of Basic Medical Sciences, College of Health Sciences and Technology, Ijero-Ekiti, Nigeria
- Department of Physics, School of Sciences, Federal University of Technology Akure, Nigeria
| | - Sedigheh Marjaneh Hejazi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, 1417613151, Tehran, Iran
- Bio Optical Imaging Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Razieh Mohammad Jafari
- Experimental Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Elyassi
- Bio Optical Imaging Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Bagheri
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, 1417613151, Tehran, Iran
- Bio Optical Imaging Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Seydi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, 1417613151, Tehran, Iran
- Bio Optical Imaging Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
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Shen Loo Y, Yee Wong T, Veettil SK, Se Wong P, Gopinath D, Mooi Ching S, Kunnath Menon R. Antifungal agents in preventing oral candidiasis in clinical oncology: A network meta-analysis. Oral Dis 2020; 27:1631-1643. [PMID: 32762108 DOI: 10.1111/odi.13588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This review examined the comparative efficacy and safety of antifungal agents in preventing oral candidiasis among patients on cancer treatment. METHODS We performed a systematic review and network meta-analysis based on randomised controlled trials that compared antifungal agents to placebo or other antifungal agents used in patients undergoing cancer treatment. Relative ranking of antifungal agents was evaluated with surface under the cumulative ranking (SUCRA) probability score. A total of 20 randomised controlled trials (3,215 participants) comparing 11 interventions were included. RESULTS Compared with placebo, clotrimazole was ranked the best agent for preventing the incidence of oral candidiasis (risk ratio (RR), 0.21 [95% CI 0.08 to 0.55]; SUCRA = 0.89). Fluconazole was ranked the safest among other antifungal agents (SUCRA = 0.80), whereas clotrimazole (SUCRA = 0.36) and amphotericin B (SUCRA = 0.18) were ranked low for safety. Amphotericin B was associated with highest risk of adverse events (RR, 3.52 [95% CI 1.27 to 9.75]). CONCLUSION Clotrimazole is the most effective in preventing oral candidiasis, whereas fluconazole has the most favourable risk-benefit profile in patients undergoing cancer treatment. However, we are unable to recommend clotrimazole as the best choice to prevent oral candidiasis due to unavailability of studies comparing clotrimazole with other antifungal agents.
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Affiliation(s)
- Yee Shen Loo
- School of Pharmacy, International University Medical, Kuala Lumpur, Malaysia
| | - Tse Yee Wong
- School of Pharmacy, International University Medical, Kuala Lumpur, Malaysia
| | - Sajesh K Veettil
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Pei Se Wong
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Divya Gopinath
- Oral Diagnostics and Surgical Sciences, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Rohit Kunnath Menon
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Oliveira DM, Silva TFR, Martins MM, de Morais SAL, Chang R, de Aquino FJT, da Silva CV, Teixeira TL, Martins CHG, Moraes TS, Cunha LCS, Pivatto M, de Oliveira A. Antifungal and cytotoxicity activities of Banisteriopsis argyrophylla leaves. J Pharm Pharmacol 2018; 70:1541-1552. [PMID: 30136729 DOI: 10.1111/jphp.12996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/21/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This work aimed to evaluate the antifungal and cytotoxic activity of the EtOH extract and fractions of Banisteriopsis argyrophylla leaves, and to perform the identification of these bioactive metabolites. METHODS The EtOAc fraction (EAF) obtained from the ethanolic extract of B. argyrophylla leaves showed better antifungal potential against Candida spp. In this fraction, ten flavonoids have been identified by UHPLC-ESI-MSn . Then, EAF was submitted to column chromatography to give four new fractions (A1-A4). The cytotoxicity was determined against Vero cells. KEY FINDINGS The EAF showed better antifungal potential against Candida spp. with minimum inhibitory concentrations (MICs) between 31.25 and 93.75 μg/ml. The (-)-catechin (fraction A1) showed a MIC of 2.83 μg/ml against Candida glabrata. Fractions A2, A3 and A4 were rich in quercetins and kaempferols and showed good inhibitory concentrations (5.86-46.87 μg/ml) against C. albicans, C. glabrata and C. tropicalis. CONCLUSIONS The EtOH extract, fractions and the isolated (-)-catechin showed lower toxicity to Vero cells than cisplatin, used as a positive control. Thus, the leaves of B. argyrophylla are a promising source of antifungal agents.
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Affiliation(s)
- Daiane M Oliveira
- Nucleus of Research in Natural Products (NuPPeN), Institute of Chemistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Tomás F R Silva
- Nucleus of Research in Natural Products (NuPPeN), Institute of Chemistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Mário M Martins
- Nucleus of Research in Natural Products (NuPPeN), Institute of Chemistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Sérgio A L de Morais
- Nucleus of Research in Natural Products (NuPPeN), Institute of Chemistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Roberto Chang
- Nucleus of Research in Natural Products (NuPPeN), Institute of Chemistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Francisco J T de Aquino
- Nucleus of Research in Natural Products (NuPPeN), Institute of Chemistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Claudio V da Silva
- Trypanosomatids Laboratory (LATRI), Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | - Thaise L Teixeira
- Trypanosomatids Laboratory (LATRI), Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | - Carlos H G Martins
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology (LaPeMA), University of Franca, Franca, Brazil
| | - Thaís S Moraes
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology (LaPeMA), University of Franca, Franca, Brazil
| | - Luís C S Cunha
- Bioprospecting Center for Natural Products (NuBiProN), Chemistry Department, Federal Institute of Triângulo Mineiro, Uberaba, Brazil
| | - Marcos Pivatto
- Nucleus of Research in Natural Products (NuPPeN), Institute of Chemistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Alberto de Oliveira
- Nucleus of Research in Natural Products (NuPPeN), Institute of Chemistry, Federal University of Uberlândia, Uberlândia, Brazil
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Comparison of the efficacy of a novel sustained release clotrimazole varnish and clotrimazole troches for the treatment of oral candidiasis. Clin Oral Investig 2014; 19:467-73. [PMID: 24867230 DOI: 10.1007/s00784-014-1259-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Candida albicans is a common fungal infection and is commensal in 40-65 % of healthy adults. The development and pharmacokinetics of a novel sustained release clotrimazole varnish (Clot-SRV) for topical oral use have been reported. The aim of this study was to compare the efficacy of this varnish with clotrimazole troche treatment of oral candidiasis. MATERIALS AND METHODS Of the 12 patients with denture stomatitis treated for 14 days, six used Clot-SRV (study group) and six clotrimazole troches (control). The patients were instructed to use Clot-SRV (50 mg of clotrimazole) once a day, and the control group was instructed to use five troches of 10 mg clotrimazole/day. Microbiological samples were obtained from saliva, buccal mucosa, palate, and denture. The degree of erythema was recorded at three time points, and subjective opinions noted using a questionnaire. RESULTS At the end of the study, the control group had relatively more cases of erythema on all examined surfaces; patients who applied the Clot-SRV had significantly lower levels of candida on the denture surfaces and in saliva, and had better compliance to the medication. CONCLUSIONS The novel clotrimazole sustained release varnish may be an important part of a new protocol for oral candidiasis, with improved clinical outcomes.
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Qutob AF, Gue S, Revesz T, Logan RM, Keefe D. Prevention of oral mucositis in children receiving cancer therapy: A systematic review and evidence-based analysis. Oral Oncol 2013; 49:102-7. [DOI: 10.1016/j.oraloncology.2012.08.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 08/14/2012] [Accepted: 08/15/2012] [Indexed: 10/27/2022]
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8
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Mansouri A, Hadjibabaie M, Iravani M, Shamshiri AR, Hayatshahi A, Javadi MR, Khoee SH, Alimoghaddam K, Ghavamzadeh A. The effect of zinc sulfate in the prevention of high-dose chemotherapy-induced mucositis: a double-blind, randomized, placebo-controlled study. Hematol Oncol 2011; 30:22-6. [DOI: 10.1002/hon.999] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 04/27/2011] [Indexed: 11/12/2022]
Affiliation(s)
- Ava Mansouri
- Faculty of Pharmacy; Department of Clinical Pharmacy; Tehran University of Medical Sciences; Tehran; Iran
| | - Molouk Hadjibabaie
- Faculty of Pharmacy; Department of Clinical Pharmacy; Tehran University of Medical Sciences; Tehran; Iran
| | - Masoud Iravani
- Hematology-Oncology and SCT Research Center; Department of Hematology-Oncology, Shariati Hospital; Tehran University of Medical Sciences; Tehran; Iran
| | - Ahmad Reza Shamshiri
- Department of Epidemiology and Biostatistics; School of Public Health; Tehran University of Medical Sciences; Tehran; Iran
| | - Alireza Hayatshahi
- Faculty of Pharmacy; Department of Clinical Pharmacy; Tehran University of Medical Sciences; Tehran; Iran
| | - Mohammad Reza Javadi
- Faculty of Pharmacy; Department of Clinical Pharmacy; Tehran University of Medical Sciences; Tehran; Iran
| | - Seid Hamid Khoee
- Faculty of Pharmacy; Department of Clinical Pharmacy; Tehran University of Medical Sciences; Tehran; Iran
| | - Kamran Alimoghaddam
- Hematology-Oncology and SCT Research Center; Department of Hematology-Oncology, Shariati Hospital; Tehran University of Medical Sciences; Tehran; Iran
| | - Ardeshir Ghavamzadeh
- Hematology-Oncology and SCT Research Center; Department of Hematology-Oncology, Shariati Hospital; Tehran University of Medical Sciences; Tehran; Iran
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Oton-Leite AF, Corrêa de Castro AC, Morais MO, Pinezi JCD, Leles CR, Mendonça EF. Effect of intraoral low-level laser therapy on quality of life of patients with head and neck cancer undergoing radiotherapy. Head Neck 2011; 34:398-404. [PMID: 21472883 DOI: 10.1002/hed.21737] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/10/2010] [Accepted: 01/04/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Low-level laser therapy has been used to reduce complications of head and neck cancer treatment. The aim was to assess the impact of laser in the quality of life (QOL) of patients receiving radiotherapy. METHODS Sixty outpatients were randomly assigned into 2 groups. The laser group received applications and the placebo group received sham laser. QOL was assessed using the University of Washington QOL questionnaire. A repeated-measures analysis of variance (ANOVA) was used for comparisons of overall QOL scores and Mann-Whitney test compared changes in domain scores. RESULTS A decrease in QOL scores was observed in both groups and the reduction in the laser group was significantly lower (p < .01). Changes in QOL scores regarding pain, chewing, and saliva domains were evident in the placebo group. Both health-related QOL and overall QOL were rated higher by patients who received laser therapy. CONCLUSION Laser therapy reduces the impact of radiotherapy on the QOL of patients with head and neck cancer.
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10
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Candidoses oropharyngées (COP) et cancers solides. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-1983-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Zheng C, Cotrim AP, Sunshine AN, Sugito T, Liu L, Sowers A, Mitchell JB, Baum BJ. Prevention of radiation-induced oral mucositis after adenoviral vector-mediated transfer of the keratinocyte growth factor cDNA to mouse submandibular glands. Clin Cancer Res 2009; 15:4641-8. [PMID: 19584147 DOI: 10.1158/1078-0432.ccr-09-0819] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The study aims to evaluate if human keratinocyte growth factor (hKGF), secreted after transduction of murine salivary glands with adenoviral vectors, can prevent oral mucositis resulting from radiation. EXPERIMENTAL DESIGN Two serotype 5 adenoviral vectors encoding hKGF were constructed: AdEF1alpha-hKGF and AdLTR(2)EF1alpha-hKGF. Female C3H mice, 8 weeks old, were irradiated by single (22.5 Gy) or fractionated (5 x 8 Gy for 5 days) doses to induce oral mucositis (ulcers on tongue). One day before irradiation, the above viral vectors or an empty vector, Adcontrol, was given (10(10) particles per gland) to both submandibular glands by retrograde ductal instillation. Each experiment included five groups: no irradiation and irradiation (+/-Adcontrol, AdEF1alpha-hKGF, or AdLTR(2)EF1alpha-hKGF). Blood, saliva, submandibular glands, and tongue were collected on day 7 for single-dose studies or day 10 for fractionated dosing. hKGF levels were measured by ELISA. RESULTS In three separate single-dose irradiation experiments, lingual ulcers were dramatically reduced after either KGF-expressing vector. Similarly, in two separate fractionated irradiation experiments, the hKGF-expressing vectors completely prevented ulcer formation. QPCR data indicated that approximately 10(7) to 10(8) particles of each vector remained in the targeted submandibular glands at the terminal time. Transgenic hKGF protein was found at high levels in saliva, serum, and submandibular gland extracts. CONCLUSIONS hKGF gene transfer to salivary glands prevented radiation-induced oral mucositis in mice. This proof of concept study suggests that transgenic hKGF secreted from transduced salivary glands may be useful clinically to prevent oral mucositis caused by radiation.
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Affiliation(s)
- Changyu Zheng
- Molecular Physiology and Therapeutics Branch, National Institute of Dental and Craniofacial Research, National Cancer Institute, Bethesda, Maryland, USA
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Czerninski R, Sivan S, Steinberg D, Gati I, Kagan L, Friedman M. A novel sustained-release clotrimazole varnish for local treatment of oral candidiasis. Clin Oral Investig 2009; 14:71-8. [PMID: 19404692 DOI: 10.1007/s00784-009-0275-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 04/03/2009] [Indexed: 12/20/2022]
Abstract
The use of dental varnish for therapeutic purposes has been reported for fluoride or antibacterial drugs. Our objectives were to develop a sustained-release varnish containing an antifungal drug (clotrimazole) for topical application and to evaluate the release rate of the drug in human saliva in comparison with an available commercial troche and their acceptance by healthy volunteers. Following in vitro optimization of the release rate from the varnish, we have embarked on a crossover comparative study assessing the oral sensations and pharmacokinetics of a 10-mg clotrimazole oral troche versus a 10-mg sustained-release clotrimazole varnish in 14 human volunteers over a period of 5 h. Saliva samples were assessed for clotrimazole concentration by high performance liquid chromatography analysis. The volunteers' evaluation of the varnish and troche (taste, other sensory changes, convenience, and oral suitability) were recorded. At all time points, salivary clotrimazole concentrations were higher, and the terminal half-life was significantly prolonged in the varnish group in comparison to the control group. This can be attributed to continuous release of clotrimazole from the varnish formulation. The duration of the drug over the minimal inhibitory concentration, following application of the varnish, was more than threefold longer than following administration of the troche. The developed sustained-release varnish can be applied in patients at a lower frequency than troches, thus, achieving higher patient compliance and efficacy. This novel varnish application can serve as the basis for a new treatment approach to oral candidiasis, a very common chronic opportunistic infection with improved clinical outcome.
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Affiliation(s)
- Rakefet Czerninski
- The Department of Oral Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
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13
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França CM, França CM, Núñez SC, Prates RA, Noborikawa E, Faria MR, Ribeiro MS. Low-intensity red laser on the prevention and treatment of induced-oral mucositis in hamsters. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2009; 94:25-31. [DOI: 10.1016/j.jphotobiol.2008.09.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 07/28/2008] [Accepted: 09/24/2008] [Indexed: 11/16/2022]
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14
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Sacono NT, Costa CA, Bagnato VS, Abreu-e-Lima FC. Light-emitting diode therapy in chemotherapy-induced mucositis. Lasers Surg Med 2008; 40:625-33. [DOI: 10.1002/lsm.20677] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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15
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Larson E, Nirenberg A. Evidence-Based Nursing Practice to Prevent Infection in Hospitalized Neutropenic Patients With Cancer. Oncol Nurs Forum 2007; 31:717-25. [PMID: 15252428 DOI: 10.1188/04.onf.717-725] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To review studies that have assessed the effectiveness of selected nursing interventions used in hospitals to prevent healthcare-associated infections in neutropenic patients with cancer. DATA SOURCES Literature review of low microbial diets, protective clothing and environments, personal hygiene, and oral care in English-language articles from PubMed; the Cumulative Index of Nursing and Allied Health Literature; the National Guideline Clearinghouse, 1980-June 2003; and Cochrane Database of Systematic Reviews. DATA SYNTHESIS Few studies have demonstrated the effectiveness of low microbial food and water and protective environments and clothing in reducing infections in neutropenic patients with cancer, and hospitals vary in these practices. Skin antisepsis reduces microbial counts, but data regarding the effect on infections are lacking. Many studies were characterized by insufficient sample sizes or use of multiple interventions. CONCLUSIONS Major gaps exist in empirical evidence regarding which nursing interventions might be helpful in preventing or controlling healthcare-associated infections in neutropenic patients. IMPLICATIONS FOR NURSING Although the evidence base for clinical practices such as a low microbial diet, protective environments and clothing, and special skin antisepsis regimens is weak, some of these practices seem prudent and reasonable. Until further evidence is available, clinicians can use consensus guidelines and should assist in identifying clinical practices that require additional research. Ultimately, interventions with little or no demonstrated efficacy should be examined systematically or abandoned. Additional studies of sufficient sample size regarding nursing practices such as the role of protective environments, room placement, antiseptic bathing, and prevention and treatment of oral complications are indicated. Because of difficulties in randomization and risk stratification, rigorous observational studies often may be an acceptable alternative to clinical trials.
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Affiliation(s)
- Elaine Larson
- School of Nursing, Columbia University in New York, NY, USA.
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Zitella LJ, Friese CR, Hauser J, Gobel BH, Woolery M, O'Leary C, Andrews FA. Putting Evidence Into Practice: Prevention of Infection. Clin J Oncol Nurs 2007; 10:739-50. [PMID: 17193941 DOI: 10.1188/06.cjon.739-750] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevention of infection is an important outcome to measure in patients with cancer because infectious complications are a significant cause of morbidity and mortality. Nurses play a vital role in the prevention of infection in patients with cancer through nursing practice, research, and patient education. However, many common nursing interventions to prevent infection are based on tradition or expert opinion and have not been subjected to scientific examination. The 2005 Oncology Nursing Society Prevention of Infection Outcomes Intervention Project Team reviewed, critiqued, and summarized the research evidence for nursing interventions to prevent infections in patients with cancer. Pharmacologic and nonpharmacologic interventions were included because many advanced practice nurses prescribe medications. This article is an evidence-based review of nursing interventions to prevent infection in patients with cancer.
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Affiliation(s)
- Laura J Zitella
- Division of Oncology, Stanford Hospital and Clinics, California, USA.
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Stiff PJ, Emmanouilides C, Bensinger WI, Gentile T, Blazar B, Shea TC, Lu J, Isitt J, Cesano A, Spielberger R. Palifermin Reduces Patient-Reported Mouth and Throat Soreness and Improves Patient Functioning in the Hematopoietic Stem-Cell Transplantation Setting. J Clin Oncol 2006; 24:5186-93. [PMID: 16391299 DOI: 10.1200/jco.2005.02.8340] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo describe patient-reported outcomes of mouth and throat soreness (MTS) and related sequelae on daily activities from a phase III study of palifermin in the autologous hematopoietic stem-cell transplantation (HSCT) setting and to compare patient self-evaluations with clinicians' assessments of oral mucositis using objective scales.Patients and MethodsPatients (n = 212) received palifermin (60 μg/kg/d) or placebo for 3 days before total-body irradiation (12 Gy), etoposide 60 mg/kg, and cyclophosphamide 100 mg/kg, and 3 days after HSCT. Patients completed a daily questionnaire (Oral Mucositis Daily Questionnaire [OMDQ]) evaluating MTS severity and its effects on daily functional activities. Patients' self-assessment data were compared with clinicians' assessments of oral mucositis using the objective scales.ResultsPalifermin reduced the incidence and duration of severe oral mucositis, as assessed by both clinicians and patients. Comparisons between patient and clinician assessments demonstrated that the average daily scores between mucositis grade and subjective (MTS) instruments were similar, although patients reported MTS onset, peak, and resolution earlier (1 to 3 days) than clinicians' assessments. Patients receiving palifermin reported statistically significant improvements (P < .001) in daily functioning activities (swallowing, drinking, eating, talking, sleeping) and required significantly less narcotic opioids (P < .001); improvement in the patient's overall physical and functional well-being was also reported. This was confirmed by the results of the Functional Assessment of Cancer Treatment questionnaire.ConclusionThese results support the clinical benefit of palifermin in the HSCT setting, providing evidence that a patient's self-assessment instrument (OMDQ) may serve as an alternative tool to assess oral mucositis severity in clinical trials.
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Borges L, Rex KL, Chen JN, Wei P, Kaufman S, Scully S, Pretorius JK, Farrell CL. A protective role for keratinocyte growth factor in a murine model of chemotherapy and radiotherapy-induced mucositis. Int J Radiat Oncol Biol Phys 2006; 66:254-62. [PMID: 16904525 DOI: 10.1016/j.ijrobp.2006.05.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 04/26/2006] [Accepted: 05/09/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the activity of palifermin (rHuKGF) in a murine model of mucosal damage induced by a radiotherapy/chemotherapy (RT/CT) regimen mimicking treatment protocols used in head-and-neck cancer patients. METHODS AND MATERIALS A model of mucosal damage induced by RT/CT was established by injecting female BDF1 mice with cisplatin (10 mg/kg) on Day 1; 5-fluorouracil (40 mg/kg/day) on Days 1-4, and irradiation (5 Gy/day) to the head and neck on Days 1-5. Palifermin was administered subcutaneously on Days -2 to 0 (5 mg/kg/day) and on Day 5 (5 mg/kg). Evaluations included body weight, organ weight, keratinocyte growth factor receptor expression, epithelial thickness, and cellular proliferation. RESULTS Initiation of the radiochemotherapeutic regimen resulted in a reduction in body weight in control animals. Palifermin administration suppressed weight loss and resulted in increased organ weight (salivary glands and small intestine), epithelial thickness (esophagus and tongue), and cellular proliferation (tongue and salivary glands). CONCLUSIONS Administration of palifermin before RT/CT promotes cell proliferation and increases in epithelial thickness in the oral mucosa, salivary glands, and digestive tract. Palifermin administration before and after RT/CT mitigates weight loss and a trophic effect on the intestinal mucosa and salivary glands, suggesting that palifermin use should be investigated further in the RT/CT settings, in which intestinal mucositis and salivary gland dysfunction are predominant side effects of cytotoxic therapy.
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Affiliation(s)
- Luis Borges
- Departments of Hematology, Cancer Biology, and Pathology, Amgen Inc., Thousand Oaks, CA 91320, USA.
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Migliorati CA, Oberle-Edwards L, Schubert M. The role of alternative and natural agents, cryotherapy, and/or laser for management of alimentary mucositis. Support Care Cancer 2006; 14:533-40. [PMID: 16572313 DOI: 10.1007/s00520-006-0049-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 02/21/2006] [Indexed: 10/24/2022]
Abstract
GOALS OF WORK To review the literature and update the current guidelines of alternative/natural agents, cryotherapy, and/or laser therapy in the management of alimentary mucositis (AM). MATERIALS AND METHODS The original guidelines developed by the Multinational Association for Supportive Care in Cancer (MASCC)/International Society for Oral Oncology (ISOO) mucositis study group were the basis for this study. A medical librarian conducted an initial Medline search to identify research articles published between 2002 and 2005 in English language. A search term combination that included stomatitis, mucositis, mucous membrane, neoplasm, lasers, complimentary therapies, amino acids, antioxidants, vitamins, minerals, plant extracts, and cryotherapy was conducted. This initial search identified articles with a strong scientific methodology that included both preclinical and clinical research. Using standardized scoring forms, authors reviewed and scored individual articles. A consensus result of the review was achieved in a meeting of reviewers in June of 2005. RESULTS The initial search identified a total of 167 new articles. Of these, 14 were selected and reviewed: alternative/natural therapy (one preclinical study); cryotherapy (four clinical studies); lasers (two clinical studies); and alternative/natural agents (seven clinical studies). A new guideline could be established for the use of cryotherapy in the management of AM in hematopoietic stem cell transplant (HSCT) patients receiving melphalan in the conditioning phase. CONCLUSION The rapid progress in the understanding of AM created a need for new prevention and management protocols. Frequent literature review is now necessary to identify agents and protocols being developed in this important area of supportive care in cancer.
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Affiliation(s)
- Cesar A Migliorati
- Department of Diagnostic Sciences, Nova Southeastern University College of Dental Medicine, 3200 S. University Drive, Fort Lauderdale, FL 33328, USA.
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Karagözoğlu S, Filiz Ulusoy M. Chemotherapy: the effect of oral cryotherapy on the development of mucositis. J Clin Nurs 2005; 14:754-65. [PMID: 15946284 DOI: 10.1111/j.1365-2702.2005.01128.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVE The aim of this study is to investigate the effect of oral cryotherapy on the development of chemotherapy-induced mucositis in patients administered combined chemotherapy. BACKGROUND Mucositis has been of interest to scientists for more than 20 years. Unfortunately, this has not resulted in the development of standard procedures for prevention and management. To cope with this side-effect and to prevent opportunistic infections that may emerge during treatment, attempts are taken to provide preventative and comfort measures. In this context, cryotherapy (oral cooling) has become popular as a cheap and readily applicable method in preventing the developing due the rapid infusion of chemotherapy agents, or decreasing its severity. DESIGN AND METHOD Study involved 60 patients, 30 of whom were in the study group and 30 in the control group. Ice cubes at a size that can be moved easily in the mouth and whose corners have been smoothed in order that they will not cause irritation in the mouth has been used in oral cryotherapy in the study group. Oral chemotherapy was initiated five minutes before chemotherapy and maintained during venous infusions of etoposide (Vepesid), platinol (Cisplatin), mitomycin (Mitomycin-C) and vinblastin (Velbe) depending on the chemotherapy course. RESULTS According to Patient-Judged Mucositis Grading, the rate of mucositis is 36.7% in study group and 90.0% in control group, the difference between two groups being statistically significant (P < 0.05). According to Physician-Judged Mucositis Grading, the rate of mucositis is 10.0% in the study group and 50.0% in the control group, the difference between two groups being statistically significant (P < 0.05). Oral pH values decreased in 90% of the subjects in study group, i.e. mucositis risk was reduced whereas oral pH values remained unchanged or decreased in 86.7% of the subjects in the control group, namely mucositis risk increased. The difference between study and control groups in terms of the change in pH values after chemotherapy was found to be statistically significant (P < 0.05). CONCLUSION Our findings have demonstrated that oral cryotherapy makes an important contribution to the protection of oral health by reducing the mucositis score according to patient- and physician-judged mucositis score and by increasing oral pH values. RELEVANCE TO CLINICAL PRACTICE Aggressive cancer therapy places patients at greater risk for oral complications and treatment-related consequences. Unfortunately, prevention and/or treatment of such oral sequelae have often become overlooked as priorities of the treatment team. Effective approaches for the prevention or treatment of oral mucositis have not been standardized, and vary considerably among institutions. Prophylactic measures begin with an increased emphasis on improved oral status. Oral cryotherapy, the therapeutic administration of cold, is a prophylactic measure for oral inflammation. The relevance for clinical practice will be to understand the content of mucositis; comprehensive care should focus on the prevention of this complication in the clinical practice.
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Lövenich H, Schütt-Gerowitt H, Keulertz C, Waldschmidt D, Bethe U, Söhngen D, Cornely OA. Failure of anti-infective mouth rinses and concomitant antibiotic prophylaxis to decrease oral mucosal colonization in autologous stem cell transplantation. Bone Marrow Transplant 2005; 35:997-1001. [PMID: 15806134 DOI: 10.1038/sj.bmt.1704933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Autologous stem cell transplantation has augmented treatment successes. However, high-dose chemotherapy is still accompanied by dose-limiting toxicities, for example, severe mucositis. Mucosal lesions serve as portals of entry for infections. In order to reduce the oral microbial burden, we prospectively evaluated the microbiological impact of a complex regimen of mouth rinses consisting of concomitantly applied polyene antifungals, povidone-iodine, chlorhexidine, sage tea, and prophylactic ciprofloxacin and fluconazole. A total of 15 patients were enrolled into this longitudinal evaluation. Colony-forming units (CFU) were quantitated from saliva, buccal and palatinal swabs during high-dose chemotherapy and autologous stem cell transplantation. The number of CFU did not show any significant changes after initiation of the mouth rinses and the prophylactic antibiotics. The median CFU count was 268 x 10(6)/ml saliva before chemotherapy and decreased after initiation of intravenous antibiotics only. Neither prophylactic nor therapeutic antifungals significantly reduced the number of cultures positive for yeasts. Since 90% of our patients had febrile neutropenia at some time point during the observation period, the approach evaluated cannot be recommended as prophylaxis of febrile neutropenia as such.
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Affiliation(s)
- H Lövenich
- Universität Koeln, Klinik I für Innere Medizin, Koeln, Germany
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Soysa NS, Samaranayake LP, Ellepola ANB. Cytotoxic drugs, radiotherapy and oral candidiasis. Oral Oncol 2004; 40:971-8. [PMID: 15509487 DOI: 10.1016/j.oraloncology.2003.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2003] [Accepted: 12/10/2003] [Indexed: 11/23/2022]
Abstract
The increased incidence of oral candidiasis in patients with malignancies stems partly from the systemic disease itself and, partly from the therapeutic measures such as cytotoxic and other immunosuppressive drugs and radiotherapy they receive during management of such malignancies. In this review we discuss the clinical and laboratory findings on the relationship between cytotoxics, radiotherapy and oral candidiasis, possible mechanisms of pathogenicity following such therapy, as well as precautions that could be taken to minimize such recalcitrant yeast infections.
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Affiliation(s)
- Niroshani S Soysa
- Division of Pharmacology, Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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Belfield PM, Dwyer AA. Oral complications of childhood cancer and its treatment. Eur J Cancer 2004; 40:1035-41; discussion 1042-4. [PMID: 15093579 DOI: 10.1016/j.ejca.2003.09.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2003] [Revised: 09/19/2003] [Accepted: 09/29/2003] [Indexed: 10/26/2022]
Affiliation(s)
- P M Belfield
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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