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Mould DR, Hutson PR. Critical Considerations in Anticancer Drug Development and Dosing Strategies: The Past, Present, and Future. J Clin Pharmacol 2019; 57 Suppl 10:S116-S128. [PMID: 28921645 DOI: 10.1002/jcph.983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/19/2017] [Indexed: 01/26/2023]
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Gandhi K, Datta G, Ahuja S, Saxena T, G Datta A. Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy. Int J Clin Pediatr Dent 2017; 10:166-171. [PMID: 28890617 PMCID: PMC5571386 DOI: 10.5005/id-iournals-10005-1428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/29/2016] [Indexed: 11/23/2022] Open
Abstract
Multiagent chemotherapy, radiotherapy, or a combination of both are the contemporary methods of cancer treatment. With medical advancements, though cure rates have increased considerably, focus is now shifted to the potential early and late complications of the same. The aim of this study was to assess the early oral complications in pediatric patients receiving chemotherapy. Sixty-two children with cancer undergoing chemotherapy with the mean age of 7.42 ± 3.6 years were included in the study. The various types of malignancies and oral problems during chemotherapy were recorded in the subjects. The most commonly encountered malignancy was acute lymphoblastic leukemia at 35.5%. Various oral and associated complications like mucosal inflammation with ulcerations, oral pain, xerostomia, and secondary infections were commonly seen, with mucositis being the most commonly observed complication in 58.1% of the subjects undergoing chemotherapy. Clinical importance of timely medical and dental interventions by a multidisciplinary team involving a pediatric dentist at different stages of anticancer treatment is also emphasized to minimize discomfort, increase treatment compliance, and improve the quality of life of pediatric patients.
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Affiliation(s)
- Kapil Gandhi
- Professor, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Geetika Datta
- Reader, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Shilpa Ahuja
- Senior Lecturer, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Tanvi Saxena
- Senior Lecturer, Department of Pedodontics and Preventive Dentistry Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
| | - Ankush G Datta
- Ex-Senior Lecturer, Department of Orthodontics and Dentofacial Orthopedics Inderprastha Dental College & Hospital, Ghaziabad, Uttar Pradesh, India
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Datta G, Saxena T, Datta AG. Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy. Int J Clin Pediatr Dent 2017. [DOI: 10.5005/jp-journals-10005-1428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
ABSTRACT
Multiagent chemotherapy, radiotherapy, or a combination of both are the contemporary methods of cancer treatment. With medical advancements, though cure rates have increased considerably, focus is now shifted to the potential early and late complications of the same. The aim of this study was to assess the early oral complications in pediatric patients receiving chemotherapy. Sixty-two children with cancer undergoing chemotherapy with the mean age of 7.42 ± 3.6 years were included in the study. The various types of malignancies and oral problems during chemotherapy were recorded in the subjects. The most commonly encountered malignancy was acute lymphoblastic leukemia at 35.5%. Various oral and associated complications like mucosal inflammation with ulcerations, oral pain, xerostomia, and secondary infections were commonly seen, with mucositis being the most commonly observed complication in 58.1% of the subjects undergoing chemotherapy. Clinical importance of timely medical and dental interventions by a multidisciplinary team involving a pediatric dentist at different stages of anticancer treatment is also emphasized to minimize discomfort, increase treatment compliance, and improve the quality of life of pediatric patients.
How to cite this article:
Gandhi K, Datta G, Ahuja S, Saxena T, Datta AG. Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy. Int Int J Clin Pediatr Dent 2017;10(2):166-171.
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Haverkamp H, Böll B, Eichenauer DA, Sasse S, Fuchs M, Borchmann P, Diehl V, Engert A, von Tresckow B. Impact of Bleomycin and Vincristine Dose Reductions in Patients With Advanced Hodgkin Lymphoma Treated With BEACOPP: An Analysis of the German Hodgkin Study Group HD12 and HD15 Trials. J Clin Oncol 2015; 33:2430-6. [DOI: 10.1200/jco.2014.60.4264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The role of bleomycin and vincristine in the treatment of patients with advanced Hodgkin lymphoma (HL) is unclear, and the impact of dose reductions of these drugs on outcome and tolerability has not been systematically assessed. Because both drugs can cause significant toxicity and are frequently discontinued, we performed an analysis of patients with HL treated with BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) in the German Hodgkin Study Group HD12 and HD15 trials. Patients and Methods Characteristics and outcome of patients were analyzed with respect to discontinuation of bleomycin and/or vincristine. Results With 3,309 patients with HL analyzed, bleomycin was discontinued in 17.6% and vincristine in 32.6%. A total of 157 patients (4.7%) received ≤ four cycles of bleomycin, and 218 (6.6%) received ≤ three cycles of vincristine; these were compared with patients receiving > four cycles of bleomycin or > three cycles of vincristine, respectively. After a median follow-up of 59 and 67 months for progression-free survival (PFS) and overall survival (OS), respectively, there was no significant difference in PFS or OS in patients receiving ≤ or > four cycles of bleomycin (5-year PFS difference, 1.7%; 95% CI, −4.2% to 7.6%; 5-year OS difference, 1.5%; 95% CI, −2.6% to 5.5%). Similarly, there was no significant difference in patients receiving ≤ or > three cycles of vincristine (5-year PFS difference, −1.3%; 95% CI, −5.6% to 3.1%; 5-year OS difference, −0.1%; 95% CI, −3.1% to 2.9%). Conclusion Bleomycin and vincristine discontinuation because of drug-specific adverse effects does not affect the efficacy of treatment in this setting.
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Affiliation(s)
- Heinz Haverkamp
- All authors: University Hospital of Cologne, Cologne, Germany
| | - Boris Böll
- All authors: University Hospital of Cologne, Cologne, Germany
| | | | - Stephanie Sasse
- All authors: University Hospital of Cologne, Cologne, Germany
| | - Michael Fuchs
- All authors: University Hospital of Cologne, Cologne, Germany
| | - Peter Borchmann
- All authors: University Hospital of Cologne, Cologne, Germany
| | - Volker Diehl
- All authors: University Hospital of Cologne, Cologne, Germany
| | - Andreas Engert
- All authors: University Hospital of Cologne, Cologne, Germany
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Kasetty S, Khan S, Shridhar SU, Gupta S, Tijare M, Kallianpur S, Raju Ragavendra T. Cancer Therapy: A Continuance of Health Burden. World J Oncol 2012; 3:205-209. [PMID: 29147307 PMCID: PMC5649897 DOI: 10.4021/wjon581e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 11/18/2022] Open
Abstract
Background Cancer diagnosis coupled with emotional impact converge to create one of the most difficult physical and emotional periods of life. Cancer treatment causes plethora of short and long term complications which can be so debilitating that patient may interrupt treatment. Pretreatment oral assessment and supportive oral care during and after cancer therapy can increase quality of life and supportive care costs. Methods Study was conducted on 189 patients (86: head and neck cancer cases, group I and 103: other than head and neck cancer cases, group II) receiving cancer therapy. Patients were subjected to clinical assessment and findings were recorded in specially designed proforma and complete oral (objective and subjective) and constitutional findings were recorded. Results Among the patients undergoing chemotherapy in both groups, prevalence of oral findings was found to be highest with methotrexate whereas constitutional symptoms was found to be highest with doxyrubicin. Whereas in radiotherapy patients subjective and objective oral symptoms increased from 10th - 30th fractionated dose of radiations and then subsequently decreased and constitutional symptoms were found to be consistent in all fractionated dosages with lowest at 50th fraction. Under combined chemo and radiotherapy patients, constitutional symptoms were highest than the oral findings. Conclusions Cancer therapy can greatly damage the normal tissues and diminish patients quality of life and often leads to serious clinical sequelae. Therefore, therapy induced damage should be anticipated and prevented whenever possible and managed early.
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Affiliation(s)
- Sowmya Kasetty
- Department of Oral Pathology, Peoples College of Dental Sciences and Research Centre, Bhopal-462037, MadhyaPradesh, India
| | - Samar Khan
- Department of Oral Pathology, Peoples College of Dental Sciences and Research Centre, Bhopal-462037, MadhyaPradesh, India
| | - Sudheendra U Shridhar
- Department of Oral Pathology, Peoples College of Dental Sciences and Research Centre, Bhopal-462037, MadhyaPradesh, India
| | - Sandeep Gupta
- Department of Oral Pathology, Peoples College of Dental Sciences and Research Centre, Bhopal-462037, MadhyaPradesh, India
| | - Manisha Tijare
- Department of Oral Pathology, Peoples College of Dental Sciences and Research Centre, Bhopal-462037, MadhyaPradesh, India
| | - Shreenivas Kallianpur
- Department of Oral Pathology, Peoples College of Dental Sciences and Research Centre, Bhopal-462037, MadhyaPradesh, India
| | - T Raju Ragavendra
- Department of Oral Pathology, Peoples College of Dental Sciences and Research Centre, Bhopal-462037, MadhyaPradesh, India
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Malik IA, Moid I, Haq S, Sabih M. A double-blind, placebo-controlled, randomized trial to evaluate the role of tetrachlorodecaoxide in the management of chemotherapy-induced oral mucositis. J Pain Symptom Manage 1997; 14:82-7. [PMID: 9262037 DOI: 10.1016/s0885-3924(97)00018-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We conducted a double-blind, placebo-controlled, randomized trial to evaluate the efficacy and safety of tetrachlorodecaoxide (TCDO) in patients with chemotherapy-induced mucositis. Sixty-two patients with World Health Organization grade II-IV oral mucositis were eligible for the study. They were randomized to receive TCDO or placebo, 10 ml, twice daily, swish and swallow, for 7 days. Patients were evaluated for oral pain, dysphagia, and oral intake. Downgrading and total duration of mucositis were documented. Thirty-two were randomized to receive TCDO. Thirty received the placebo. All were evaluable. Both arms were well matched for age, gender, type of underlying neoplasm, and prior history of oral mucositis. Intensity of initial symptoms, degree of mucositis, and time period between delivery of chemotherapy and development of mucositis were also similar. Post-therapy evaluation revealed no significant difference in the mean grade of oral and esophageal pain, or dysphagia between TCDO and placebo. Downgrading or total duration of mucositis did not differ between the two groups. Oral intake improved significantly in patients taking TCDO. Time to subjective improvement in oral pain was significantly shorter with TCDO (3.1 versus 3.6 days). Evaluation on day 3 revealed that 77% of those receiving TCDO were free of oral pain in comparison to 46% receiving placebo (P = 0.05). These results indicate that TCDO may be helpful in palliating some of the symptoms related to oral mucositis. The therapeutic benefit, however, is small and needs to be confirmed in a larger trial.
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Affiliation(s)
- I A Malik
- Division of Medical Oncology, National Cancer Institute, Clifton, Karachi, Pakistan
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Abstract
Germ-line cytogenetic damage is well documented in laboratory animals exposed to anti-cancer agents, but has been harder to verify in the human. This paper reviews published studies demonstrating cytogenetic damage in human sperm following exposure to anti-cancer chemicals, as measured by the human-sperm/ hamster-egg cytogenetic technique and fluorescence in situ hybridization. These two assays have provided important information on one step in the pathway leading to induced, transmissible germ line damage in the human. By way of introduction, a short review of the traditional human endpoints used to address the question of induced, transmissible genetic damage in human germ cells (mutation epidemiology) related to anti-cancer chemicals is presented.
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Affiliation(s)
- W A Robbins
- School of Public Health, University of North Carolina at Chapel Hill, USA.
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Laine PO, Lindqvist JC, Pyrhönen SO, Teerenhovi LM, Syrjänen SM, Meurman JH. Lesions of the oral mucosa in lymphoma patients receiving cytostatic drugs. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1993; 29B:291-4. [PMID: 11706423 DOI: 10.1016/0964-1955(93)90050-o] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The 1-year incidence of oral mucosal lesions during cytostatic therapy was investigated in 67 patients [34 men and 33 women (mean age 49 years)] out of 79 original patients, being treated for non-Hodgkin lymphoma or Hodgkin's disease. The incidence of lesions during examinations was 43.4%. Recurrent lesions were observed in 19.4% of cases. Mean leukocyte counts were statistically significantly lower (P < 0.01) during lesion periods than before cytostatic therapy in all lesion groups. Leukocytopenia was found in 85.4% of patients with hairy leukoplakia-like lesions (HLL), and in 81.8% of the patients with angular cheilitis. 5 out of 14 patients with oral ulcers (35.7%) had episodes of septicaemia. Mean thrombocyte counts of patients in various lesion groups were normal (< 140 x 10/1). However, low thrombocyte counts were more statistically significant (P < 0.05), when haemorrhages or HLL were present. Clinical candidiasis was diagnosed in 28.4% of patients during the treatment. However, cultivation revealed that 62.3% of salivary yeast cultures were positive. The study reported here shows a correlation between mucosal ulcers and septicemia, and between leukocytopenia, angular cheilitis and HLL. The disparity between clinically diagnosed candidiasis and the occurrence of salivary yeast counts suggests that antifungal drugs might be of prophylactic value during cytostatic therapy.
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Affiliation(s)
- P O Laine
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Kasarmikatu 11-13, 00140 Helsinki, Finland
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Laine PO, Lindqvist JC, Pyrhönen SO, Strand-Pettinen IM, Teerenhovi LM, Meurman JH. Oral infection as a reason for febrile episodes in lymphoma patients receiving cytostatic drugs. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1992; 28B:103-7. [PMID: 1306727 DOI: 10.1016/0964-1955(92)90036-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
56 patients receiving chemotherapy for non-Hodgkin lymphoma or Hodgkin's disease with curative intent were monitored for up to one year after initiation of treatment. During chemotherapy (mean duration 5.2 months), 26 of the patients (46%) suffered from 38 febrile episodes. In only 16 instances was an extraoral cause for the septicaemia found. However, severe dental infection, reflected in an elevated radiological index for the jaws, was found more frequently in patients suffering febrile episodes than in those without (P = 0.02). Moderate to severe gingival inflammation was observed during 22 (58%) of episodes. During 71% of the episodes various pathological findings were also recorded in the oral mucosa. No source of infection other than an oral one was found in 42% of the patients. Our results emphasise the importance of oral foci as the possible infection source in patients receiving intensive chemotherapy.
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Affiliation(s)
- P O Laine
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Finland
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Maiche AG, Gröhn P, Mäki-Hokkonen H. Effect of chamomile cream and almond ointment on acute radiation skin reaction. Acta Oncol 1991; 30:395-6. [PMID: 2036252 DOI: 10.3109/02841869109092392] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A G Maiche
- Department of Radiotherapy and Oncology, Helsinki University Central Hospital, Finland
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