Pathogenesis and Amelioration of Radiation-Induced Oral Mucositis

Correlation between Salivary Oxidative Stress Biomarkers and Clinical Severity of Radiation-Induced Oral Mucositis in Head and Neck Cancer Patients

Radiation-induced oral mucositis (RIOM) is the most common side effect of radiotherapy (RT) in head and neck cancer (HNC) patients. Oxidative stress plays a major role in the multistep pathogenesis of RIOM. However, the current understanding of the relationship between salivary biomarkers of oxidative stress and the clinical severity of RIOM remains limited. This study aims to analyze the correlation between salivary oxidative stress biomarkers and the clinical severity of RIOM.This cross-sectional study analyzed the levels of salivary oxidative stress biomarkers from 25 HNC patients who underwent RT using enzyme-linked immunosorbent assay and the clinical grades of RIOM in the cohort. The data were then analyzed using the Spearman's correlation statistical test (p-value < 0.05).The findings demonstrated a significant correlation between salivary glutathione levels (r: -0.396; p: 0.050), superoxide dismutase levels (r: -0.447; p: 0.025), malondialdehyde levels (r: 0.479; p: 0.015), and lactate dehydrogenase levels (r: 0.460; p: 0.025) with the clinical severity of RIOM.The higher salivary oxidative stress correlates with higher severity of RIOM.

Risk factors and prediction models for severe radiation-induced oral mucositis in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy

OBJECTIVE

This study aimed to investigate the factors associated with severe radiation-induced oral mucositis (SRIOM) in nasopharyngeal carcinoma (NPC) patients undergoing chemoradiotherapy (CRT) and to establish a prediction model for SRIOM.

METHODS

A total of 262 NPC patients who underwent CRT were analyzed retrospectively, including 192 in the modeling group and 70 in the validation group. The modeling group was divided into the non-SRIOM group (n = 112) and the SRIOM group (n = 80), and the validation group was divided into the non-SRIOM group (n = 40) and the SRIOM group (n = 30) according to the presence of SRIOM. Univariate and multivariate logistic logistic analyses were performed on the clinical data and general characteristics of all patients to construct a prediction model for SRIOM in NPC patients. The practical efficacy of the prediction model was evaluated using Hosmer-Lemeshow test, receiver operating characteristic curve (ROC), and decision curve analysis (DCA).

RESULTS

BMI < 23.9 kg/m2, history of periodontal disease, history of alcohol consumption, history of smoking, non-use of oral mucosal protectants, and poor oral hygiene were independent risk factors for SRIOM in NPC patients. The prediction model showed an area under the ROC curve of 0.813 (95% CI 0.752-0.875). The prediction model demonstrated strong predictive accuracy and clinical utility, as evidenced by both calibration and DCA curves.

CONCLUSION

The SRIOM prediction model, developed from the clinical characteristics and general information of NPC patients, is beneficial in clinical practice for identifying high-risk SRIOM and creating tailored treatment plans.

A Pilot Study Comparing Intraoral and Transcutaneous Photobiomodulation for Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy or Chemoradiotherapy

Background: Photobiomodulation (PBM) therapy has shown potential in managing oral mucositis (OM), a frequent and painful side effect of radiotherapy or chemoradiotherapy in head and neck cancer patients. Although PBM is increasingly used in clinical settings, the optimal delivery method-transcutaneous or intraoral-remains undetermined. Methods: This prospective, single-center, randomized pilot study (clinicaltrials.gov NCT06458517) aims to compare the efficacy of transcutaneous versus intraoral PBM in preventing and managing OM in patients undergoing radiotherapy or chemoradiotherapy for cancers of the oral cavity or oropharynx. Participants will be randomized into two groups: one receiving intraoral PBM with the CareMin650™ device, and the other receiving transcutaneous PBM with the ATP38® device. Results: Primary and secondary outcomes will include the incidence and severity of OM, treatment interruptions, patient-reported pain levels, and quality of life, assessed using validated tools. Conclusions: This study will provide comparative data on two PBM modalities, contributing to the development of standardized PBM protocols in supportive oncology care and informing future multicenter trials aimed at improving patient outcomes during radiotherapy for head and neck cancer.

Efficacy of different pharmaceutical forms of Curcuma longa or curcumin in reducing oral mucositis severity and incidence in cancer patients: a systematic review and meta-analysis

Background

Curcuma longa L. (turmeric, Zingiberaceae) has been traditionally used for its anti-inflammatory, wound-healing, and antimicrobial properties. These characteristics have made it a key component in managing inflammatory and ulcerative conditions like oral mucositis (OM). This study aimed to evaluate the effectiveness of various pharmaceutical formulations of C. longa or curcumin in reducing the OM severity, incidence and associated pain in patients undergoing chemotherapy and/or radiotherapy for cancer.

Methods

This systematic review and meta-analysis of randomized clinical trials was conducted according to PRISMA guidelines, registered in PROSPERO (#CRD42024504111). Searches were performed in PubMed, Embase, and Cochrane databases. Studies comparing C. longa or curcumin with placebo in cancer patients experiencing oral mucositis, reporting outcomes such as the World Health Organization Oral Mucositis Grading Scale, pain scores (visual analogue scale), or OM incidence were included. Risk ratios and weighted mean differences with 95% confidence intervals were calculated using fixed- or random-effects models.

Results

Six studies with 159 patients (mean age ∼50 years, 40% women) were included. C. longa extracts, curcumin, or nanocurcumin were administered in capsules, mouthwash, or gel formulations. The pooled analysis showed significant reductions in WHO scores and oral pain compared to placebo. OM incidence decreased by 6% overall, with a notable 37%-reduction observed in patients using curcumin-containing mouthwash during radiotherapy alone. Subgroup analyses revealed consistent benefits across all oncological treatments.

Conclusion

C. longa, curcumin, or nanocurcumin in various formulations, effectively reduce OM severity and pain while curcumin-containing mouthwash reduced OM incidence in cancer patients undergoing treatment.

Systematic Review Registration

identifier CRD 42024504111.

Huoshan Dendrobium Zengye Jiedu Formula mitigates radiation-induced oral mucositis and improves oral immune microenvironment by targeting the EGFR/PI3K/AKT pathway: evidence from network pharmacology, molecular docking, and experimental validation

Introduction

Radiation-induced oral mucositis (RIOM) manifests as mucosal ulceration, pain, and dysphagia, disrupting treatment and quality of life. Its pathogenesis involves inflammatory imbalance and immune dysregulation, driven by microbial infiltration and cytokine storms. Current therapies remain inadequate, necessitating deeper exploration of immune-microbial interactions for effective interventions.

Methods

Bioactive components of Huoshan Dendrobium Zengye Jiedu Formula (HDZJF) and RIOM-related targets were retrieved from public databases. Core therapeutic targets and pathways were systematically analyzed via protein-protein interaction (PPI) networks, Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Molecular docking evaluated interactions between HDZJF components and key targets. A rat RIOM model validated HDZJF efficacy by assessing mucositis severity, inflammatory cytokines, and EGFR/PI3K/AKT pathway protein expression.

Results

A total of 102 bioactive components and 379 potential targets for RIOM were identified. GO and KEGG enrichment analyses suggest that HDZJF exerts therapeutic effects on RIOM by modulating processes such as angiogenesis, inflammation, and apoptosis through pathways like PI3K-AKT. Molecular docking confirmed strong binding affinities between HDZJF components and key targets. In vivo, HDZJF reduced inflammation, promoted mucosal healing, improved body weight, and modulated protein expression related to EGFR/PI3K/AKT.

Discussion

The findings highlight HDZJF's capacity to alleviate RIOM by targeting the EGFR/PI3K/AKT pathway, thereby suppressing inflammatory responses and apoptotic processes. These results underscore HDZJF's translational potential for RIOM treatment and justify further clinical investigation into its therapeutic utility.

Dual-functional guanosine-based hydrogel: high-efficiency protection in radiation-induced oral mucositis

Radiation-induced oral mucositis (RIOM) is the most common adverse effect experienced by cancer patients following radiotherapy; however, effective clinical treatments remain insufficiently recognized. In this study, a guanosine-polyvinyl alcohol (G-PVA) supramolecular hydrogel was developed using a one-pot synthesis method. The G-PVA hydrogel demonstrated remarkable wet adhesion properties measuring 74.16 kPa (±3.53 kPa), biocompatibility and shape adaptability, making it suitable for the dynamic conditions of the oral cavity. Under radiation exposure, the G-PVA hydrogel not only mitigated oxidative stress but also provided effective protection to cells against direct damage, as shown by the decrease in the number of γ-H2AX foci from 79.81% (±1.33%) to 5.70% (±0.88%) and 17.12% (±3.44%), respectively. In vivo investigations further validated that the G-PVA hydrogel significantly reduced RIOM, with a decrease in the relative ulcerative area by 52.23% in comparison to the IR group. This dual-functional supramolecular hydrogel may represent a promising new clinical strategy for the prevention of RIOM in the future.

Unraveling the complexity of radiotherapy- and chemotherapy-induced oral mucositis: insights into pathogenesis and intervention strategies

Radiotherapy- or chemotherapy-induced oral mucositis (RIOM/CIOM) presents significant challenges in cancer treatment, severely impacting patients' quality of life (QoL) and therapeutic outcomes. Despite advancements, existing prevention and treatment measures have notable limitations. RIOM/CIOM involves a multifaceted interplay of inflammatory cascades orchestrated by the innate immune response. Furthermore, dysbiosis of oral and intestinal microbiota, triggered by anticancer therapy, exacerbates mucosal damage through intricate interactions with the innate immune system. This review provides an update on pivotal signaling pathways governing the initiation and progression of RIOM/CIOM. It also elucidates the intricate relationship between microbiota dysbiosis and dysregulation of oral mucosal immune homeostasis. Moreover, potential interventions targeting these pathogenic mechanisms are summarized, offering valuable insights for further exploration of RIOM/CIOM's complex pathophysiology and the development of more effective interventions.

Correlation Analysis Between Prognostic Nutritional Index Trajectory Categories and Radiotherapy-induced Severe Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy

PURPOSE

To establish the potential prognostic nutritional index (PNI) trajectory categories and examine the association between these PNI trajectory categories and severe radiotherapy-induced oral mucositis (RIOM).

MATERIALS AND METHODS

This was a longitudinal retrospective observational study on 470 head and neck cancer inpatients who were to undergo radiotherapy from a grade-A tertiary hospital in Hunan Province between July 2022 and October 2023. The latent class growth model and growth mixed model were used to identify PNI trajectory categories. Logistic regression analysis was used to examine the correlation between PNI trajectory categories and severe RIOM.

RESULTS

Three PNI trajectory categories were identified: 'PNI high-level group' (20.9%), 'PNI medium-level group' (61.3%) and 'PNI low-level group' (17.9%). The risk of severe RIOM was statistically significantly higher in the 'PNI medium-level group' and 'PNI low-level group' with OR 2.174 (95%CI 0.980-4.822) and OR 3.45 (95%CI 1.212-9.815), respectively. PNI trajectory categories and cancer type were independent risk factors for severe RIOM.

CONCLUSION

PNI can be used as a biomarker to predict severe RIOM. Patients with head and neck cancer who have a lower PNI are at higher risk of severe RIOM.

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.

Prediction of severe radiation-induced oral mucositis in locally advanced nasopharyngeal carcinoma using the combined systemic immune-inflammatory index and prognostic nutritional index

OBJECTIVE

Severe radiation-induced oral mucositis (sRIOM) can seriously affect patients' quality of life and treatment compliance. This study was to investigate the utility of the systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI) in predicting sRIOM in patients with locally advanced nasopharyngeal carcinoma (LANPC).

METHODS

295 patients with LANPC were retrospectively screened. The pre-radiotherapy SII and PNI were calculated based on peripheral blood samples. A receiver operating characteristic (ROC) curve was used to determine the cut-off value. Logistic regression was used for univariate and multivariate analyses. Patients were classified into three groups based on the SII-PNI score: score of 2, high SII (> cut-off value) and low PNI (≤ cut-off value); score of 1, either high SII or low PNI; score of 0, neither high SII nor low PNI.

RESULTS

The SII-PNI demonstrated significant predictive ability for sRIOM occurrence, as evidenced by an area under the curve (AUC) of 0.738. The incidence rates of sRIOM with SII-PNI score of 2, 1, and 0 were 73.86%, 44.35%, and 18.07%, respectively. Multivariate analysis confirmed that the SII-PNI score was an independent risk factor for sRIOM.

CONCLUSION

The SII-PNI score is a reliable and convenient indicator for predicting sRIOM in patients with LANPC.

Efficacy of Lvpao Powder on Radiation Therapy-Induced Mucositis: A Retrospective Study of 114 Patients With Head and Neck Carcinoma

Purpose

To compare the efficacy and safety of Kangfuxin solution and lvpao powder on mucositis induced by radiation therapy in head and neck carcinoma patients. We retrospectively analyzed 114 patients with head and neck malignant tumors in our center.

Methods and Materials

Patients were given Kangfuxin solution to rinse the mouth or Lvpao powder sprayed on oral mucosa after the solution use. The side effect was evaluated by Common Terminology Criteria for Adverse Events version 4.0.

Results

The grade 3 mucositis occurred in 32.9% (23/70) and 11.4% (5/44) in Kangfuxin solution group and Kangfuxin solution + lvpao powder group, respectively (P = .009). The pain score of the Kangfuxin solution group was significantly higher than that of the Kangfuxin solution and lvpao powder group, with 4.26 ± 0.81 versus 3.75 ± 1.03 (P = .007). The time of symptom relief in the combined group was significantly shorter than that in the single drug group, with 3 days versus 6 days (P = .000). The weight loss of the former groups was bigger than that of the latter group (6.67 ± 1.20 kg vs 5.95 ± 0.94 kg; P = .001). There was no statistical difference in the limitations in mouth opening (P = .164).

Conclusions

Lvpao powder is safe and effective as a mucosal repair drug in accelerating the recovery of patients and reducing their body weight.

Evidence summary on managing radiotherapy-induced oral mucositis in patients with head and neck cancer

Objective

To summarize the best evidence for managing radiotherapy-induced oral mucositis in patients with head and neck cancer, and improve the quality of care.

Methods

According to the "6S" evidence pyramid model, we searched local and other part of world published clinical guidelines, expert consensus, evidence summary, and systematic review. The literature quality assessment followed the Appraisal of Guidelines for Research and Evaluation (AGREE II). for guidelines, AMSTAR-2 for systematic reviews, and Joanna Briggs Institute (JBI) Evidence-Based Health Care Center's quality evaluation tool for expert opinions and expert consensus articles. The quality of other literature was evaluated according to the type of original literature. If there were any conflicts about the conclusions drawn from different sources of evidence, this study followed the principle of high-quality evidence priority and the latest published authoritative literature priority. The "JBI Evidence Pre-grading and Evidence Recommendation Level System 2014" was adopted for the evidence lacking a grading system. Quality evaluation, evidence extraction, and summary were performed by 2 or more researchers, combined with the advice of the head and neck cancer radiotherapy professionals.

Results

Finally, a total of ten pieces of literature were included. Twenty-two best evidence items for radiotherapy-induced oral mucositis management were summarized from six aspects, including multidisciplinary management, oral assessment, basic oral care, pain management, nutritional support, and application of honey or propolis.

Conclusions

This study provides clinical caregivers with the evidence-based measures on managing radiotherapy-induced oral mucositis. Clinical backgrounds, patients' condition, willingness, economy, and cost-effectiveness should be fully considered when promoting evidence transformation. Applying evidence-based approaches with high feasibility, strong appropriateness, clinical significance and high effectiveness could reduce the incidence of severe radiotherapy-induced oral mucositis in patients with head and neck cancer.

Systematic review registration

This study has been registered on the Fudan University Centre for Evidence-based Nursing. Registration No. is ES20232732.

Microbial Analysis of Obturators During Maxillofacial Prosthodontic Treatment Over an 8-Year Period

The aim of the study was to investigate the microbial colonization (by Candida species, anaerobic and facultative anaerobic bacteria) of maxillary obturators used for the restoration of maxillary defects, including during radiotherapy.

Retrospective cohort study.

Fifteen patients requiring a maxillary obturator prosthesis had swabs of their obturators and adjacent tissues taken at different stages of their treatment over a period of 8 years.

Identification of microbial species from the swabs was carried out using randomly amplified polymorphic DNA polymerase chain reaction (RAPD PCR) analysis, checkerboard DNA-DNA hybridization, CHROMagar Candida chromogenic agar, and DNA sequencing.

Candida species were detected in all patients and all patients developed mucositis and candidiasis during radiotherapy which was associated with an increase in colonization of surfaces with Candida spp., particularly C albicans. Microbial colonization increased during radiotherapy and as an obturator aged, and decreased following a reline, delivery of a new prosthesis, or antifungal treatment during radiotherapy.

Microbial colonization of maxillary obturators was related to the stage of treatment, age of the obturator material, radiotherapy and antifungal medications, and antifungal treatment may be recommended if C albicans colonization of palatal tissues is greater than 105 colony-forming units per cm2 following the first week of radiotherapy.

Methylene Blue for the Treatment of Radiation-Induced Oral Mucositis during Head and Neck Cancer Treatment: An Uncontrolled Cohort

Pain from radiation-therapy-induced oral mucositis during head-neck cancer treatment is aggravated by concurrent chemotherapy and commonly fails traditional treatments. To explore safe and sustainable alternatives, we investigated methylene blue oral rinse to reduce radiation-therapy-related oral mucositis pain. For this, we conducted a retrospective observational cohort study in a tertiary-care academic care cancer center including 85 patients with refractory oral mucositis pain during radiation therapy for head-neck cancer. Changes in pain (scale 0-10), oral function burden (scale 0-6) and requirement for percutaneous endoscopic gastrostomy tube placement were measured. Among 58 patients, 60% received radiation therapy alone and 40% received concurrent chemotherapy-radiation therapy. Methylene blue oral rinse (MBOR) significantly decreased oral mucositis pain for at least 6.2 h (median + SD 8 ± 1.68 before vs. 2 ± 2.20 after; p < 0.0001) and oral function burden (3.5 ± 1.33 before vs. 0 ± 0.86 after; p < 0.0001). Eleven patients (19%) had percutaneous endoscopic gastrostomy tubes placed before using methylene blue oral rinse; subsequently, four (36%) resumed oral alimentation after methylene blue oral rinse. Two patients (3%) required percutaneous endoscopic gastrostomy tubes despite methylene blue oral rinse. Minimal adverse events were reported (n = 9, 15%). Our study showed that methylene blue oral rinse was an effective and safe topical treatment for opioid-refractory oral pain from oral mucositis associated with radiation therapy for head-neck cancer.

A Prospective Study of Nurse-Led Oral Mucositis Management: Impact on Health Outcomes of Patients Receiving Radiotherapy for Head and Neck Cancer and Lung Cancer

OBJECTIVES

The study aimed to evaluate the impact of nurse-led mucositis management on the health outcomes of patients receiving radiotherapy for head and neck cancer and lung cancer. The study adopted a holistic approach that involved the patient in the care process by screening, providing education and counseling about mucositis management and integrating it into daily life by the radiotherapy nurse.

DATA SOURCES

In this prospective, longitudinal cohort study, 27 patients were assessed and monitored through use of the WHO Oral Toxicity Scale and Oral Mucositis Follow-up Form and educated on mucositis during their radiotherapy through use of the Mucositis Prevention and Care Guide. At the end of radiotherapy, an evaluation of the radiotherapy process was performed. In this study, each patient was followed for 6 weeks from the start of radiotherapy.

CONCLUSION

The worst clinical data for oral mucositis and its variables emerged at week 6 of treatment. While the Nutrition Risk Screening score increased over time, weight decreased was observed to decrease. The mean stress level was 4.74 ± 0.33 in the first week and 5.77 ± 0.35 in the last week. It was observed that 88.9% of the patients showed good compliance with the treatment.

IMPLICATIONS FOR NURSING PRACTICE

Nurse-led mucositis management contributes to better patient outcomes during the radiotherapy process. Such an approach improves oral care management in patients receiving radiotherapy for head and neck and lung cancer, demonstrating its positive impact on additional patient-focused outcomes.

Network Pharmacology and Molecular Docking Reveal the Mechanism of Corydalis saxicola Bunting Total Alkaloids in Treating Radiation-Induced Oral Mucositis

The study aims to explore the effect and mechanism of total alkaloids of Corydalis saxicola Bunting (CSBTA) in the treatment of radiation induced oral mucositis (RIOM) through network pharmacology and molecular docking. The components and corresponding targets of Corydalis saxicola Bunting were screened by literature review. RIOM related targets were obtained in GeneCards. Cytoscape software was used to construct the component-target-pathway network. Protein-Protein Interaction (PPI) networks was constructed by String database. GO and KEGG enrichment analyses were performed by Metascape. AutoDock Vina 4.2 software was used for molecular docking. There were 26 components of CSBTA targeting 61 genes related to RIOM. Through Cytoscape and PPI analysis, 15 core target genes of CSBTA for treating RIOM were identified. GO functional analysis indicated that CSBTA might play a role through kinase binding and protein kinase activation. KEGG pathway analysis showed that the core targets of CSBTA were mainly focused on cancer and reactive oxygen species (ROS) pathway. The results of molecular docking showed that CSBTA had strong binding energy with target protein including SRC, AKT and EGFR. The study demonstrates that CSBTA may treat RIOM by affecting SRC, AKT and EGFR through ROS pathway.

Avasopasem for the treatment of radiotherapy-induced severe oral mucositis

INTRODUCTION

Oral mucositis (OM) remains a significant, highly symptomatic, disruptive side effect of radiation and concomitant chemoradiation therapy used for the treatment of squamous cell cancers of the head and neck. Despite its clinical and economic burden, implementation of an effective intervention has been elusive.

AREAS COVERED

Increased understanding of the complexity of the biological basis for its pathogenesis has yielded potential druggable targets of such as the mitigation of superoxide formation and oxidative stress. Avasopasem manganese is a selective superoxide dismutase mimetic being developed by Galera Therapeutics, which recently submitted a New Drug Application (NDA) to the FDA for a severe OM indication. This review describes the preclinical and clinical studies which led to, and supported the NDA, and assesses the potential utility of avasopasem clinically.

EXPERT OPINION

Avasopasem manganese appears to effectively mitigate severe OM associated with concomitant chemoradiation used in the treatment of head and neck cancers, as well as cisplatin-associated renal toxicity in the absence of impairing tumor response.

Management of Oral Hygiene in Head-Neck Cancer Patients Undergoing Oncological Surgery and Radiotherapy: A Systematic Review

BACKGROUND

In the literature, among oral health prevention programs dedicated to cancer patients, a wide heterogeneity is evident. The purpose of this work is to analyze the available scientific evidence for the treatment of head and neck cancer (HNC) patients undergoing resective surgery and radiotherapy and to draw up a diversified oral hygiene protocol during oncological therapy.

METHODS

PubMed was used as database. Studies published from 2017 to September 2022 were analyzed. Studies investigating the effectiveness of the preventive procedures carried out by the dental professionals in HNC patients undergoing postoperative adjuvant therapy have been taken into account.

RESULTS

The application of the search string on PubMed allowed the selection of 7184 articles. The systematic selection of articles led to the inclusion of 26 articles in this review, including 22 RCTs, 3 observational studies, and 1 controlled clinical study. Articles were divided according to the debated topic: the management of radiation-induced mucositis, xerostomia, the efficacy of an oral infection prevention protocol, and the prevention of radiation-induced caries.

CONCLUSIONS

Dental hygienists are fundamental figures in the management of patients undergoing oncological surgery of the maxillofacial district. They help the patient prevent and manage the sequelae of oncological therapy, obtaining a clear improvement in the quality of life.

Recent Advances in Cellular Signaling Interplay between Redox Metabolism and Autophagy Modulation in Cancer: An Overview of Molecular Mechanisms and Therapeutic Interventions

Autophagy is a fundamental homeostatic process in which certain cellular components are ingested by double-membrane autophagosomes and then degraded to create energy or to maintain cellular homeostasis and survival. It is typically observed in nutrient-deprived cells as a survival mechanism. However, it has also been identified as a crucial process in maintaining cellular homeostasis and disease progression. Normal cellular metabolism produces reactive oxygen (ROS) and nitrogen species at low levels. However, increased production causes oxidative stress, which can lead to diabetes, cardiovascular diseases, neurological disorders, and cancer. It was recently shown that maintaining redox equilibrium via autophagy is critical for cellular responses to oxidative stress. However, little is understood about the molecular cancer processes that connect to the control of autophagy. In cancer cells, oncogenic mutations, carcinogens, and metabolic reprogramming cause increased ROS generation and oxidative stress. Recent studies have suggested that increased ROS generation activates survival pathways that promote cancer development and metastasis. Moreover, the relationship between metabolic programming and ROS in cancer cells is involved in redox homeostasis and the malignant phenotype. Currently, while the signaling events governing autophagy and how redox homeostasis affects signaling cascades are well understood, very little is known about molecular events related to autophagy. In this review, we focus on current knowledge about autophagy modulation and the role of redox metabolism to further the knowledge of oxidative stress and disease progression in cancer regulation. Therefore, this review focuses on understanding how oxidation/reduction events fine-tune autophagy to help understand how oxidative stress and autophagy govern cancer, either as processes leading to cell death or as survival strategies for maintaining redox homeostasis in cancer.