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Lynggaard CD, Grønhøj C, Christensen R, Fischer-Nielsen A, Melchiors J, Specht L, Andersen E, Mortensen J, Oturai P, Barfod GH, Haastrup EK, Møller-Hansen M, Haack-Sørensen M, Ekblond A, Kastrup J, Jensen SB, von Buchwald C. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:478-489. [PMID: 35435231 PMCID: PMC9154319 DOI: 10.1093/stcltm/szac011] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
No effective therapy exists for the most common long-term side effect of radiation therapy for head and neck cancer (HNC)—xerostomia. The objective was to evaluate safety and provide proof of concept for efficacy of allogeneic adipose tissue-derived mesenchymal stem/stromal cells (AT-MSCs) injected into the major salivary glands of irradiated patients. This open-label, first-in-human, phase 1b, and single-center trial was conducted with repeated measurements days 0, 1, 5, and 30 and 4 months. Eligible patients with objective and subjective signs of radiation-induced salivary gland damage after treatment of oropharyngeal squamous cell carcinoma stages I-II (UICC 8) were enrolled. Twenty-five million cryopreserved AT-MSCs were injected into each submandibular and 50 million AT-MSCs into each parotid gland. Data were collected on adverse events, unstimulated and stimulated whole saliva (UWS and SWS) flow rates and saliva composition, patient-reported outcomes (EORTC QLQ-H&N35 and Xerostomia Questionnaire [XQ]), blood samples and salivary gland scintigraphy. Data were analyzed using repeated measures linear mixed models. Ten patients (7 men, 3 women, 59.5 years [range: 45-70]) were treated in 4 glands. No treatment-related serious adverse events occurred. During 4 months, UWS flow rate increased from 0.13 mL/minute at baseline to 0.18 mL/minute with a change of 0.06 (P = .0009) mL/minute. SWS flow rate increased from 0.66 mL/minute at baseline to 0.75 mL/minute with a change of 0.09 (P = .017) mL/minute. XQ summary score decreased by 22.6 units (P = .0004), EORTC QLQ-H&N35 dry mouth domains decreased by 26.7 (P = .0013), sticky saliva 23.3 (P = .0015), and swallowing 10.0 (P = .0016). Our trial suggests treatment of the major salivary glands with allogenic AT-MSCs is safe, warranting confirmation in larger trials.
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Affiliation(s)
- Charlotte Duch Lynggaard
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Corresponding author: Charlotte Duch Lynggaard, MD, PhD Student, Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 8, DK-2100 Copenhagen, Denmark. Tel: +45 6178 4460;
| | - Christian Grønhøj
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Anne Fischer-Nielsen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Melchiors
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lena Specht
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Elo Andersen
- Department of Oncology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jann Mortensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Eva Kannik Haastrup
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Møller-Hansen
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mandana Haack-Sørensen
- Cardiology Stem Cell Centre, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annette Ekblond
- Cardiology Stem Cell Centre, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Kastrup
- Cardiology Stem Cell Centre, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Siri Beier Jensen
- Department of Dentistry and Oral Health, Aarhus University, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Jensen SB, Vissink A, Limesand KH, Reyland ME. Salivary Gland Hypofunction and Xerostomia in Head and Neck Radiation Patients. J Natl Cancer Inst Monogr 2020; 2019:5551361. [PMID: 31425600 DOI: 10.1093/jncimonographs/lgz016] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The most manifest long-term consequences of radiation therapy in the head and neck cancer patient are salivary gland hypofunction and a sensation of oral dryness (xerostomia). METHODS This critical review addresses the consequences of radiation injury to salivary gland tissue, the clinical management of salivary gland hypofunction and xerostomia, and current and potential strategies to prevent or reduce radiation injury to salivary gland tissue or restore the function of radiation-injured salivary gland tissue. RESULTS Salivary gland hypofunction and xerostomia have severe implications for oral functioning, maintenance of oral and general health, and quality of life. Significant progress has been made to spare salivary gland function chiefly due to advances in radiation techniques. Other strategies have also been developed, e.g., radioprotectors, identification and preservation/expansion of salivary stem cells by stimulation with cholinergic muscarinic agonists, and application of new lubricating or stimulatory agents, surgical transfer of submandibular glands, and acupuncture. CONCLUSION Many advances to manage salivary gland hypofunction and xerostomia induced by radiation therapy still only offer partial protection since they are often of short duration, lack the protective effects of saliva, or potentially have significant adverse effects. Intensity-modulated radiation therapy (IMRT), and its next step, proton therapy, have the greatest potential as a management strategy for permanently preserving salivary gland function in head and neck cancer patients.Presently, gene transfer to supplement fluid formation and stem cell transfer to increase the regenerative potential in radiation-damaged salivary glands are promising approaches for regaining function and/or regeneration of radiation-damaged salivary gland tissue.
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Affiliation(s)
- Siri Beier Jensen
- Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center, Groningen, The Netherlands
| | | | - Mary E Reyland
- Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
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Liu YJ, Lee YH, Chang HC, Chiu HC, Chiu TW, Hsu K, Pen CM, Hsu HH, Juan CJ. Proton change of parotid glands after gustatory stimulation examined by magnetic resonance imaging. NMR IN BIOMEDICINE 2018; 31:e3885. [PMID: 29315960 DOI: 10.1002/nbm.3885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to investigate proton changes of the parotid gland after gustatory stimulation by semi-quantitative parameters and an empirical mathematical model (EMM) using high-temporal-resolution, double-echo, echo-planar imaging (EPI). Approved by a local institutional review board, this study examined 20 parotid glands from 10 healthy volunteers (male:female = 6: 4; age ± standard deviation =35.1 ± 14.1 years) with written informed consent obtained. All participants underwent 1.5-T, double-echo EPI with gustatory stimulation. Semi-quantitative parameters, including maximal drop ratio (MDR), time to peak (TTP), drop slope (DS), recovery slope (RS) and recovery ratio (RR), were calculated. The effect of temporal resolution on parotid functional parameters was evaluated. An EMM comprising an output function ( Sot=Aoe-kot+B) and an input function ( Sint=Ain1-e-kint) was also applied to fit all dynamic curves. Kruskal-Wallis test, Wilcoxon test, linear regression analysis and goodness of fit were used for statistical analysis. p < 0.05 was considered to be statistically significant. The signal intensity dropped significantly after gustatory stimulation on the proton density (PD) image (p < 0.01). MDR was 8.26% in the PD image. MDR and RR were negatively associated with time interval, whereas DS and TTP were significantly positively associated with time interval (all p < 0.05). EMM parametric values derived from PD-time curves of parotid glands were 12.04 ± 6.81%, 6.43 ± 4.23 min-1 , 88.73 ± 6.18%, 8.41 ± 4.86 min-1 and 1.09 ± 1.35 for Ao , ko , B, Ain and kin , respectively. Semi-quantitative functional parameters and EMM parameters using high-temporal-resolution, double-echo EPI allow the quantification of parotid proton changes after gustatory stimulation.
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Affiliation(s)
- Yi-Jui Liu
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan, Republic of China
| | - Yi-Hsiung Lee
- PhD Program in Electrical and Communication Engineering, Feng Chia University, Taichung, Taiwan, Republic of China
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Hing-Chiu Chang
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
| | - Hui-Chu Chiu
- PhD Program of Technology Management, Chung Hua University, Hsinchu, Taiwan, Republic of China
| | - Ta-Wei Chiu
- Department of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Kang Hsu
- Department of Dentistry, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Cheng-Ming Pen
- PhD Program in Electrical and Communication Engineering, Feng Chia University, Taichung, Taiwan, Republic of China
- Da Vinci Minimally Invasive Surgery Center, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chun-Jung Juan
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Lee SW, Kang KW, Wu HG. Prospective investigation and literature review of tolerance dose on salivary glands using quantitative salivary gland scintigraphy in the intensity-modulated radiotherapy era. Head Neck 2016; 38 Suppl 1:E1746-55. [DOI: 10.1002/hed.24310] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sea-Won Lee
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine; Seoul National University College of Medicine; Seoul Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Korea
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Temporal Evolution of Parotid Volume and Parotid Apparent Diffusion Coefficient in Nasopharyngeal Carcinoma Patients Treated by Intensity-Modulated Radiotherapy Investigated by Magnetic Resonance Imaging: A Pilot Study. PLoS One 2015; 10:e0137073. [PMID: 26323091 PMCID: PMC4556378 DOI: 10.1371/journal.pone.0137073] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/12/2015] [Indexed: 12/18/2022] Open
Abstract
Purpose To concurrently quantify the radiation-induced changes and temporal evolutions of parotid volume and parotid apparent diffusion coefficient (ADC) in nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy by using magnetic resonance imaging (MRI). Materials and Methods A total of 11 NPC patients (9 men and 2 women; 48.7 ± 11.7 years, 22 parotid glands) were enrolled. Radiation dose, parotid sparing volume, severity of xerostomia, and radiation-to-MR interval (RMI) was recorded. MRI studies were acquired four times, including one before and three after radiotherapy. The parotid volume and the parotid ADC were measured. Statistical analysis was performed using SPSS and MedCalc. Bonferroni correction was applied for multiple comparisons. A P value less than 0.05 was considered as statistically significant. Results The parotid volume was 26.2 ± 8.0 cm3 before radiotherapy. The parotid ADC was 0.8 ± 0.15 × 10−3 mm2/sec before radiotherapy. The parotid glands received a radiation dose of 28.7 ± 4.1 Gy and a PSV of 44.1 ± 12.6%. The parotid volume was significantly smaller at MR stage 1 and stage 2 as compared to pre-RT stage (P < .005). The volume reduction ratio was 31.2 ± 13.0%, 26.1 ± 13.5%, and 17.1 ± 16.6% at stage 1, 2, and 3, respectively. The parotid ADC was significantly higher at all post-RT stages as compared to pre-RT stage reciprocally (P < .005 at stage 1 and 2, P < .05 at stage 3). The ADC increase ratio was 35.7 ± 17.4%, 27.0 ± 12.8%, and 20.2 ± 16.6% at stage 1, 2, and 3, respectively. The parotid ADC was negatively correlated to the parotid volume (R = -0.509; P < .001). The parotid ADC was positively associated with the radiation dose significantly (R2 = 0.212; P = .0001) and was negatively associated with RMI significantly (R2 = 0.203; P = .00096) significantly. Multiple regression analysis further showed that the post-RT parotid ADC was related to the radiation dose and RMI significantly (R2 = 0.3580; P < .0001). At MR stage 3, the parotid volume was negatively associated with the dry mouth grade significantly (R2 = 0.473; P < .0001), while the parotid ADC was positively associated with the dry mouth grade significantly (R2 = 0.288; P = .015). Conclusion Our pilot study successfully demonstrates the concurrent changes and temporal evolution of parotid volume and parotid ADC quantitatively in NPC patients treated by IMRT. Our results suggest that the reduction of parotid volume and increase of parotid ADC are dominated by the effect of acinar loss rather than edema at early to intermediate phases and the following recovery of parotid volume and ADC toward the baseline values might reflect the acinar regeneration of parotid glands.
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Lapiedra RC, Gómez GE, Sánchez BP, Pereda AA, Turner MD. The Effect of a Combination Saliva Substitute for the Management of Xerostomia and Hyposalivation. J Maxillofac Oral Surg 2015. [PMID: 26225058 DOI: 10.1007/s12663-015-0752-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the difference between the combination agent of xylitol, beatine and olive oil in a chewable capsule versus the control agent of a sorbitol tablet in subjects with hyposalivation and xerostomia. MATERIALS AND METHODS The subjects had xerostomia over 3 months and a measured hyposalivation. The study was 3 weeks in duration, with 2 treatment phases of 1 week and a 7 day wash out period in between. At the end of each treatment phase, subjects returned for a follow up evaluation. At this visit they were given the subjective sensation questionnaire, as well as their unstimulated whole salivary flow and stimulated whole salivary flow were measured. RESULTS There was a greater increase in the unstimulated and stimulated whole salivary flow rate, although the results were not statistically significant. The subjective evaluation as measured by the questionnaire showed that both agents reduced the mean score as compared to the baseline, although only the findings in the active agent was statistically significant (p = 0.0015). CONCLUSION The significant conclusions found in this study were that the active agent provided a significant subjective improvement in speech, swallowing, and decreased subjective xerostomia as compared to the control tablet. CLINICAL RELEVANCE This combination agent has a significant effect on patients with subjective xerostomia but does not have a significant effect on objective hyposalivation.
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Affiliation(s)
- R C Lapiedra
- Department of Oral Medicine & Orofacial Surgery, University Complutense of Madrid, Madrid, Spain
| | - G E Gómez
- Department of Oral Medicine & Orofacial Surgery, University Complutense of Madrid, Madrid, Spain
| | - B P Sánchez
- Department of Oral Medicine & Orofacial Surgery, University Complutense of Madrid, Madrid, Spain
| | | | - M D Turner
- Division of Oral and Maxillofacial Surgery, NY Center for Salivary Gland Diseases, Mount Sinai Beth Israel Medical Center NY, New York, NY USA
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Sim CPC, Wee J, Xu Y, Cheung YB, Soong YL, Manton DJ. Anti-caries effect of CPP-ACP in irradiated nasopharyngeal carcinoma patients. Clin Oral Investig 2014; 19:1005-11. [PMID: 25261399 DOI: 10.1007/s00784-014-1318-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 09/09/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on caries progression in irradiated nasopharyngeal carcinoma (NPC) patients. METHODS Twenty-one males and three females (median age, 50 years) were randomized into two groups before radiotherapy. Subjects had at least eight teeth after oral health clearance. The test group used 0.4 % stannous fluoride gel and a crème containing 10 % CPP-ACP daily; the control group used a similar crème without CPP-ACP and otherwise identical care. Subjects applied the crème three times daily and fluoride gel once daily. Caries status, saliva and plaque parameters were measured pre-radiotherapy, at 2 weeks and 3 months post-radiotherapy. RESULTS Baseline International Caries Detection and Assessment System (ICDAS) scores were 0-1126 surfaces (93.9 %), 1-28 surfaces (2.3 %), 2-40 surfaces (3.3 %) and 3-6 surfaces (0.5 %) for the control and 0-1186 surfaces (95.6 %), 1-31 surfaces (2.5 %), 2-15 surfaces (1.2 %) and 3-8 surfaces (0.7 %) for the test group. Twenty-two subjects returned at 3 months post-radiotherapy with reduced plaque pH, salivary flow, pH and buffering capacity. Nine test and 8 control subjects developed 32 and 59 new caries lesions, respectively. Test subjects showed lower caries progression than the controls: all surfaces (OR 0.51, 95 % CI 0.17∼1.59), occlusal (OR 0.20, 95 % CI 0.03∼1.29) and smooth surfaces (OR 0.61, 95 % CI 0.16∼2.38). The difference was not statistically significant. CONCLUSION Application of CPP-ACP did not significantly reduce caries progression in NPC patients in the first 3 months after radiotherapy as compared to controls. CLINICAL RELEVANCE Adjunct use of CPP-ACP with stannous fluoride gel in irradiated NPC patients gave comparable results compared to stannous fluoride gel alone in reducing caries progression.
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Affiliation(s)
- Christina P C Sim
- Department of Restorative Dentistry, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore, 168938, Singapore,
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Harada H, Omura K, Tomioka H, Nakayama H, Hiraki A, Shinohara M, Yoshihama Y, Shintani S. Multicenter phase II trial of preoperative chemoradiotherapy with S-1 for locally advanced oral squamous cell carcinoma. Cancer Chemother Pharmacol 2013; 71:1059-64. [PMID: 23377375 PMCID: PMC3607732 DOI: 10.1007/s00280-013-2101-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/19/2013] [Indexed: 11/10/2022]
Abstract
Purpose We evaluated whether preoperative chemotherapy with S-1 and concurrent radiotherapy is feasible and efficacious in the treatment of advanced oral squamous cell carcinoma. Methods Participants comprised 39 patients with oral carcinoma (stage III, n = 15; stage IVA, n = 24). All patients received a total radiation dose of 40 Gy, in once-daily 2-Gy fractions, and received S-1 at 65 mg/m2/day for 5 consecutive days, over 4 consecutive weeks with concurrent radiotherapy. Results Hematological toxicity was mild and reversible. The most common non-hematological toxicity was grade 3 mucositis, but this was transient and tolerable. Radical surgery was performed for 37 patients, with the remaining 2 patients declining the surgery. Postoperatively, local failure developed in 1 patient, and neck failure in 2 patients. Distant metastases were identified in 4 patients. At a median follow-up of 38.0 months (range 23–88 months), locoregional control, disease-specific survival, and overall survival rates at 3 years were 91.5, 83.8, and 83.8 %, respectively. Conclusion Concurrent administration of S-1 and radiotherapy combined with surgery offers a well-tolerated method of successfully treating advanced oral squamous cell carcinoma. The locoregional control rate remains high even at 3 years of follow-up, and no serious adverse effects have been encountered.
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Affiliation(s)
- Hiroyuki Harada
- Department of Oral Surgery, Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
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Alikhasi M, Kazemi M, Nokar S, Khojasteh A, Sheikhzadeh S. Step-by-step full mouth rehabilitation of a nasopharyngeal carcinoma patient with tooth and implant-supported prostheses: A clinical report. Contemp Clin Dent 2011; 2:256-60. [PMID: 22090777 PMCID: PMC3214541 DOI: 10.4103/0976-237x.86489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This clinical report presents a 46-year-old man diagnosed with nasopharyngeal carcinoma with the chief complaint of masticatory and speech deficiency because of radiation therapy. After a period of controlling post radiation caries, the patient was rehabilitated with tooth and implant supported metal ceramic restorations following surgical and endodontic intervention.
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Affiliation(s)
- Marzieh Alikhasi
- Department of Dental Research and Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Legert KG, Remberger M, Ringdèn O, Heimdahl A, Dahllöf G. Salivary secretion in children after fractionated or single-dose TBI. Bone Marrow Transplant 2011; 47:404-10. [DOI: 10.1038/bmt.2011.96] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mücke T, Konen M, Wagenpfeil S, Kesting MR, Wolff KD, Hölzle F. Low-Dose Preoperative Chemoradiation Therapy Compared with Surgery Alone with or Without Postoperative Radiotherapy in Patients with Head and Neck Carcinoma. Ann Surg Oncol 2011; 18:2739-47. [DOI: 10.1245/s10434-011-1643-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Indexed: 02/02/2023]
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Simões A, de Campos L, de Souza DN, de Matos JA, Freitas PM, Nicolau J. Laser Phototherapy as Topical Prophylaxis Against Radiation-Induced Xerostomia. Photomed Laser Surg 2010; 28:357-63. [DOI: 10.1089/pho.2009.2486] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alyne Simões
- Department of Dental Materials, Division of Oral Biology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luana de Campos
- Department of Dental Materials, Division of Oral Biology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Douglas Nesadal de Souza
- Department of Dental Materials, Division of Oral Biology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jonas Alencar de Matos
- Department of Dental Materials, Division of Oral Biology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Patricia Moreira Freitas
- Department of Restorative Dentistry, Special Laboratory of Lasers in Dentistry, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jose Nicolau
- Department of Dental Materials, Division of Oral Biology, Universidade de São Paulo, São Paulo, SP, Brazil
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Jensen SB, Pedersen AML, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NNF, Mello ALS, Muniz LV, Murdoch-Kinch CA, Nair RG, Napeñas JJ, Nogueira-Rodrigues A, Saunders D, Stirling B, von Bültzingslöwen I, Weikel DS, Elting LS, Spijkervet FKL, Brennan MT. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 2010; 18:1039-60. [PMID: 20237805 DOI: 10.1007/s00520-010-0827-8] [Citation(s) in RCA: 257] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 01/26/2010] [Indexed: 01/09/2023]
Abstract
PURPOSE This systematic review aimed to assess the literature for prevalence, severity, and impact on quality of life of salivary gland hypofunction and xerostomia induced by cancer therapies. METHODS The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. Two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results and conclusions for each article. RESULTS The inclusion criteria were met by 184 articles covering salivary gland hypofunction and xerostomia induced by conventional, 3D conformal radiotherapy or intensity-modulated radiotherapy in head and neck cancer patients, cancer chemotherapy, total body irradiation/hematopoietic stem cell transplantation, radioactive iodine treatment, and immunotherapy. CONCLUSIONS Salivary gland hypofunction and xerostomia are induced by radiotherapy in the head and neck region depending on the cumulative radiation dose to the gland tissue. Treatment focus should be on optimized/new approaches to further reduce the dose to the parotids, and particularly submandibular and minor salivary glands, as these glands are major contributors to moistening of oral tissues. Other cancer treatments also induce salivary gland hypofunction, although to a lesser severity, and in the case of chemotherapy and immunotherapy, the adverse effect is temporary. Fields of sparse literature included pediatric cancer populations, cancer chemotherapy, radioactive iodine treatment, total body irradiation/hematopoietic stem cell transplantation, and immunotherapy.
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Affiliation(s)
- S B Jensen
- Department of Oral Medicine, University of Copenhagen, Copenhagen, Denmark.
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Simões A, Platero MD, Campos L, Aranha AC, Eduardo CDP, Nicolau J. Laser as a therapy for dry mouth symptoms in a patient with Sjögren's syndrome: a case report. SPECIAL CARE IN DENTISTRY 2009; 29:134-7. [PMID: 19938253 DOI: 10.1111/j.1754-4505.2009.00078.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This clinical case study reports on dry mouth symptoms in a patient with Sjögren's syndrome (SS) who was treated with laser phototherapy (LPT). A 60-year-old woman diagnosed with SS was referred to the laboratory for lasers in dentistry to treat her severe xerostomia. A diode laser (780 nm, 3.8 J/cm2, 15 mW) was used to irradiate the parotid, submandibular, and sublingual glands, three times per week, for a period of 8 months. The salivary flow rate and xerostomia symptoms were measured before, during, and after LPT. Dry mouth symptoms improved during LPT. After LPT, the parotid salivary gland pain and swelling were no longer present. Treatment with LPT was an effective method to improve the quality of life of this patient with SS.
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Affiliation(s)
- Alyne Simões
- Oral Biology Research Center, Department of Biomaterials and Oral Biochemistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
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Campos L, Simões A, Sá PHRN, Eduardo CDP. Improvement in Quality of Life of An Oncological Patient by Laser Phototherapy. Photomed Laser Surg 2009; 27:371-4. [DOI: 10.1089/pho.2008.2300] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luana Campos
- Oral Biology Research Center, Department of Biomaterials and Oral Biochemistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Alyne Simões
- Oral Biology Research Center, Department of Biomaterials and Oral Biochemistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Pedro Henrique Rosário Nogueira Sá
- Special Laboratory of Lasers in Dentistry (LELO), Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Carlos De Paula Eduardo
- Special Laboratory of Lasers in Dentistry (LELO), Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Juan CJ, Chen CY, Jen YM, Liu HS, Liu YJ, Hsueh CJ, Wang CY, Chou YC, Chai YT, Huang GS, Chung HW. Perfusion characteristics of late radiation injury of parotid glands: quantitative evaluation with dynamic contrast-enhanced MRI. Eur Radiol 2008; 19:94-102. [PMID: 18661135 DOI: 10.1007/s00330-008-1104-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 05/28/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
Abstract
We aimed to quantitatively investigate the alteration of parotid perfusion after irradiation using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) based on a two-compartment tracer kinetic model. This study enrolled 19 patients (53.2 +/- 14.9 years) treated by head and neck radiotherapy and 19 age-relevant and sex-matched subjects as a control group. Perfusion parameters (K ( el ), k (21) and A) of parotid glands were analyzed based on the Brix model from T1-weighted DCE-MRI. Suitability of the Brix model was evaluated via Monte Carlo simulation for the goodness-of-fit. Analysis of nonlinear goodness-of-fit showed that the Brix model is appropriate in evaluating the parotid perfusion (R(2) = 0.938 +/- 0.050). The irradiated parotid glands showed significantly lower K ( el ) (P < 0.0005) and k (21) (P < 0.05) and consequently significantly higher value of peak enhancement (P < 0.0005) and time-to-peak (P < 0.0005) compared with non-irradiated ones, suggestive of gradual and prolonged accumulation and delayed wash-out of contrast agent due to increased extracellular extravascular space and decreased vascular permeability in the irradiated glands. Linear regression analysis showed dose-dependent perfusion changes of the irradiated parotid glands. We conclude that quantitative DCE-MRI is a potential tool in investigating parotid gland perfusion changes after radiotherapy.
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Affiliation(s)
- Chun-Jung Juan
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
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Neoadjuvant concurrent radiochemotherapy followed by surgery in advanced oral squamous cell carcinoma (OSCC): A retrospective analysis of 207 patients. Oral Oncol 2008; 44:116-23. [DOI: 10.1016/j.oraloncology.2007.01.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 12/31/2006] [Accepted: 01/02/2007] [Indexed: 11/18/2022]
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Chambers MS, Jones CU, Biel MA, Weber RS, Hodge KM, Chen Y, Holland JM, Ship JA, Vitti R, Armstrong I, Garden AS, Haddad R. Open-label, long-term safety study of cevimeline in the treatment of postirradiation xerostomia. Int J Radiat Oncol Biol Phys 2007; 69:1369-76. [PMID: 17855005 DOI: 10.1016/j.ijrobp.2007.05.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 04/18/2007] [Accepted: 05/14/2007] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess the safety of long-term cevimeline treatment of radiation-induced xerostomia in patients with head-and-neck cancer; and to assess the efficacy of cevimeline in these patients. METHODS AND MATERIALS A total of 255 adults with head-and-neck cancer who had received more than 40 Gy of radiation 4 months or more before entry and had clinically significant salivary gland dysfunction received cevimeline hydrochloride 45 mg t.i.d. orally for 52 weeks. Adverse events (AEs), their severity, and their relationship to the study medication were assessed by each investigator. The efficacy assessment was based on subjects' global evaluation of oral dryness on a scale of 0 (none) to 3 (severe). RESULTS Overall, 175 subjects (68.6%) experienced expected treatment-related AEs, most mild to moderate. The most frequent was increased sweating (47.5%), followed by dyspepsia (9.4%), nausea (8.2%), and diarrhea (6.3%). Fifteen subjects (5.9%) experienced Grade 3 treatment-related AEs, of which the most frequent was increased sweating. Eighteen subjects (7.1%) reported at least one serious AE, and 45 subjects (17.6%) discontinued study medication because of an AE. The global efficacy evaluation at the last study visit showed that cevimeline improved dry mouth in most subjects (59.2%). Significant improvement was seen at each study visit in the mean change from baseline of the numeric global evaluation score (p < 0.0001). CONCLUSIONS Cevimeline 45 mg t.i.d. was generally well tolerated over a period of 52 weeks in subjects with xerostomia secondary to radiotherapy for cancer in the head-and-neck region.
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Affiliation(s)
- Mark S Chambers
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Mohammadi N, Seyyednejhad F, Alizadeh Oskoee P, Savadi Oskoee S, Mofidi N. Evaluation of Radiation-induced Xerostomia in Patients with Nasopharyngeal Carcinomas. J Dent Res Dent Clin Dent Prospects 2007; 1:65-70. [PMID: 23277836 PMCID: PMC3525927 DOI: 10.5681/joddd.2007.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 09/01/2007] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIMS Salivary glands are extremely susceptible to radiation injuries. The aim of this study was to evaluate radiation-induced xerostomia in patients with nasopharyngeal carcinomas, referring to Tabriz Imam Khomeini Hospital in 2005-2006. MATERIALS AND METHODS Thirty patients with nasopharyngeal carcinomas, who received conventional radiotherapy, were included in the present study. The patients' unstimulated saliva samples were collected at three intervals, i.e. before treatment, 3 weeks after the initiation of treatment and at the end of treatment by spitting, and measured with a graduated pipette. RESULTS The differences in the mean values of the patients' salivary flow rates at three afore-mentioned intervals were statistically significant (p<0.001). Two-by-two comparison of the mean values of salivary flow rates of all the patients and of males and females, carried out separately, demonstrated statistically significant differences (p<0.0025). However, there were no statistically significant differences between males and females before treatment (p = 0.723), 3 weeks after the initiation of treatment (p = 0.724) and at the end of treatment (p = 0.595). There were no statistically significant relationships between age and a decrease in salivary flow rate in the total sample (p = 0.76, r = -0.057), in males (p = 0.96, r = 0.011) and in females (p = 0.539, r = -0.208). CONCLUSION Conventional radiotherapy results in severe xerostomia in 3 weeks in patients with nasopharyngeal carcinomas. Age and sex do not influence radiotherapy-induced xerostomia.
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Affiliation(s)
- Narmin Mohammadi
- Assistant Professor, Department of Operative Dentistry, Faculty of Dentistry, Tabriz University of Medical Sciences, Iran
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