Oral complications of cancer

Osteoradionecrosis of the jaws--a current overview--Part 2: dental management and therapeutic options for treatment

PURPOSE

The aim of this paper is to explore the current theories about pretreatment assessment and dental management of patients receiving head and neck radiotherapy, and the therapeutic options to treat osteoradionecrosis of the jaws, based on the literature review.

DISCUSSION

Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. Osteoradionecrosis is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal. Osteoradionecrosis either stabilizes or gradually worsens and is notoriously difficult to manage. Because most cases occur in patients who were dentulous in the mandible at tumor onset, proper dental management is the single most important factor in prevention.

CONCLUSIONS

Complete dental clearance before treatment is no longer necessary. Controversy exists regarding the management of osteoradionecrosis of the maxillofacial skeleton because of the variability of this condition. The treatment of osteoradionecrosis has included local wound care, antibiotic therapy, surgical procedures, and the administration of hyperbaric oxygenation. Recently, new methods of treatment were introduced, according to the new theory about its pathophysiology.

Palliation of Oral Mucositis Symptoms in Pediatric Patients Treated With Cancer Chemotherapy

This prospective randomized 2-period crossover study aimed at comparing the efficacy of 2 oral care protocols differing in the type of mouthwashes: chlorhexidine versus benzydamine in alleviating oral mucositis symptoms for children undergoing chemotherapy. Forty subjects were randomly allocated to receive either chlorhexidine first then benzydamine protocols or benzydamine first then chlorhexidine protocols. Each protocol was started on the first day of chemotherapy and continued for 21 days. Subjects were evaluated in intervals of 3 to 4 days using the World Health Organization (WHO) grading for mucositis and 10-cm visual analogue scale for oral symptoms evaluations. Among 34 evaluable subjects, 26% and 48% of them using chlorhexidine and benzydamine had WHO grade II mucositis, respectively (P < .05). The results revealed a significant difference in mean area under the curve (AUC) of mouth pain (1.35 +/- 2.26 versus 3.09 +/- 3.21) (P = .05), and a trend of a lessening of mean AUC of difficulty in eating/chewing (2.49 +/- 3.74 versus 2.71 +/- 4.1) (P = .82) and swallowing (1.34 +/- 3.31 versus 1.91 +/- 4.03) (P = .53) for subjects receiving chlorhexidine compared to those receiving benzydamine. In conclusion, chlorhexidine may be helpful in palliating mucositis symptoms for children in chemotherapy. The beneficial effect, however, is small and needs to be confirmed in a larger trial.

The development of patient information leaflets. Care of the mouth after radiotherapy

OBJECTIVES

Describe the methodology used to produce a patient leaflet on care of the mouth after radiotherapy.

DESIGN

Prospective study to design a patient information leaflet.

SETTING AND SUBJECTS

Patients undergoing radiotherapy for oral cancer.

INTERVENTION

After a review of the relevant literature, a patient questionnaire was produced. This was then completed by patients undergoing radiotherapy treatment and gave an indication of the problems being encountered. Healthcare professionals were surveyed for their views. A leaflet was then produced according to published guidelines. It was taken back to another group of patients and a further version produced after input from a health promotion group.

RESULTS

A leaflet was produced after wide consultation and survey.

CONCLUSIONS

Considerable effort must to be put into the production to patient information leaflet. It must be discussed with patients in the target group if it is to be sensitive, understood and find acceptance among its users.

Treatment of oral cancer by interstitial irradiation using iridium-192

Sixty-seven patients with squamous cell carcinoma of the oral cavity were treated by implantation of radio-active iridium wire between 1977 and 1986. The results are presented in the hope of providing a comparison with those of primary surgical management. The crude 5-year survival rates were 61% for T1, 74% for T2, and 37% for T3 tumours. The major causes of death were uncontrolled tumour in the neck and intercurrent disease. Seven of 52 patients with T1 or T2 tumours (13%) developed local recurrence at the primary site; five were salvaged surgically, for an ultimate failure rate of 4%. The ultimate failure for a group of 15 T3 tumours was 47%. The only morbidity was a 31% incidence of soft tissue ulcers occurring during the first 18 months after treatment, none of which persisted. Elective external beam radiotherapy to the clinically negative neck significantly reduced the incidence of overt lymph node metastases.