Construction and clinical evaluation of a new customized bite block used in radiotherapy of head and neck cancer

Feng, Zhen Xing; Wang, P.; Gong, Lin; Xu, Liming; Zhang, J.; Zheng, Junrong; Zhang, D.; Tian, Tieshuan

doi:10.1016/j.canrad.2018.05.005

Cited by 19 publications

(38 citation statements)

References 25 publications

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“…Intraoral stents are personalized medical devices designed to position and stabilize the oral cavity to prevent unnecessary irradiation of adjacent tissues. These devices are easy to manufacture [193] and have been demonstrated to efficiently reduce irradiation of off-target tissues [194][195][196]. Salivary glands can be protected from irradiation by temporarily relocating them further away from the field of irradiation in a procedure known as temporary SMG transplantation.…”

Section: Intraoral Stents and Temporary Submandibular Gland (Smg) Tramentioning

confidence: 99%

Radiation-Induced Salivary Gland Dysfunction: Mechanisms, Therapeutics and Future Directions

Jasmer

Gilman

Forti

et al. 2020

JCM

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Salivary glands sustain collateral damage following radiotherapy (RT) to treat cancers of the head and neck, leading to complications, including mucositis, xerostomia and hyposalivation. Despite salivary gland-sparing techniques and modified dosing strategies, long-term hypofunction remains a significant problem. Current therapeutic interventions provide temporary symptom relief, but do not address irreversible glandular damage. In this review, we summarize the current understanding of mechanisms involved in RT-induced hyposalivation and provide a framework for future mechanistic studies. One glaring gap in published studies investigating RT-induced mechanisms of salivary gland dysfunction concerns the effect of irradiation on adjacent non-irradiated tissue via paracrine, autocrine and direct cell–cell interactions, coined the bystander effect in other models of RT-induced damage. We hypothesize that purinergic receptor signaling involving P2 nucleotide receptors may play a key role in mediating the bystander effect. We also discuss promising new therapeutic approaches to prevent salivary gland damage due to RT.

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Section: Intraoral Stents and Temporary Submandibular Gland (Smg) Tramentioning

confidence: 99%

Radiation-Induced Salivary Gland Dysfunction: Mechanisms, Therapeutics and Future Directions

Jasmer

Gilman

Forti

et al. 2020

JCM

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“…The dosimetric advantage of different oral stent types as well as the ''stick-out" tongue technique for HNC RT has already been described in other studies [8][9][10][11][12][13][14]21] (Table 4). To our knowledge, this study of over 450 patients with OPC and long-term survival is the first to attempt to translate these dosimetric advantages of stent usage into a clinical benefit with regards to decreasing late symptoms in HNC patients.…”

Section: Discussionmentioning

confidence: 96%

“…Furthermore, due to the eligibility criteria of the parent study including only patients without active disease, any positive or negative association of stent use with local control could not be assessed. However, there is evidence that stent use is beneficial in terms of dosimetric parameters of the organs at risk [8][9][10][11][12][13][14]21], and we add data to suggest a clinical benefit with regards to patient reported long-term outcomes. This study is a retrospective analysis of prospectively collected data, and while randomized data is regarded as strongest from a scientific perspective, recognizing stents improve dosimetry with regards to avoidance of normal tissue, and treatment reproducibility, it is moot whether randomized data is an absolute necessity.…”

Section: Discussionmentioning

confidence: 99%

“…While patient-specific custom oral stents, fabricated by our dental oncologists, are commonly used at our center for the treatment of OPC based on the aforementioned rationale and the demonstrated dosimetric advantages [8][9][10][11][12][13][14], the use of custom oral stents may not be routinely used in many radiation oncology practices owing to availability of dental expertise/resources or lack of studies demonstrating clinical benefit in terms of late toxicity reduction. In recent years, pre-fabricated commercial stent products became available and stent fabrication became easier and less time consuming with the innovation of 3D printers [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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The impact of tongue-deviating and tongue-depressing oral stents on long-term radiation-associated symptoms in oropharyngeal cancer survivors

Stieb

Perez-Martinez

Mohamed

et al. 2020

Clinical and Translational Radiation Oncology

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Objectives: To evaluate whether the use of oral stents during intensity modulated radiation therapy (IMRT) for oropharyngeal cancer (OPC) is associated with long-term patient reported symptoms. Materials and methods: Data was obtained from a prospective observational study of disease-free head and neck cancer survivors. Radiation-associated patient reported symptoms were assessed using the MD Anderson Symptom Inventory Head and Neck module (MDASI-HN). Scores of 5 (11-point Likert scale, 0-10) were considered moderate/severe. Stratification was performed regarding IMRT volume (uni-versus bilateral neck) and stent utilization, with non-parametric analyses between groups. Results: 462 OPC survivors formed the cohort (54% tonsil, 46% base of tongue primaries). A tonguedeviating stent was used in 17%, tongue-depressing stent in 46%, and no stent in 37%. Median prescribed dose to the high dose clinical target volume was 66.0 Gy. Median follow-up from RT to MDASI-HN assessment was 68 months. Twenty percent had received unilateral neck RT (all had tonsil primaries), in whom a significant improvement in the proportion of patients with moderate/severe taste impairment (2% vs. 15%, p = 0.047) and lack of appetite (0% vs. 9%, p = 0.019) was associated with the use of tonguedeviating stents compared to no oral stent. In those who had received bilateral neck RT, a significant improvement in the proportion of patients with moderate/severe difficulty swallowing/chewing was associated with use of a tongue-depressing stent (21% vs. 31% without oral stent, p = 0.013). Conclusion: Disease-site specific select use of oral stents during IMRT was associated with reduced longterm patient reported symptoms in OPC survivors.

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“…No passado, métodos simples para imobilização de estruturas orais trans-RT eram feitas com espátulas com o intuito de afastar os tecidos sadios da região alvo, porém apresentavam desvantagens como a baixa reprodutibilidade de posicionamento, desconforto e efeito protetor limitado. Na busca de resultados efetivos, a odontologia tem buscado desenvolver dispositivos que promovem um posicionamento bucal diferenciado, ou pela abertura bucal proporcionada por ele ou pelo afastamento de tecidos moles, como a língua e lábio (Johnson et al, 2013;Feng et al, 2019).…”

Section: Abridores De Bocaunclassified

O impacto do abridor bucal na diminuição das toxicidades bucais induzidas pela radioterapia em cabeça e pescoço: revisão sistemática

Pinto¹

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Construction and clinical evaluation of a new customized bite block used in radiotherapy of head and neck cancer

Cited by 19 publications

References 25 publications

Radiation-Induced Salivary Gland Dysfunction: Mechanisms, Therapeutics and Future Directions

Radiation-Induced Salivary Gland Dysfunction: Mechanisms, Therapeutics and Future Directions

The impact of tongue-deviating and tongue-depressing oral stents on long-term radiation-associated symptoms in oropharyngeal cancer survivors

O impacto do abridor bucal na diminuição das toxicidades bucais induzidas pela radioterapia em cabeça e pescoço: revisão sistemática

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