Oral mucositis in head and neck cancer: Evidence-based management and review of clinical trial data

Blakaj, Adriana; Bonomi, Marcelo; Gamez, M.E.; Blakaj, Dukagjin

doi:10.1016/j.oraloncology.2019.05.013

Cited by 78 publications

(69 citation statements)

References 39 publications

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“…Also, the use of preventive agents has a significant positive effect on the quality of life of patients, which has been recorded, both in our study and in similar studies devoted to the prevention and treatment of OM [2,3]. Given that this complication is frequent and significantly affects patients, the prevention and treatment of OM is an important aspect of concomitant treatment of oncohematologic patients.…”

Section: Discussionsupporting

confidence: 76%

“…Accordingly, at the cellular level, factors of impaired OM development were damage to epithelial cells, development of local inflammation with induction of apoptosis of cells of different layers of the mucosa [1,10]. As a consequence, additional infectious agents penetrate into the depths of the mucosa through the damaged epithelium, the rapid spread of which is due to cytostatic immunosuppression [3,9]. Thus, the development of OM, as a phenomenon with complex pathogenetic character, requires complex therapy [20,21].…”

Section: Introductionmentioning

confidence: 99%

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Pharmacological correction of various morphological forms of oral mucositis in patients with leukemia

et al. 2019

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Oral mucositis (OM) is a common complication against the background of modern leukemia therapy, which significantly impairs patients’ quality of life. The purpose of the study was to evaluate the effectiveness of the use of local Cyanocobalamin and Decamethoxine therapy for the prevention and treatment of OM. The study was conducted on the basis of the hematology department of Vinnytsia Regional Clinical Hospital n.a. M.I. Pirogov in 2013-2019 (58 patients were studied with standard combination chemotherapy with Cytarabine, Methotrexate and anthracycline antibiotics). In addition to the standard clinical and laboratory study, dental examination was performed before treatment, at 7 and 14 days of treatment with determination of the degree of mucositis according to the NCI-CTC criteria and determination of quality of life indicators. At the same time, a sample incisional biopsy of the oral mucosa was performed with photo-fixation of histopreparations. In a group of 28 patients, 7 days orally administered a combination of Septefril (Decamethoxine) 0.2 mg 4-6 times daily, and Cyanocobalamin 500 mg 3 times daily. Statistical processing of the obtained results was carried out in the license package “STATISTICA 6.1” using non-parametric methods of evaluation of the obtained results. Prior to the onset of cytostatic therapy, no signs of inflammatory lesions were reported. However, patients with pre-established signs of caries, periodontal disease and lack of teeth subsequently experienced OM, even with the use of Cyanocobalamin and Septefril. Thus, after 7 days in 8 patients on the background of medication correction I-II degree of OM according to NCI-CTC was recorded, and only in 2 – III degree, unlike the group without correction. In the group where this combination of drugs was used, OM was recorded after 7 days in 12 patients, in contrast to the indices where the correction was not performed and the development of OM had a more pronounced course and was present in all patients. According to the morphological study, several degrees of OM were observed in patients. Initially, catarrhal stomatitis with pronounced plethora and swelling of the mucous membrane was detected. During the transition to the second stage of mucositis, the aphthous stomatitis was morphologically observed, as well as dead epithelial cells and the cells undergoing parakeratotic transformation. After the application of the proposed therapy, erosion remained after the film rejection, which recovered without scarring. Thus, cytostatic therapy in patients with leukemia always causes manifestations of OM, which are more pronounced in patients with concomitant risk factors. The use of a combination of Cyanocobalamin and Septefril significantly reduces the manifestation of OM and improves the quality of life of patients against cytostatic therapy.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Pharmacological correction of various morphological forms of oral mucositis in patients with leukemia

et al. 2019

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“…The investigation of the occurred timing for acute adverse events will be bene t to prevent these radiation-related toxicities during the treatment. 22 The purpose of this study was to provide a comprehensive description of radiation-induced toxicity rates and acute side effects for IMRT vs. 3D-CRT in LANPC with platinum-based IC-CCRT.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Radiation-Induced Acute Injury of Intensity-Modulated Radiotherapy vs. Three-Dimensional Conformal Radiotherapy in Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma: A Prospective Cohort Study

Yao

Lei

Chen

et al. 2020

Preprint

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Abstract Purpose: Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) was the new standard treatment for locoregionally advanced nasopharyngeal carcinoma (LANPC). We aimed to address whether the addition of intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT) aggravate radiation-induced acute injury of these patients.Methods: We conducted a prospective study of consecutive patients in the stage III to IVb with biopsy-proven nonmetastatic LANPC who newly underwent radiotherapy and sequentially received IC, followed by CCRT at our institution. Among 182 patients included, 87 (47.80%) were treated with IMRT and 95 (52.20%) with 3D-CRT. Occurring time of radiation-induced toxicities were estimated and compared using the Kaplan-Meier method and Log-rank test. Results: The most severe acute toxicities included oral mucositis in 97.25% and dermatitis in 90.11%. Subset analysis revealed that Grade 3-4 acute dermatitis were significantly higher in the IMRT than 3D-CRT (P=0.0482). Oral mucositis and dermatitis were the earliest occurrence of acute injuries (2 years: 60.44% and 17.58%). Patients in IMRT group achieved significantly lower risk of bone marrow toxicity (Hazard ratio [HR]= 0.426, P=0.0009), but higher risk of leukopenia (HR=1.444, P=0.0344) and gastrointestinal injury (HR=2.383, P=0.0103). Multivariate analyses also demonstrated that IMRT (HR=0.429, P=0.0211), female gender (HR=2.070, P=0.0531) and hepatitis (HR=2.152, P=0.0552) were the independent prognostic factors for bone marrow toxicity. The use of IMRT was a predictive factor of significantly better short-term efficacy, whereas anemia was a significant independent predictor.Conclusions: In a combined regimen of IC followed by CCRT for the treatment of LANPC, IMRT seems to be an aggressive technique with a trend towards increased gastrointestinal and hematological toxicities, but decreased bone marrow toxicity than those treated with 3D-CRT.

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“…For this reason, we should pay attention to injury-sparing IMRT and 3D-CRT, which is an active method to reduce radiation-related acute toxicity. The investigation of the occurred timing for acute adverse events will be benefit to prevent these radiation-related toxicities during the treatment [22]. The purpose of this study was to provide a comprehensive description of radiationinduced toxicity rates and acute side effects for IMRT vs. 3D-CRT in NPC with platinum-based IC-CCRT.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for nasopharyngeal carcinoma: a prospective cohort study

Yao

Lei

Chen

et al. 2020

Preprint

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Background: Induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) was the new standard treatment for nasopharyngeal carcinoma (NPC). We aimed to address whether the addition of intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT) aggravate radiation-induced acute injury of these patients. Methods: We conducted a prospective study of consecutive patients with biopsy-proven nonmetastatic NPC who newly underwent radiotherapy and sequentially received IC, followed by CCRT at our institution. Among the 224 patients included, 108 (48.21%) were treated with IMRT and 116 (51.78%) with 3D-CRT. Clinicians evaluated routinely acute injury each day during radiotherapy according to the Radiation Therapy Oncology Group (RTOG). Radiation-induced dermatitis, oral mucositis, bone marrow toxicity and gastrointestinal toxicity were compared using the Kaplan-Meier method and the Log-rank test. Overall survival (OS), locoregional progression-free survival (LRFS) distant metastasis-free survival (DMFS) and progression-free survival (PFS) were analyzed during standard follow-up consultations. Results: There was no difference in patient characteristics between groups; however, IMRT plans had higher docetaxel and nedaplatin compared with 3D-CRT plans. The most severe acute toxicities included oral mucositis in 96.43% and dermatitis in 88.84%. Subset analysis revealed that Grade 3-4 acute dermatitis, oral mucositis and bone marrow toxicity were not significantly lower in the IMRT than 3D-CRT (P>0.05). Patients in IMRT group achieved significantly lower risk of bone marrow toxicity (Hazard ratio [HR]=2.557, P=0.0029) in Kaplan-Meier test, but higher risk of leukopenia (HR=0.492, P=0.0165) and gastrointestinal injury (HR=0.432, P=0.0011). Multivariate analyses also demonstrated that IMRT, male gender and hepatitis were the independent prognostic factor for bone marrow toxicity (HR=2.557, P=0.0032). No significant difference was found between the 3D-CRT and IMRT groups in terms of survival. The use of IMRT was a predictive factor of significantly better short-term efficacy, whereas anemia was a significant independent predictor. Conclusions: In a combined regimen of IC followed by CCRT for the treatment of NPC, IMRT seems to be an aggressive technique with a trend towards increased gastrointestinal and hematological toxicities than those treated with 3D-CRT. Predicting the occurrence time of various side effects is beneficial to early protection and focus on to coherent treatment.

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Oral mucositis in head and neck cancer: Evidence-based management and review of clinical trial data

Cited by 78 publications

References 39 publications

Pharmacological correction of various morphological forms of oral mucositis in patients with leukemia

Pharmacological correction of various morphological forms of oral mucositis in patients with leukemia

WITHDRAWN: Radiation-Induced Acute Injury of Intensity-Modulated Radiotherapy vs. Three-Dimensional Conformal Radiotherapy in Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma: A Prospective Cohort Study

WITHDRAWN: Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for nasopharyngeal carcinoma: a prospective cohort study

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