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Journal of Cancer Research and... Apr 2023This study aimed to estimate the fitting parameters of sigmoidal dose-response (SDR) curve of radiation-induced acute oral and pharyngeal mucositis in head-and-neck (H...
PURPOSE/OBJECTIVE(S)
This study aimed to estimate the fitting parameters of sigmoidal dose-response (SDR) curve of radiation-induced acute oral and pharyngeal mucositis in head-and-neck (H and N) cancer patients treated with Intensity Modulated Radiation Therapy (IMRT) for the calculation of normal tissue complication probability (NTCP).
MATERIALS AND METHODS
Thirty H-and-N cancer patients were enrolled to model the SDR curve for oral and pharyngeal mucositis. The patients were evaluated weekly for acute radiation-induced (ARI) oral and pharyngeal mucositis toxicity, and their scoring was performed as per the common terminology criteria adverse events version 5.0. The radiobiological parameters, namely n, m, TD50, and γ50 were calculated from the fitted SDR curve obtained from the clinical data of H-and-N cancer patients.
RESULTS
ARI toxicity for oral and pharyngeal mucosa in carcinoma of H-and-N cancer patients was calculated for the endpoint oral mucositis and pharyngeal mucositis. The n, m, TD50, and γ50 parameters from the SDR curve of Grade 1 and Grade 2 oral mucositis were found to be [0.10, 0.32, 12.35 ± 3.90 (confidence interval [CI] 95%) and 1.26] and [0.06, 0.33, 20.70 ± 6.95 (CI 95%) and 1.19] respectively. Similarly for pharyngeal mucositis, n, m, TD50, and γ50 parameters for Grade 1 and Grade 2 were found to be [0.07, 0.34, 15.93 ± 5.48 (CI. 95%) and 1.16 ] and [0.04, 0.25, 39.02 ± 9.98(CI. 95%) and 1.56] respectively.
CONCLUSION
This study presents the fitting parameters for NTCP calculation of Grade 1 and Grade 2 ARI toxicity for the endpoint of oral and pharyngeal mucositis. The provided nomograms of volume versus complication and dose versus complication for different grades of oral mucositis and pharyngeal mucositis help radiation oncologists to decide the limiting dose to reduce the acute toxicities.
Topics: Humans; Mucositis; Stomatitis; Head and Neck Neoplasms; Radiotherapy, Intensity-Modulated; Radiation Injuries; Mouth Mucosa; Carcinoma, Squamous Cell
PubMed: 37147947
DOI: 10.4103/jcrt.jcrt_504_21 -
Ear, Nose, & Throat Journal Jul 2020
Topics: Cheek; Diagnosis, Differential; Female; Humans; Medical Illustration; Middle Aged; Mucositis; Palate, Soft; Pharyngeal Diseases; Pharynx; Plasma Cells; Singing
PubMed: 31072192
DOI: 10.1177/0145561319849001 -
Klinicka Onkologie : Casopis Ceske a... 2011Oropharyngeal mucositis is a clinically significant and painful complication of an intensive chemotherapy or head and neck radiotherapy. The management of a patient in... (Review)
Review
Oropharyngeal mucositis is a clinically significant and painful complication of an intensive chemotherapy or head and neck radiotherapy. The management of a patient in risk of this complication must include appropriate and generally recommended prophylactic measures. An effective and safe treatment must be offered to patients who have developed oropharyngeal mucositis. The basic care involves local mouthwashes, sprays or viscous gels with variable effect on pain reduction. In more serious cases, tramadol and morphine are the drugs of choice; transdermal fentanyl or buprenorphine can be considered as an alternative. Pain management must be individualized.
Topics: Analgesia; Antineoplastic Agents; Head and Neck Neoplasms; Humans; Mouth Diseases; Mucositis; Pain; Pain Management; Pharyngeal Diseases; Radiation Injuries
PubMed: 21905618
DOI: No ID Found -
BMC Cancer Sep 2021The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that informs clinical decisions regarding recurrence and overall survival in most...
BACKGROUND
The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that informs clinical decisions regarding recurrence and overall survival in most epithelial cancers. Radiotherapy for head and neck cancer leads to mucositis in almost all patients and severe radiation-mucositis affects their quality of life (QOL). However, little is known about the NLR for severe mucositis. Therefore, this study aimed to show the association between the NLR and severe radiation-induced mucositis in hypopharyngeal or laryngeal cancer patients.
METHODS
In this retrospective study, we determined the incidence of grade 3 mucositis in 99 patients who were receiving definitive radiotherapy or chemoradiotherapy (CRT) for hypopharyngeal or laryngeal cancer. We performed univariate and multivariate logistic regression analyses to investigate the characteristics of grade 3 mucositis. Kaplan-Meier curves and log-rank tests were used to evaluate the occurrence of grade 3 mucositis between two groups with high (NLR > 5) or low (NLR < 5) systemic inflammation.
RESULTS
The incidence of grade 3 mucositis was 39%. Univariate logistic regression analysis showed that the NLR (Odd ratio [OR] = 1.09; 95% confidence interval [CI] = 1.02-1.16; p = 0.016) and smoking (OR = 1.02; 95% CI = 1.00-1.03; p = 0.048) were significantly associated with grade 3 mucositis. Multivariate logistic regression analysis showed that the NLR was independently associated with grade 3 mucositis (OR = 1.09; 95% CI = 1.01-1.17; p = 0.021). Kaplan-Meier curves also showed that patients with higher NLR (NLR > 5) prior to radiotherapy developed grade 3 mucositis more frequently than those with lower NLR during radiotherapy (p = 0.045).
CONCLUSION
This study suggests that a higher NLR is a risk factor and predictor of severe radiation-induced mucositis in hypopharyngeal or laryngeal cancer patients.
Topics: Adult; Aged; Female; Humans; Hypopharyngeal Neoplasms; Kaplan-Meier Estimate; Laryngeal Diseases; Laryngeal Neoplasms; Leukocyte Count; Logistic Models; Lymphocyte Count; Lymphocytes; Male; Middle Aged; Mucositis; Neutrophils; Pharyngeal Diseases; Quality of Life; Radiation Injuries; Retrospective Studies; Smoking
PubMed: 34583669
DOI: 10.1186/s12885-021-08793-6 -
Pathogens and Disease Jun 2018Leishmania (Viannia) guyanensis is a causal agent of American tegumentary leishmaniasis (ATL). This protozoan has been poorly investigated; however, it can cause... (Review)
Review
Leishmania (Viannia) guyanensis is a causal agent of American tegumentary leishmaniasis (ATL). This protozoan has been poorly investigated; however, it can cause different clinical forms of ATL, ranging from a single cutaneous lesion to severe lesions that can lead to destruction of the nasopharyngeal mucosa. L. (V.) guyanensis and the disease caused by this species can present unique aspects revealing the need to better characterize this parasite species to improve our knowledge of the immunopathological mechanisms and treatment options for ATL. The mechanisms by which some patients develop a more severe form of ATL remain unclear. It is known that the host immune profile and parasite factors may influence the clinical manifestations of the disease. Besides intrinsic parasite factors, Leishmaniavirus RNA 1 (LRV1) infecting L. guyanensis can contribute to ATL immunopathogenesis. In this review, general aspects of L. guyanensis infection in humans and mouse models are presented.
Topics: Animals; Disease Models, Animal; Host-Parasite Interactions; Humans; Immunity, Innate; Interleukin-17; Leishmania guyanensis; Leishmaniasis, Cutaneous; Leishmaniavirus; Mice; Mucous Membrane; Nasopharynx; Severity of Illness Index
PubMed: 29722820
DOI: 10.1093/femspd/fty025 -
Expert Opinion on Emerging Drugs May 2006Oral mucositis is a common treatment-limiting side effect of cancer therapy that may have a significant impact on quality of life and on the cost of care. Oral mucositis... (Review)
Review
Oral mucositis is a common treatment-limiting side effect of cancer therapy that may have a significant impact on quality of life and on the cost of care. Oral mucositis is the most distressing complication of cancer therapy as reported by head and neck cancer patients, in patients receiving dose-dense myelosuppressive chemotherapy and in patients receiving haematopoietic stem cell transplant. Mucositis may increase the risk of local and systemic infection, particularly in myelosuppressed patients. Severe oral mucositis can lead to the need to interrupt or discontinue cancer therapy, and thus may impact cure of the primary disease. Current care of patients with mucositis is essentially palliative, and includes appropriate oral hygiene, nonirritating diet and oral care products, topical palliative mouth rinses, topical anaesthetics and use of systemic opioid analgesics. Emerging approaches for prevention and treatment of oral mucositis are developing based on an increasing understanding of the pathobiology of mucosal damage and repair. New interventions are expected to be administered based on the mechanisms of initiation, progression and resolution of the condition. The approval by the FDA of keratinocyte growth factor (palifermin; Amgen) in 2004 represents a new step in prevention of oral mucositis in stem cell transplant patients based on the increasing understanding of the pathogenesis of mucositis. Progress in the prevention and management of mucositis will improve quality of life, reduce cost of care and facilitate completion of more intensive cancer chemotherapy and radiotherapy protocols. Improved management of mucositis may allow implementation of cancer treatment protocols that are currently excessively mucotoxic, but have potentially higher cure rates of the malignant disease.
Topics: Antineoplastic Agents; Drugs, Investigational; Humans; Mouth; Mucositis; Neoplasms; Pharynx; Radiation-Protective Agents
PubMed: 16634706
DOI: 10.1517/14728214.11.2.353 -
Plastic and Reconstructive Surgery Feb 1975
Topics: Adult; Cleft Palate; Female; Humans; Male; Methods; Mucous Membrane; Nasopharynx; Pharynx; Suture Techniques
PubMed: 1090945
DOI: 10.1097/00006534-197502000-00003 -
Genesis (New York, N.Y. : 2000) Dec 2014As a group closely related to chordates, hemichordate acorn worms are in a key phylogenic position for addressing hypotheses of chordate origins. The stomochord of acorn... (Review)
Review
As a group closely related to chordates, hemichordate acorn worms are in a key phylogenic position for addressing hypotheses of chordate origins. The stomochord of acorn worms is an anterior outgrowth of the pharynx endoderm into the proboscis. In 1886 Bateson proposed homology of this organ to the chordate notochord, crowning this animal group "hemichordates." Although this proposal has been debated for over a century, the question still remains unresolved. Here we review recent progress related to this question. First, the developmental mode of the stomochord completely differs from that of the notochord. Second, comparison of expression profiles of genes including Brachyury, a key regulator of notochord formation in chordates, does not support the stomochord/notochord homology. Third, FoxE that is expressed in the stomochord-forming region in acorn worm juveniles is expressed in the club-shaped gland and in the endostyle of amphioxus, in the endostyle of ascidians, and in the thyroid gland of vertebrates. Based on these findings, together with the anterior endodermal location of the stomochord, we propose that the stomochord has evolutionary relatedness to chordate organs deriving from the anterior pharynx rather than to the notochord.
Topics: Animals; Biological Evolution; Chordata; Endoderm; Fetal Proteins; Forkhead Transcription Factors; Gastric Mucosa; Notochord; Pharynx; T-Box Domain Proteins
PubMed: 25303744
DOI: 10.1002/dvg.22831 -
European Archives of... Jul 2018Superiorly based posterior pharyngeal flap is performed via rotation of tissues of the posterior pharyngeal wall anteriorly and anchoring it to the soft palate....
BACKGROUND AND PURPOSE
Superiorly based posterior pharyngeal flap is performed via rotation of tissues of the posterior pharyngeal wall anteriorly and anchoring it to the soft palate. Unfortunately, bad healing of the donor site defect might be a considerable cause of morbidity of the surgery. With some modifications of flap elevation we could achieve better surgical outcomes. The aim of this study was to present the new modification of the conventional maneuver and its surgical/functional outcomes.
SUBJECTS AND METHODS
The study design is a case series. 17 patients underwent the de-mucosalized superiorly based pharyngeal flap for the treatment of velopharyngeal insufficiency. A wide laterally based (mucosa-only) flap was elevated off the submucosa of the posterior pharyngeal wall and then a superiorly based posterior pharyngeal flap (bared of its covering mucosa) was elevated and sutured to the palate. The mucosal flap was draped over the bed and sutured.
RESULTS
No significant complications as airway problems, infection and bleeding were reported. Also, the postoperative pain was tolerable and there were no reports of neck rigidity with early ambulation; VAS showed significant improvement. No patients showed flap dehiscence or palatal fistula. Speech assessment showed improvement.
CONCLUSION
The modified de-mucosalized, superiorly based pharyngeal flap technique ensured self-mucosal draping of the bed, thus it would enhance primary healing and decrease postoperative pain with the resultant early ambulation. We believe that the new modified technique could correct VPI, in addition to the improvement of patients' comfort and decrease the morbidity of the procedure.
Topics: Adolescent; Child; Child, Preschool; Cohort Studies; Female; Humans; Male; Palate, Soft; Pharynx; Surgical Flaps; Treatment Outcome; Velopharyngeal Insufficiency; Wound Healing
PubMed: 29804131
DOI: 10.1007/s00405-018-5018-0 -
Texas Dental Journal May 2010Effective pain control for mucositis requires constant attention and willingness on the part of managing clinicians to evaluate and adapt pain-relieving strategies...
Effective pain control for mucositis requires constant attention and willingness on the part of managing clinicians to evaluate and adapt pain-relieving strategies throughout the period of risk for oral mucositis. By utilizing the principles of an individualized, tiered approach to pain management that addresses the multidimensional components of a patient's pain, maximum comfort can be consistently provided while reducing the risk for side effects.
Topics: Analgesics, Opioid; Antineoplastic Agents; Cranial Irradiation; Facial Pain; Head and Neck Neoplasms; Humans; Mucositis; Oral Hygiene; Oropharynx; Preoperative Care; Stomatitis
PubMed: 20549993
DOI: No ID Found