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International Journal of Radiation... Aug 2012One of the worst radiation-induced acute effects in treating head-and-neck (HN) cancer is grade 3 or higher acute (oral and pharyngeal) mucosal toxicity (AMT), caused by... (Review)
Review
PURPOSE
One of the worst radiation-induced acute effects in treating head-and-neck (HN) cancer is grade 3 or higher acute (oral and pharyngeal) mucosal toxicity (AMT), caused by the killing/depletion of mucosa cells. Here we aim to testing a predictive model of the AMT in HN cancer patients receiving different radiotherapy schedules.
METHODS AND MATERIALS
Various radiotherapeutic schedules have been reviewed and classified as tolerable or intolerable based on AMT severity. A modified normal tissue complication probability (NTCP) model has been investigated to describe AMT data in radiotherapy regimens, both conventional and altered in dose and overall treatment time (OTT). We tested the hypothesis that such a model could also be applied to identify intolerable treatment and to predict AMT. This AMT NTCP model has been compared with other published predictive models to identify schedules that are either tolerable or intolerable. The area under the curve (AUC) was calculated for all models, assuming treatment tolerance as the gold standard. The correlation between AMT and the predicted toxicity rate was assessed by a Pearson correlation test.
RESULTS
The AMT NTCP model was able to distinguish between acceptable and intolerable schedules among the data available for the study (AUC = 0.84, 95% confidence interval = 0.75-0.92). In the equivalent dose at 2 Gy/fraction (EQD2) vs OTT space, the proposed model shows a trend similar to that of models proposed by other authors, but was superior in detecting some intolerable schedules. Moreover, it was able to predict the incidence of ≥G3 AMT.
CONCLUSION
The proposed model is able to predict ≥G3 AMT after HN cancer radiotherapy, and could be useful for designing altered/hypofractionated schedules to reduce the incidence of AMT.
Topics: Acute Disease; Area Under Curve; Dose Fractionation, Radiation; Head and Neck Neoplasms; Humans; Models, Biological; Mouth Mucosa; Mucositis; Organs at Risk; Pharynx; Radiation Injuries; Radiation Tolerance
PubMed: 22578541
DOI: 10.1016/j.ijrobp.2012.02.004 -
Minerva Anestesiologica Nov 2013
Topics: Aged, 80 and over; Female; Humans; Intubation; Larynx; Mucous Membrane; Pharynx; Subcutaneous Emphysema
PubMed: 23719653
DOI: No ID Found -
The Journal of Allergy and Clinical... Jul 1997In sinusitis bronchoconstriction is supposed to originate from pharyngobronchial reflexes triggered by seeding of the inflammatory process into the pharynx. (Clinical Trial)
Clinical Trial
BACKGROUND
In sinusitis bronchoconstriction is supposed to originate from pharyngobronchial reflexes triggered by seeding of the inflammatory process into the pharynx.
OBJECTIVE
Our aim was to evaluate whether in sinusitis bronchial and extrathoracic airway (EA) dysfunction correlate with morphologic abnormalities of the pharyngeal mucosa.
METHODS
We performed histamine inhalation challenge, nasal lavage, and nasopharyngeal biopsies in 24 nonasthmatic patients with exacerbation of chronic sinusitis. The histamine PC20 was the threshold of bronchial responsiveness, and that causing 25% fall in maximal midinspiratory flow was the threshold of EA responsiveness (PC25MIF50). Thresholds of 8 mg/ml or less were assumed to indicate bronchial hyperresponsiveness (BHR) or EA hyperresponsiveness (EAHR). PC20 and PC25MIF50 values were related to clinical data, nasal lavage fluid eosinophils, pharyngeal epithelium and basement membrane thickness, and density of submucosal vessels and nervous fibers.
RESULTS
The PC20 was closely related to PC25MIF50 (p = 0.0004). Ten patients had EAHR, 9 had combined EAHR and BHR, and 5 had neither EAHR nor BHR. EAHR was strongly associated with epithelial thinning, and BHR with long-standing sinusitis, a lower PC25MIF50, increased submucosal nerve density and increased nasal lavage fluid eosinophils.
CONCLUSIONS
Our findings suggest that in nonasthmatic patients with sinusitis, pharyngeal damage may contribute to airway dysfunction by favoring the access of irritants to submucosal nerve endings, with activation of constrictive reflexes to the EA. Proliferation of sensory neurons, consequent to long-lasting pharyngeal inflammation, may cause more severe EA narrowing and activate pharyngobronchial reflexes.
Topics: Adult; Bronchial Hyperreactivity; Female; Humans; Male; Middle Aged; Mucous Membrane; Nasopharynx; Pharynx; Regression Analysis; Sinusitis; Therapeutic Irrigation
PubMed: 9257787
DOI: 10.1016/s0091-6749(97)70194-5 -
Bacteriological Reviews Sep 1972
Review
Topics: Animals; Cells, Cultured; Chick Embryo; Cytopathogenic Effect, Viral; Disease Models, Animal; Humans; Mononuclear Phagocyte System; Mucous Membrane; Organ Culture Techniques; Organ Specificity; Pharynx; Species Specificity; Virulence; Virus Diseases; Virus Replication; Viruses
PubMed: 4565236
DOI: 10.1128/br.36.3.291-310.1972 -
American Journal of Otolaryngology 2017Mucosal melanoma of the palatine tonsil is extremely rare. Due to its poor prognosis, primary tonsillar melanoma requires prompt recognition and treatment. (Review)
Review
BACKGROUND
Mucosal melanoma of the palatine tonsil is extremely rare. Due to its poor prognosis, primary tonsillar melanoma requires prompt recognition and treatment.
METHODS
A 62-year-old female presented with a deeply pigmented and exophytic lesion in the left tonsillar fossa. The patient underwent a partial pharyngectomy through a midline labio-mandibulotomy approach along with a left level I-V neck dissection. Reconstruction with a left radial forearm free flap and a pharyngeal constrictor advancement pharyngoplasty was performed.
RESULTS
The patient remains free of disease at eight months after adjuvant proton therapy and eleven months after surgery. To our knowledge, less than thirty cases have been either reported or referenced in the literature since the early 1900's. This report is the first in English literature to compile all reported cases of primary tonsillar melanoma.
CONCLUSION
Currently, evidence suggests that mucosal melanoma in the palatine tonsil should be treated in the same fashion as other head and neck mucosal melanomas, mindful of the high rates at which locoregional and distant metastases occur.
Topics: Female; Humans; Melanoma; Middle Aged; Mucous Membrane; Palatine Tonsil; Tonsillar Neoplasms; Tonsillectomy
PubMed: 28449824
DOI: 10.1016/j.amjoto.2017.04.010 -
Oncology Reports Jan 2015The incidence of severe mucositis in the oral cavity, pharynx and larynx is high among patients with head and neck cancer (HNC) receiving chemoradiotherapy (CRT),... (Randomized Controlled Trial)
Randomized Controlled Trial
L-glutamine decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: a double-blind, randomized, placebo-controlled trial.
The incidence of severe mucositis in the oral cavity, pharynx and larynx is high among patients with head and neck cancer (HNC) receiving chemoradiotherapy (CRT), resulting in significant pain and impairment of quality of life. The present study investigated whether L-glutamine (glutamine) decreases the severity of mucositis in the oral cavity, pharynx and larynx induced by CRT. This double-blind, randomized, placebo-controlled trial included 40 untreated patients with squamous cell carcinoma of the nasopharynx, oropharynx, hypopharynx or larynx. Patients received 66 or 70 Gy of total radiation at the rate of 2 Gy/fraction daily and 5 fractions/week. Cisplatin (20 mg/m2) and docetaxel (10 mg/m2) were intravenously co-administered once a week for 6 weeks. Patients were randomized to orally receive either glutamine (group G) or placebo (group P) at a dose of 10 g 3 times a day throughout the CRT course. Mucositis was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. The primary end point was mucositis severity. Mucositis developed in all patients. A maximal mucositis grade of G4 was observed in 0 and 25% group G and P patients, respectively, while that of G2 was observed in 10 and 0% group G and P patients, respectively (p=0.023). Glutamine significantly decreased the maximal mucositis grade (group G, 2.9±0.3; group P, 3.3±0.4; p=0.005) and pain score at weeks 4, 5 and 6. Glutamine significantly decreased mucositis severity in the oral cavity, pharynx and larynx induced by CRT in patients with HNC.
Topics: Adult; Aged; Carcinoma, Squamous Cell; Chemoradiotherapy; Double-Blind Method; Female; Glutamine; Head and Neck Neoplasms; Humans; Male; Middle Aged; Mucositis; Quality of Life; Treatment Outcome
PubMed: 25351453
DOI: 10.3892/or.2014.3564 -
JCO Oncology Practice Feb 2020On June 10, 2019, the US Food and Drug Administration approved pembrolizumab for first-line treatment of metastatic or unresectable human papillomavirus (HPV)-positive...
Management of Immune-Related Dermatitis and Mucositis Associated With Pembrolizumab in Metastatic Human Papillomavirus-Associated Squamous Cell Carcinoma of the Oropharynx.
On June 10, 2019, the US Food and Drug Administration approved pembrolizumab for first-line treatment of metastatic or unresectable human papillomavirus (HPV)-positive and HPV-negative recurrent head and neck squamous cell carcinoma (HNSCC) based on the KEYNOTE-048 phase III study. Pembrolizumab is now the first anti-programmed cell death protein 1 (PD-1) therapy approved in the first-line HNSCC setting. Pembrolizumab is approved as first-line monotherapy for tumors that express programmed death-ligand 1 (PD-L1) or in combination with chemotherapy regardless of PD-L1 expression. As the indications for immunotherapy for HNSCC broaden, practitioners will need to know how to recognize and manage more immunotherapy-related toxicities. The following case study provides insight into the assessment and management of the specific immune-related toxicities of dermatitis and mucositis associated with pembrolizumab-chemotherapy combination therapy using Immuno-Oncology Essentials guidance. Assessment and early management of immunotherapy toxicity is critical, as is a multidisciplinary approach.
Topics: Alphapapillomavirus; Antibodies, Monoclonal, Humanized; Carcinoma, Squamous Cell; Dermatitis; Head and Neck Neoplasms; Humans; Mucositis; Neoplasm Recurrence, Local; Oropharynx; Papillomaviridae
PubMed: 32045535
DOI: 10.1200/JOP.19.00648 -
Anesthesia and Analgesia Dec 1998We measured pharyngeal mucosal pressures at six different locations on the laryngeal mask airway (LMA) and tested the hypothesis that the efficacy of the seal is not... (Comparative Study)
Comparative Study
UNLABELLED
We measured pharyngeal mucosal pressures at six different locations on the laryngeal mask airway (LMA) and tested the hypothesis that the efficacy of the seal is not related to pharyngeal mucosal pressure. Twenty anesthetized, paralyzed adult patients were studied. Microchip sensors were attached to the size 5 LMA at locations corresponding to the lateral and posterior pharynx, the hypopharynx, the pyriform fossa, the base of tongue, and the oropharynx. Mucosal pressures and airway sealing pressures were recorded during inflation of the cuff from 0 to 40 mL in 10-mL increments. The highest mean mucosal pressure was in the oropharynx (26 cm H2O), and the lowest was in the posterior pharynx (2 cm H2O). Mucosal pressures increased with increasing intracuff pressure and cuff volume, but the rate of increase varied among locations. Airway sealing pressure increased with increasing intracuff volume from 0 to 10 mL (P < 0.0001) and 10 to 20 mL (P = 0.0001), was unchanged from 20 to 30 mL, and decreased from 30 to 40 mL (P = 0.005). The airway sealing pressure was higher than pharyngeal mucosal pressure until the intracuff volume was > or =30 mL. There was no correlation between mucosal pressures and airway sealing pressure at any location. We conclude that the efficacy of the seal is not related to pharyngeal mucosal pressure. Pharyngeal mucosal pressures are generally lower than those considered safe for the tracheal mucosa during prolonged intubation.
IMPLICATIONS
We measured pharyngeal mucosal pressures at six different locations on the laryngeal mask airway and showed that the efficacy of the seal is not related to pharyngeal mucosal pressure. Pharyngeal mucosal pressures are generally lower than those considered safe for the tracheal mucosa during prolonged intubation.
Topics: Adult; Aged; Anesthesia; Female; Humans; Laryngeal Masks; Male; Middle Aged; Mucous Membrane; Pharynx; Pressure
PubMed: 9842832
DOI: 10.1097/00000539-199812000-00032 -
Laryngo- Rhino- Otologie May 2009The existing therapeutical options for the tracheal and pharyngeal reconstruction by use of implant materials are described. Inspite of a multitude of options and the... (Review)
Review
The existing therapeutical options for the tracheal and pharyngeal reconstruction by use of implant materials are described. Inspite of a multitude of options and the availability of very different materials none of these methods applied for tracheal reconstruction were successfully introduced into the clinical routine. Essential problems are insufficiencies of anastomoses, stenoses, lack of mucociliary clearance and vascularisation. The advances in Tissue Engineering (TE) offer new therapeutical options also in the field of the reconstructive surgery of the trachea. In pharyngeal reconstruction far reaching developments cannot be recognized at the moment which would allow to give a prognosis of their success in clinical application. A new polymeric implant material consisting of multiblock copolymers was applied in our own work which was regarded as a promising material for the reconstruction of the upper aerodigestive tract (ADT) due to its physicochemical characteristics. In order to test this material for applications in the ADT under extreme chemical, enzymatical, bacterial and mechanical conditions we applied it for the reconstruction of a complete defect of the gastric wall in an animal model. In none of the animals tested either gastrointestinal complications or negative systemic events occurred, however, there was a multilayered regeneration of the gastric wall implying a regular structured mucosa. In future the advanced stem cell technology will allow further progress in the reconstruction of different kind of tissues also in the field of head and neck surgery following the principles of Tissue Engineering.
Topics: Animals; Biocompatible Materials; Disease Models, Animal; Gastric Mucosa; Humans; Pharynx; Polymers; Prosthesis Implantation; Regeneration; Respiratory Mucosa; Stem Cell Transplantation; Swine; Tissue Engineering; Tissue Scaffolds; Trachea
PubMed: 19353460
DOI: 10.1055/s-0028-1119566 -
Advances in Oto-rhino-laryngology 1992
Review
Topics: Animals; Antibodies, Viral; Herpesvirus 4, Human; Humans; Lymphocyte Transfusion; Mice; Mice, SCID; Mucous Membrane; Palatine Tonsil; Respiratory Syncytial Viruses
PubMed: 1333724
DOI: 10.1159/000421722