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Targeted Oncology Jun 2024Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) remain the frontline standard of care for patients with EGFR-mutant non-small cell lung cancer....
BACKGROUND
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) remain the frontline standard of care for patients with EGFR-mutant non-small cell lung cancer. An updated toxicity profile of EGFR-TKIs proves valuable in guiding clinical decision making.
OBJECTIVE
This study comprehensively assessed the risk of EGFR-TKI-related adverse events (AEs) involving different systems/organs.
METHODS
We systematically searched PubMed, Embase, Web of Science, and Cochrane library for phase III randomized controlled trials comparing EGFR-TKI monotherapy with placebo or chemotherapy in patients with non-small cell lung cancer. The odds ratio (OR) of all-grade and high-grade adverse events (AEs) including dermatologic, gastrointestinal, hematologic, hepatic, and respiratory events was pooled for a meta-analysis. Subgroup analyses based on the control arm (placebo or chemotherapy) and individual EGFR-TKIs (erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib) were conducted.
RESULTS
Thirty-four randomized controlled trials comprising 15,887 patients were included. The pooled OR showed EGFR-TKIs were associated with a significantly increased risk of all-grade dermatologic AEs including paronychia, pruritus, rash, skin exfoliation, and skin fissures, gastrointestinal AEs including abdominal pain, diarrhea, dyspepsia, mouth ulceration, and stomatitis, hepatic AEs including elevated alanine aminotransferase and aspartate aminotransferase, and respiratory AEs including epistaxis, interstitial lung disease and rhinorrhea. Furthermore, a significantly increased risk of high-grade rash (OR 7.83, 95% confidence interval [CI] 5.11, 12.00), diarrhea (OR 2.10, 95% CI 1.44, 3.05), elevated alanine aminotransferase (OR 3.93, 95% CI 1.71, 9.03), elevated aspartate aminotransferase (OR 3.22, 95% CI 1.05, 9.92) and interstitial lung disease (OR 2.35, 95% CI 1.38, 4.01) was observed in patients receiving EGFR-TKIs. When stratified by individual EGFR-TKIs, gefitinib showed a significant association with all-grade and high-grade hepatotoxicity and interstitial lung disease.
CONCLUSIONS
Epidermal growth factor receptor tyrosine kinase inhibitors were associated with a significantly increased risk of various types of AEs. Clinicians should be vigilant about the risks of these EGFR-TKI-related AEs, particularly for severe hepatotoxicity and interstitial lung disease, to facilitate early detection and proper management.
PubMed: 38824269
DOI: 10.1007/s11523-024-01073-w -
Prognostic role of lymph node micrometastasis in oral and oropharyngeal cancer: A systematic review.Oral Oncology Jul 2024An estimated 20% of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC) have micrometastases (Mi) or isolated tumor cells (ITC) in the cervical lymph... (Review)
Review
BACKGROUND
An estimated 20% of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC) have micrometastases (Mi) or isolated tumor cells (ITC) in the cervical lymph nodes that evade detection by standard histological evaluation of lymph node sections. Lymph node Mi and ITC could be one reason for regional recurrence after neck dissection. The aim of this study was to review the existing data regarding the impact of Mi on the survival of patients with OOSCC.
METHODS
PubMed and the Cochrane Library were searched for articles reporting the impact of Mi and ITC on patient survival. Two authors independently assessed the methodological quality of retrieved studies using the Downs and Black index. Data were also extracted on study type, number of included patients, mode of histological analysis, statistical analysis, and prognostic impact.
RESULTS
Sixteen articles with a total of 2064 patients were included in the review. Among the 16 included studies, eight revealed a statistically significant impact of Mi on at least one endpoint in the Kaplan-Meier and/or multivariate analysis. Three studies regarded Mi as Ma, while five studies found no impact of Mi on survival. Only one study demonstrated an impact of ITC on patient's prognosis in the univariate but not in the multivariate analysis.
CONCLUSION
The majority of cases included in the review were patients with oral cancer. The findings provide low-certainty evidence that Mi negatively impacts survival. Data on ITC were scarcer, so no conclusions can be drawn about their effect on survival. The lower threshold to discriminate between Mi and ITC should be defined for OOSCC since the existing thresholds are based on data from different tumors. The histological, immunohistological, and anatomical characteristics of Mi and ITC in OOSCC as well as the effect of radiotherapy on Mi should be further investigated separately for oral and oropharyngeal carcinomas.
Topics: Humans; Oropharyngeal Neoplasms; Mouth Neoplasms; Prognosis; Neoplasm Micrometastasis; Lymphatic Metastasis; Lymph Nodes; Carcinoma, Squamous Cell
PubMed: 38823172
DOI: 10.1016/j.oraloncology.2024.106808 -
The Journal of Evidence-based Dental... Jun 2024The extraction of third molars is one of the most performed surgical procedures in oral and maxillofacial surgery. Pain, oedema, and trismus are the most frequently... (Meta-Analysis)
Meta-Analysis Review
IS THE PHOTOBIOMODULATION THERAPY EFFECTIVE IN CONTROLLING POST-SURGICAL SIDE EFFECTS AFTER THE EXTRACTION OF MANDIBULAR THIRD MOLARS? A SYSTEMATIC REVIEW AND META-ANALYSIS.
OBJECTIVES
The extraction of third molars is one of the most performed surgical procedures in oral and maxillofacial surgery. Pain, oedema, and trismus are the most frequently complications related in the surgical postoperative period. The literature has indicated PBM as a potential adjuvant method to reduce these complications. The aim of this review and meta-analysis is evaluate the PBM, as an optimal method to improve patient experience and minimize postoperative morbidity. Additionally, we seek to determine which wavelength, site, and frequency of application are most effective.
METHODS
This review was registered in PROSPERO (CRD42023429966) and followed PRISMA guidelines. The search was carried out in the main databases, PubMed/MEDLINE, Cochrane Library, Embase, Scopus, and Lilacs, including reviews in the most important journals in the area of oral surgery and laser applied to oral surgery. In addition, all article references and also gray literature were reviewed. After the studies selection, the relevant data was collected. All the studies were randomized controlled trials and the patients were allocated into two groups: active PBM and inactive PBM. The statistical analysis was carried out using Stata v.16, and the methodological quality and risk of bias were assessed by the Jadad scale and RoB 2.0, respectively.
RESULTS
Where included 22 studies and 989 subjects, to all with a minimum follow-up of 7 days. Pain and oedema showed statistically significant results in favor to the active PBM group. Especially when laser applied in infrared mode, for pain and oedema at 48 h, MD = -1.80 (CI95% -2.88, -0.72) I² = 92.13% and MD = -1.45 (CI95% -2.42, -0.48) I² = 65.01%, respectively. The same is not true for trismus at 48 h, MD = 0.07 (CI95% -0.06, 0.21) I² = 3.26%. The meta-analysis also presented results in respect of laser site of application and number of PBM sessions.
CONCLUSIONS
PBM with infrared laser, in a combination intraoral and extraoral application, in one session in the immediate postoperative period, has been shown to be effective to achieve the objectives of reducing pain and oedema after third molar extraction.
Topics: Humans; Molar, Third; Tooth Extraction; Low-Level Light Therapy; Pain, Postoperative; Edema; Postoperative Complications; Mandible; Trismus
PubMed: 38821660
DOI: 10.1016/j.jebdp.2024.101983 -
The Journal of Evidence-based Dental... Jun 2024Despite phototherapy (in the form of photodynamic therapy (PDT)-mediated oxidative stress) being utilized in the management of oral potentially malignant disorders... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Despite phototherapy (in the form of photodynamic therapy (PDT)-mediated oxidative stress) being utilized in the management of oral potentially malignant disorders (OPMDs), the evidence of certainty remains unclear. Hence, this systematic review and meta-analysis (PROSPERO # CRD42021218748) is aimed to evaluate the clinical efficacy of PDT-induced oxidative stress in OPMDs METHODS: PubMed, Embase, Web of Science, Scopus, and Cochrane Library databases were searched without restriction of language or year of publication. In addition, gray literature was searched and a manual search was performed. Two independent reviewers screened all the studies, assessing data extraction, risk of bias and certainty of evidence. A narrative synthesis was carried out. For the meta-analysis, random effects were considered to determine the prevalence of a total and a partial remission (PR) of oral potentially malignant disorders (OPMDs). The certainty of evidence was explored using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
RESULTS
Twenty-three studies were included in the qualitative and quantitative syntheses. A total of 880 patients were included (564 males; 218 females) with an age range between 24 and 89-years-old. The results showed the prevalence of the total and partial remissions respectively for the following OPMLs: actinic cheilitis (AC): 69.9% and 2.4%; oral leukoplakia (OL): 44% and 36.9%; oral verrucous hyperplasia (OVH): 98.5%; oral erythroleukoplakia (OEL): 92.1% and 7.9%. The prevalence of no remission of OL was 18.8%.
CONCLUSIONS
PDT demonstrated significant results in clinical remission of OPMDs and most of the eligible studies have shown a total or a partial remission of the included lesions, but at a low or a very low certainty of evidence. Hence, further clinical studies with robust methodology are warranted to offer further validated data. Also, further evidence is required to understand further the mechanism of PDT-induced oxidative stress.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Cheilitis; Mouth Neoplasms; Oxidative Stress; Photochemotherapy; Photosensitizing Agents; Precancerous Conditions; Treatment Outcome; Adult; Middle Aged
PubMed: 38821659
DOI: 10.1016/j.jebdp.2023.101899 -
Journal of Endodontics May 2024Automated segmentation of three-dimensional pulp space on cone-beam computed tomography (CBCT) images presents a significant opportunity for enhancing diagnosis,... (Review)
Review
INTRODUCTION
Automated segmentation of three-dimensional pulp space on cone-beam computed tomography (CBCT) images presents a significant opportunity for enhancing diagnosis, treatment planning, and clinical education in endodontics. The aim of this systematic review was to investigate the performance of AI-driven automated pulp space segmentation on CBCT images.
METHODS
A comprehensive electronic search was performed using PubMed, Web of Science, and Cochrane databases, up until February 2024. Two independent reviewers participated in the selection of studies, data extraction, and evaluation of the included studies. Any disagreements were resolved by a third reviewer. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the risk of bias.
RESULTS
Thirteen studies that met the eligibility criteria were included. Most studies demonstrated high accuracy in their respective segmentation methods, although there was some variation across different structures (pulp chamber, root canal) and tooth types (single-rooted, multi-rooted). Automated segmentation showed slightly superior performance for segmenting the pulp chamber compared to the root canal and single-rooted teeth compared to multi-rooted ones. Furthermore, second mesiobuccal (MB2) canal segmentation also demonstrated high performance. In terms of time efficiency, the minimum time required for segmentation was 13 seconds.
CONCLUSION
AI-driven models demonstrated outstanding performance in pulp space segmentation. Nevertheless, these findings warrant careful interpretation, and their generalizability is limited due to the potential risk and low evidence level arising from inadequately detailed methodologies and inconsistent assessment techniques. In addition, there is room for further improvement, specifically for root canal segmentation and testing of AI performance in artifact-induced images.
PubMed: 38821262
DOI: 10.1016/j.joen.2024.05.012 -
International Journal of Implant... May 2024The rise of stereolithographic surgical guides and digital workflow, combined with a better knowledge of materials and loading principle, has enabled the placement of... (Review)
Review
PURPOSE
The rise of stereolithographic surgical guides and digital workflow, combined with a better knowledge of materials and loading principle, has enabled the placement of the temporary prosthesis at the time of implant placement. This scoping review aimed to assess the current knowledge available on stackable guides.
METHODS
The review focused on fully edentulous or requiring total edentulism patients. The procedure studied was the use of stackable guides for edentulous patients in order to place immediate temporary prostheses. The clinical endpoint was immediate placement of the provisional prosthesis after surgery combined with a prior bone reduction using a stackable guide.
RESULTS
12 case reports or case series articles met inclusion criteria, which did not allow an analysis by a systematic review. The included studies were case reports or case series. Most of the articles showed a base stabilized by 3 or 4 bone-pins, anchored in buccal or lingual part. Regarding the accuracy of bone reduction (ranged from 0.0248 mm to 1.98 mm) and implant placement when compared to planned, only 4 articles reported quantitative data. 11 articles showed an immediate loading with the transitional prosthesis after implant placement.
CONCLUSIONS
There are as yet no prospective or comparative studies on the efficiency of this technique. In a reliable way, stackable guides seem to be able to guide the practitioner from the flap elevation to the placement of the temporary screw-retained implant supported prosthesis. Given the lack of studies in this specific field of guided surgery, further studies are needed to confirm the clinical relevance of this technique.
Topics: Humans; Dental Implantation, Endosseous; Surgery, Computer-Assisted; Immediate Dental Implant Loading; Mouth, Edentulous
PubMed: 38819752
DOI: 10.1186/s40729-024-00547-w -
Asian Pacific Journal of Cancer... May 2024To systematically review the existing scientific literature in providing a comprehensive, quantitative analysis on the prognostic ability of Cancer Associated... (Meta-Analysis)
Meta-Analysis
AIM
To systematically review the existing scientific literature in providing a comprehensive, quantitative analysis on the prognostic ability of Cancer Associated Fibroblasts (CAFs) in Oral Squamous Cell Carcinoma (OSCC) a novel meta-analysis.
METHODS
Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO - CRD CRD42023467899. Electronic databases were searched for studies having data on effect of CAFs on overall survival rate and disease prognosis in patients with OSCC, oral epithelial dysplasia (OED) compared to normal healthy controls. Quality assessment of included was evaluated through Newcastle Ottawa scale (NOS) for included studies through its domains. The hazard ratio (HR) and risk ratio (RR) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant.
RESULTS
Twenty studies fulfilled the eligibility criteria and were included in qualitative synthesis and eighteen studies for meta -analysis. Included studies had moderate to low risk of bias. It was observed through the pooled estimate that overall survival rate - (HR) =2.30 (1.71 - 3.10) was lesser in group with high CAFs compared to low CAFs while pooled estimate through RR =1.53 (0.73 - 3.19) and RR = 5.72 (2.40 - 13.59) signified that overall survival rate was lower n OSCC patients with high CAF compared to patients with OED and healthy controls. Publication bias through the funnel plot showed asymmetric distribution with presence of systematic heterogeneity indicating presence of publication bias.
CONCLUSION
Abundance of CAFs in tumor stroma of OSCC patients is associated with overall poor survival rate and poor disease prognosis. CAFs acts as a good prognostic and therapeutic marker in disease progression and advancements and should be assessed early to reduce patient's mortality and morbidity.
Topics: Humans; Mouth Neoplasms; Prognosis; Myofibroblasts; Carcinoma, Squamous Cell; Survival Rate; Biomarkers, Tumor
PubMed: 38809619
DOI: 10.31557/APJCP.2024.25.5.1477 -
PloS One 2024This review aimed to chart the landscape of literature concerning the precise applications of traditional medicine in managing specific oral diseases and, in doing so,...
BACKGROUND
This review aimed to chart the landscape of literature concerning the precise applications of traditional medicine in managing specific oral diseases and, in doing so, to pinpoint knowledge gaps surrounding the use of traditional medicine for oral disease management in the African context.
METHODS
A systematic search of the literature was conducted on PubMed, Web of Science, Scopus, and CINAHL. The search was conducted from the inception of the database till September 2023. A search of related citations and references was also carried out. Only English language publications were included. A summary of studies that met the inclusion criteria was conducted.
RESULTS
Of the 584 records identified, 11 were duplicates and 12 studies, published between 2006 and 2021, met the inclusion criteria. The studies were published from eight countries located in the five sub-regions on the continent. All the studies were either experimental designs or ethnobotanical surveys and they all utilized plant-based remedies. The five experimental studies aimed to assess the impact of whole plants or plant extracts on the three microorganisms responsible for dental caries and seven responsible for periodontal diseases. The number of plant species identified by the seven ethnobotanical surveys ranged from 29 to 62 while the number of plan families ranged from 15 to 29. The remedies were either topical applied, use as mouth rinses, gargled, or chewed. The systemic routes of administration identified were inhalation and drinking. The remedies were used for the treatment of hard such as dental caries and tooth sensitivity, to soft tissue lesions such as mouth ulcers, gingival bleeding, and mouth thrush. Other oral disorders managed include halitosis, jaw fracture, and oral cancer.
CONCLUSIONS
Given the increasing prevalence of oral diseases within the region, the shortage of oral healthcare professionals and limited access to financial resources, it becomes imperative to support the generation of empirical evidence to enhance the provision of traditional medicine for oral healthcare in Africa.
Topics: Humans; Africa; Dental Caries; Ethnobotany; Medicine, African Traditional; Medicine, Traditional; Mouth Diseases; Oral Health; Periodontal Diseases; Phytotherapy
PubMed: 38805486
DOI: 10.1371/journal.pone.0297570 -
Medicina (Kaunas, Lithuania) Apr 2024The oral cavity is a habitat to a diverse range of organisms that make up an essential element of the human microbiota. There are up to 1000 species of micro-organisms... (Meta-Analysis)
Meta-Analysis Review
The oral cavity is a habitat to a diverse range of organisms that make up an essential element of the human microbiota. There are up to 1000 species of micro-organisms capable of colonizing the mouth. Thirty percent of them are uncultivable. The genus Entamoeba includes several species, out of which at least seven of them are able to inhabit the human body (, , , , , , ). It was shown that only is able to colonize the oral cavity. The aim of this study was to evaluate the association and prevalence of in periodontal disease using two electronic database search engines. In order to have a broader view of the subject, a comprehensive manual search was conducted between 15th February 2023 and 1 April 2023 on these content aggregators and the initial search resulted in 277 articles using the keywords "", "periodontitis", "", "periodontal disease", "prevalence", and "incidence", in different combinations. The results showed that 755 patients were infected with out of a total number of 1729 patients diagnosed with periodontal disease, indicating a global prevalence of 43% in the set of patients analyzed. was prevalent in 58% of the patients that had gingivitis and in 44% of the patients with periodontitis. Prevalence of based on gender was 43% in female patients and 47% in male patients. The results indicate that the higher incidence of in people with periodontal disease compared to healthy people is more than just a sign of the disease; it could also be linked to the severity of the condition and the disease propensity to progress.
Topics: Humans; Entamoeba; Periodontal Diseases; Entamoebiasis; Prevalence; Female; Male
PubMed: 38792919
DOI: 10.3390/medicina60050736 -
Archives of Dermatological Research May 2024The use of botulinum toxin for off-label indications has become more prevalent, but the specific benefits in Mohs micrographic surgery (MMS) have not yet been fully... (Review)
Review
The use of botulinum toxin for off-label indications has become more prevalent, but the specific benefits in Mohs micrographic surgery (MMS) have not yet been fully elucidated. A systematic review was performed of PubMed, Cochrane, EMBASE, and Scopus databases to identify all articles describing the use of botulinum toxin in MMS. Analysis was subdivided into scar minimization, parotid injury, and pain management. A total of nine articles were included. Scar minimization and treatment of parotid injury were the most reported uses. One case reported the use of botulinum toxin for pain management. Off label uses of botulinum toxin are being explored. Additional research is warranted to determine the efficacy and utility of botulinum toxin in MMS.
Topics: Humans; Mohs Surgery; Off-Label Use; Cicatrix; Skin Neoplasms; Botulinum Toxins, Type A; Botulinum Toxins; Pain Management; Parotid Gland
PubMed: 38787406
DOI: 10.1007/s00403-024-02904-6