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Frontiers in Immunology 2021Earlier evidence has proven that probiotic supplements can reduce concurrent chemoradiotherapy (CCRT)-induced oral mucositis (OM) in nasopharyngeal cancer (NPC). The... (Randomized Controlled Trial)
Randomized Controlled Trial
A Phase II Randomized Clinical Trial and Mechanistic Studies Using Improved Probiotics to Prevent Oral Mucositis Induced by Concurrent Radiotherapy and Chemotherapy in Nasopharyngeal Carcinoma.
Earlier evidence has proven that probiotic supplements can reduce concurrent chemoradiotherapy (CCRT)-induced oral mucositis (OM) in nasopharyngeal cancer (NPC). The incidence of severe OM (grade 3 or higher) was the primary endpoint in this study. We first enrolled 85 patients with locally advanced NPC who were undergoing CCRT. Of them, 77 patients were finally selected and randomized (1:1) to receive either a probiotic cocktail or placebo. To investigate the protective effects and the mechanism of probiotic cocktail treatment on OM induced by radiotherapy and chemotherapy, we randomly divided the rats into the control (C) group, the model (M) group, and the probiotic (P) group. After treatment, samples from the tongue, blood, and fecal and proximal colon tissues on various days (7th, 14th, and 21st days) were collected and tested for the inflammatory response, cell apoptosis, intestinal permeability, and intestinal microbial changes. We found that patients taking the probiotic cocktail showed significantly lower OM. The values of the incidence of 0, 1, 2, 3, and 4 grades of OM in the placebo group and in the probiotic cocktail group were reported to be 0, 14.7, 38.2, 32.4, and 14.7% and 13.9, 36.1, 25, 22.2, and 2.8%, respectively. Furthermore, patients in the probiotic cocktail group showed a decrease in the reduction rate of CD3 T cells (75.5% vs. 81%, < 0.01), CD4 T cells (64.53% vs. 79.53%, < 0.01), and CD8 T cells (75.59 vs. 62.36%, < 0.01) compared to the placebo group. In the rat model, the probiotic cocktail could ameliorate the severity of OM, decrease the inflammatory response, cause cell apoptosis and intestinal permeability, and restore the structure of gut microbiota to normalcy. In conclusion, the modified probiotic cocktail significantly reduces the severity of OM by enhancing the immune response of patients with NPC and modifying the structure of gut microbiota. The Clinical Trial Registration should be the NCT03112837.
Topics: Animals; Chemoradiotherapy; Disease Management; Disease Models, Animal; Disease Susceptibility; Duration of Therapy; Gastrointestinal Microbiome; Humans; Male; Metagenome; Metagenomics; Nasopharyngeal Neoplasms; Probiotics; Rats; Severity of Illness Index; Stomatitis; Treatment Outcome
PubMed: 33841399
DOI: 10.3389/fimmu.2021.618150 -
International Journal of Molecular... Oct 2022Oral mucositis is a common adverse effect of cancer therapy. Probiotics have been shown to exert anti-inflammatory and immunomodulatory effects. We performed a... (Meta-Analysis)
Meta-Analysis
Oral mucositis is a common adverse effect of cancer therapy. Probiotics have been shown to exert anti-inflammatory and immunomodulatory effects. We performed a meta-analysis of randomized controlled trials (RCTs) to investigate whether probiotics can prevent cancer therapy−induced oral mucositis. We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases for trials related to probiotics and oral mucositis published before September 2022; no language restrictions were applied. The primary outcome was the incidence of oral mucositis and severe oral mucositis. Secondary outcomes were the requirement for enteral nutrition during treatment, body weight loss, and decreased quality of life. The study has been registered in PROSPERO (number: CRD 42022302339). Eight RCTs, including 708 patients, were reviewed; however, a meta-analysis of only seven trials could be performed. Three trials using Lactobacilli-based probiotics reported that the incidence of oral mucositis in the probiotic group was significantly low (risk ratio [RR] = 0.84, 95% confidence interval [CI] = 0.77−0.93, p = 0.0004). Seven trials reported a significantly low incidence of severe oral mucositis in the probiotic group (RR = 0.65, 95% CI = 0.53−0.81, p < 0.0001). The requirement of enteral nutrition was significantly low in the probiotic group (odds ratio = 0.34, 95% CI: 0.13−0.92, p < 0.05). This study demonstrated the effectiveness of probiotics in the prevention and mitigation of cancer therapy−induced oral mucositis. We recommend the use of probiotics to prevent and treat oral mucositis during cancer therapy.
Topics: Humans; Probiotics; Stomatitis; Neoplasms; Lactobacillus; Enteral Nutrition
PubMed: 36362057
DOI: 10.3390/ijms232113268 -
Asian Pacific Journal of Cancer... Jul 2020To investigate the use of glutamine administered orally during Methotrexate chemotherapy to prevent oral mucositis and reduce hospital costs in children with acute... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the use of glutamine administered orally during Methotrexate chemotherapy to prevent oral mucositis and reduce hospital costs in children with acute lymphoblastic leukemia (ALL).
METHODS
Twenty-four children received oral glutamine (400 mg/kg body weight per day) and twenty four received placebo on days of chemotherapy administration and for at least 14 additional days. Oral mucositis was graded daily at each day of treatment till completion of therapy. The study groups were compared for the oral mucositis development using the WHO scale.
RESULTS
Oral mucositis occurred in 4.2 % of the glutamine group and 62.5% in the placebo group. The use of glutamine was directly associated with prevention of oral mucositis than placebo (OR 0,026; 95% CI: 0,003-0,228). The duration of length hospital stay was lower in the glutamine group than in the placebo group ((8 vs 12 days); p = 0,005). Hospital cost per day for glutamine group was 40 USD per day while placebo group was 48 USD per day.
CONCLUSIONS
There was significant difference in the prevention of oral mucositis by oral glutamine vs placebo. The hospital cost for glutamine supplementation was lower than control group.
Topics: Administration, Oral; Adolescent; Antineoplastic Combined Chemotherapy Protocols; Case-Control Studies; Child; Child, Preschool; Female; Follow-Up Studies; Glutamine; Hospital Costs; Humans; Infant; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prognosis; Stomatitis
PubMed: 32711440
DOI: 10.31557/APJCP.2020.21.7.2117 -
Medicina Oral, Patologia Oral Y Cirugia... Jan 2017Inflammatory papillary hyperplasia (IPH) is a benign lesion of the palatal mucosa. It is usually found in denture-wearers but also has been reported in patients without... (Review)
Review
INTRODUCTION
Inflammatory papillary hyperplasia (IPH) is a benign lesion of the palatal mucosa. It is usually found in denture-wearers but also has been reported in patients without a history of use of a maxillary prosthesis use.
OBJECTIVES
The aim of this study is to review the literature to assess the prevalence of denture stomatitis and inflammatory papillary hyperplasia and the etiological factors associated.
MATERIAL AND METHODS
A search was carried out in PubMed (January 2005 to October 2015) with the key words "inflammatory papillary hyperplasia", "denture stomatitis", "granular stomatitis" and "Newton's type III" The inclusion criteria were studies including at least a sample of 50 apparently healthy patients, articles published from 2005 to 2015 written in English. The exclusion criteria were reviews and non-human studies.
RESULTS
Out of the 190 studies obtained initially from the search 16 articles were selected to be included in our systematic review. The prevalence of denture stomatitis was 29.56% and 4.44% for IPH. We found 5 cases of denture stomatitis among non-denture-wearer individuals. All IPH cases were associated with the use of prosthesis. Smoking and continued use of ill-fitting dentures turned out to be the most frequent risk factors for developing IPH.
CONCLUSIONS
IPH is a rare oral lesion and its pathogenesis still remains unclear. Its presentation among non-denture-wearers is extremely unusual.
Topics: Humans; Hyperplasia; Mouth Mucosa; Palate; Prevalence; Stomatitis; Stomatitis, Denture
PubMed: 27918740
DOI: 10.4317/medoral.21405 -
Oral Surgery, Oral Medicine, Oral... Aug 2022
Topics: Antineoplastic Agents; Humans; Mouth Mucosa; Stomatitis
PubMed: 35165057
DOI: 10.1016/j.oooo.2021.12.001 -
BioMed Research International 2018Multitargeted tyrosine kinase inhibitors (TKIs) represent a new class of target-specific antineoplastic agents. These agents show some specific adverse events such as... (Review)
Review
BACKGROUND
Multitargeted tyrosine kinase inhibitors (TKIs) represent a new class of target-specific antineoplastic agents. These agents show some specific adverse events such as fatigue/asthenia, anorexia/loss of appetite, dysgeusia, diarrhea/abdominal pain, hypothyroidism, hypertension, myelosuppression, and stomatitis.
MATERIALS AND METHODS
A systematic search was performed on PubMed online database using a combination of MESH terms and free text words, "sunitinib" OR "sorafenib" OR "axitinib" OR "cabozantinib" OR "pazopanib" OR "regorafenib" OR "nintedanib" OR "vatalanib" combined through the use of Boolean operator AND with the key words "stomatitis" OR "mucositis," (i) on human subjects, (ii) written in the English language, and (iii) reporting about the incidence of stomatitis or oral mucositis.
RESULTS
The incidence of stomatitis of any grade was 35.2% for sunitinib, 20.52% for sorafenib, 20.63% for axitinib, and 34.21% for cabozantinib. All the agents showed high rates of low-grade stomatitis (G1-G2), while the onset of severe stomatitis (G3-G4) was very low.
CONCLUSIONS
Analysis of the reports with patients treated with sunitinib, sorafenib, axitinib, and cabozantinib showed a clear prevalence of stomatitis grade 1 or grade 2. These data differ from those of patients treated with conventional chemotherapy in which mucositis is predominantly of grade 3 or grade 4.
Topics: Antineoplastic Agents; Humans; Protein Kinase Inhibitors; Protein-Tyrosine Kinases; Stomatitis
PubMed: 29992147
DOI: 10.1155/2018/5035217 -
Indian Journal of Dental Research :... 2020Radiation-induced oral mucositis (RIOM) is considered the most severe non-haematological complication affecting almost every head and neck cancer patient during the... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Radiation-induced oral mucositis (RIOM) is considered the most severe non-haematological complication affecting almost every head and neck cancer patient during the course of radiotherapy (RT). Curcumin, a herbal agent present in Indian spice 'Turmeric' has anti-inflammatory, immunomodulation and wound healing properties. The objective of this pilot randomised controlled clinical trial was to compare the effectiveness and safety of 0.1% curcumin (freshly prepared using nanoparticles) and 0.15% benzydamine mouthwash on RIOM among 74 head and neck cancer patients scheduled to receive RT.
MATERIALS AND METHODS
Assessment of RIOM was carried out using WHO criteria once in a week for 6 weeks. Both modified intention to treat (MIT) and per protocol (PP) analysis were carried out to test the null hypothesis of equal effectiveness on prevention and severity of RIOM.
RESULTS
As far as the onset of RIOM is concerned, MIT analysis showed that the instantaneous risk of getting the onset of RIOM was 50% lower (hazard ratio 0.5) in curcumin. Onset of RIOM was also significantly delayed (mean = 19.56, median = 21) in the test group by 2 weeks. But in 'PP' analysis, no significant difference was observed between two preparations and almost all patients experienced the onset. Both the mouthwashes were equally effective in preventing the occurrence of severe form of RIOM in PP analysis after dichotomisation of severity score (≥3 and ≤2).
CONCLUSION
Though both the mouthwashes were not able to completely prevent the onset of RIOM and reduce the severity of RIOM, use of 0.1% curcumin mouthwash was able to significantly delay the onset of RIOM (Clinical trial registration no. CTRI/2018/04/013362).
Topics: Curcumin; Double-Blind Method; Head and Neck Neoplasms; Humans; Mouthwashes; Pilot Projects; Stomatitis
PubMed: 33433509
DOI: 10.4103/ijdr.IJDR_822_18 -
BMJ Case Reports Oct 2019
Topics: Adult; Biomarkers; Diagnosis, Differential; Humans; Male; Renal Insufficiency; Renal Replacement Therapy; Stomatitis; Tongue Diseases; Uremia
PubMed: 31628094
DOI: 10.1136/bcr-2019-231948 -
BMJ (Clinical Research Ed.) Dec 1990
Topics: Adhesives; Consumer Behavior; Dental Prophylaxis; Denture Design; Denture Identification Marking; Denture Retention; Denture, Complete, Immediate; Dentures; Humans; Stomatitis
PubMed: 2271830
DOI: 10.1136/bmj.301.6763.1265 -
Medicina Oral, Patologia Oral Y Cirugia... Sep 2022Oral mucositis (OM) is an important acute adverse effect of anticancer therapy. This condition presents high morbidity and may lead to the suspension of anticancer... (Review)
Review
BACKGROUND
Oral mucositis (OM) is an important acute adverse effect of anticancer therapy. This condition presents high morbidity and may lead to the suspension of anticancer therapy.
MATERIAL AND METHODS
We reviewed the literature on the pathobiology of OM and the properties of erythromycin (EM), to consider the possibility of its use for the prevention and treatment of OM. We searched the PubMed, Scopus and Web of Science databases and selected complete articles published in English or Spanish that met the inclusion criteria. The search terms "erythromycin", "inflammation", "immunomodulation" and "oral mucositis" were used.
RESULTS
The control of free radicals, transcription factors and pro-inflammatory cytokines has been considered as the key to the management of OM. EM has the ability to modulate oxidative stress, acts on the transcriptional system and inhibits the production of several cytokines that have been directly implicated in OM pathobiology.
CONCLUSIONS
The present review suggests that EM could be effective in the treatment of OM. Experimental studies investigating the use of EM in OM should be encouraged.
Topics: Cytokines; Erythromycin; Humans; Mucositis; Stomatitis
PubMed: 35717620
DOI: 10.4317/medoral.25439