Mucositis en pacientes portadores de cáncer de cabeza y cuello sometidos a radioquimioterapia

The objective of present study was to classify oral mucositis according to the Common Toxicity Criterion (CTC) international parameters in head and neck tumor patients simultaneously treated with radio and chemotherapy, and characterize a patient profile in our area, observing the individuals' habits, tumor characteristics, treatment protocol and acute reaction intensity. Fifty patients undergoing simultaneous 66 to 70 Gy megavoltage radiotherapy and cisplatin/carboplatin chemotherapy were evaluated in this study. Weekly evaluations of the degree of mucositis were perfoemed according to CTC, a four-degree ordinal scale; 36% of all patients and 100% of those with diabetes discontinued treatment due to mucositis, showing that this pathology contributes to the severity of mucositis.El trabajo objetivó clasificar el grado de Mucositis oral de acuerdo a parámetros internacionales del CTC en pacientes portadores de tumores de cabeza y cuello sometidos a radioterapia y quimioterapia concomitantes, y caracterizar un perfil de pacientes en nuestro medio, verificando hábitos de los individuos, características del tumor, protocolo de tratamiento e intensidad de esta reacción aguda. Fueron evaluados 50 pacientes sometidos a radioterapia en megavoltaje con dosis entre 66 y 70 G y quimioterapia con cisplatino o carboplatino concomitante. Se evaluó semanalmente el grado de Mucositis según el Common Toxicity Criterio - CTC, una escala ordinal que presenta cuatro grados. Se observó interrupción del tratamiento por Mucositis en 36% del total de pacientes y en 100% de los pacientes diabéticos, lo que nos permite verificar que dicha patología potencia la gravedad de la mucositis.O objetivo do presente trabalho é classificar o grau de mucosite oral de acordo com os parâmetros internacionais do Common Toxicity Criterion (CTC) em pacientes portadores de tumor de cabeça e pescoço submetidos à radioterapia e quimioterapia concomitantes, e caracterizar um perfil dos pacientes em nosso meio, verificando os hábitos dos indivíduos, as características do tumor, o protocolo de tratamento e a intensidade desta reação aguda. Neste estudo foram avaliados 50 pacientes, submetidos à radioterapia em megavoltagem com doses entre 66 a 70 Gy e quimioterapia com cisplatina ou carboplatina concomitante. Semanalmente foi avaliado o grau de mucosite de acordo com o CTC, uma escala ordinal que apresenta 4 graus. Observou-se interrupção do tratamento por mucosite em 36% do total de pacientes e em 100% dos pacientes diabéticos, o que nos permitiu verificar que esta patologia contribui para a gravidade da mucosite.Universidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de Oncologia Programa de Pós-Graduação em RadioterapiaUniversidade Federal de São Paulo (UNIFESP) Departamento de Oncologia Setor de RadioterapiaUniversidade Federal de São Paulo (UNIFESP) Departamento de Oncologia Laboratório de Radioterapia ExperimentalUNIFESP, Depto. de Oncologia Programa de Pós-Graduação em RadioterapiaUNIFESP, Depto. de Oncologia Setor de RadioterapiaUNIFESP, Depto. de Oncologia Laboratório de Radioterapia ExperimentalSciEL

Mucositis in head and neck cancer patients undergoing radiochemotherapy

The objective of present study was to classify oral mucositis according to the Common Toxicity Criterion (CTC) international parameters in head and neck tumor patients simultaneously treated with radio and chemotherapy, and characterize a patient profile in our area, observing the individuals' habits, tumor characteristics, treatment protocol and acute reaction intensity. Fifty patients undergoing simultaneous 66 to 70 Gy megavoltage radiotherapy and cisplatin/carboplatin chemotherapy were evaluated in this study. Weekly evaluations of the degree of mucositis were perfoemed according to CTC, a four-degree ordinal scale; 36% of all patients and 100% of those with diabetes discontinued treatment due to mucositis, showing that this pathology contributes to the severity of mucositis.O objetivo do presente trabalho é classificar o grau de mucosite oral de acordo com os parâmetros internacionais do Common Toxicity Criterion (CTC) em pacientes portadores de tumor de cabeça e pescoço submetidos à radioterapia e quimioterapia concomitantes, e caracterizar um perfil dos pacientes em nosso meio, verificando os hábitos dos indivíduos, as características do tumor, o protocolo de tratamento e a intensidade desta reação aguda. Neste estudo foram avaliados 50 pacientes, submetidos à radioterapia em megavoltagem com doses entre 66 a 70 Gy e quimioterapia com cisplatina ou carboplatina concomitante. Semanalmente foi avaliado o grau de mucosite de acordo com o CTC, uma escala ordinal que apresenta 4 graus. Observou-se interrupção do tratamento por mucosite em 36% do total de pacientes e em 100% dos pacientes diabéticos, o que nos permitiu verificar que esta patologia contribui para a gravidade da mucosite.El trabajo objetivó clasificar el grado de Mucositis oral de acuerdo a parámetros internacionales del CTC en pacientes portadores de tumores de cabeza y cuello sometidos a radioterapia y quimioterapia concomitantes, y caracterizar un perfil de pacientes en nuestro medio, verificando hábitos de los individuos, características del tumor, protocolo de tratamiento e intensidad de esta reacción aguda. Fueron evaluados 50 pacientes sometidos a radioterapia en megavoltaje con dosis entre 66 y 70 G y quimioterapia con cisplatino o carboplatino concomitante. Se evaluó semanalmente el grado de Mucositis según el Common Toxicity Criterio - CTC, una escala ordinal que presenta cuatro grados. Se observó interrupción del tratamiento por Mucositis en 36% del total de pacientes y en 100% de los pacientes diabéticos, lo que nos permite verificar que dicha patología potencia la gravedad de la mucositis

What's new for the clinician? - Excerpts from and summaries of recently published papers

The effects of a hydrogen peroxide mouthrinse on the intraoral viral load of SARS-CoV-2 - The effect of adjuvant oral irrigation on self-administered oral care in the management of peri-implant mucositi

Validity and reliability of the Italian version of the Oral Assessment Guide

Mucositis is a frequent side-effect of chemotherapy and radiotherapy. Assessment of oral cavity is important to detect alterations in the mouth and plan appropriate interventions. A reliable tool can help to have a better assessment of mucositis and a major knowledge about this phenomenon. Since no valid and reliable tool for the assessment of mucositis is still available in Italy, the aim of this study was to establish the validity and reliability of the Italian version of the Oral Assessment Guide (OAG). A panel of health care experts established the content validity of the tool both for the items and the descriptors. To establish the reliability of the tool, a sample of 14 inpatients with haematological diseases were recruited. Couples of dental hygienists separately performed 60 pairs of assessments (for a total of 120 assessments) on the sample. The Italian version of OAG was found to have an acceptable Content Validity Index (CVI) for items and related descriptors ranging between 0.67 and 1. Cronbach’s alpha was 0.84, agreement of assessment ranged between 0.87 and 0.65 with Cohen’s Kappa coefficient ranging from good to very good. This study showed that the Italian version of the OAG has good psychometric properties of validity and reliability to assess mucositis in patients undergoing chemotherapy. This tool will have a great importance to carry out future research in Italy aimed to improve the patient's outcomes particularly in terms of functional ability and quality of life

Nutraceutical Analysis of Marticaria recutita (Chamomile) Dried Leaves and Flower Powder and Comparison between Them

Chamomile is known as German Chamomile (Marticaria recutita) and Roman Chamomile (Chamaemelum nobile) a very famous daisy plant. The work mainly focuses on the nutraceuticals potential of Chamomile leaf and flower of this plant. The nutrient contains of the leaf and flower power was determined by various methods. The phytochemicals screening of the leaf and flower aqueous extract was performed by the different procedure. Leaf of this plant is rich in carbohydrate, protein, fat and also rich in vitamin C, iron, zinc and calcium. Whereas flower is rich in moisture and fiber as compared to leaf. The aqueous extract of leaf of Chamomile showed the presence of steroids, terpenoids, flavonoids, tannins and saponins and flower were lacked in alkaloids, saponins, gelatin and phenolic compounds. The results record that leaf and flowers powder contains different types of nutrients and phytochmicals in it. Chamomile is rich in different bioactive compounds, antioxidant and phytochemicals; carries many pharmacological and traditional properties. Leaves, flowers and stems of Chamomile are used as anti-oxidant, analgesic, anti-viral, anti-inflammatory, anti-septic, anti-diabetic, anti-proliferative, anti-bacterial activities and many more diseases. This paper put a light on nutrient content and phytochemical properties of Chamomile leaf and flower

Efficacy of a Solution Composed by Verbascoside, Polyvinylpyrrolidone (PVP) and Sodium Hyaluronate in the Treatment of Chemotherapy-induced Oral Mucositis in Children With Acute Lymphoblastic Leukemia

Summary: The aim of this study was to assess the efficacy of a solution composed by verbascoside, polyvinylpyrrolidone, and sodium hyaluronate (Mucosyte) in the treatment of chemotherapy- induced oral mucositi (OM). Patients between 5 and 18 years receiving chemotherapy for acute lymphoblastic leukemia and with OM grade 1 or 2 were randomized in group A (treated with Mucosyte, 3 mouthwashes/d per 8d) and group B (treated with placebo, ie, an inert water-based solution, 3 mouthwashes/d per 8 d). The OM scoring was performed at day 1 (diagnosis of OM- T0), after 3 days of treatment (T1), and at day 8 (T2). Pain was evaluated through the visual analog scale with the same timing of OM measurement. A total of 56 patients were included (28 patients per group). Group A experienced a statistically significant decline of OM at T2 (P=0.0038); a statistically significant difference in pain reduction between 2 groups both at T1 and at T2 (P < 0.005) was observed. The use of Mucosyte mouthwashes in children with chemotherapy-induced OM may be recommended as supportive therapy

La nutrizione nel paziente oncologico: a che punto siamo?

SommarioLa prima osservazione che la malnutrizione e la perdita di peso contribuiscano alla morte dei malati di cancro in maniera significativa e indipendentemente dagli effetti del tumore stesso risale a più di 70 anni fa. Da allora l'intervento nutrizionale, inteso sia come screening sia come trattamento medico orientato alla ricerca e alla cura della malnutrizione, ha assunto sempre più significato nella gestione della patologia tumorale. Ciò sia al suo esordio sia durante la naturale evoluzione della malattia, anche quando accompagnata dai trattamenti medici convenzionali (radioterapia, chemioterapia, chirurgia e cure palliative). La nutrizione artificiale nelle sue diverse declinazioni (supplementi nutrizionali orali, nutrizione enterale e parenterale), la farmacoterapia, il protocollo enhanced recovery after surgery (ERAS) e l'immunonutrizione sono ad oggi gli strumenti a nostra disposizione per invertire o almeno arrestare il processo prima che sopraggiunga la cachessia. Questa breve rassegna nasce con l'intento di descrivere a che punto siamo nel trattamento nutrizionale del paziente oncologico e quali sono ad oggi le evidenze di efficacia dei vari interventi nei diversi momenti di malattia

Phase-III Randomized trial comparing topical application of natural honey in the management of radiation mucositis among patient undergoing radical radiotherapy for nasopharyngeal cancer

Introduction: Radiation n1ucositis is a very common acute morbidity su fered by almost all patients undergoing radiotherapy to the head and neck region. Mater als and Methods: This is a prospective double blind randomized control trial comparing t pical application of natural honey in mucositis induced by che1no-radiotherapy in nasopl aryngeal cancer. One hundred twenty patients were treated with chemo-radiotherapy usi g cisplatinun1. Radioth~:rapy consists of 70Gy in 35 fractions over 7 weeks period alo g with 30mg parenteral \Veekly cisplatinum was administered. Sixty (60) patients we ·e subjected to j topical application of honey before and after each fractions of radiother~py. The n1ucositis, dysphagia and dry mouth were assessed using RTOG gradink systetn. Weekly body weight n1onitoring, the EORTC QLQ-H&N35 and general EORTb QLQ-C30 questionnaire were recorded before and after radiotherapy. Results: ThJre were 82 1nales and 38 f<~male with a median age of 48 years (I O-S I years) in this studyj The compliance I to honey and placebo application was poor in our patient population with only 49-patients l (40.8°/o) accepted con1plete course; 21 (17.5o/o)-incon1plete and remainir1g refused application including 6-patients developed adverse effects in the fonn ~f bun1ing mucosal pain. The concurrent chemotherapy was accepted in 51 ( 42.5%) patient~, incomplete in 6 7 (55. 8%) patients and not received in 2 ( 1.6%) patients. The quality of life in Head & Neck specific scale changed fron1 42 to 54 points in study arm and 43 tp 54 points in control arn1. The grade4 n1ucositis appeared to be less in honey treated larm co1npared to controls \Vhoever other grades of mucositis or weight changes was equt'vocal in both anns Conclusions: Due to non-co1npliance of topical application of study ag nts, there was no significant difference in mucositis, body weight, dysphagia grade or drt mouth in study and control group of patients. Proper selection of honey, method of ap lication of honey with mucosal adhesion properties might reveal imnprovement of n1ucos tis in future researc

Guidelines for promotion of oral health in children in remission from malignant disease.

Obiettivi: Descrivere lo stato di salute orale e le anomalie dentali attese in un gruppo di pazienti in età evolutiva in remissione da patologie oncologiche, per individuare linee guida di prevenzione e di terapia mirate. Materiali e Metodi: in 50 pazienti in età evolutiva in remissione da patologie tumorali sottoposti a terapie oncologiche prima dei 10 anni (gruppo studio) e in 50 pazienti in età evolutiva con anamnesi medica negativa (gruppo controllo) è stata valutata la prevalenza di carie e di difetti dello smalto. Per valutare anomalie dentali e correlazione tra età cronologica ed età dentale, è stata eseguita in ogni soggetto una ortopantomografia. Al fine di valutare l’influenza dell’età sullo sviluppo di anomalie dentali, il gruppo di studio è stato suddiviso in tre sottogruppi per età all’epoca delle terapie: 5,1 anni. Risultati: per quanto concerne la prevalenza di carie, non è emersa una differenza statisticamente significativa tra i due gruppi. Per quanto concerne la prevalenza di difetti dello smalto, anomalie dello sviluppo dentale e la correlazione tra età cronologica ed età dentale è emersa una differenza statisticamente significativa tra i due gruppi. E’ emersa una correlazione tra età all’epoca delle terapie e presenza di anomalie dentarie: il rischio di sviluppare anomalie diminuisce all’aumentare dell’età del paziente al momento della terapia, risultando a più alto rischio i bambini sottoposti a terapie ad un’età inferiore ai 5 anni. Conclusioni: nell’ambito del follow-up medico previsto al termine delle terapie, in considerazione del fatto che le alterazioni patologiche correlate alla citotossicità dei farmaci si manifestano a lungo termine, risulta evidente la necessità di uno stretto monitoraggio del cavo orale e dell’evoluzione della dentizione del paziente prolungato nel tempo, che includa una attenta valutazione ortodontica in previsione di una eventuale riabilitazione protesica a fine crescita.Aim: to investigate the oral features in Italian patients in remission from cancer, highlighting the relationship with age at cancer therapy and to compare the data with healthy controls. Materials and methods: fifty childhood cancer survivors treated under the age of 10 years with chemotherapy, haemopoietic stem cell transplantation and/or head-neck Radiotherapy, in remission from cancer for at least 3 years, were examined for dental caries and enamel defects. For each patient a panoramic radiograph was taken to assess dental age and dental abnormalities. Patients were grouped according to age at cancer therapy (5 years: subgroup O). A control group of 50 healthy children was included. Results: There was not a statistically significant difference in caries prevalence between the two groups. A statistically significant difference was found for enamel defects, dental abnormalities and dental age. The chi-squared test revealed a relationship between age at cancer therapy and specific dental abnormalities. Conclusion: The risk of developing dental abnormalities decreases with the patient’s age at the beginning of therapy: the highest risk was for children treated before 5 years-old. A oral follow-up is needed do diagnose and treat dental late adverse effects