Quality of Life and Survivorship in Head and Neck Cancer
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
As previously mentioned, the severity of of xerostomia correlates with oral discomfort, difficulty chewing/-swallowing/speaking, altered taste and low mood.245 Sticky saliva and profund dryness at night can be major issues.246 Prevention is better than measures aimed at symptom control; hence there have been technological advances in the delivery of radiotherapy and this has led to less salivary gland hypofunction with sparing of the partoid glands and a potential improvement in HRQoL.247, 248 IMRT is a technique that allows delivery of lower doses of radiation to normal tissue, while maintaining or increasing the tumour dose, compared with two-dimensional radiotherapy (2DRT) or 3D-CRT. Patients treated with IMRT experience statistically significant improvements in several important HRQoL domains.249 IMRT had significantly better outcome in various scales such as global QoL, physical functioning, swallowing, senses (taste/smell), speech, social eating, social contact, teeth, opening mouth, dry mouth, sticky saliva and feeling ill.101, 250 Adaptive head and neck radiotherapy (ART) is a new concept in which there is dose avoidance to anatomical structures. A timed replan can achieve dosimetric improvement and needs further outcomes research.251
Oral Mucosal Reactions to Anticancer Therapies
Gabriella Fabbrocini, Mario E. Lacouture, Antonella Tosti in Dermatologic Reactions to Cancer Therapies, 2019
Chemotherapy-related mucositis usually starts 4–7 days after the first cycle. It typically involves the nonkeratinized mucosa (floor of the mouth, soft palate, oral mucosa, ventral part of the tongue, lips), with a relative sparing of keratinized areas. The premonitory phase includes erythema and burning. Lesions may evolve to form erosions and ulcerations (1,10,11,13), covered by a pseudomembrane consisting of fibrin, altered leucocytes, and epithelial debris (Figure 8.1a through d). Ulcerations are initially distinct, but may ultimately become diffuse, poorly circumscribed, and confluent. Pain and xerostomia are readily reported by patients. Inference with food/fluid intake is also common. Concomitant gastrointestinal involvement is also frequently noted (1,12,13).
Hospice, Cancer Pain Management, and Symptom Control
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Oral care is routinely performed by healthy individuals and sadly forgotten in some terminal patients. With dehydration due to decreased oral intake, coupled with mouth breathing as death approaches, it is common for the oral membranes to become dry and irritated. Cleansing the mouth with small quantities of water, giving ice chips, wiping the mouth with a lemon-flavored glycerine swab, and applying a lip balm are soothing for the dying patient (Kaye, 1989) and also help to relieve the sensation of thirst. Xerostomia can be treated by removing offending agents, frequent sips of liquids, salivary stimulants such as pilocarpine and sugarless gum or lozenges, and by use of saliva substitutes (Sweeney & Bagg, 2000). Oral mucositis can also accompany the use of chemotherapy and radiotherapy. Patients with mucositis frequently experience increased depression, anger, fatigue, and anxiety with an overall decrease in quality of life (Dodd et al., 2001). Many single and combination agents and modalities have been used to prevent and treat oral mucositis with varying degrees or success and without establishing one standard of care (Köstle et al., 2001).
Management of iodine contrast induced salivary gland swelling (sialadenitis): experiences from an observational study
Published in Acta Oto-Laryngologica, 2023
Miguel Saro-Buendía, Lidia Torres-García, Claudia Mossi Martínez, Eduardo Battig Arriagada, Joan Carreres Polo, José María Perolada Valmaña, Miguel Armengot Carceller
Four cases of CIS were diagnosed and managed during the study period at our institution ER. Demographic, clinical and radiological features of the patients are summarized in Table 1. Moreover, clinical and radiological features are represented in Figures 1 (case 1), 2 (case 2), 3 (case 3) and 4 (case 4). Individuals were aged between 68 and 76 years and three of them were females. None of the patients had allergy history and all of them got a CT with IC 12 to 72 h before CIS onset. The submandibular glands were the only salivary glands affected in all the cases. Enlargement was always bilateral and in half of the cases it was painful. Two patients referred xerostomia. Diagnosis was clinical supported by ultrasonography which often described gland enlargement, heterogenous echotexture, increased doppler flow and hypoechoic internal septa. Glomerular filtration rate (GFR) at ER admission ranged between 47 and 70 ml/min/1.73m2. The course was benign, and all four patients were symptomless 60 to 150 h after CIS onset. Only two patients required analgesia.
A Walk with Lu-177 PSMA: How Close we Have Reached from Bench to Bedside?
Published in Cancer Investigation, 2020
Manoj Gupta, G. Karthikeyan, P. S. Choudhury, Venkata Pradeep Babu Koyyala, Manish Sharma, Parveen Jain, Vineet Talwar, Amitabh Singh, Sudhir Rawal
Ahmadzadehfar et al. reported early side effects and first results of a single cycle of Lu-177 PSMA in 10 mCRPC patients. Five patients showed >50% decline in PSA while 3 patients showed PSA progression. Significant hematological toxicity was reported in one (28). The first multicentre study initiated by the German Society of Nuclear Medicine was a retrospective analysis of 145 mCRPC patients treated in 12 centers to evaluate the efficacy and safety of 177Lu-PSMA-617 (29). Patients received 1-4 therapy cycles with Lu-177 PSMA radioactivity range of 2-8 GBq per cycle. PSA response was documented in 40% after one cycle, while 45% of the patients after all therapy cycles. Eighteen patients showed grade 3-4 hematotoxicity with anemia, thrombocytopenia, and leukopenia in 10%, 4%, and 3% of the patients, respectively. Xerostomia was reported in 8% of the patients. Calopedos et al. did a systematic review and meta-analysis of 10 studies with 369 mCRPC patients treated with Lu-177 labeled J591, PSMA 617, and PSMA imaging and therapy (PSMA I&T). The pooled ≥50% decline in PSA was seen in 37% of the patients, whereas it was 51% in patients who underwent Lu-177 PSMA617/I&T therapy (30).
Relationship between patient and physician-rated xerostomia and dose distribution to the oral cavity and salivary glands for head and neck cancer patients after radiotherapy
Published in Acta Oncologica, 2019
J. K. Kaae, L. Johnsen, C. R. Hansen, M. H. Kristensen, C. Brink, J. G. Eriksen
To assess patient-reported xerostomia, the validated EORTC QLQ-H&N35 questionnaire was used [12,13]. EORTC QLQ-H&N35 is a disease-specific questionnaire consisting of 35 questions divided into 18 symptom scales. All questions are rated on a four-point Likert scale ranging from ‘Not at all’ (score 1), ‘A little’ (score 2), ‘Quite a bit’ (score 3) to ‘Very much’(score 4), with the highest scores indicating the highest symptom burden [14]. Physician-rated xerostomia was assessed by the observer-based DAHANCA toxicity scale with scores ranging from ‘None’ (score 0), ‘Slight’ (score 1), ‘Moderate’ (score 2) to ‘Severe’ (score 3) xerostomia [15]. All physicians were blinded to the EORTC score. Assessment of xerostomia was done at the time of inclusion to the ongoing trial by both patients and physicians. The subjective assessment of xerostomia was reported before intervention with chewing gum thus not influencing the results of the present study.
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