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[The New Generation of Particle Therapy Focused on Boron Element (Boron Neutron Capture Therapy; BNCT) -The World's First Approved BNCT Drug].
Nakashima, H
Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan. 2022;(2):155-164
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Abstract
Boron neutron capture therapy (BNCT) is a type of radiation therapy and a new modality for cancer treatment. The radiation used in BNCT is a very low energy neutron called a "thermal neutron", and unlike other radiation, it has no effect on treating cancer on its own. However, when this neutron collides with boron-10 (10B), which is a stable isotope of boron, fission occurs into a high-energy helium nucleus (α-particle) and a lithium nucleus. Moreover, the effect of this fission reaction is limited to a range of about 10 μm, which corresponds to the approximate size of one cell. Therefore, the basic principle of BNCT is "cell-selective" radiation therapy that only damages cells that have taken up 10B present in the area irradiated with thermal neutrons. For the practical application of BNCT, it is indispensable to generate a boron drug capable of selectively accumulating 10B in cancer cells. We have successfully developed a boron drug for BNCT targeting amino acid transporters. We have obtained manufacturing and marketing approval for the world's first boron drug for BNCT, Steboronine® intravenous drip bag 9000 mg/300 mL (March 25, 2020), for indications of locally unresectable recurrent or advanced unresectable head and neck cancer. This uses Borofalan (10B), which is 10B introduced into l-phenylalanine, as a drug substance. This review describes the progress of drug development and future prospects of boron drugs for BNCT.
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[Predictive factors for mandibular osteoradionecrosis after irradiation of head and neck cancers].
Dutheil, F, Guillemin, F, Biau, J, Pham-Dang, N, Saroul, N, Clavère, P, Lapeyre, M
Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique. 2021;(5):484-493
Abstract
The identification of the different risk factors for mandibular osteoradionecrosis (ORN) must be done before and after the management of patients with head and neck cancer. Various clinical criteria for this severe radiation-induced complication are related to the patient (intrinsic radiosensitivity, malnutrition associated with thin weight loss, active smoking intoxication, microcapillary involvement, precarious oral status, hyposalivation) and/or related to the disease (oral cavity, large tumor size, tumor mandibular invasion). Therapeutic risk factors are also associated with a higher risk of ORN (primary tumor surgery, concomitant radio-chemotherapy, post-irradiation dental avulsion, preventive non-observance with the absence of stomatological follow-up and daily installation of gutters fluoride and, non-observance curative healing treatments). Finally, various dosimetric studies have specified the parameters in order to target the dose values distributed in the mandible, which increases the risk of ORN. An mean mandibular dose greater than 48-54Gy and high percentages of mandibular volume receiving 40 to 60Gy appear to be discriminating in the risk of developing an ORN.
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Early side effects of radiation treatment for head and neck cancer.
Brook, I
Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique. 2021;(5):507-513
Abstract
Purpose of this review of medical literature is to present the immediate side effects of radiation therapy for head and neck cancer and their treatment. The likelihood and severity of these immediate side effects depends on a number of factors, including the total dose of radiation delivered, over what time it was delivered and what parts of the head and neck received radiation. Early side effects include: inflammation of the oropharyngeal mucosa (mucositis), painful swallowing (odynophagia), difficulty swallowing (dysphagia), hoarseness, lack of saliva (xerostomia), orofacial pain, laryngeal radionecrosis, dermatitis, hair loss, nausea, vomiting, inadequate nutrition and hydration, and weight loss. These complications can interfere with, and delay treatment. Most of these side effects generally dissipate over time. In conclusion, radiation treatment for the head and neck cancer causes significant early side effects. Many of these side effects present difficult challenges to the patients. Their recognition and treatment can significantly improve the patients' health, long-term survival and quality of life. The review provides information that can assist head and cancer survivors deal with radiation side effects.
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Adherence to nutritional interventions in head and neck cancer patients: a systematic scoping review of the literature.
de Oliveira Faria, S, Alvim Moravia, R, Howell, D, Eluf Neto, J
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2021;(3):562-571
Abstract
BACKGROUND Dietary counselling provided by a dietitian, with or without oral nutritional supplements, can impact on nutritional and clinical outcomes in head and neck cancer (HNC) patients undergoing radiotherapy. However, little is known about the role of adherence to oral nutritional interventions in this population. This review aimed to map the literature for evidence of adherence to oral nutritional interventions in HNC patients undergoing radiotherapy and to identify gaps in knowledge in this field. METHODS A scoping review methodology was used to identify studies, extract data, and collate and summarise results. We searched Medline, Embase, Cochrane Central and CINAHL, from the earliest available time up to 8 January 2020. RESULTS In total, 2315 unique articles were identified, 163 studies were assessed in full and niner were included in the scoping review. The use of different measures to assess adherence and variability in the timing of the assessments was noted across studies. Despite identifying studies that have measured adherence to oral nutritional interventions, very few studies monitored its influence on clinical and nutritional outcomes in HNC patients or reported factors related to adherence. CONCLUSIONS A robust evidence base is lacking for adherence to oral nutritional intervention in HNC patients. Overall, further studies evaluating the impact of oral nutritional interventions in HNC patients undergoing radiotherapy should measure adherence to the intervention. Early recognition of non-adherence and the contributing factors could ensure intensification of nutritional support and better health outcomes.
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The Association between Carotenoids and Head and Neck Cancer Risk.
Brewczyński, A, Jabłońska, B, Kentnowski, M, Mrowiec, S, Składowski, K, Rutkowski, T
Nutrients. 2021;(1)
Abstract
Head and neck cancer (HNC) includes oral cavity cancer (OCC), pharyngeal cancer (PC), and laryngeal cancer (LC). It is one of the most frequent cancers in the world. Smoking and alcohol consumption are the typical well-known predictors of HNC. Human papillomavirus (HPV) is an increasing etiological factor for oropharyngeal cancer (OPC). Moreover, food and nutrition play an important role in HNC etiology. According to the World Cancer Research Fund and the American Institute for Cancer Research, an intake of non-starchy vegetables and fruits could decrease HNC risk. The carotenoids included in vegetables and fruits are well-known antioxidants which have anti-mutagenic and immune regulatory functions. Numerous studies have shown the relationship between carotenoid intake and a lower HNC risk, but the role of carotenoids in HNC risk is not well defined. The goal of this review is to present the current literature regarding the relationship between various carotenoids and HNC risk.
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Electrochemotherapy in the head and neck area: an addition to the treatment armamentarium.
de Bree, R, Wessel, I
Current opinion in otolaryngology & head and neck surgery. 2020;(2):112-117
Abstract
PURPOSE OF REVIEW Electrochemotherapy (ECT) is increasingly used in different settings in head and neck cancer patients when conventional treatment options are not available. RECENT FINDINGS Recent improvements of electroporation and ECT include new advanced electrode probes, the combination with intratumorally injected supraphysiological doses of calcium and an update of the standard operating procedures. SUMMARY ECT is a treatment modality that combines administration of a chemotherapeutic drug, for example, bleomycin, with electroporation therapy (EPT). EPT uses brief, high-intensity, pulsed electrical currents to enhance the uptake of cytotoxic drugs by producing a transient increase in cell wall permeability. ECT increases the effect of cytostatic drugs, is independent on histology of the lesion, enables treatment to previously treated areas, preserves healthy tissue, has no significant side effects (low-dose chemotherapy) and enables repeated treatments. ECT can be combined with other treatment modalities and is an addition to the current treatment options of head and neck cancer. ECT is not only able to palliate symptoms but can also provide complete responses and curation.
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Topical Fluorides for Head and Neck Cancer Patients Subjected to Surgical Resection and Radiation Therapy in Resource Restraint Settings.
Sheikh, A, Khan, FR, Tabassum, S
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2020;(2):205-209
Abstract
Patients undergoing surgical resection and ionizing radiations for the treatment of head and cancer may lead a challenging life even after the cure of the disease; because these procedures can adversely affect the oral mucosa, salivary gland, bone, masticatory musculature, and the dentition. Especially, if major salivary glands are exposed to high dose radiation, an irreversible xerostomia may occur that can lead to rampant dental caries. Treatment of these complications demands high cost and time; and is often unaffordable for the patients in the resource constraint setting rendering them to compromise on their quality of life. The healthcare providers should work together in a team to prevent or manage these complications and improve the lives of the patients. This review paper focuses on the significance of low cost fluoride treatment for salvaging the dentition among patients who have had developed head and neck carcinoma and later got subjected to surgical resection and radiation therapy.
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Magnetic Resonance Spectroscopy of the Head and Neck: Principles, Applications, and Challenges.
Fujima, N, Carlota Andreu-Arasa, V, Barest, GD, Srinivasan, A, Sakai, O
Neuroimaging clinics of North America. 2020;(3):283-293
Abstract
Several investigations have revealed the utility of magnetic resonance spectroscopy (MRS) as an adjunct in the evaluation of lesions of the head and neck. This technique remains a challenge in the head and neck because of its low signal-to-noise ratio and long acquisition times. In this review article, the basics of image acquisition technique and reported clinical utilities of head and neck MRS are presented.
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Quality assurance in head and neck cancer surgery: where are we, and where are we going?
Simon, C, Dietz, A, Leemans, CR
Current opinion in otolaryngology & head and neck surgery. 2019;(2):151-156
Abstract
PURPOSE OF REVIEW The scope of this review is to summarize current efforts in quality assurance for head and neck cancer surgery. National and international initiatives are summarized and progress in terms of identification of process indicators and outcome indicators delineated. RECENT FINDINGS Massive efforts have been made in order to improve quality of head and neck cancer surgery. New guidelines for quality assurance of head and neck cancer surgery in clinical trials have recently been proposed by EORTC. SUMMARY Quality assurance programs can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit from such initiatives on a global level.
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Tracheostomies and PEGs: When Are They Really Indicated?
Hoffman, MR
The Surgical clinics of North America. 2019;(5):955-965
Abstract
Surgeons are often asked to perform tracheostomies and percutaneous endoscopic gastrostomies for a wide variety of patients. As consultants, surgeons are tasked with honoring the relationship between the referring provider and the patient while also assessing whether the consult is appropriate given the patient's prognosis and goals of care. This article discusses the most common conditions for which these procedures are requested and reviews the evidence supporting either the placement or avoidance of these tubes in each condition. It provides a framework for surgeons to use when discussing these procedures in the context of goals of care.