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1.
Results of a randomized controlled phase III trial: efficacy of polyphenol-containing cystus® tea mouthwash solution for the reduction of mucositis in head and neck cancer patients undergoing external beam radiotherapy.
Ebert, N, Kensche, A, Löck, S, Hadiwikarta, WW, Hänsch, A, Dörr, W, Krause, M, Hannig, C, Baumann, M
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]. 2021;(1):63-73
Abstract
PURPOSE To determine the effect of Cystus® tea (Naturprodukte Dr. Pandalis GmbH & Co. KG) as mouthwash compared to sage tea on oral mucositis in patients undergoing radio(chemo)therapy for head and neck cancer. METHODS In this randomized, prospective phase III study, 60 head and neck cancer patients with primary or postoperative radio(chemo)therapy were included between 04/2012 and 06/2014. They received either sage or Cystus® tea for daily mouthwash under therapy. Mucositis was scored twice a week following the Radiation Therapy Oncology Group and the European Organization for Research and Treatment Cancer (RTOG/EORTC) scoring system. Dental parameters were also recorded. Statistical evaluation of the primary endpoint was performed using t‑test and log rank test. RESULTS Data from 57 patients could be evaluated. Patient characteristics showed no significant difference between the two groups (n = 27 sage; n = 30 Cystus®). A total of 55 patients received the prescribed dose (60-66 Gy postoperative; 70-76.8 Gy primary). Mucositis grade 3 was observed in 23 patients (n = 11 sage; n = 12 Cystus®) and occurred between day 16 and 50 after start of therapy. There was no significant difference between the two groups in latency (p = 0.75) and frequency (p = 0.85) of the occurrence of mucositis grade 3. The self-assessment of the oral mucosa and the tolerability of the tea also showed no significant differences. Occurrence of dental pathologies appeared to increase over time after radiotherapy. CONCLUSION Cystus® and sage tea have a similar effect on the occurrence of radiation-induced mucositis regarding latency and incidence. Cystus® tea mouthwash solution is tolerated well and can be applied in addition to intensive oral care and hygiene along with the application of fluorides.
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2.
Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review.
McClelland, S, Andrews, JZ, Chaudhry, H, Teckie, S, Goenka, A
Oral oncology. 2018;:77-81
Abstract
Although chemoradiotherapy (CRT) has improved disease outcomes in advanced head and neck cancer (aHNC), toxicity remains a major concern. Treatment interruptions and decreased quality of life (QOL) can occur due to malnutrition, secondary to mucositis, dysphagia and odynophagia. Gastrostomy tubes are used in many patients to improve nutrition during CRT. The optimal timing of PEG placement in patients with aHNC undergoing CRT remains controversial. Using the PubMed database, we performed a systematic review of published CRT series in aHNC to guide decision-making regarding optimal timing of percutaneous endoscopic gastrostomy (PEG) placement. We aimed to compare outcomes when patients are treated with prophylactic PEG (pPEG) versus reactive PEG (rPEG). Twenty-two studies examining the role of PEG placement in CRT for aHNC were reviewed. pPEG reduces the number of malnourished patients (defined as >10% of body weight), but average weight loss at various time points following treatment appears similar to patients with rPEG. pPEG is also associated with improved QOL at 6 months, and greater long term PEG dependence. Clinical and dosimetric parameters that correlate with malnutrition in patients without pPEG include advanced age, percent weight loss preceding treatment, and radiation dose to the pharyngeal constrictor muscles. Based on this evidence, our institutional strategy is to encourage pPEG in those patients deemed at greatest risk of becoming malnourished during the course of treatment, and to approach the remainder of patients with rPEG.
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3.
A prospective study comparing prophylactic gastrostomy to nutritional counselling with a therapeutic feeding tube if required in head and neck cancer patients undergoing chemoradiotherapy in Thai real-world practice.
Pramyothin, P, Manyanont, S, Trakarnsanga, A, Petsuksiri, J, Ithimakin, S
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2016;(6):768-776
Abstract
BACKGROUND Concurrent chemoradiotherapy (CRT) is the standard treatment for head and neck (HN) cancer patients. Most patients experience malnutrition and weight loss during treatment because of mucositis and difficulty in swallowing. Prevention of malnutrition may allow more patients to complete their treatment. The present study aimed to examine whether prophylactic gastrostomy tube (PGT) could reduce treatment interruption, prevent malnutrition and maintain quality of life, especially in Thai patients who generally do not accept feeding tubes. METHODS A prospective study was performed on HN cancer patients undergoing CRT at a tertiary hospital in Thailand (n = 95). Before starting CRT, all patients received nutritional assessment and were counselled about the risks and benefits of PGT. According to patient discretion, they chose to have a PGT (experimental group) or only nutritional counselling with a therapeutic feeding tube if required (control group). During CRT, weight, degree of mucositis, delayed chemotherapy and/or radiotherapy, and nutritional status were recorded. Quality of life (Functional Assessment of Cancer Therapy - Head and Neck Scale; FACT-H&N) was compared between two groups. RESULTS There was no significant difference in the rates of delayed treatment. Mean weight loss was 3.1 and 4.8 kg in the experimental and control groups, respectively (P = 0.04). A higher proportion of patients in the control group experienced ≥10% weight loss (24% versus 4%; P = 0.03). In terms of quality of life, no significant difference in FACT-H&N score was found. CONCLUSIONS The results of the present study suggest that PGT provided similar quality of life without a reduction in treatment interruption. However, patients with PGT had significantly less weight loss (P = 0.04) during CRT.
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4.
Clinical benefits of two different dosing schedules of recombinant human erythropoietin in anemic patients with advanced head and neck cancer.
Gupta, S, Singh, PK, Bhatt, ML, Pant, MC, Sundar, S, Verma, J, Paul, S, Kumar, D, Shah, A, Gupta, R, et al
Bioscience trends. 2010;(5):267-72
Abstract
A total of 100 patients with stage III or IV head or neck cancer, a performance status of 0-1, and anemia with hemoglobin (Hb) < 10 g/dL at baseline who where to receive chemotherapy concomitantly or sequentially with radiotherapy were randomized to receive either epoetin beta 10,000 IU thrice weekly (TW) (n = 52) and oral iron starting 10-15 days before the start of treatment or epoetin beta 30,000 IU once weekly (OW) (n = 48) and oral iron before the start of treatment. The mean Hb in patients on the thrice weekly (11.96 g/dL) and once weekly (12.50 g/dL) dosing schedules increased significantly (p < 0.01) at the end of the treatment in comparison to respective baseline values of 9.38 g/dL and 9.41 g/dL; levels were 1.2-fold higher, which was significant (p < 0.01), for patients on the once weekly schedule. That said, there was significant improvement (p < 0.01) in mean linear analog scale assessment (LASA) scores for energy level (EL), ability to perform daily activities (AL), and overall quality of life (QOL) for patients on both dosing schedules but these improvements did not differ significantly between schedules (p > 0.05). The 2-year overall survival for patients on both dosing schedules did not differ significantly (p > 0.05). Epoetin beta therapy was found to be equally beneficial and well tolerated for patients on both thrice weekly and once weekly dosing schedules.
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5.
Relief of radiation-induced oral mucositis in head and neck cancer.
Putwatana, P, Sanmanowong, P, Oonprasertpong, L, Junda, T, Pitiporn, S, Narkwong, L
Cancer nursing. 2009;(1):82-7
Abstract
This study was a prospective, randomized clinical trial carried out to explore the efficacy of payayor in the prevention and relief of radiation-induced oral mucositis compared with benzydamine. Sixty patients with head and neck cancer, who have started to receive radiotherapy and met predetermined criteria, were randomly assigned into each group to use assigned products 3 times a day from the first to the last day of radiation. The first group used glycerin payayor, a Thai prepared herbal product, by dripping it into the mouth. Another group rinsed their mouths with benzydamine hydrochloride. The World Health Organization Mucositis Grading System was used to assess oral status every week and 2 weeks after radiation. Comparison of time to the onset, pain, severity, xerostomia, postponement of treatment, satisfaction of the solution, and body weight between the 2 groups was performed by t test. The average time to the onset of oral mucositis in the payayor group was significantly later, and its severity and pain score were less than those of the benzydamine group throughout the study period. Significantly higher satisfaction with the solution and higher body weight at the end of the study were shown in the payayor group. Payayor seemed to be superior to benzydamine for preventing and relieving radiation-induced oral mucositis.
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6.
A review of functional outcomes related to prosthetic treatment after maxillary and mandibular reconstruction in patients with head and neck cancer.
Tang, JA, Rieger, JM, Wolfaardt, JF
The International journal of prosthodontics. 2008;(4):337-54
Abstract
PURPOSE This review examined literature that reported functional outcomes across 3 categories of prosthetic treatment after microvascular reconstruction of the maxilla and mandible: (1) conventional dental/tissue-supported prosthesis, (2) implant-retained prosthesis, and (3) no prosthesis. MATERIALS AND METHODS Library databases were searched for articles related to reconstruction of the maxilla and mandible, and references of selected articles were hand searched. Relevant literature was identified and reviewed with criteria specified a priori. RESULTS Forty-nine articles met the inclusion criteria. Twelve articles reported on function after maxillary reconstruction, with the majority of articles reporting on outcomes for 1 to 6 subjects. Thirty-nine articles reported on function after mandibular reconstruction. Speech outcomes were satisfactory across all groups. Swallowing reports indicated that many patients who received either type of prosthetic rehabilitation resumed a normal diet, whereas those without prosthetic rehabilitation were often restricted to liquid diets or feeding tubes. Patients without prosthetic rehabilitation reportedly had poor masticatory ability, whereas conventional prosthetic treatment allowed some recovery of mastication and implant-retained prosthetic treatment resulted in the most favorable masticatory outcomes. Quality-of-life outcomes were similar across all patients. CONCLUSIONS Several limitations of the current literature prevented definitive conclusions from being reached within this review, especially regarding maxillary reconstruction. However, recognition of these limitations can direct functional assessment for the future.
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7.
Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiation.
Corry, J, Poon, W, McPhee, N, Milner, AD, Cruickshank, D, Porceddu, SV, Rischin, D, Peters, LJ
Journal of medical imaging and radiation oncology. 2008;(5):503-10
Abstract
Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGT) for nutritional support of patients with head and neck cancer undergoing curative (chemo)radiotherapy without any good scientific basis. A randomized trial was conducted to compare PEG tubes and NGT in terms of nutritional outcomes, complications, patient satisfaction and cost. The study was closed early because of poor accrual, predominantly due to patients' reluctance to be randomized. There were 33 patients eligible for analysis. Nutritional support with both tubes was good. There were no significant differences in overall complication rates, chest infection rates or in patients' assessment of their overall quality of life. The cost of a PEG tube was 10 times that of an NGT. The duration of use of PEG tubes was significantly longer, a median 139 days compared with a median 66 days for NGT. We found no evidence to support the routine use of PEG tubes over NGT in this patient group.
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8.
Ketoprofen is superior to metamizole in relieving postoperative pain after head and neck tumor operation.
Jovic, R, Dragicevic, D, Komazec, Z, Sabo, A
Journal of B.U.ON. : official journal of the Balkan Union of Oncology. 2008;(4):519-23
Abstract
PURPOSE Recently, nonsteroidal analgoantipyretics are recommended in the management of postoperative pain, with great attention to their safety. We conducted a randomized, single blind study to compare the analgesic efficacy and safety of ketoprofen and dipyrone (metamizole) after major head and neck surgery. PATIENTS AND METHODS 60 patients received postoperatively 100 mg ketoprofen or 2.5 g metamizole i.v. every 8h over 72h with additional administration of tramadol in case of inadequate analgesia. Pain was assessed by visual numeric scale every 2h during the 72h. RESULTS Patients in both groups had similar pain score during the first 2 postoperative days, while on the 3rd postoperative day patients in the ketoprofen group had significantly lower pain score (p <0.05). CONCLUSION The efficacy of ketoprofen to achieve postoperative analgesia was comparable to metamizole during the first 48h, while ketoprofen was superior to metamizole during the 3rd postoperative day.
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9.
Antibiotic prophylaxis in clean-contaminated head and neck oncological surgery.
Skitarelić, N, Morović, M, Manestar, D
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2007;(1):15-20
Abstract
BACKGROUND Perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures but controversy still remains regarding the optimal antibiotic regime. OBJECTIVE To examine the efficacy of different antibiotics in head and neck oncological surgery prophylaxis. PATIENTS AND METHODS In this prospective, double-blind clinical trial, 189 patients with carcinoma of the upper aerodigestive tract were randomized to receive amoxicillin-clavulanate or cefazolin intravenously up to 1h before surgery and at 8-h intervals for an additional three doses. RESULTS An overall wound infection rate of 22% was observed. The infection rate in patients receiving cefazolin was 24% (22/92) vs. 21% (20/97) in those receiving amoxicillin-clavulanate; the difference was not statistically significant. Postoperative overall non-wound infection developed in 12% (22/189) patients; the rate of infection was 9.8% (9/92) in patients receiving cefazolin vs. 13.4% (13/97) in those receiving amoxicillin-clavulanate, without a statistically significant difference between the two groups. Gram-negative bacteria were more often isolated with Pseudomonas aeruginosa as the dominant species. The risk of postoperative infection was more influenced by the type of surgical procedure than by disease stage. CONCLUSION In clean-contaminated head and neck oncologic surgery amoxicillin-clavulanate prophylaxis was at least as efficient as cefazolin. However, when taking into account the fact that beta-lactamase containing strains have recently been spreading, amoxicillin-clavulanate should be the logical first choice.
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10.
Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging.
de Bondt, RB, Nelemans, PJ, Hofman, PA, Casselman, JW, Kremer, B, van Engelshoven, JM, Beets-Tan, RG
European journal of radiology. 2007;(2):266-72
Abstract
PURPOSE To perform a meta-analysis comparing ultrasonography (US), US guided fine needle aspiration cytology (USgFNAC), computed tomography (CT), and magnetic resonance imaging (MRI) in the detection of lymph node metastases in head and neck cancer. METHODS MEDLINE, EMBASE and Cochrane databases were searched (January 1990-January 2006) for studies reporting diagnostic performances of US, USgFNAC, CT, and MRI to detect cervical lymph node metastases. Two reviewers screened text and reference lists of potentially eligible articles. Criteria for study inclusion: (1) histopathology was the reference standard, (2) primary tumors and metastases were squamous cell carcinoma and (3) data were available to construct 2 x 2 contingency tables. Meta-analysis of pairs of sensitivity and specificity was performed using bivariate analysis. Summary estimates for diagnostic performance used were sensitivity, specificity, diagnostic odds ratios (DOR) (95% confidence intervals) and summary receiver operating characteristics (SROC) curves. RESULTS From seventeen articles, 25 data sets could be retrieved. Eleven articles studied one modality: US (n=4); USgFNAC (n=1); CT (n=3); MRI (n=3). Six articles studied two or more modalities: US and CT (n=2); USgFNAC and CT (n=1); CT and MRI (n=1); MRI and MRI-USPIO (Sinerem) (n=2); US, USgFNAC, CT and MRI (n=1). USgFNAC (AUC=0.98) and US (AUC=0.95) showed the highest areas under the curve (AUC). MRI-USPIO (AUC=0.89) and CT (AUC=0.88) had similar results. MRI showed an AUC=0.79. USgFNAC showed the highest DOR (DOR=260) compared to US (DOR=40), MRI-USPIO (DOR=21), CT (DOR=14) and MRI (DOR=7). Conclusion USgFNAC showed to be the most accurate imaging modality to detect cervical lymph node metastases.