Patient-reported oral mucositis in solid tumour patients undergoing chemotherapy: a Ugandan experience.

Purpose: The mitotic rate of the gastrointestinal tract (GIT) mucosa predisposes the entire system to chemotherapeutic-induced mucositis but the oral cavity due to its accessibility provides an opening to evaluate the extent of the problem much more easily. In addition, the oral cavity being the gateway to the GIT affects the feeding ability of the patient when the ulcers set in.It is therefore from this perspective that we embarked on a study to evaluate the extent of mucositis among patients being treated for solid tumours at our centre. Methods: Using the mouth and throat soreness (OMDQ MTS) questionnaire, we prospectively evaluated mucositis among 100 patients undergoing chemotherapy for solid tumours at the Uganda Cancer Institute. In addition to patient reported outcomes, we also had clinician assessed mucositis measurements. Results: Approximately, 50% of the participants were breast cancer patients. The results demonstrated that patient assessment of mucositis is possible in our setting at a 76% full compliance rate. Up to 30% of our patients reported moderate-to-severe mucositis, though the figure was lower as assessed by the clinicians. Conclusions: The self-reported OMDQ MTS can be useful in our setting for daily mucositis evaluation, hence leading to timely hospital visits before the manifestation of severe complications.

Evaluation of oral mucositis, candidiasis, and quality of life in patients with head and neck cancer treated with a hypofractionated or conventional radiotherapy protocol: a longitudinal, prospective, observational study.

BACKGROUND: Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, recently, Radiotherapy (RT) protocols requiring fewer sessions (hypofractionated) have been used to shorten RT treatment and minimize patient exposure to medical centers, and decrease the risk of SARS-CoV-2 infection. METHODS: This longitudinal, prospective, observational study aimed to compare the quality of life (QoL) and the incidence of oral mucositis and candidiasis in 66 patients with head and neck cancer (HNC) who undergo a hypofractionated RT protocol (GHipo), total of 55 Gy for 4 weeks, or a conventional RT protocol (GConv), total of 66 - 70 Gy for 6 - 7 weeks. PURPOSE: To assess the incidence and severity of oral mucositis, the incidence of candidiasis, and QoL were evaluated using the World Health Organization scale, clinical evaluation, and the QLC-30 and H&N-35 questionnaires, respectively, at the beginning and the end of RT. RESULTS: The incidence of candidiasis did not show differences between the two groups. However, at the end of RT, mucositis had a higher incidence (p < 0.01) and severity (p < 0.05) in GHipo. QoL was not markedly different between the two groups. Although mucositis worsened in patients treated with hypofractionated RT, QoL did not worsen for patients on this regimen. CONCLUSIONS: Our results open perspectives for the potential use of RT protocols for HNC with fewer sessions in conditions that require faster, cheaper, and more practical treatments.

Phase 2 study of anlotinib combined with taxanes and lobaplatin in the neoadjuvant treatment of triple-negative breast cancer: Efficacy, safety and biomarker analysis

Background: Pathological complete response (pCR) is associated with improved prognosis in triple-negative breast cancer (TNBC). Anlotinib, a novel multi-target tyrosine kinase inhibitor that effectively inhibits VEGFR, FGFR, c-KIT, c-MET, and RET, monotherapy has been proven effective in HER-2 negative metastatic breast cancer, but its efficacy in early-stage TNBC is unknown. This phase 2 study aims to evaluate the efficacy and safety of adding anlotinib to neoadjuvant chemotherapy in patients (pts) with primary TNBC. Methods: Pts with clinical stage II/III TNBC were to be treated with 5 cycles of anlotinib (12mg, d1-14, q3w) plus 6 cycles of taxanes (docetaxel 75 mg/m2 or nab-paclitaxel 260 mg/m2, d1, q3w) and lobaplatin (30 mg/m2, d1, q3w), followed by surgery. The primary endpoint was the total pCR (tpCR;ypT0/is ypN0). A Simon's two-stage optimum design was used, and > 5 of 11 pts were required to achieve tpCR in the first stage, with a pre-specified tpCR rate of 54.5% before proceeding to the second stage. A total of 31 participants was required for the study. Results: Six out of 11 pts achieved tpCR in the first stage, reaching the threshold for the second stage. From Jan 2021 to Jan 2022, a total of 22 pts were enrolled and 12 received surgery after the completion of neoadjuvant therapy, but a total of 2 pts withdrew from the study due to the COVID-19 pandemic or serious adverse events. Of the 22 eligible pts, the median age was 49 years (range, 29-64), 64% were postmenopausal, and 73% were nodal involved. At the time of surgery, 58.3% (7/12) achieved tpCR. Of the 9 pts with the node-positive disease at diagnosis, 88.9% (8/9) became ypN0. The results of FUSCC TNBC classification (IHC-based) revealed the tpCR rates were 57.1% (4/7), 100% (3/3), and 0% (0/2) for BLIS subtype, IM subtype and LAR/unknown subtypes, respectively. Biomarker analysis showed the tpCR rates were 100% (3/3) and 100% (4/4) in patients with gBRCA1 mutation and MYC amplification, respectively. The most common grade 3 or 4 treatment-related adverse events were leucopenia (6/22, 27%), neutropenia (6/22, 27%), anemia (5/22, 23%), decreased appetite (5/22, 23%), hypertension (2/22, 9%), ALT increased (1/22, 5%) and oral mucositis (1/22, 5%). No treatment-related deaths occurred. The trial is ongoing. Conclusions: The addition of anlotinib to neoadjuvant chemotherapy showed manageable toxicity and promising antitumor activity for patients with early-stage TNBC.

Phase 2, randomized, double-blind trial of EC-18 versus placebo to mitigate the development and time course of oral mucositis from concomitant chemoradiation for head and neck cancer

Background: Oral mucositis (OM) is a debilitating side effect of concomitant chemoradiotherapy (CRT) for head and neck cancer (HNC). EC-18 may effectively mitigate OM by minimizing the CRT-induced innate immune response. This Phase II, 2-stage trial evaluated safety, tolerability, and efficacy of EC- 18 in reducing the duration, incidence, and trajectory of severe OM (SOM) in HNC patients. Methods: Patients (n = 105) with pathologically confirmed oral cavity, oropharynx, hypopharynx, or nasopharynx squamous cell cancers who received intensity-modulated radiation therapy (IMRT;with ≥ 55 Gy on ≥ 2 oral sites) and weekly or tri-weekly cisplatin were studied. In Stage 1, 24 patients were randomized (n = 6 per arm) to receive 500, 1000, or 2000 mg of EC-18, or placebo. Following independent Data Safety Monitoring Board review, 81 patients in Stage 2 received EC-18 2000 mg (n = 41) or placebo (n = 40) throughout CRT. WHO OM grade was assessed twice weekly during IMRT and then once weekly for up to 6 weeks post-IMRT. The primary efficacy endpoint was duration of SOM during the active and short-term follow-up (STFU) periods in the compliant per-protocol population (PP). Much of Stage 2 was conducted during peak periods of the COVID-19 pandemic which measurably impacted patient compliance relative to test medication dosing and planned radiation. Consequently, to assess efficacy most accurately, the PP population was analyzed (with at least 4 weeks of study drug dosing, minimum cumulative radiation of 55 Gy, 80% study drug compliance in the first 28 days of dosing, and without using not-allowed-therapy). Results: Patient demographics and baseline characteristics were balanced between groups. Adverse events (AEs) were comparable amongst cohorts without drug-related severe AEs. In the PP, the median duration of SOM from baseline through STFU was 0 day in the EC-18 group (n = 22) v 13.5 days in the placebo group (n = 20). SOM incidence through STFU (45.5% v 70%) and opioid use (time to onset: 32.3 v 26.0 days;and duration: 32.8 v 37.5 days) favored EC-18 v placebo. Results of the covariates analyses suggested that EC-18 favorably impacted SOM incidence in patients who experienced SOM treated with weekly low-dose cisplatin (n = 26;37.5% v placebo 70.0%) and HPV+ tumors (n = 29;35.3% v placebo 66.7%;Table). One-year long-term follow-up for tumor outcomes is ongoing. Conclusions: EC-18 safely mitigated the development and the time course of SOM in CRT-treated HNC patients. In addition, EC-18 may provide substantial benefits to subpopulations of HPV+ HNC patients treated with low dose cisplatin.

Primary analysis of MUKDEN 01: A multicenter, single-arm, prospective, phase 2 study of neoadjuvant treatment with pyrotinib and letrozole plus dalpiciclib in triplepositive breast cancer

Background: Despite the use of multiple lines of targeted therapy has revolutionized treatment for HER2-positive breast cancer, these methods still have limited efficacy for triple-positive breast cancer (TPBC), which calls for persistent exploration for optimized treatment strategy. This MUKDEN-01 prospective trial aimed to evaluate the efficacy of oral, chemo-sparing neoadjuvant therapy with pyrotinib, letrozole and dalpiciclib, which also meet the need for treatment convenience under COVID-19 pandemic, for patients with TPBC. Methods: The MUKDEN 01 was an investigator-initiated, multicentre, single arm, prospective phase II trial, which was performed at twelve hospitals in China( NCT04486911). Treatment-naïve patients with stage II-III tumors that according to the AJCC 8th edition criteria were eligible. Patients were treated with each cycle of 4 weeks with oral administration of pyrotinib 320 mg, and letrozole 2.5mg once daily for 4 weeks, and dalpiciclib 125 mg once daily for three weeks, followed by one week off, for five cycles. The primary endpoint was pathological complete response (pCR) in the breast and axilla (ypT0/is ypN0). Secondary endpoints included pCR in the breast (ypT0/is). residual cancer burden (RCB) score, Ki67 index change at surgery compared with baseline, and safety. Safety was analyzed in all patients, who received treatment. The study is still ongoing, and the enrollment has been completed. Results: Between June 20, 2020 and Sep. 6, 2021, 68 patients were screened for eligibility and 61 patients were recruited into this first stage of study. After surgery, 18 (29.5%, 95% CI 18.5-42.6) out of 61 patients achieving tpCR(ypT0/is ypN0), 21 (34.4%, 95% CI 22.7-47.7) patients achieved bpCR(ypT0/is). The patients with excellent pathologic response (RCB 0-1) to the combined therapy accounted for 54.1% (33/61, 95% CI 40.9-66.9). Mean Ki67 expression was reduced from 38.7% (95%CI: 31.3-46.0) at baseline to 19.3% (95% CI:13.6- 25.0;p=0.0001) in the surgical samples. The most frequent grade 3 AE were neutropenia (35 [57%]), leukopenia (13 [21%]), diarrhea (9 [15%]) and oral mucositis (4 [7%]). There were five grade 4 neutropenia (8%) and one grade 4 increased AST (2%), but without other SAE and death throughout the study. Conclusions: Neoadjuvant therapy with pyrotinib, letrozole and dalpiciclib yielded a pCR rate comparable to standard chemotherapy plus dual HER2 blockade in TPBC patients. The combined therapy was also well-tolerated and provided a chemo-sparing neoadjuvant approach for TPBC patients. To our knowledge, this is the first study to evaluate the therapeutic efficacy of a chemo-free neoadjuvant treatment with HER2 TKI pyrotinib and letrozole plus CDK4/6 inhibitor dalpiciclib for TPBC patients. Further validation in a large-scale randomized controlled trial is warranted.

Toxic Epidermal Necrolysis(TEN) Associated with covid-19 Infection, a Case Report

Introduction: Covid-19 infection has been spreading worldwide since December 2019. Skin manifestations are common as 60% of patients had skin involvement such as rashes, chilblains, urticaria, purpura and vasculitis (1). Toxic Epidermal Necrolysis (TEN) is a life-threatening dermatological disease with > 30% of body surface area involved. TEN pathophysiology is linked to immune system activation triggered by drugs or infections or unknown causes (2). We are reporting a case of biopsy confirmed TEN in pediatrics patient with history of recent Covid19 infection. Case Description: A 6-year-old boy with history of mild Covid 19 infection two weeks ago presented with fever, oral ulcers and maculopapular rash on the trunk and extremities for 2 days. He was admitted for supportive care. His skin rash was progressing to violaceous targetoid lesions on the trunk and extremities with genital erosion, Nickolsky sign was positive. He had purulent conjunctivitis and crusted lips lesions with deepithelization of the oral mucosa. SCROTEN score was 2 for detachment more than 30%, low bicarbonate of 19. All virology tests came out negative including respiratory and blood PCR testing. A 4-mm punch skin biopsy histopathology was consistent with TEN. He was treated with supportive care, IVIG 1 g/Kg daily for 5 days, IV dexamethasone shifted later to oral Prednisolone, Cyclosporin 3 mg/kg/day. His rash and oral mucositis improved within 1 week and he was discharged in stable condition. He was seen in the clinic after 1 month of discharge and recovery of the skin, oral and eye mucosa was observed. Discussion: This report presented a case of a child with TEN and history of recent Covid-19 infection. Most cases of TEN are triggered by drugs and some by infections (3)(4). There were case reports of TEN associated with Covid 19 infection in adults with probable association with drugs such as hydroxychloroquine (3), Allopurinol (5), Lamotrigine (6), one case with no history of drug exposure (7). In a report of more than 5000 pediatrics patients with Covid-19 infection only one patient had SJS (8). Another case of 8-year-old boy with Covid-19 infection who developed SJS rash was reported (9). Both pediatrics cases had history of Amoxicillin- Clavulanate use. In our case the relationship between Covid-19 infection and TEN is not clear as the child had a history of Ibuprofen use that could be the culprit trigger. However, Covid-19 could still be the trigger in this case. It is worth reporting this case to keep in mind the wide spectrum of dermatological presentation in Covid-19 patients. Conclusion: Whether Covid 19 infection can trigger TEN in pediatrics patient is an important question that needs larger studies, yet it is worth reporting this case of possible correlation between Covid 19 and TEN in pediatrics.

REACTIVE INFECTIOUS MUCOCUTANEOUS ERUPTION (RIME) THROUGH REASON: EVALUATING ORAL SWELLING IN A PATIENT WITH COVID-19

CASE: A 22-year-old woman with h/o asthma initially presented to the hospital with lip swelling and sore throat. She tested positive for COVID-19 and received a casirivimab-imdevimab (monoclonal antibody) infusion. She returned a week later with worsening lip swelling, dysphagia and conjunctivitis. Physical exam revealed edematous lips with vesicular lesions, no tongue swelling, tonsillar exudate, 4+ conjunctival injection bilaterally with purulent discharge, and shallow clean based clitoral ulceration. She reports no history of allergic reactions, angioedema or exposure to new medications. Nasopharyngolaryngoscopy showed no laryngeal edema but visualized exudates throughout the supraglottis and glottis. C4, ANA, CMV, EBV, throat and blood cultures were negative. STI testing was trichomonas positive and gonorrhea/chlamydia negative. Respiratory virus panel remained positive for COVID-19. HSV swab of lip lesion, HSV 1/2 IgG and IgM were negative. Mycoplasma pneumoniae IgG was elevated (0.60, negative is ≤0.09), IgM equivocal (0.85, negative is ≤0.76), and nasopharyngeal PCR negative. Conjunctival culture showed rare bacteria (S. Aureus) and no leukocytes. She initially received methylprednisolone IV due to concern for angioedema, acyclovir for empiric HSV treatment and empiric antibacterial moxifloxacin eye drops. Given lack of infectious trigger, her presentation was concerning for reactive infectious mucocutaneous eruption (RIME) associated with SARSCoV-2 or Mycoplasma. Prednisone 1mg/kg daily was initiated followed by improvement in oral mucositis and conjunctivitis within days. IMPACT/DISCUSSION: A broad differential is important when evaluating oral swelling and mucositis. Her lack of cutaneous involvement, medication exposure or family history and negative infectious, autoimmune and inflammatory workup make other causes including Stevens-Johnson syndrome, erythema multiforme, angioedema, and HSV less likely. Our final diagnosis of RIME describes mucocutaneous eruptions likely due to an immune response triggered by bacterial or viral infection. Our patient's RIME may be due to COVID-19 or Mycoplasma given her equivocal Mycoplasma IgM. Eruptions generally involve two or more mucosal sites and occur mostly in children and adolescents. Common presentations include oral erosions and ulcers, purulent bilateral conjunctivitis, or urogenital lesions, which were all seen in our patient. As this is a relatively rare and new condition, no standard of care treatment exists for RIME but systemic steroids have been effective in case reports for initial treatment and subsequent flares. CONCLUSION: RIME is a rare, newly described condition in young patients who develop postinfectious mucocutaneous eruptions of two or more mucosal sites. It has been recently reported in association with COVID-19 and its association with Mycoplasma infection is important to evaluate. This condition is important to recognize and treat given the requirement for higher dose steroids than that used for angioedema.

Erythema multiforme major requiring intensive care admission in conjunction with COVID-19 infection

A 13-year-old boy presented with oral pain and mucositis on a background of preceding sore throat, fever and malaise. His lips were swollen and ulcerated with tonsillar exudate visible. Reverse transcriptase polymerase chain reaction testing for SARS-CoV-2 was positive, and inflammatory markers were raised (C-reactive protein 77 mg L-1, erythrocyte sedimentation rate 31 mm h-1);additional virology (herpes simplex virus, cytomegalovirus, Epstein-Barr virus and HIV) was negative. Intravenous fluids, ceftriaxone, acyclovir and analgesia including morphine were commenced. He was unable to tolerate soluble oral steroid rinses. Over 24 h, his oral mucositis progressed with the additional development of conjunctival injection and nontargetoid, erythematous papules. A diagnosis of erythema multiforme (EM) major in conjunction with COVID-19 infection was made. His condition deteriorated with oral intubation required to maintain airway patency and deep sedation for pain control. During a 13-day paediatric intensive care admission he developed an extensive rash including ulceration of the external genitalia. There was marked ulceration of the trachea but fortunately tracheostomy was avoided. The patient has subsequently recovered well. A variety of cutaneous features, including EM, have been described in conjunction with COVID-19 infection. The incidence of distinct rashes varies between adults and children with EM uncommon in both groups but seemingly more frequent in paediatric patients (Bennardo L, Nistoc®o SP, Dastoli S et al. Erythema multiforme and COVID-19: what do we know? Medicina (Kaunas) 2021;57: 828). The relationship of EM to outcome from COVID-19 infection itself is yet to be fully established. As with other infections, EM in children with COVID-19 exhibits a range of clinical presentations. This case highlights the severe end of the disease spectrum and underlines the role of the multidisciplinary team in management.

Omission of day 11 methotrexate in regimen for the prophylaxis of graft-versus-host disease after haploid hematopoietic stem cell transplantation.

BACKGROUND: The regimen of cyclosporin combined with four times of short-range methotrexate is still recognized as the classic prevention regimen for acute graft-versus-host disease. Previous studies have shown that whether day 11 methotrexate is used in sibling transplantation has no effect on the incidence of acute graft-versus-host disease. However, the effect of reducing day 11 methotrexate on the incidence of acute graft-versus-host disease in haploid hematopoietic stem cell transplantation patients remains unclear. OBJECTIVE: To investigate the efficacy of the omission of day 11 methotrexate in the regimen for the prophylaxis of graft-versus-host disease in haploid hematopoietic stem cell transplantation. METHODS: The clinical data of 63 patients with malignant hematologic diseases who received haploid hematopoietic stem cell transplantation from January 2017 to December 2019 were retrospectively analyzed. The graft-versus-host disease prevention regimen was cyclosporine combined with methotrexate 15 mg/m² on day 1, 10 mg/m² on day 3, day 6 and day 11. In the observation group (n=19), oral mucositis was grade III-IV at day 11, and day 11 methotrexate was cancelled. In the control group (n=44), oral mucositis was grade 0-II at day 11, and day 11 methotrexate was applied. The implantation situation, incidence of acute graft-versus-host disease, overall survival rate, and recurrence rate of the two groups were analyzed. RESULTS AND CONCLUSION: (1) The median follow-up time was 30(3-54) months and all neutrophils were successfully implanted in both groups. The median implantation time was 12(9-29) days and 12(8-25) days, respectively, showing no significant difference (P=0.682). There was one patient with poor platelet implantation in the observation group, and four patients with poor platelet implantation in the control group. The median time of platelet implantation was 12(9-18) days and 13(9-31) days in the two groups, respectively, (P=0.71), showing no statistical difference. (2) The overall incidence of acute graft-versus-host disease was 44.4%, and grade II-IV acute graft-versus-host disease was 28.6%. The incidence of II-IV acute graft-versus-host disease in the observation group and control group was 31.5% and 27.3%, respectively, (P=0.728), and there was no statistical difference between the two groups. (3) The results showed that for haploid hematopoietic stem cell transplantation, the omission of day 11 methotrexate did not increase the incidence of acute graft-versus-host disease compared with the standard methotrexate regimen. (English) [ FROM AUTHOR] 背景：环孢素联合4次短程甲氨蝶呤方案仍是目前公认的、经典的预防急性移植物抗宿主病方案，以往研究显示在同胞全相合移植后第11 天是否应用甲氨蝶呤对于急性移植物抗宿主病的发生率没有影响，但减少第11天甲氨蝶呤对单倍体造血干细胞移植患者急性移植物抗宿主 病发生率的影响仍不清楚。 目的：探讨移植物抗宿主病预防方案中去除第11天甲氨蝶呤的应用对单倍体造血干细胞移植患者发生急性移植物抗宿主病的影响。 方法：回顾性分析 2017年1月至2019年12月接受单倍体造血干细胞移植治疗的 63例恶性血液病患者的临床资料，移植物抗宿主病预防方案 为环孢素联合甲氨蝶呤15 mg/m²(第1天)，10 mg/m2(第3，6，11天)。在第11天时发生严重口腔黏膜炎(Ⅲ-Ⅳ级)的患者，取消第4次甲氨蝶 呤应用，归为观察组，共19例；在第11天时发生轻度口腔黏膜炎(0-Ⅱ级)的患者，按标准方案继续第4次甲氨蝶呤应用，归为对照组，共 44例。对两组植入情况、急性移植物抗宿主病发生率、总体生存率及复发率进行分析。 结果与结论：①中位随访时间 30(3-54)个月，两组患者中性粒细胞全部植活，中位植入时间分别为 12(9-29) d 和12(8-25) d，差异无显著 性意义(P=0.682)；观察组1例血小板植入不良，对照组4例血小板植入不良，可分析数据两组中位植入时间分别为 12(9-18) d 和13(9-31) d， 差异无显著性意义(P=0.71)；②急性移植物抗宿主病总体发生率为 44.4%，Ⅱ-Ⅳ度急性移植物抗宿主病为28.6%；观察组及对照组Ⅱ-Ⅳ度 急性移植物抗宿主病发生率分别为31.5%，27.3%，差异无显著性意义(P=0.728)；③结果表明，对于单倍体造血干细胞移植，与标准甲氨蝶 呤预防方案比较，去除第11天甲氨蝶呤的应用并不引起急性移植物抗宿主病发生率升高。 (Chinese) [ FROM AUTHOR] Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo zu zhi gong cheng yan jiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Impact of daily intravenous hydration on radio-chemotherapy compliance in head and neck cancer patients

Introduction: Concurrent radio-chemotherapy (RCT) improves overall survival in resected high risk or locally advanced head and neck squamous carcinomas (HNSCCs). RCT can be a challenging treatment burdened by high toxicities, resulting in a discontinuation rate of 20-40%. Poor compliance to RCT affects negatively outcomes. We hypothesize that daily intravenous hydration during RCT could improve treatment adherence and handle toxicities, such as anorexia and weight loss. Methods: We retrospectively collected clinical data from 35 patients (pts) with stage II-IV HNSCCs treated with RCT from January 2017 to December 2020 in our institution. They received cisplatin 100 mg/mq d1w21 and daily intravenous 1000 ml saline solution, infused from day 10 after the start of RCT until the end of treatment. Here we report the clinical impact of daily hydration during RCT. Results: Pts were affected by larynx (28%), oropharynx (22%) and oral (17%) squamous carcinoma. The majority of pts had stage IV (77%) and III (14%) HNSCCs. The median age was 63 years (range 42-77), with 74% of male. At least 2 cycles of chemotherapy were administered in 94% of pts. A cumulative cisplatin dose of 200 mg/mq was reached in 46% of pts, with a median cumulative dose of 199 mg/mq. The optimal radiation dose was administered in 89% of pts, with a 20% of radiotherapy (RT) interruption. Only 14% of pts discontinued RT, mostly for toxicity, and in 80% of cases they had oropharynx carcinomas. Only 23% and 40% of pts suffered from oral mucositis CTCAE G3 and anorexia G3 respectively, without leading to treatment discontinuation. During RCT, 54% of pts had a performance status (PS) worsening: moving to PS 1 ECOG in 79% of cases and to PS 2 in 21% of cases. There were no hospitalizations during RCT. Intravenous steroids and analgesic therapy were administered in 80% and 49% of pts, respectively. Only 31% of pts received tube feeding or total parenteral nutrition. The majority of pts (77%) underwent hydration supportive treatment with home care assistance. Conclusions: Daily intravenous hydration during RCT could improve compliance and toxicity management, especially for anorexia, dehydration and weight loss. In our real-life experience we reached a relevant cumulative cisplatin dose in almost half of pts and low RT discontinuation rate. No hospitalizations were reported and the majority of pts underwent supportive treatment with home care assistance, a meaningful aspect during SARS-COV2 pandemic.

Multisystem inflammatory syndrome in children (MIS-C) temporarily associated with the new coronavirus infection COVID-2019 and its short-and long-term consequence

Background: Children develop severe COVID-19 much less often than adults. However, a small proportion of children present with a complication, known as a multisystem inflammatory syndrome (MIS-C) sometimes associated with admission to an intensive care unit or death. Clinical presentation and consequences of MIS-C are still unclear. The aim of our study is to assess the features of MIS-C and its consequences on a child's health. Method: An observational longitudinal study of children and adolescents hospitalised from May 17 to October 26, 2020, with MIS-C to Morozovskaya Children's City Clinical Hospital, Moscow Department of Health Care, Moscow, Russia. Results: 37 children with MIS-C (meeting WHO, CDC, or RCPCH criteria) were hospitalised. The median age was 6 years (interquartile range 3.3-9.9 years), and 22 patients (59.5%) were male. The most common symptoms on admission were fever (97.3%), fatigue (86.5%), scleritis (85%), oral mucosal inflammation (83.8%), rash (70.3%), tachycardia (51.4%), nausea (51.4%), bilateral conjunctivitis (43.2%), cervical lymphadenopathy (43.2%). The most common laboratory abnormalities detected during hospitalization were elevated CRP (100%), ferritin (100%), D-dimer (89.19%), CRP (86.49%), platelets (85.49%), hypoalbuminemia (100%) and anemia (95.59%). EchoCG abnormalities were present in 6 (16.2%) children with evidence of myocardial dysfunction, 5 (13.5%)-pericarditis, and 3 (8.1%) with a coronary anomaly. The median time from discharge to the first follow-up was 15 days (interquartile range, 14-18 days) to the second follow-up was 47 days (interquartile range, 41-52 days). At the first follow-up, 7/33 (21.21%) children had at least 1 symptom, of whom 5 (15.15%) reported fatigue. At the second follow-up, only 1 child reported a symptom (rash). The normalisation of laboratory values and EchoCG findings was noted in all the children. Conclusion: In spite of the MIS-C severity, the tendency to fast regression of symptoms and laboratory and instrumental indexes is traced, which suggests recovery of children and adolescents from MIS-C without long-term consequences. Further long-term follow-up of patients with MIS-C is necessary since data on long-term health outcomes are limited.

Impact of pandemic COVID-19 outbreak on oral mucositis preventive and treatment protocols: new perspectives for extraoral photobiomodulation therapy.

This communication discusses the current challenges of oral mucositis (OM) management during the pandemic COVID-19 outbreak and reflects about an extraoral photobiomodulation protocol as an optimal alternative for preventing and treating OM in advanced cancer patients while minimizing the risk of infection by avoiding intraoral manipulation.