A randomized phase III prospective trial of bethanechol to prevent mucositis, candidiasis, and taste loss in patients with head and neck cancer undergoing radiotherapy: a secondary analysis.

The aim of this study was to determine the impact of bethanechol administration concomitant to radiotherapy (RT) on oral mucositis, candidiasis and taste loss. We performed a secondary analysis of a previously conducted prospective randomized trial which evaluated the effect of bethanechol on salivary gland dysfunction before, during, and after RT for head and neck cancer (HNC), in comparison to artificial saliva. Mucositis, candidiasis and taste loss were analyzed in 36 patients. Mucositis was scored using the World Health Organization (WHO) method; candidiasis was diagnosed by means of clinical examination, whereas taste loss was assessed by the patients' subjective report of absence of taste. No significant differences were observed between groups in relation to frequency and severity of mucositis or frequency of candidiasis and taste loss. In conclusion, bethanechol does not appear to reduce the incidence of mucositis, candidiasis, and taste loss when administered during RT.

A review of the biological and clinical aspects of radiation caries.

AIM: The aim of this article is to review the clinical and biological features underlying the development and progression of radiation caries. BACKGROUND: Although radiotherapy (RT) plays an important role in the management of patients with head and neck cancer (HNC), it is also associated with several undesired side effects such as radiation caries which is a common, yet serious, complication. To review the condition, the Pubmed database was searched using the keywords "radiotherapy," "radiation," "caries," "hyposalivation," "prevention" and "management". Only studies published in the English language were selected. Cross-referencing identified additionally relevant studies. REVIEW RESULTS: RT leads to alterations in the dentition, saliva, oral microflora, and diet of patients. Consequently, irradiated patients are at increased risk for the development of a rapid, rampant carious process known as radiation caries. Motivation of patients, adequate plaque control, stimulation of salivary flow, fluoride use, and nutritional orientation are essential to reduce the incidence of radiation caries and ultimately improve the quality of life for HNC patients. CONCLUSION: Radiation caries is an aggressive side effect of RT. Dentists play an important role in the prevention of the condition via comprehensive oral healthcare before, during, and after the active cancer therapy. CLINICAL SIGNIFICANCE: Dentists should understand the clinical and biological aspects underlying radiation caries to prevent the development of lesions and provide optimal treatment when needed.

Oral health status of 207 head and neck cancer patients before, during and after radiotherapy.

The aim of this retrospective study was to describe the oral health status of patients before, during, and after radiotherapy (RT) for the treatment of head and neck cancer (HNC). Before RT, the following data was collected: presence of unrecoverable teeth, residual roots, unerupted teeth, use of dentures, periodontal alterations, caries, candidiasis, and xerostomia. Mucositis, candidiasis, and xerostomia were evaluated during RT. Patients continued to be followed after RT for evaluation of mucositis, candidiasis, xerostomia, radiation caries, and osteoradionecrosis. For statistical analysis, 95% confidence intervals (CI) were determined using sample size, population, and percentages. Before RT, 120 (57.9%) patients presented with alterations in the oral cavity namely, 85 (41.0%) with periodontal disease, 44 (21.2%) with residual roots, 25 (12.0%) with caries, 15 (7.2%) with candidiasis, and 12 (5.8%) had an unerupted tooth present. Xerostomia was a complaint of 19 patients (9.1%). Restorations were indicated for 33 patients (15.9%), whereas extraction was indicated for 104 (50.2%) patients. During RT, mucositis was found in 80 (61.7%) patients, candidiasis in 60 (45.8%), and xerostomia was a complaint of 82 patients (62.6%). After RT, mucositis persisted in 21 patients (19.2%), candidiasis was identified in 23 patients (21.1%), and xerostomia was reported by 58 patients (53.2%). Radiation caries developed in 12 patients (11.0%), whereas six patients (5.5%) developed osteoradionecrosis. The demographic profile herein presented will be useful as baseline data to provide additional epidemiological information and to determine future measures for prevention and treatment of RT-induced complications and sequelae.

Computed tomography and lymphoscintigraphy to identify lymph node metastases and lymphatic drainage pathways in oral and oropharyngeal squamous cell carcinomas.

Clinical examination alone is not enough to establish the true extent of local involvement and regional metastases. It has been suggested that computed tomography (CT) may provide valuable information for pretreatment staging. The role of lymphoscintigraphic analysis has not been investigated extensively in oral and oropharyngeal carcinoma. Information about the age, gender, site, size of the tumor, lymph node status and the tomographic and lymphoscintigraphic data were analyzed in 48 patients diagnosed with oral and oropharyngeal squamous cell carcinoma. The sensitivity of the homolateral clinical examination and CT were 77% and 55%, respectively, and the contralateral results were 66% and 16%, respectively. The specificity of the homolateral exams was 71% and 76% for the clinical examination and CT, respectively, whereas that of the contralateral exams was 100% and 90%, respectively. Lymphoscintigraphy showed the drainage pathway of the (99m )Tc-Dextran 500 in 64.6% of the cases. Homolateral drainage was favored by the tumors staged T1 and T2 that were clinically negative for nodal metastases. Bilateral drainage was associated with tumors close to or involving the midline. Non-drainage was related to tumors larger than 3.5 cm, stages T3 and T4, and the clinical presence of cervical metastases. Clinical examination was more efficient than CT to identify lymph node metastases. Lymphatic drainage of the head and neck regions is complex, and lymphoscintigraphy can be useful in oral and oropharyngeal carcinomas in clinical stages I and II, but further studies are necessary to standardize the methodology.