Risk of oral and gastrointestinal mucosal injury among patients receiving selected targeted agents: a meta-analysis.

PURPOSE: The purpose of this study was to estimate the risk and severity of oral and gastrointestinal mucosal toxicities associated with selected targeted agents. METHODS: We searched the English-language literature in February 2011 for reports of randomized clinical trials comparing a FDA-approved targeted agent to a standard of care regimens. Long-term follow-up and secondary reports of trials were excluded, leaving 85 studies for analysis. Using meta-analytic methods, we calculated the relative risks of oral and gastrointestinal toxicities, adjusting for sample size using the inverse variance technique. For each targeted agent and each side effect, we calculated the number needed to harm, the number of patients that, if treated with the more toxic regimen, would produce one additional episode of the toxicity. RESULTS: Oral mucositis was significantly more frequent among patients treated with bevacizumab, erlotinib, sorafenib, or sunitinib, although this difference was confined to low-grade mucositis. The clinical significance of these findings is unclear given its low incidence and mild severity. In contrast, diarrhea was significantly more frequent with most of the targeted agents studied, with adjusted relative risks between 1.5 and 4.5. An additional patient with diarrhea will be observed for every three to five patients treated with these targeted agents, compared with conventional regimens. CONCLUSIONS: Oral mucosal toxicities occasionally complicate treatment with these targeted agents, but the clinical significance of this finding is not clear. Diarrhea is a hallmark of treatment with these targeted agents; this side effect should be carefully ascertained to permit early intervention and control.

Endodoncia en pacientes oncohematológicos / Endodontic therapy in oncohematological patients

Los pacientes oncohematológicos y oncológicos en general pueden recibir una atención endodóntica normal, siempre y cuando tengamos en cuenta su patología sistémica. El objetivo del presente trabajo es exponer las principales pautas que se deben considerar para realizar un tratamiento de endodoncia adecuado en pacientes oncológicos sometidos a quimioterapia y/o radioterapia.

Endodoncia en pacientes oncohematológicos / Endodontic therapy in oncohematological patients

Los pacientes oncohematológicos y oncológicos en general pueden recibir una atención endodóntica normal, siempre y cuando tengamos en cuenta su patología sistémica. El objetivo del presente trabajo es exponer las principales pautas que se deben considerar para realizar un tratamiento de endodoncia adecuado en pacientes oncológicos sometidos a quimioterapia y/o radioterapia.(AU)

Caries and periodontal disease in cancer survivors.

DATA SOURCES: PubMed and EMBASE were searched for articles published between 1 January 1990 and 31 December 2008. STUDY SELECTION: Eligible studies were those that included dental caries and periodontal disease and pre-cancer dental clearance protocols in cancer patients undergoing head and neck radiotherapy, chemotherapy or combined treatment modalities. Rather than any study inclusion criteria this review had a number of exclusion criteria instead: systematic and non-systematic reviews; microbiology studies; growth and development studies; organ transplant studies; studies eliciting dental complications through questionnaires, studies reporting data from previous publications; phase I and II studies; opinion papers and case reports; articles published before 1990. All reports also had to be in English. DATA EXTRACTION AND SYNTHESIS: Each article was reviewed by two authors independently with pilot-tested data collection forms. No quality assessment was pre-specified. RESULTS: Sixty-four articles were included. Forty-six of these were observational (24 cohort, eight case control, 14 cross-sectional), and 18 were interventional studies. It is unclear how many participants this included. A weighted prevalence of caries was reported but it is unclear how the weighting was calculated. Overall the weighted prevalence was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n=457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (SD, 0.25; n=189). CONCLUSIONS: Patients who were post-radiotherapy had the highest DMFT compared to those who were post-chemotherapy and healthy controls.

Swallowing dysfunction in cancer patients.

PURPOSE: Dysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools, prevalence, complications, and impact on quality of life in patients with a variety of different cancers, particularly in those treated with curative chemoradiation for head and neck cancer. METHODS: The literature search was limited to the English language and included both MEDLINE/PubMed and EMBASE. The search focused on papers reporting dysphagia as a side effect of cancer and cancer therapy. We identified relevant literature through the primary literature search and by articles identified in references. RESULTS: A wide range of assessment tools for dysphagia was identified. Dysphagia is related to a number of factors such as direct impact of the tumor, cancer resection, chemotherapy, and radiotherapy and to newer therapies such as epidermal growth factor receptor inhibitors. Concomitant oral complications such as xerostomia may exacerbate subjective dysphagia. Most literature focuses on head and neck cancer, but dysphagia is also common in other types of cancer. CONCLUSIONS: Swallowing impairment is a clinically relevant acute and long-term complication in patients with a wide variety of cancers. More prospective studies on the course of dysphagia and impact on quality of life from baseline to long-term follow-up after various treatment modalities, including targeted therapies, are needed.

Epidemiology of treatment-associated mucosal injury after treatment with newer regimens for lymphoma, breast, lung, or colorectal cancer.

GOALS OF WORK: Oral and gastrointestinal (GI) mucositis are frequent complications of chemotherapy and radiotherapy for cancer, contributing to not only the morbidity of treatment but its cost as well. The risk associated with specific chemotherapeutic agents, alone and in combination, has been characterized previously. In the current study, we sought to estimate the risk associated with newer regimens for the treatment of non-Hodgkin's lymphoma (NHL) and common solid tumors. METHODS: We reviewed published studies reporting phase II and III clinical trials of dose-dense regimens for breast cancer and NHL, TAC (docetaxel, adriamycin, cyclophosphamide) chemotherapy for breast cancer, and infusional 5-fluorouracil-based regimens for colorectal cancer. Platinum-, gemcitabine-, and taxane-based regimens for lung cancer, either alone or in combination with radiotherapy, were also considered. Using modified meta-analysis methods, we calculated quality-adjusted estimates of the risk for oral and GI mucositis by tumor type and regimen. Case reports are used to emphasize the relevance of the findings for patient care. MAIN RESULTS: Our findings demonstrate that mucosal toxicity remains an important complication of cancer treatment. Moreover, innovations in drug combinations, scheduling, or mode of administration significantly modulate the risk for both oral and GI mucositis. CONCLUSIONS: Ongoing review of the clinical trial experience will remain important as newer, targeted agents enter standard clinical practice.

Tratamiento de las complicaciones bucales en pacientes oncohematológicos, durante la granulocitopenia producida por la quimioterapia. Parte I / Treatment of oral complications in oncohematologic patients during granulocytopenia produced by chemotherapy. Part I

Al observar clínicamente las diferentes lesiones que se presentan en los pacientes sometidos a tratamientos con quimioterápicos por diferentes tipos de patologías sistémicas, que no sólo traen inconvenientes dolorosos sino también infecciosos, se realizaron distintos tipos de tratamientos locales y/o sistémicos. Para el presente trabajo se tomaron en cuenta todos aquellos pacientes que presentaban granulocitopenia en un período determinado, durante el cual permanecieron internados por distintas manifestaciones clínicas. Como se puede observar en las conclusiones del presente trabajo, se llegó a demostrar que la prevención en la salud bucal de los pacientes que serán sometidos a este tipo de tratamiento es fundamental para disminuir las posibilidades de lesiones "oportunistas". Pero ante la aparición de éstas, el tratarlas adecuadamente ayuda al bienestar del enfermo y minimiza los riesgos para el estado general

Tratamiento de las complicaciones bucales en pacientes oncohematológicos, durante la granulocitopenia producida por la quimioterapia. Parte I / Treatment of oral complications in oncohematologic patients during granulocytopenia produced by chemotherapy. Part I

Al observar clínicamente las diferentes lesiones que se presentan en los pacientes sometidos a tratamientos con quimioterápicos por diferentes tipos de patologías sistémicas, que no sólo traen inconvenientes dolorosos sino también infecciosos, se realizaron distintos tipos de tratamientos locales y/o sistémicos. Para el presente trabajo se tomaron en cuenta todos aquellos pacientes que presentaban granulocitopenia en un período determinado, durante el cual permanecieron internados por distintas manifestaciones clínicas. Como se puede observar en las conclusiones del presente trabajo, se llegó a demostrar que la prevención en la salud bucal de los pacientes que serán sometidos a este tipo de tratamiento es fundamental para disminuir las posibilidades de lesiones "oportunistas". Pero ante la aparición de éstas, el tratarlas adecuadamente ayuda al bienestar del enfermo y minimiza los riesgos para el estado general (AU)