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Query: UMLS:C0043352 (xerostomia)
 4,250 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The general internist has an important role in the management of head and neck squamous cell cancers. This heterogeneous group of cancers must be accurately diagnosed and staged before planning treatment. Curability is directly related to stage at presentation and, because most patients with such cancers present to internists first, these physicians must be familiar with presenting symptoms and must be suspicious enough to refer patients with symptoms for appropriate evaluation. The work-up of patients with suspected unknown primary cancer presenting as adenopathy is detailed, and the physician is cautioned not to immediately proceed to open biopsy. As many as 10% of such primary cancers remain undetected, although, with proper therapy, the 5-year survival rate for squamous cell cancer of the head and neck is 60%. Those patients cured of head and neck cancer still face significant psychosocial and medical problems, including hypothyroidism, xerostomia, and a 20% rate of second primary cancer. Head and neck cancer is highly preventable; 75% of cases are related to tobacco and alcohol use. Smokeless tobacco has gained popularity among young Americans and is associated with an increased incidence of head and neck cancer at several sites. Education is crucial, and internists must seek strategies to stop patients from using tobacco products. Other etiologic factors include industrial carcinogens, Epstein-Barr virus, and diet. Retrospective serologic and dietary recall studies of vitamin A suggest an etiologic role of diet; vitamin A analogs have been tested in preneoplastic lesions. To reduce mortality from head and neck cancers, the general internist must play a central role in prevention and early detection.
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PMID:The internist in the management of head and neck cancer. 224 Aug 79

Radiotherapy of head and neck malignancies results in severe xerostomia which induces radiation caries. Hard cheese has potent anti-cariogenic effects, even with minimal salivary gland function. Eight patients irradiated for neck cancer volunteered for this study. The saliva flow rate varied between 0.0-0.15 ml/minute. In vitro etched enamel slabs, prepared from human teeth, were exposed intraorally to parafilm stimulated salivary secretion for 5 minutes or, alternatively, to cheese compounds and saliva due to masticating 20 gm hard cheese for 5 minutes. Microhardness measurements were carried out on the enamel surface at start (baseline), after etching and after rehardening. Stimulated saliva or cheese compounds and saliva, due to mastication, induced rehardening of surface enamel in both, non-irradiated and irradiated subjects. The rehardening was significantly increased in the irradiated group consuming cheese as compared to rehardening by stimulated saliva only and not significantly less of that achieved in non-irradiated subjects. Rehardening achieved with stimulated saliva in irradiated patients was of a borderline-significant lower degree in comparison to non-irradiated subjects. The reduced rehardening capacity of a decreased saliva flow in irradiated patients may be complemented by cheese compounds. For xerostomic patients, hard cheese consumption may be regarded as effective to keep initial caries under control.
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PMID:Enamel rehardening with cheese in irradiated patients. 799

The tightly conformal doses produced by intensity-modulated radiotherapy (IMRT), the existence of many critical structures in close proximity to the target, and the lack of internal organ motion in the head and neck, provide the potential for organ sparing and improved tumor irradiation. Many studies of treatment planning for head-and-neck cancer have demonstrated the dosimetric superiority of IMRT over conventional techniques in these respects. The initial results of clinical studies demonstrate reduced xerostomia. They suggest an improvement in tumor control, which needs to be verified in larger studies and longer follow-up.
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PMID:Clinical aspects of IMRT for head-and-neck cancer. 1207 74

Background and purpose. Intensity modulated radiation therapy (IMRT) offers an opportunity to generate dose distributions highly conformal to the target volume. Head and neck cancer patients, referred for radiotherapy, may be good candidates to benefit from IMRT. This paper discusses the clinical implementation of IMRT for oropharyngeal and oral cavity tumors, and reports the clinical results of the 14 patients treated with this technique at Ghent University Hospital (GUH). Patients and Methods. Between May 1999 and May 2001, 14 patients were treated with IMRT at GUH for oropharyngeal or oral cavity tumors. Two groups of patients can be distinguished. The first group consists of eight patients re-irradiated with IMRT for a locoregional relapse. The second group of six patients were treated with IMRT for a primary tumor. For the first group, IMRT was used to treat the relapse by generating a concave dose distribution, i.e. to combine a homogeneous target re-irradiation with a dose to the spinal cord as low as possible. For the second group, IMRT was applied in order to achieve a more homogeneous dose distribution inside the PTV and to preserve parotid gland function. Results. The majority of the patients of group 1 (6/8) relapsed in field within four months after the end of the re-irradiation, with a median overall survival of 7 months. For group 2, two patients died shortly after the end of the IMRT treatment, the other four patients are free of tumor relapse with a median follow-up of 5 months (1-13 months). The acute toxicity due to radiation was acceptable for both patient groups. Dysphagia and pain was more present in group 1. Regarding late complications for the group of re-irradiations (group 1), no myelitis, carotid rupture or cranial nerve palsy was observed. One patient of group 1 developed osteoradionecrosis of the mandible and feeding tube dependency was present for another patient. No fatal late complications were observed in this group. For the first two patients of group 2, sparing of the parotid function was not a treatment objective. For the other patients of group 2, the mean dose to the contralateral parotid gland ranged from 17 to 25 Gy, which resulted in a decrease of subjective symptoms of xerostomia compared to patients treated with conventional radiotherapy. Conclusions. The implementation of IMRT for oropharyngeal and oral cavity tumors results in a homogeneous target irradiation and allows to re-irradiate locoregional relapses with acceptable adverse effects. Sparing of the parotid gland by IMRT is feasible, although this may be significantly influenced by the delineation method of the elective lymph node regions.
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PMID:Intensity modulated radiation therapy for oropharyngeal and oral cavity tumors: clinical use and experience. 1216 38

Radiotherapy is common treatment for head-and-neck cancer, during which the salivary glands are often included within the radiation field. The most common side effect of this treatment is the development of oral dryness (xerostomia). This study considers the administration of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF or FGF2) at physiological concentrations before and after irradiation in order to repair radiation-induced damage in salivary gland cells. As a preliminary examination of the efficacy of this approach we have characterized the effects of EGF and bFGF on the apoptotic response of 15-Gy irradiated rat salivary glands in vitro. Also, we have developed a controlled-release delivery system to effectively administer the growth factor to the gland since local delivery is essential to avoid unwanted protection of cancer cells. In vitro administration of bFGF prior to and immediately after irradiation partially protected (44%) the rat parotid gland. EGF did not show any significant radioprotective effect on parotid glands after a single 15-Gy irradiation dose. Encapsulation, storage and release of bFGF from biodegradable 50/50 PLGA microspheres did not affect the functionality of the growth factor in vitro.
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PMID:Effects of EGF and bFGF on irradiated parotid glands. 1598 68

Radiation induced xerostomia is a frequent consequence of radiotherapy (RT) for head-neck cancer (HNC) patients, when parotid glands are included in the radiation fields. Although early appearing xerostomia may be alleviated with the use of pilocarpine, persistent chronic xerostomia affects more than 70% of HNC patients treated with post-operative or radical radiotherapy and significantly impairs the quality of life potentially cured patients. The present manuscript reviews and discusses the current technological (conformal and intensity modulated RT) and pharmacological (amifostine) developments aiming to prevent the severity and reduce incidence of both acute and late radiation xerostomia in patients with HNC.
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PMID:Preventing radiation induced xerostomia. 1625 25

In 148 head-and-neck cancer patients treated with surgery plus radiotherapy (RT), IMRT, 3D-conformal RT, and conventional RT and 10 potential prognostic factors were evaluated for overall survival (OS), metastasis-free survival (MFS), and loco-regional control (LC). On univariate analysis, ECOG performance status, T-stage, AJCC-stage, extent of resection, and pre-RT hemoglobin level (>or=12 g/dl better than <12 g/dl) were significantly associated with treatment outcome, whereas RT technique had no significant impact. On multivariate analysis, performance status maintained significance for OS (P=0.019), AJCC-stage for LC (P=0.034), extent of resection for OS (P=0.045) and MFS (P=0.021), pre-RT hemoglobin for MFS (P<0.001). IMRT was associated with less xerostomia than conformal RT and conventional RT (17% versus 63% and 73%, P=0.037). Otherwise, acute and late toxicity was similar. Outcome was significantly associated with performance status, tumor stage, extent of resection, and pre-RT hemoglobin. The three radiation techniques provided similar disease control. IMRT was effective in significantly reducing xerostomia.
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PMID:Prognostic factors in head-and-neck cancer patients treated with surgery followed by intensity-modulated radiotherapy (IMRT), 3D-conformal radiotherapy, or conventional radiotherapy. 1700 37

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they receive radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral adverse effects after radiation therapy. Part I of this series reviews the management of xerostomia. The management of the effect of xerostomia to the dentition/oral cavity is discussed in Part II.
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PMID:Managing complications of radiation therapy in head and neck cancer patients: Part I. Management of xerostomia. 1737 33

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral complications after radiation therapy. The management of xerostomia has been reviewed in Part I of this series. In this article, the management of dental caries, a sequalae of xerostomia following radiation therapy is reviewed.
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PMID:Managing complications of radiation therapy in head and neck cancer patients: Part II. Management of radiation-induced caries. 1737 34

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Pretreatment dental assessment should be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally and, as a result, they succumb to complicated oral adverse effects after radiation therapy. The management of radiation-induced caries, a sequelae of xerostomia has been reviewed in Part II of this series. In this article, the management of difficulty with dentures, another sequelae of xerostomia following radiation therapy is reviewed.
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PMID:Managing complications of radiation therapy in head and neck cancer patients: Part III. Provision of dentures. 1737 35


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