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Oral Cancer

, Volume 3, Issue 3–4, pp 59–67 | Cite as

Pilot study: protective effect on mucosal tissue using dental waterjet and dexpanthenol rinsing solution during radiotherapy in head and neck tumor patients

  • Timo Wilhelm-BuchstabEmail author
  • Christopher Thelen
  • Frederik Amecke-Mönnighoff
  • Leonard Christopher Schmeel
  • Birgit Simon
  • Thomas Müdder
  • Felix Schoroth
  • Stephan Garbe
  • Fred Röhner
  • Susanne Vornholt
  • Andreas Schröck
  • Hans H. Schild
  • Heinrich Schüller
  • Christina Leitzen
Original Article
  • 1 Downloads

Abstract

Purpose

Radiogenic side effects are frequently seen in patients undergoing radiotherapy for head and neck tumors. Intensified dental and mucosal care reduce oral hygienic deficits. The aim of this study was the optimization of mouth hygiene using dexpanthenol rinsing solution applied with a dental waterjet system (DWS).

Methods

30 consecutive head and neck tumor patients (44–75 years) were analyzed, who received intensity-modulated radiation treatment (IMRT; total dose range: 54–66 Gy) with helical Tomotherapy HiArt II. The group under investigation (n = 10) additionally received a professional DWS using dexpanthenol mouthrinse (Bepanthen). The first control group received dexpanthenol mouthrinse alone. The second control group only performed the standardized mouth hygiene protocol. Grade of xerostomia, taste, dysphagia, thrush, and mucositis was evaluated on a daily basis.

Results

29 of 30 patients completed radiation therapy. Change in taste occurred in all patients in all groups, however, with a delay in the study group. The occurrence of grade III stomatitis and Xerostomia grade II was significantly reduced in the study arm. No patient suffered from grade III xerostomia in the study arm versus four patients in the control groups. Dysphagia grade II was observed significantly less frequent in the study group (p = 0.0004). Thrush occurrence showed a delay in the study group.

Conclusions

Our study underlines the importance of an intensified mouth hygiene during radiation therapy. The combination of dexpanthenol rinsing solution + DWS reduces the incidence of high-grade early side effects which often lead to a reduced quality of life and abortion of the treatment.

Keywords

Head and neck cancer Rinsing solution Mouth shower Tomotherapy Mucositis Radiation therapy 

Notes

Acknowledgements

We thank Procter & Gamble Service GmbH, GAS-Global After Sales, Frankfurter Str.145, D-61476 Kronberg/Taunus for the support of the study by kindly providing 10 dental waterjet systems.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Brodin NP, Kabarriti R, Garg MK, Guha C, Tomé WA (2018) Systematic review of normal tissue complication models relevant to standard fractionation radiation therapy of the head and neck region published after the QUANTEC reports. Int J Radiat Oncol Biol Phys 100(2):391–407CrossRefGoogle Scholar
  2. 2.
    Tao Z, Gao J, Qian L, Huang Y, Zhou Y, Yang L, He J, Yang J, Wang R, Zhang Y (2017) Factors associated with acute oral mucosal reaction induced by radiotherapy in head and neck squamous cell carcinoma: a retrospective single-center experience. Medicine 96(50):e8446CrossRefGoogle Scholar
  3. 3.
    Ursino S, D’Angelo E, Mazzola R, Merlotti A, Morganti R, Cristaudo A, Paiar F, Musio D, Alterio D, Bacigalupo A, Russi EG, Lohr F (2017) A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy: a systematic review by the Italian Head and Neck Radiotherapy Study Group. Strahlenther Onkol 193(11):877–889CrossRefGoogle Scholar
  4. 4.
    Trotti A, Eisbruch A (2011) Reducing xerostomia through advanced technology. Lancet Oncol 12(2):110–111CrossRefGoogle Scholar
  5. 5.
    Kałużny J, Wierzbicka M, Nogala H, Milecki P, Kopeć T (2014) Radiotherapy induced xerostomia: mechanisms, diagnostics, prevention and treatment—evidence based up to 2013. Otolaryngol Pol 68(1):1–14CrossRefGoogle Scholar
  6. 6.
    Nutting CM, van Herpen CM, Miah AB, Bhide SA, Machiels JP, Buter J et al (2009) Phase II study of 3-AP triapine in patients with recurrent or metastatic head and neck squamous cell carcinoma. Ann Oncol 20(7):1275–1279CrossRefGoogle Scholar
  7. 7.
    Bücheler BM, Ehnes A, Kavsadze M, Langenberg S, Wilhelm-Buchstab T, Zipfel M, Keiner S, Gerstner AO (2012) Quality of life after treatment of head and neck tumors: longitudinal comparison after operation and adjuvant radio(chemo)therapy. HNO 60(12):1053–1059CrossRefGoogle Scholar
  8. 8.
    Maria OM, Eliopoulos N, Muanza T (2017) Radiation-induced oral mucositis. Front Oncol 7:89CrossRefGoogle Scholar
  9. 9.
    Lalla RV, Saunders DP, Peterson DE (2014) Chemotherapy or radiation-induced oral mucositis. Dent Clin N Am 58(2):341–349CrossRefGoogle Scholar
  10. 10.
    Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, McGuire DB, Migliorati C, Nicolatou-Galitis O, Peterson DE, Raber-Durlacher JE, Sonis ST, Elad S (2014) Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 120(10):1453–1461CrossRefGoogle Scholar
  11. 11.
    Frings K, Gruber S, Kuess P, Kleiter M, Dörr W (2016) Modulation of radiation-induced oral mucositis by thalidomide: preclinical studies. Strahlenther Onkol 192(8):561–568CrossRefGoogle Scholar
  12. 12.
    Gruber S, Bozsaky E, Roitinger E, Schwarz K, Schmidt M, Dörr W (2017) Early inflammatory changes in radiation-induced oral mucositis: effect of pentoxifylline in a mouse model. Strahlenther Onkol 193(6):499–507CrossRefGoogle Scholar
  13. 13.
    AWMF (2017) S3 Leitlinie Supportive Therapie bei onkologischen Patienten. https://www.awmf.org/uploads/tx_szleitlinien/032-054OLl_S3_Supportiv_2017-05.pdf. Accessed May 2019
  14. 14.
    Dörr W, Dörr E, Herrman TH (2005) Einfluss der Mundpflege mit Dexpanthenol auf die Ausprägung und klinischen Konsequenzen der radiogenen Mukositis enoralis. Exp Strahlenther Klin Strahlenbiol 14:91–94Google Scholar
  15. 15.
    Dörr W, Schlichting S, Bray MA, Flockhart IR, Hopewell JW (2005) Effects of dexpanthenol with or without Aloe vera extract on radiation-induced oral mucositis: preclinical studies. Int J Radiat Biol 81(3):243–250CrossRefGoogle Scholar
  16. 16.
    Leitzen C, Herberhold S, Wilhelm-Buchstab T, Garbe S, Müdder T, Schoroth F, Schild HH, Bootz F, Schüller H (2015) Change of taste during and after IM-/IG-radiotherapy for head and neck cancer patients. Laryngorhinootologie 94(6):383–387PubMedGoogle Scholar
  17. 17.
    Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA et al (2001) A prospective study of salivary function sparing in patients with head and neck cancers receiving intensity modulated or three dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys 49(4):907–916CrossRefGoogle Scholar
  18. 18.
    Barbieri M, Pia F, Magnano M et al (1988) Le variazioni del gusto nei soggetti radiotrattati per neoplasie della faringe e del cavo orale. Acta Otorhinolaringol Ital 8:397–404Google Scholar
  19. 19.
    Maes A, Huygh I, Weltens C et al (2002) De Gustibus: time scale of loss and recovery of tastes caused by radiotherapy. Radiother Oncol 63:195–201CrossRefGoogle Scholar
  20. 20.
    Sato K, Kamata R (1984) Quantitative examination of taste deficiency due to radiation therapy. Radiat Med 2:61–70PubMedGoogle Scholar
  21. 21.
    Saadeh CE (2005) Chemotherapy- and radiotherapy-induced oral mucositis: review of preventive strategies and treatment. Pharmacotherapy 25(4):540–554CrossRefGoogle Scholar
  22. 22.
    Ihara Y, Crary MA, Madhavan A, Gregorio DC, Im I, Ross SE, Carnaby GD (2018) Dysphagia and oral morbidities in chemoradiation-treated head and neck cancer patients. Dysphagia.  https://doi.org/10.1007/s00455-018-9895-6 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Timo Wilhelm-Buchstab
    • 1
    Email author
  • Christopher Thelen
    • 1
  • Frederik Amecke-Mönnighoff
    • 2
  • Leonard Christopher Schmeel
    • 1
  • Birgit Simon
    • 1
  • Thomas Müdder
    • 1
  • Felix Schoroth
    • 1
  • Stephan Garbe
    • 1
  • Fred Röhner
    • 1
  • Susanne Vornholt
    • 1
  • Andreas Schröck
    • 3
  • Hans H. Schild
    • 1
  • Heinrich Schüller
    • 1
  • Christina Leitzen
    • 1
  1. 1.Department of Radiology and Radiation OncologyUniversity Hospital BonnBonnGermany
  2. 2.Management, Economics and Social SciencesFaculty of Cologne UniversityCologneGermany
  3. 3.Department for Head and Neck/SurgeryUniversity Hospital BonnBonnGermany

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