Güler YAVAŞ, Çağda YAVAŞ, Özlem ATA, Sema HAKKI

Ba-boyun kanserli hastalarda oral komplikasyonlar, tedavi seçenekleri ve dental yaklam

Her yl dünyada yaklak 400 bin oral kavite ve farinks kanseri ile 160 bin larinks kanseri vakas tan almakta ve bunlarda yaklak 300 bini ölümle sonuçlanmaktadr. Bu hastalarn tedavileri s- rasnda gelien akut dental sorunlar kanser tedavisinde istenmeyen ara vermelere, hastann yaam kalitesinin dümesine ve tedavi maliyetinin artna neden olmaktadr. Oral yerleimli lezyonlara tan konulmasnda ve tedavisinin planlanmasnda di hekimleri ile birlikte kulak burun boaz hastalklar, medikal onkoloji ve radyasyon onkolojisi uzmanlar multidisipliner olarak hareket etmelidirler. Kanser tedavisi gören hastalarda tedaviye veya kansere bal komplikasyonlarn multidisipliner olarak ele alnarak önlenmesi çok önemlidir. Ba-boyun kanseri ve tedavilerine bal oral komplikasyonlarn önlenmesi veya tedavi edilmesi, oral fonksiyonlar iyiletirecei gibi, hastalarda hayat kalitesini arttrmakta, morbidite oranlarn azaltmaktadr. Son yllarda kanser ve tedavisi ile ilgili çalmalar hz kazandndan pek çok kanser hastasnn prognozu iyilemekte ve yaam süresi uzamaktadr. Bu nedenle kronik dental sorunlar da giderek artan bir öneme sahip olmaktadr. Anahtar kelimele

Oral complications, treatment options and dental approach in patients with head and neck cancer

Approximately 400 thousands of oral cavity and pharyngeal cancer and 160 thousands of laryngeal cancer patients are diagnosed in the world and approximately 300 thousands of them eventually die because of the cancer. Acute dental problems which develop during the treatment of these patients may cause unwanted treatment breaks, reduce the quality of life of the patients and leads to the increase in the cost of the treatment. The diagnosis and the treatment of oral lesions should be achieved in a multidisciplinary team which includes a dentists and doctors from the ear, nose and throat diseases, medical oncology and radiation oncology departments. It is very important to handle the treatment and cancer related complications by a multidisciplinary team in patients with the diagnosis of cancer. The prevention and treatment of oral complication related to head and neck cancer and its treatment improves oral functions, such as increasing the quality of life of patients, decreases the rate of morbidity. In recent years, there are many studies on the treatment of cancer which eventually improve the prognosis and the life span of the patients with the diagnosis of cancer. Therefore chronic dental problems have been increasingly important.

___

1. Boyle P, Smans M. IARC Scientific Publications, Number 156, Atlas of cancer mortality in the European Union and the European Economic Area 1993-1997. 2008; Lyon, France: International Agency for Research on Cancer.
2. Franceschi S, Bidoli E, Herrero R, Muñoz N. Comparison of cancers of the oral cavity and pharynx worldwide: etiological clues. Oral Oncol 2000; 36: 106-15.
3. Mealey BL, Semba SE, Hallmon WW. Dentistry and the cancer patient: Part 1--Oral manifestations and complications of chemotherapy. Compendiu 1994;15:1252,1254, 1256 passim; quiz 1262.
4. Yava Ö, Hakk SS. Onkoloji hastalarnda oral komplikasyonlar ve dental yaklam. Hacettepe Dihekimlii Fakültesi Dergisi 2005;29(4):58-67.
5. Hakki SS, Aprikyan AA, Yildirim S, Aydinbelge M, Gokalp A,et al. Periodontal status in two consaguineous siblings with severe congenital neutropenia: Diagnosis and mutational analysis of the cases. J Periodontol. 2005;76(5):837-44.
6. Sonis ST, Woods PD, White BA. Oral complications of cancer therapies. Pretreatment oral assessment. NCI Monogr 1990;9:29-32.
7. Yaprak E, Yava Ö, Dursun R, Toy H, Hakk SS. Oral Findings and the Management of Chronic Graft versus Host Disease in a Bone Marrow Transplant Recipient. SÜ Dihek Fak Derg 19(2):163-7, 2010.
8. Barker GJ. Current practices in the oral management of the patient undergoing chemotherapy or bone marrow transplantation. Support Care Cancer 1999;7:17-20.
9. Epstein JB and Stevenson-Moore P. Periodontal disease and periodontal management in patients with cancer. Oral Oncol 2001;37:613-19.
10. Rubenstein EB, Peterson DE, Schubert M, Keefe D, McGuire D et al. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 2004;100:2026-46.
11. Lockhart PB and Clark J. Pretherapy dental status of patients with malignant conditions of the head and neck. Oral Surg Oral Med Oral Pathol 1994;77:236-41.
12. Harrison JS, Dale RA, Haveman CW, Redding SW. Oral complications in radiation therapy. Gen Dent. 2003; 51:552- 60.
13. Sonis S and Costa J. Cancer Medicine. Oral Complications. Eds: Holland FE, London J, Decker BC. 2003;2: 2589.
14. Bourhis J, Le Maître A, Baujat B, Audry H, Pignon JP. Individual patients data meta-analyses in head and neck cancer. Curr Opin Oncol 2007;19:188-94.
15. Brockstein B, Haraf DJ, Rademaker AW, Kies MS, Stenson KM et al. Patterns of failure, prognostic factors and survival in locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy: a 9-year, 337-patient, multi-institutional experience. Ann Oncol 2004; 15:1179-86.
16. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004; 350:1945-52.
17. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004; 350:1937-44.
18. Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003; 349:2091-8.
19. Hall SF, Groome PA, Irish J, OSullivan B. The natural history of patients with squamous cell carcinoma of the hypopharynx. Laryngoscope 2008; 118:1362-71.
20. Lee NY, de Arruda FF, Puri DR, Wolden SL, Narayana A et al. A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2006; 66(4):966 974.
21. Valero V, Holmes FA, Walters RS, Theriault RL, Esparza L et al. Phase II trial of docetaxel: a new, highly effective antineoplastic agent in the management of patients with anthracycline-resistant metastatic breast cancer. J Clin Oncol 1995; 13:2886-94.
22. Piccart MJ, Klijn J, Paridaens R, Nooij M, Mauriac L et al. Corticosteroids significantly delay the onset of docetaxelinduced fluid retention: final results of a randomized study of the European Organization for Research and Treatment of Cancer Investigational Drug Branch for Breast Cancer. J Clin Oncol 1997; 15:3149-55
23. Rugg T, Saunders MI, Dische S. Smoking and mucosal reactions to radiotherapy. Br J Radiol 1990; 63:554-6. 24. Browman GP, Wong G, Hodson I, Sathya J, Russell R et al. Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med 1993; 328:159-63.
25. Fulton JS, Middleton GJ, McPhail JT. Management of oralcomplications. Semin Oncol Nurs 2002; 18: 28-35. 26. Rosenthal DI, Trotti A. Strategies for managing radiationinduced mucositis in head and neck cancer. Semin Radiat Oncol 2009;19:29-34.
27. Vera-Llonch M, Oster G, Hagiwara M, Sonis S. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer 2006; 106(2):329-36.
28. Elting LS, Cooksley CD, Chambers MS, Garden AS. Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys. 2007; 68(4):1110-20.
29. Lalla RV, Sonis ST, Peterson DE. Management of oral mucositis in patients with cancer. Dent Clin North Am 2008;52:61-78.
30. Sonis ST, Peterson RL, Edwards LJ, Lucey CA, Wang L et al. Defining mechanisms of action of interleukin-11 on the progression of radiation- induced oral mucositis in hamsters. Oral Oncol. 2000;36:373-81.
31. Yavas G, Yavas C, Bozkurt B, Ata O, Hakki S. Radiation induces cytokines and MMP-1, TIMP-1 and suppresses type 1 collagen mRNA expressions in human gingival fibroblasts. MASCC/ISOO, International Symposium on Supportive Care in Cancer, Athens, Greece June 2011.
32. Paris F, Fuks Z, Kang A, Capodieci P, Juan G, et al. Endothelial apoptosis as the primary lesion initiating intestinal radiation damage in mice. Science. 2001;293:293-7.
33. Handschel J, Prott FJ, Sunderkotter C, Metze D, Meyer U et al. Irradiation induces increase of adhesion molecules and accumulation of beta2-integrin-expressing cells in humans. Int J Radiat Oncol Biol Phys. 1999;45:475-81.
34. Wang J, Albertson CM, Zheng H, Fink LM, Herbert JM et al. Short-term inhibition of ADP-induced platelet aggregation by clopidogrel ameliorates radiationinduced toxicity in rat small intestine. Thromb Haemost. 2002;87:122-8.
35. Epstein JB, Silverman S Jr, Paggiarino DA, Crockett S, Schubert MM et al. Benzydamine HCl for prophylaxis of radiation-induced oral mucositis: results from a multicenter, randomized, double-blind, placebo- controlled clinical trial. Cancer. 2001;92:875-85.
36. Barker GJ. Current practices in the oral management of the patient undergoing chemotherapy or bone marrow transplantation. Support Care Cancer 1999; 7: 17-20.
37. Rubenstein EB, Peterson DE, Schubert M, Keefe D, McGuire D et al. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 2004; 100: 2026-46.
38. Lalla RV, Peterson DE. Treatment of mucositis, including new medications. Cancer J 2006; 12(5):348-54.
39. Keefe DM, Schubert MM, Elting LS, Sonis ST et al. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 2007; 109(5):820-31.
40. Dreizen S, Daly DE, Drane JB, Brown LR. Oral complications of cancer radiotherapy. Postgrad Med 1977;61: 85-92.
41. Engelmeier RL and King GE. Complications of head and neck radiation therapy and their management. J Prosthet Dent 1983; 49: 514-22
42. Barasch A, Elad S, Altman A, Damato K, Epstein J. Antimicrobials, mucosal coating agents, anesthetics, analgesics, and nutritional supplements for alimentary tract mucositis. Support Care Cancer 2006; 14(6):528-32.
43. Barasch A, Peterson DE. Risk factors for ulcerative oral mucositis in cancer patients: unanswered questions. Oral Oncol 2003; 39: 91-100.
44. Mealey BL, Semba SE, Hallmon WW. The head and neck radiotherapy patient: Part 2-Management of oral complications. Compendium. 1994; 15: 446-52.
45. Epstein JB, Parker IR, Epstein MS, Stevenson-Moore P. Cancer-related oral health care services and resources: A survey of oral and dental care in Canadian cancer centres. J Can Dent Assoc 2004; 70: 302-4.
46. Harrison JS, Dale RA, Haveman CW, Redding SW. Oral complications in radiation therapy. Gen Dent. 2003; 51: 552-60.
47. Soysa NS, Samaranayake LP, Ellepola ANB. Cytotoxic drugs, radiotherapy and oral candidiasis. Oral Oncol 2004;40: 971-8
48. Hancock PJ, Epstein JB, Sadler GR. Oral and dental management related to radiation therapy for head and neck cancer. J Can Dent Assoc 2003; 69: 585-90
49. Hakki SS, Nazliel H, Karaduman A, Usubutun A, Ertoy D et al. Epidermolysis Bullosa Acquisita: Clinical manifestations, microscopic findindings and surgical periodontal therapy: A case report. J Periodontol 2001; 72: 679-87.
50. Hovan AJ, Williams PM, Stevenson-Moore P, Wahlin YB, Ohrn KE et al. A systematic review of dysgeusia induced by cancer therapies. Support Care Cancer 2010; 18:1081.
51. Ozyar E, Karakaya E, Yldz F, Atahan L. Nazofarenks kanserli hastalarda geç yan etki olarak ortaya çkan trismus geliimine etkili faktörler. Türk Onkoloji Dergisi 2006;21(2):57-62.
52. Vissink A, Burlage FR, Spijkervet FK, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med 2003;14(3):213-25.
53. Goldstein M, Maxymiw WG, Cummings BJ, Wood RE. The effects of antitumor irradiation on mandibular opening and mobility: a prospective study of 58 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88(3):365-73.
54. Carl W. Local radiation and systemic chemotherapy: preventing and managing the oral complications. J Am Dent Assoc 1993;124:119-23.
55. Borowski B, Benhamou E, Pico JL, Laplanche A, Margainaud JP et al. Prevention of oral mucositis in patients treated with high-dose chemotherapy and bone marrow transplantation: a randomised controlled trial comparing two protocols of dental care. Eur J Cancer B Oral Oncol 1994;30B(2):93-7.
56. Harrison JS, Dale RA, Haveman CW, Redding SW. Oral complications in radiation therapy. Gen Dent. 2003;51: 552-60.
57. Hancock PJ, Epstein JB, Sadler GR. Oral and dental management related to radiation therapy for head and neck cancer. J Can Dent Assoc 2003; 69: 585-90.
58. Langer C, Hirsh V. Skeletal morbidity in lung cancer patients with bone metastases: demonstrating the need for early diagnosis and treatment with bisphosphonates. Lung Cancer 2010; 67:4112.
59. Ricciardi S, Marinis F. Treatment of bone metastases in lung cancer: the actual role of zoledronic acid. Rev Recent Clin Trials 2009; 4(3):205-11.
60. Jimenez-Soriano Y, Bagan JV. Bisphosphonates, as a new cause of druginduced jaw osteonecrosis: an update. Med Oral Patol Oral Cir Bucal 2005; 10(Suppl 2):E88E91
61. Morgan G, Lipton A. Antitumor effects and anticancer applications of bisphosphonates. Semin Oncol 2010; 37:S30S40
62. Soulafa A, Almazrooa BDS, Sook-Bin W. Bisphosphonate and nonbisphosphonate-associated osteonecrosis of the jaw: a review. JADA 2009; 140: 864-75
63. Reilly MM. Osteonecrosis of the jaw in a patient receiving bisphosphonate therapy. Oncol Nurs Forum 2007; 34(2):301-5.
64. Woo SK, Hellstein JW, Kalmar JR. Systematic review: Bisphosphonates and osteonecrosis of the jaws. Ann Inter Med 2006; 144 (10): 753-61.
65. Bamias A, Kastritis E, Bamia C, Moulopoulos LA, Melakopoulos I et al. Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. J Clin Oncol 2005; 23(34):8580-7.
66. Murad OM, Arora S, Farag AF, Guber HA. Bisphosphonates and osteonecrosis of the jaw: a retrospective study. Endocr Pract 2007; 13(3):232-8.
67. Migliorati CA, Schubert MM, Peterson DE, Seneda LM. Bisphosphonate-associated osteonecrosis of mandibular and maxillary bone: an emerging oral complication of supportive cancer therapy. Cancer 2005 Jul 1;104(1):83- 93.
68. Curi MM, Cossolin GS, Koga DH, Araujo SR, Feher O et al. Treatment of avascular osteonecrosis of the mandible in cancer patients with a history of bisphosphonate therapy by combining bone resection and autologous platelet-rich plasma: report of 3 cases. J Oral Maxillofac Surg 2007; 65(2):34955.
69. Peterson DE, DAmbrosio JA. Neurosurgical management of head and neck cancer patients. Dent. Clin North Am 1994; 38: 425.
70. Chura JC, Van Iseghem K, Downs LS Jr, Carson LF, Judson PL. Bevacizumab plus cyclophophamide in hevavily pretreated patients with recurrent ovarian cancer. Gynecol Oncol 2007; 107:326.
71. Aframian DJ, Lalla RV, Peterson DE. Management of dental patients taking common hemostasisaltering medications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103(Suppl):S454111.
72. Kömürcü . Ba-boyun kanserli hastalarda beslenme problemi. KBB ve BBC Dergisi, 2004; 12 (2): 1018.
73. Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006; 354:567.