scholarly journals The Effect of Radiation and Chemoradiation Therapy on the Head and Neck Mucosal Microbiome: A Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Ivry Zagury-Orly ◽  
Nader Khaouam ◽  
Jonathan Noujaim ◽  
Martin Y. Desrosiers ◽  
Anastasios Maniakas
Keyword(s):  
Oral Cavity ◽  
Head And Neck ◽  
Treatment Effectiveness ◽  
Therapy Resistance ◽  
Chemoradiation Therapy ◽  
Oral Microbiome ◽  
Molecular Methods ◽  
Future Research ◽  
Culture Independent ◽  
The Impact

Radiation (RT) and chemoradiation therapy (CRT) play an essential role in head and neck cancer treatment. However, both cause numerous side effects in the oral cavity, paranasal sinuses, and pharynx, having deleterious consequences on patients’ quality of life. Concomitant with significant advances in radiation oncology, much attention has turned to understanding the role of the microbiome in the pathogenesis of treatment-induced tissue toxicity, to ultimately explore microbiome manipulation as a therapeutic intervention. This review sought to discuss current publications investigating the impact of RT and CRT-induced changes on the head and neck microbiome, using culture-independent molecular methods, and propose opportunities for future directions. Based on 13 studies derived from a MEDLINE, EMBASE, and Web of Science search on November 7, 2021, use of molecular methods has uncovered various phyla and genera in the head and neck microbiome, particularly the oral microbiome, not previously known using culture-based methods. However, limited research has investigated the impact of RT/CRT on subsites other than the oral cavity and none of the studies aimed to examine the relationship between the head and neck microbiome and treatment effectiveness. Findings from this review provide helpful insights on our current understanding of treatment-induced oral mucositis, dental plaque, and caries formation and highlight the need for future research to examine the effect of RT/CRT on the sinonasal and oropharyngeal microbiome. In addition, future research should use larger cohorts, examine the impact of the microbiome on treatment response, and study the effect of manipulating the microbiome to overcome therapy resistance.

Quality Indicators: Measurement and Predictors in Head and Neck Cancer Free Flap Patients

2018 ◽  
Vol 158 (2) ◽  
pp. 265-272 ◽  
Author(s):  
Antoine Eskander ◽  
Stephen Y. Kang ◽  
Benjamin Tweel ◽  
Jigar Sitapara ◽  
Matthew Old ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Length Of Stay ◽  
Oral Cavity ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Preoperative Assessment ◽  
Assessment Clinic ◽  
Primary Radiotherapy ◽  
The Impact

Objective To determine the predictors of length of stay (LOS), readmission within 30 days, and unplanned return to the operating room (OR) within 30 days in head and neck free flap patients. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (OSU, 2006-2012) were assessed. Multivariable logistic regression to assess the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results In total, 515 patients were identified, of whom 66% had oral cavity cancers, 33% had recurrent tumors, and 28% underwent primary radiotherapy. Of the patients, 31.5% had a LOS greater than 9 days, predicted by longer operative time, oral cavity and pharyngeal tumor sites, blood transfusion, diabetes mellitus, and any complication. A total of 12.6% of patients were readmitted within 30 days predicted by absent OSU preoperative assessment clinic attendance and any complication, and 14.8% of patients had an unplanned OR return predicted by advanced age. Conclusions When assessing quality metrics, adjustment for the complexity involved in managing patients with head and neck cancer with a high comorbidity index, clean contaminated wounds, and a high degree of primary radiotherapy is important. Patients seen in a preoperative assessment clinic had a lower risk of readmission postoperatively, and this should be recommended for all head and neck free flap patients. Quality improvement projects should focus on predictors and prevention of complications as this was the number one predictor of both increased length of stay and readmission.

PO-085: Evaluation of the impact of the oral cavity contour on dose and constraint compliance in head-and-neck IMRT

2015 ◽  
Vol 114 ◽  
pp. 43-44
Author(s):  
I. Prieto ◽  
S. Gomez-Tejedor ◽  
J.P. Marin ◽  
A.M. Perez
Keyword(s):  
Oral Cavity ◽  
Head And Neck ◽  
The Impact

scholarly journals SP4.2.13 The staging of head and neck cancers at presentation during the COVID-19 pandemic: a regional analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Anni Ding ◽  
Lauren Smith ◽  
Aubrey Dickason ◽  
Rachel Easto ◽  
Philip Reece
Keyword(s):  
Oral Cavity ◽  
Head And Neck ◽  
Cancer Patients ◽  
Regional Analysis ◽  
Thyroid Neoplasms ◽  
Delayed Presentation ◽  
Treatment Pathways ◽  
Face To Face ◽  
Team Meetings ◽  
The Impact

Abstract Aim The impact of COVID-19 on cancer presentations has been debated; this audit aimed to examine the stage at presentation of head and neck (H&N) cancers regionally during the COVID-19 pandemic compared to the identical time period during 2019. Methods Retrospective data was collected across 3 hospitals in the South West, identifying all H&N cancer patients discussed at Multi-disciplinary Team Meetings between 1st April-10th October 2019 and the same timeframe in 2020. Patients with lymphomas and thyroid neoplasms were excluded due to separate treatment pathways available. Results There were 234 and 272 patients identified in 2020 and 2019 respectively. The median stage at presentation for all cancers was 2 in both years. The commonest cancers in 2020 were oropharyngeal (28%) and oral cavity (22%), similar to that of 2019 (oral cavity-31%, oropharyngeal-22%). The absolute numbers of laryngeal cancers were similar but a greater percentage of those presented late (stages 3&4) in 2020 compared to 2019 (47% vs 35%). There were almost twice as many skin/lip cancers in 2020 proportionately (20% vs 12%) and a greater number of them presented at a later stage. Conclusion Overall, COVID-19 has not appeared to affect the stage at presentation of H&N cancers, reflecting an on-going continuity of care for cancer patients. Subgroup analysis revealed skin and laryngeal cancers was most adversely affected by the pandemic, possibly due to delayed presentation and reduced face-to-face consultations, highlighting the need for continued face-to-face appointments as a part of cancer care pathways.

scholarly journals Veillonellae: Beyond Bridging Species in Oral Biofilm Ecology

2021 ◽  
Vol 2 ◽  
Author(s):  
Peng Zhou ◽  
Daniel Manoil ◽  
Georgios N. Belibasakis ◽  
Georgios A. Kotsakis
Keyword(s):  
Oral Cavity ◽  
Bacterial Species ◽  
Oral Microbiome ◽  
Future Research ◽  
Great Promise ◽  
Large Species ◽  
Oral Biofilm ◽  
Human Oral Cavity ◽  
Oral Biofilms ◽  
Polymicrobial Disease

The genus Veillonella comprises 16 characterized species, among which eight are commonly found in the human oral cavity. The high abundance of Veillonella species in the microbiome of both supra- and sub-gingival biofilms, and their interdependent relationship with a multitude of other bacterial species, suggest veillonellae to play an important role in oral biofilm ecology. Development of oral biofilms relies on an incremental coaggregation process between early, bridging and later bacterial colonizers, ultimately forming multispecies communities. As early colonizer and bridging species, veillonellae are critical in guiding the development of multispecies communities in the human oral microenvironment. Their ability to establish mutualistic relationships with other members of the oral microbiome has emerged as a crucial factor that may contribute to health equilibrium. Here, we review the general characteristics, taxonomy, physiology, genomic and genetics of veillonellae, as well as their bridging role in the development of oral biofilms. We further discuss the role of Veillonella spp. as potential “accessory pathogens” in the human oral cavity, capable of supporting colonization by other, more pathogenic species. The relationship between Veillonella spp. and dental caries, periodontitis, and peri-implantitis is also recapitulated in this review. We finally highlight areas of future research required to better understand the intergeneric signaling employed by veillonellae during their bridging activities and interspecies mutualism. With the recent discoveries of large species and strain-specific variation within the genus in biological and virulence characteristics, the study of Veillonella as an example of highly adaptive microorganisms that indirectly participates in dysbiosis holds great promise for broadening our understanding of polymicrobial disease pathogenesis.

The role of ultra-sensitive molecular methods for detecting malaria – the broader perspective

2021 ◽  
Author(s):  
Claire Kamaliddin ◽  
Colin J Sutherland ◽  
Sandrine Houze ◽  
Gilles Cottrell ◽  
Valerie Briand ◽  
...  
Keyword(s):  
Limit Of Detection ◽  
Research Priorities ◽  
Molecular Methods ◽  
Future Research ◽  
Molecular Tools ◽  
Patient Screening ◽  
Antigen Tests ◽  
The Impact ◽  
Conventional Tool

Abstract Ultra-sensitive molecular diagnostics are lowering the limit of detection for malaria parasites in the blood and providing insights not captured by conventional tool such as microscopy and rapid antigen tests. Low-level malaria infections identified by molecular tools may influence clinical outcomes, transmission events, and elimination efforts. While many ultra-sensitive molecular methods require well-equipped laboratories, technologies such as loop-mediated isothermal amplification (LAMP) or recombinase polymerase amplification (RPA) provide more portable and analytically sensitive solutions. These tools may benefit asymptomatic patient screening, antenatal care, and elimination campaigns. We review the recent evidence, offer our perspective on the impact of these new tests and identify future research priorities.

scholarly journals Clozapine and hematologic adverse reactions: Impact of the Risk Evaluation and Mitigation Strategy program

2020 ◽  
Vol 10 (3) ◽  
pp. 70-75
Author(s):  
Eric P. Borrelli ◽  
Erica Y. Lee ◽  
Aisling R. Caffrey
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Risk Evaluation ◽  
Treatment Effectiveness ◽  
Adverse Event Reporting System ◽  
Fold Increase ◽  
Time Frame ◽  
Mitigation Strategy ◽  
Future Research ◽  
The Impact

Abstract Introduction In October 2015, the Food and Drug Administration (FDA) instituted an update to the mandatory Risk Evaluation and Mitigation Strategy (REMS) program for clozapine to improve safety monitoring of hematologic events. However, the impact of the clozapine REMS program on reporting of hematologic adverse events has not been quantified. Methods We assessed adverse event reports for agranulocytosis, granulocytopenia, leukopenia, and neutropenia from the FDA Adverse Event Reporting System (FAERS) for a 1-year time period before (October 2014 to September 2015, pre-REMS) and after (October 2015 to September 2016, post-REMS) the implementation of the clozapine REMS program. The AERSMine platform was used to capture historical effect estimates (October 2004 to September 2014). Reporting odds ratios (ROR), proportional reporting ratios (PRR), and corresponding Taylor series 95% confidence intervals (CIs) were calculated for hematologic events with clozapine compared with all other medications using OpenEpi. Results Reporting rates for agranulocytosis, granulocytopenia, leukopenia, and neutropenia with clozapine all increased from the pre-REMS to post-REMS time frames, ranging from a 2-fold increase with leukopenia to a 40-fold increase with neutropenia; the composite measure of all hematologic reports had a 12-fold increase. During the post-REMS time frame, the ROR increased by 1691% (111.4, 95% CI 100.6-123.4) compared with the pre-REMS time frame (7.1, 95% CI 5.2-9.6), and the PRR increased by 1280% (83.1, 95% CI 76.8-90.0 vs 6.9, 95% CI 5.1-9.4) for the composite outcome. Discussion We observed significant increases in reports of hematologic adverse events with clozapine after the introduction of the clozapine REMS program. Future research should explore the impact of the less stringent exclusionary and discontinuation criteria on utilization (eg, expanded access) and clinical outcomes (eg, treatment effectiveness and adverse events).

scholarly journals Is There an Interplay between Oral Microbiome, Head and Neck Carcinoma and Radiation-Induced Oral Mucositis?

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 5902
Author(s):  
Patryk Gugnacki ◽  
Ewa Sierko
Keyword(s):  
Head And Neck ◽  
Oral Mucositis ◽  
Head And Neck Carcinoma ◽  
Radiation Reaction ◽  
Acute Radiation ◽  
Oral Microbiome ◽  
Positive Effects ◽  
Neck Carcinoma ◽  
Radiation Induced ◽  
The Impact

Head and neck carcinoma is one of the most common human malignancy types and it ranks as the sixth most common cancer worldwide. Nowadays, a great potential of microbiome research is observed in oncology—investigating the effect of oral microbiome in oncogenesis, occurrence of treatment side effects and response to anticancer therapies. The microbiome is a unique collection of microorganisms and their genetic material, interactions and products residing within the mucous membranes. The aim of this paper is to summarize current research on the oral microbiome and its impact on the development of head and neck cancer and radiation-induced oral mucositis. Human microbiome might determine an oncogenic effect by, among other things, inducing chronic inflammatory response, instigating cellular antiapoptotic signals, modulation of anticancer immunity or influencing xenobiotic metabolism. Influence of oral microbiome on radiation-induced oral mucositis is expressed by the production of additional inflammatory cytokines and facilitates progression and aggravation of mucositis. Exacerbated acute radiation reaction and bacterial superinfections lead to the deterioration of the patient’s condition and worsening of the quality of life. Simultaneously, positive effects of probiotics on the course of radiation-induced oral mucositis have been observed. Understanding the impact on the emerging acute radiation reaction on the composition of the microflora can be helpful in developing a multifactorial model to forecast the course of radiation-induced oral mucositis. Investigating these processes will allow us to create optimized and personalized preventive measures and treatment aimed at their formation mechanism. Further studies are needed to better establish the structure of the oral microbiome as well as the dynamics of its changes before and after therapy. It will help to expand the understanding of the biological function of commensal and pathogenic oral microbiota in HNC carcinogenesis and the development of radiation-induced oral mucositis.

scholarly journals The impact of nutritional support in head and neck cancer patients treated with chemoradiation therapy

2015 ◽  
Vol 26 ◽  
pp. vi72
Author(s):  
I. Carandina ◽  
I. Carandina ◽  
L. Belluomini ◽  
F. Daniel ◽  
E. Piva ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Nutritional Support ◽  
Chemoradiation Therapy ◽  
The Impact
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