Judit Nemes

Oral health of long‐term childhood cancer survivors

As survival rate of children with cancer improved considerably during the past decades, late effects of antineoplastic therapy gained an increasing importance. Oral and dental care seem to be neglected areas resulting in considerable impairment of quality of life in adolescents and young adults cured from cancer. Even literature data surveying oral and dental status of childrenwith preceding neoplastic and hematologic disease are sparse. Here we report on the oral and dental status of longterm cancer survivors followed-up at the Outpatient Hematology-Oncology Clinic of the Department of Pediatrics, University of Debrecen, Medical and Health Science Center (UDMHSC). Forty-five children in long-term remission, previously treated for neoplastic diseases at the Division of Hematology-Oncology, Department of Pediatrics, UDMHSC were included into the study. The survey was performed in the Institute of Dental Sciences of the UDMHSC. Of the 45 patients, 25 boys and 20 girls, aged 4–25 years (mean 12.9 years), were examined. At the time of diagnosis, the age ranged from 1 to 22 years (mean 6.9 years). Mean survival time was 1–14 years (mean 5.9 years) at the time of the survey. The underlying diseases were 23/45 acute lymphoblastic leukemia, 5/45 acute myeloblastic leukemia, and 17/45 solid tumors. Patients were treated according to standard protocols as accepted by the Hungarian Pediatric Oncology Group (HPOG). In course of the combined cytotoxic treatment, out of 28 patients (ALL, AML) 13 received cranial irradiation (12 and 18 Gy, respectively) in addition to chemotherapy; while out of 17 patients (solid tumors), 11 received additional irradiation (18–40 Gy). The irradiation field of solid tumor patients did not involve the cranium. For each patient, an age and sex-matched control was chosen randomly from kindergarden and school children of similar socio-economic background attending at the Department of Pediatric Dentistry, MHSCUD. Oral and dental status, including X-ray imaging, was assessedwith informed consent. TheDMF numeric scores are generally accepted in the stomatologic literature to quantify the extent of dental disorders [1]. The scores represent the total number of decayed (D), missing (M) or filled (F) permanent teeth (DMF-T) and, allowing a more precise evaluation of dental status, the tooth surfaces (DMF-S). Of these indices, we used the combined DM scores (i.e., the number of decayedþmissing teeth/ surfaces within the denture of a proband) and F scores characteristic for dental pathology and treatment, respectively. In addition to the numeric score system, we also recorded congenital and acquired oral and dental malformations. DMandF data points did not follownormal distribution as checked with Kolmogorov–Smirnov test, therefore, we used nonparametric tests for the further statistical analysis of our data. Differences and correlations were considered significant if P-values were below 0.05. Before testing the difference of DM and F indexes of teeth and surface between patient and control group, we investigated the effect of age to these differences. We found strong and statistically significant, positive correlation between age and the DM differences (Spearman correlation, Corr1⁄4 0.463, P< 0.003 for teeth, Corr1⁄4 0.523, P< 0.001 for surface). To control for this effect of age, we created three age groups: 4–11, 12–15, and 16– 25 years. To check the relevance of these age intervals, we

Oral cancer report from Northeastern Hungary

In Hungary oral and pharyngeal cancers have been reported the fourth most common malignancy in males and the sixth for both sexes. The aim of the present study was to characterize oral squamous cell carcinoma (OSCC) patients in Northeastern Hungary. 119 randomly selected patients with OSCC were included in the study. Epidemiological data, clinicopathological parameters and the risk factors were registered. The most common sites of OSCC were the floor of the mouth (27.7%), the lip (26.9%) and the tongue (22.7%). The majority of the patients was diagnosed with early stage (I–II) lesions and moderately differentiated tumors. The 5-year overall survival rate was 38.7%. There was a significant correlation between survival and tumor size, lymph node involvement and clinical stage. At the time of diagnosis 65.5% of the patients were smokers. Smoking significantly correlated with younger age, male gender, advanced clinical stages and alcohol consumption. 75.5% of the patients consumed alcohol, 41.1% of them exceeding the conventional amount regularly. Drinking habit significantly correlated with younger age, male gender and tumor site i.e. gingiva, retromolar region, tongue. The dental status was acceptable only in 12.6% of the cases. There was a significant correlation between dental status and age, smoking and drinking habits. Clinical stage has the most significant impact on survival and the most important high-risk habits in Northeastern Hungary are smoking and alcohol consumption. Therefore, early detection and treatment, cessation of tobacco and alcohol abuse, and a regular dental care may improve patients’ survival in the region.

A gyermekkori malignus kórképek kemoterápiájának leggyakoribb mellékhatása, az oralis mucositis. Irodalmi áttekintés

Mucositis is the most common oral complication of cancer therapy. Oral mucositis in childhood is more frequent and severe compared to adults, especially in children with leukemia. Lesions develop as the chemotherapeutic agents attack the rapidly dividing cells of the oral mucous membrane. Patients may experience trouble in eating, drinking, swallowing or even speaking due to the significant pain caused by the ulceration of the oral mucosa. Oral mucositis has a direct impact on the quality of life and may affect survival. The regular assessment of the oral mucosa is crucial during chemotherapy to evaluate the effectiveness of the oral mucositis prevention and treatment. Several oral mucositis scoring tools have been developed for adults to qualify the symptoms, but there is no universally accepted assessment scale for children. The prevention and treatment of therapy-related mucositis is difficult, though several methods and pharmacologic agents have been tested. Here we discuss the pathogenesis of chemotherapy-induced oral mucositis, the available assessment tools and their applicability to pediatric patients and the available therapeutic and preventive strategies. Orv Hetil. 2018; 159(13): 495-502.

Salivary proteome profiling of oral squamous cell carcinoma in a Hungarian population

Oral squamous cell carcinoma (OSCC) is the seventh most common malignancy and the ninth most frequent cause of cancer death in Europe. Within Europe, Hungary has one of the highest rates of OSCC incidence and mortality. Thus, there is an urgent need to improve early detection. Saliva, as a readily available body fluid, became an increasingly important substance for the detection of biomarkers for many diseases. Different research groups have identified salivary biomarkers specific for OSCC for different countries. In this study, saliva samples of Hungarian patients with OSCC were studied to discover disease‐specific and perhaps region‐specific biomarkers. LC‐mass spectrometry (MS)/MS analysis on a linear ion trap‐Orbitrap mass spectrometer was used for qualitative and quantitative salivary protein profiling. More than 500 proteins were identified from saliva by shotgun proteomics. The up‐ and downregulated proteins in the saliva of patients with OSCC highlighted the importance of protein–protein interaction networks involving the immune system and proteolysis in disease development. Two potential biomarkers from our shotgun analysis and a third candidate reported earlier by a Taiwanese group were further examined by ELISA on a larger reference set of samples. Resistin, a biomarker reported in Taiwan but not validated in our study, highlights the necessity of application of standardized analysis methods in different ethnic or geographical populations to identify biomarkers with sufficient specificity and sensitivity.