Terence J. Fleming

Salivary flow rates in patients with head and neck cancer 0. 5 to 25 years after radiotherapy

In this clinical study at the University of Texas M. D. Anderson Cancer Center, unstimulated and stimulated salivary flow rates were obtained from 47 patients with head and neck cancer who had received mantle, unilateral facial, or bilateral facial field radiotherapy from 0.5 to 25 years earlier. The magnitude of salivary flow rate reduction compared with a healthy control group was primarily related to the radiation dosage and the amount of salivary gland tissue included in the irradiated fields. Flow rates were lower for women in all groups, but these differences were not statistically significant.

Oral and dental management of the cancer patient: prevention and treatment of complications

Aggressive cancer therapy places patients at greater risk for oral complications and treatment-related consequences. Unfortunately, prevention and/or treatment of such oral sequelae has become an often overlooked priority of the treatment team. We describe a philosophy of management of the cancer patient that specifically emphasizes the prevention and treatment of oral complications associated with cancer therapy. These concepts and principles are based on treatment protocols and ongoing clinical research at The University of Texas M. D. Anderson Cancer Center in Houston, Texas.

Devices valuable in head and neck radiotherapy

Normal tissue reactions limit the use of radiotherapy in the management of patients with head and neck neoplasms. Customized intraoral stents can help prevent unnecessary irradiation of various normal tissues thus reducing severity of reactions. Two basic types of devices, referred to as shielding and positional stents, are presented. The fabrication and the application of such devices are illustrated through five case reports. Recommendations on use of these tools and the possibility of combining these means with methods to improve dose distribution within the target volume containing air gaps are provided. Close collaboration between the attending radiotherapist and dentist is essential for designing appropriate devices for individual patients. However, when properly designed and used, these stents are effective in reducing treatment morbidity.

Phase II study of polymyxin B, tobramycin, and clotrimazole to prevent oral irradiation mucositis

Colonization of the oral mucosa by gram-negative organisms and/or fungi is theorized to be an etiologic factor in severe mucosal reactions in patients receiving radiation to treat head and neck cancers. Patients treated with altered fractionation schedules have high rates of confluent mucositis, which can be slow to heal and can on occasion disrupt the continuity of the radiation course, with possible detrimental effects on outcome. It has been proposed that antimicrobial agents directed at these organisms can alleviate the severity of the mucosal reactions. We studied the use of a suspension of polymyxin B and tobramycin in conjunction with a clotrimazole troche in patients receiving radiotherapy with altered fractionation schedules to the oropharynx or oral cavity. Thirty-seven patients were enrolled in the trial. Radiation doses ranged from 63 to 77 Gy over 5–7 weeks. The rate of confluent mucositis in the entire group was 84%. This was not significantly different (P > 0.1) from a rate of 85% seen in an historical control group of 79 patients treated with our concomitant boost regimen. Possible reasons for the apparent ineffectiveness of this antibacterial-antifungal regimen are discussed. Radiat Oncol Invest 1996;4:23–26.