537 results on '"Joel B. Epstein"'
Search Results
2. Conspiracy of Silence in Head and Neck Cancer Diagnosis: A Scoping Review
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Cristina Saldivia-Siracusa, Erison Santana Dos Santos, Wilfredo Alejandro González-Arriagada, Ana Carolina Prado-Ribeiro, Thaís Bianca Brandão, Adepitan Owosho, Marcio Ajudarte Lopes, Joel B. Epstein, and Alan Roger Santos-Silva
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disclosure ,diagnosis ,head and neck cancer ,scoping review ,Dentistry ,RK1-715 - Abstract
Cancer disclosure represents a complex healthcare dynamic. Physicians or caregivers may be prompted to withhold diagnosis information from patients. This study aims to comprehensively map and synthesize available evidence about diagnosis nondisclosure regarding head and neck cancer (HNC) patients. Following the Joanna Briggs Institute guidelines, a scoping review was conducted across major databases without period restriction, yielding 9238 publications. After screening and selection, a descriptive synthesis was conducted. Sixteen studies were included, primarily conducted in academic settings (75%) from Europe and Asia, with a total population of 662 patients predominantly diagnosed with brain, oral, pharyngeal, or laryngeal tumors. Remarkably, 22.51% of patients were unaware of their diagnosis. Although physicians were the main source of diagnostic information (35%), they reported to often use vague terms to convey malignancy. Additionally, 13.29% of patients were aware of their diagnosis from sources other than doctors or caregivers. Caregivers (55%) supported diagnosis concealment, and physicians tended to respect family wishes. A high diagnosis-to-death interval, education, and age significantly influenced diagnosis disclosure. HNC patients expressed a desire for personalized open communication. Multiple factors influenced the decision on diagnosis disclosure. Current evidence on this topic varies significantly, and there is limited research on the consequences of nondisclosure. These findings reflect the underestimation of the patients’ outlook in the diagnosis process and highlight the need for further research, aiming to establish open communication and patient autonomy during the oncological journey.
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- 2024
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3. Medication-Related Osteonecrosis of the Jaw: Successful Medical Management of Complex Maxillary Alveolus with Sinus Involvement
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Joel B. Epstein, Praveen R. Arany, Susan E. Yost, and Yuan Yuan
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cancer ,osteonecrosis ,jaw ,maxillary alveolus ,sinus involvement ,case report ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Medication-related osteonecrosis of the jaw (MRONJ) in cancer patients presents a considerable challenge in management. Current management is primarily based on interventions in a limited number of cases assessing a single approach. Medical management typically is reported to include antimicrobial therapy with or without surgery. Advances in the understanding of pathogenesis have led to the investigation of additional medical interventions for early-stage necrosis. We present 3 patients with advanced-stage MRONJ of the maxilla using combined medical modalities including antimicrobial therapy, photobiomodulation therapy, pentoxifylline, vitamin E, and synthetic parathyroid hormone. All patients had a good outcome and avoided surgical intervention. We also report biological and functional imaging that may assist in more effective diagnosis and management of MRONJ. The 3 patients reported suggest that combined medical management should be considered in all cases of MRONJ (including stage III) prior to determining if surgical intervention is required. Functional imaging with a technetium bone scan or positron emission tomography scan correlated with diagnosis and confirmed resolution in patients. We present 3 challenging MRONJ patients that were effectively managed with a combined medical and nonsurgical therapy that demonstrated good clinical outcomes avoiding surgical interventions.
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- 2023
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4. Clinical and Psychosocial Impact of Communication about Oral Potentially Malignant Disorders: A Scoping Review
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Lady P. A. Arboleda, Thaís C. E. Pereira, Joel B. Epstein, Cesar A. Migliorati, Saman Warnakulasuriya, Márcio Diniz-Freitas, Marcio A. Lopes, and Alan R. Santos-Silva
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oral potentially malignant disorders ,communication ,truth-telling ,scoping review ,Dentistry ,RK1-715 - Abstract
Delivering bad news has been widely studied in cancer, thus, this scoping review aims to identify the available evidence concerning the communication of oral potentially malignant disorders (OPMDs) and their clinical and psychosocial impacts. A search was performed using electronic databases (Medline/PubMed, Scopus, Embase, and Web of Science) and one grey literature database (Google Scholar). Studies focused on communicating the diagnosis of OPMDs and the patients’ perceptions were included. Study selection and data extraction were performed by two authors in a two-phase process. Five publications were included in the qualitative analysis. Differences regarding the study design, population, OPMDs assessed, and outcomes of professional–patient communication were found in each study. Protocols for OPMD communication have not yet been reported and there is a need to standardize strategies as communication skills may provide better clinical outcomes for patients diagnosed with potentially malignant disorders. Although future studies are needed, a brief list recommending the aspects that must be communicated is proposed.
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- 2023
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5. Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022
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Jolien Robijns, Raj G. Nair, Joy Lodewijckx, Praveen Arany, Andrei Barasch, Jan M. Bjordal, Paolo Bossi, Anne Chilles, Patricia M. Corby, Joel B. Epstein, Sharon Elad, Reza Fekrazad, Eduardo Rodrigues Fregnani, Marie-Thérèse Genot, Ana M. C. Ibarra, Michael R. Hamblin, Vladimir Heiskanen, Ken Hu, Jean Klastersky, Rajesh Lalla, Sofia Latifian, Arun Maiya, Jeroen Mebis, Cesar A. Migliorati, Dan M. J. Milstein, Barbara Murphy, Judith E. Raber-Durlacher, Hendrik J. Roseboom, Stephen Sonis, Nathaniel Treister, Yehuda Zadik, René-Jean Bensadoun, and “Cancer Supportive Care” WALT Working Group
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photobiomodulation (PBM) ,cancer supportive care ,guidelines ,recommendations ,mucositis ,dermatitis ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
DisclaimerThis article is based on recommendations from the 12th WALT Congress, Nice, October 3-6, 2018, and a follow-up review of the existing data and the clinical observations of an international multidisciplinary panel of clinicians and researchers with expertise in the area of supportive care in cancer and/or PBM clinical application and dosimetry. This article is informational in nature. As with all clinical materials, this paper should be used with a clear understanding that continued research and practice could result in new insights and recommendations. The review reflects the collective opinion and, as such, does not necessarily represent the opinion of any individual author. In no event shall the authors be liable for any decision made or action taken in reliance on the proposed protocols.ObjectiveThis position paper reviews the potential prophylactic and therapeutic effects of photobiomodulation (PBM) on side effects of cancer therapy, including chemotherapy (CT), radiation therapy (RT), and hematopoietic stem cell transplantation (HSCT).BackgroundThere is a considerable body of evidence supporting the efficacy of PBM for preventing oral mucositis (OM) in patients undergoing RT for head and neck cancer (HNC), CT, or HSCT. This could enhance patients’ quality of life, adherence to the prescribed cancer therapy, and treatment outcomes while reducing the cost of cancer care.MethodsA literature review on PBM effectiveness and dosimetry considerations for managing certain complications of cancer therapy were conducted. A systematic review was conducted when numerous randomized controlled trials were available. Results were presented and discussed at an international consensus meeting at the World Association of photobiomoduLation Therapy (WALT) meeting in 2018 that included world expert oncologists, radiation oncologists, oral oncologists, and oral medicine professionals, physicists, engineers, and oncology researchers. The potential mechanism of action of PBM and evidence of PBM efficacy through reported outcomes for individual indications were assessed.ResultsThere is a large body of evidence demonstrating the efficacy of PBM for preventing OM in certain cancer patient populations, as recently outlined by the Multinational Association for Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Building on these, the WALT group outlines evidence and prescribed PBM treatment parameters for prophylactic and therapeutic use in supportive care for radiodermatitis, dysphagia, xerostomia, dysgeusia, trismus, mucosal and bone necrosis, lymphedema, hand-foot syndrome, alopecia, oral and dermatologic chronic graft-versus-host disease, voice/speech alterations, peripheral neuropathy, and late fibrosis amongst cancer survivors.ConclusionsThere is robust evidence for using PBM to prevent and treat a broad range of complications in cancer care. Specific clinical practice guidelines or evidence-based expert consensus recommendations are provided. These recommendations are aimed at improving the clinical utilization of PBM therapy in supportive cancer care and promoting research in this field. It is anticipated these guidelines will be revised periodically.
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- 2022
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6. Over 300 Radiation Caries Papers: Reflections From the Rearview Mirror
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Caique Mariano Pedroso, Cesar Augusto Migliorati, Joel B. Epstein, Ana Carolina Prado Ribeiro, Thaís Bianca Brandão, Márcio Ajudarte Lopes, Mário Fernando de Goes, and Alan Roger Santos-Silva
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radiation caries ,radiotherapy ,radiation ,dental caries ,dental demineralization ,head and neck cancer ,Dentistry ,RK1-715 - Abstract
Radiation caries (RC) is an aggressive oral toxicity in head and neck cancer survivors, which develops 6 to 12 months after head and neck radiotherapy. It initially affects the tooth cervical/incisal surfaces, and if not promptly diagnosed/managed, progresses to dental crown amputation and risk of osteoradionecrosis. It results from a multidimensional cluster of treatment-induced oral symptoms, including hyposalivation, dietary changes, and oral hygiene impairment. Although recognized as a frequent complication of radiotherapy and extensively assessed by a myriad of retrospective, in vitro, and in situ studies, RC patients are still orphans of clinically validated methods for risk prediction, prevention, and treatment of early lesions. This review provides a historical overview of science-based concepts regarding RC pathogenesis and treatment, emphasizing the growing demand for interventional clinical studies (randomized trials).
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- 2022
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7. Safety and efficacy of photobiomodulation therapy in oncology: A systematic review
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René‐Jean Bensadoun, Joel B. Epstein, Raj G. Nair, Andrei Barasch, Judith E. Raber‐Durlacher, Cesar Migliorati, Marie‐Thérèse Genot‐Klastersky, Nathaniel Treister, Praveen Arany, Joy Lodewijckx, Jolien Robijns, and the World Association for Laser Therapy (WALT)
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cancer ,photobiomodulation ,safety ,supportive care ,systematic review ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract We performed a systematic review of the current literature addressing the safety and efficacy of photobiomodulation therapy (PBMT) in cancer patients. In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were used. In vitro, in vivo, and clinical studies, which investigated the effect of PBMT on cell proliferation/differentiation, tumor growth, recurrence rate, and/or overall survival were included. The Medline/PubMed, EMBASE, and Scopus databases were searched through April 2020. A total of 67 studies met the inclusion criteria with 43 in vitro, 15 in vivo, and 9 clinical studies identified. In vitro studies investigating the effect of PBMT on a diverse range of cancer cell lines demonstrated conflicting results. This could be due to the differences in used parameters and the frequency of PBM applications. In vivo studies and clinical trials with a follow‐up period demonstrated that PBMT is safe with regards to tumor growth and patient advantage in the prevention and treatment of specific cancer therapy‐related complications. Current human studies, supported by most animal studies, show safety with PBMT using currently recommended clinical parameters, including in Head & Neck cancer (HNC) in the area of PBMT exposure. A significant and growing literature indicates that PBMT is safe and effective, and may even offer a benefit in patient overall survival. Nevertheless, continuing research is indicated to improve understanding and provide further elucidation of remaining questions regarding PBM use in oncology.
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- 2020
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8. Management of salivary gland malignancies: current and developing therapies
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Mark Agulnik, Camille F. McGann, Bharat B. Mittal, Sara C. Gordon, and Joel B. Epstein
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Salivary gland neoplasm - Chemotherapy - Radiation therapy ,Other systems of medicine ,RZ201-999 ,Internal medicine ,RC31-1245 - Abstract
Salivary gland tumors are rare, clinically diverse neoplasms that represent less than 1% of all malignancies. In locoregional recurrent or metastatic disease, systemic therapy is the standard approach. While numerous small phase II studies have evaluated the activity of cytotoxic agents, either alone or in combination, the response rates are generally modest with objective response rates ranging from 15%–50%. Duration of response is cited in the range of 6–9 months. Given this, further evaluation of novel therapies is mandatory in these diseases. With the emergence of molecular targeted therapy, these tumors become optimal candidates for trials of investigational drugs and established drugs for new indications. Of note, given the often indolent nature of disease, only patients with progressive disease should be enrolled and treated on these clinical trials. Study designs must incorporate stringent inclusion criteria to enable accurate reporting of disease response and stabilization. With dedication and co-operation, patients with these rare neoplasms can be accrued to clinical trials and the establishment of new treatment guidelines will be forthcoming.
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- 2011
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9. Oral White Lesions Associated with Chewing Khat
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Meir Gorsky, Joel B. Epstein, Harel Levi, and Noam Yarom
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mucosal change ,cathinone ,oralleukoplakia ,betel quid ,exfoliative cytology ,Diseases of the respiratory system ,RC705-779 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Introduction Khat is a cultivated plant whose leaves when chewed elevate mood. Unlike the chewing of betel nut, no association between the white oral mucosal lesions in khat users and oral malignancies has been reported. Chewing of khat has been documented in many countries and has increased with worldwide migration. The impact of chewing khat upon the oral mucosa is essentially unknown. Purpose The purpose of this study was to assess the occurrence of oral white changes in chronic khat chewers. Oral mucosal changes in a group of 47 Yemenite Israeli men over 30 years of age, who had chewed khat more than 3 years, were compared to those of 55 Yemenite men who did not chew. Results White lesions were significantly more prevalent in the khat chewers (83%) compared to the non chewing individuals (16%) (P < 0.001). White oral lesions were identified primarily on the lower buccal attached gingival mucosa, the alveolar mucosa and the lower mucobuccal fold on the chewing side (p < 0.001). There was no significant association between the occurrence of the white lesions and smoking. Even though the majority of the white lesions (85.4%) were homogenous, 71.4% of the non homogenous lesions were identified in khat chewers. Vital staining with toluidine blue and exfoliative cytology was conducted on a subset of patients with homogenous and non-homogenous oral lesions, and there were no findings suspicious for pre-malignant or malignant changes. Discussion This study demonstrated a relationship between khat chewing and oral white lesions, which we attribute to chronic local mechanical and chemical irritation of the mucosa. Our findings also suggest that mucosal changes associated with khat are benign, however, this initial study requires further studies including follow-up of khat users to confirm the current findings, including the likely benign changes associated with chronic use and histologic findings of clinical lesions.
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- 2004
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10. Smoking Habits Among Patients Diagnosed with Oral Lichen Planus
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Meir Gorsky, Joel B. Epstein, Haya Hasson-Kanfi, and Eliezer Kaufman
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smoking habit ,reticular form ,Lichen planus ,oral lichen planus ,oral mucosal lesion ,Diseases of the respiratory system ,RC705-779 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Introduction Oral lichen planus (OLP) is one of the most common dermatologic diseases that manifests in the oral cavity. The purpose of this study was to evaluate the association between smoking habits and the clinical subtypes of OLP. Methods Oral findings and smoking data from 187 charts of OLP patients from an oral medicine clinic was reviewed and compared to data from 76 matched control patients. Results and Discussion Ninety-three patients were diagnosed with reticular OLP, 55 with atrophic and 39 with erosive forms of the disease. Symptomatic OLP occurred in 63.6% of patients. Fewer cases of reticular OLP were symptomatic than erosive OLP (p < 0.001). Significantly fewer OLP patients smoked than the control group (16% versus 25%) (p = 0.04). More patients with reticular OLP smoked than those with atrophic and erosive OLP (p = 0.002). It is hypothesized that the heat and irritation of smoking may aggravate symptomatic OLP lesions, and the risk of malignant transformation associated with tobacco use may play a role in patients stopping tobacco use. Because there were fewer smokers in patients with OLP, and because OLP carries an increased malignant risk, transformation of OLP may be due to a different etiology and of a different pathogenesis than squamous cell carcinoma not arising from lichen planus. Close follow-up of patients with OLP is indicated.
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- 2004
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11. Twenty-year analysis of photobiomodulation clinical studies for oral mucositis: a scoping review
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Elisa Kauark-Fontes, Cesar Augusto Migliorati, Joel B. Epstein, Rene-Jean Bensadoun, Luiz Alcino Monteiro Gueiros, James Carroll, Luciana Maria Pedreira Ramalho, and Alan Roger Santos-Silva
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Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,Pathology and Forensic Medicine - Published
- 2023
12. Patient's perceptions of oral and oropharyngeal cancer diagnosis disclosure: communication aspects based on SPIKES protocol
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Carolina G.B. Alves, Ana Carolina Prado Ribeiro, Thaís Bianca Brandão, Juliana O. Tonaki, Caique Mariano Pedroso, César Rivera, Joel B. Epstein, Cesar Augusto Migliorati, Luiz Paulo Kowalski, Milena Perez Mak, Gilberto Castro, Marcio Ajudarte Lopes, and Alan Roger Santos-Silva
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Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,Pathology and Forensic Medicine - Published
- 2023
13. Oral pain in the cancer patient
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Firoozeh, Samim, Joel B, Epstein, and Rachael, Osagie
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Meta-Analysis as Topic ,Oncology ,Cannabinoids ,Oncology (nursing) ,Neoplasms ,Humans ,Pain ,Nerve Block ,General Medicine ,Critical Care and Intensive Care Medicine ,Systematic Reviews as Topic - Abstract
Oral pain is a common complaint in patients with cancer. This review aims to summarize the knowledge on the causes and approach to management of oral pain garnered over the past 2 years.A systematic review and meta-analysis included in the review, assessed cannabinoid versus placebo and showed only a small effect on pain, physical function, and sleep quality. Another review showed that chemical neurolysis as an adjunctive therapy, is effective in patients with pain of shorter chronicity and refractory head and neck cancer-related pain.Patients with cancer frequently experience oral pain because of a variety of factors. Factors inherent in the type and location of the malignancy, the modality of cancer treatment, and a holistic approach to management together contribute to their overall pain experience. Basic oral care should be implemented wherever possible, before, during, and after cancer treatment.
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- 2022
14. Data from Toluidine Blue Staining Identifies High-Risk Primary Oral Premalignant Lesions with Poor Outcome
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Miriam P. Rosin, Wan L. Lam, John Hay, Robert Priddy, Greg Hislop, Nhu D. Le, Alan Hovan, Ken Berean, Hisae Nakamura, Scott Durham, Joel B. Epstein, Denise Laronde, Catherine F. Poh, Michele Williams, and Lewei Zhang
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There is a pressing need for the development of visual aids that will facilitate the detection of oral premalignant lesions (OPLs) with a high-risk of progression. Preliminary data suggest that toluidine blue stain may be preferentially retained by OPLs with high-risk molecular clones. In this study, we monitored OPLs from 100 patients without any history of oral cancer for an average of 44 months in order to evaluate the association of toluidine blue status with clinicopathologic risk factors, molecular patterns (microsatellite analysis on seven chromosome arms: 3p, 9p, 4q, 8p, 11q, 13q, and 17p) and outcome. Toluidine blue–positive staining correlated with clinicopathologic risk factors and high-risk molecular risk patterns. Significantly, a >6-fold elevation in cancer risk was observed for toluidine blue–positive lesions, with positive retention of the dye present in 12 of the 15 lesions that later progressed to cancer (P = 0.0008). This association of toluidine blue status with risk factors and outcome was evident even when the analysis was restricted to OPLs with low-grade or no dysplasia. Our results suggest the potential use of toluidine blue in identifying high-risk OPLs.
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- 2023
15. Supplementary Figure S1 from Toluidine Blue Staining Identifies High-Risk Primary Oral Premalignant Lesions with Poor Outcome
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Miriam P. Rosin, Wan L. Lam, John Hay, Robert Priddy, Greg Hislop, Nhu D. Le, Alan Hovan, Ken Berean, Hisae Nakamura, Scott Durham, Joel B. Epstein, Denise Laronde, Catherine F. Poh, Michele Williams, and Lewei Zhang
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Supplementary Figure S1 from Toluidine Blue Staining Identifies High-Risk Primary Oral Premalignant Lesions with Poor Outcome
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- 2023
16. Supplementary Table S1 from Toluidine Blue Staining Identifies High-Risk Primary Oral Premalignant Lesions with Poor Outcome
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Miriam P. Rosin, Wan L. Lam, John Hay, Robert Priddy, Greg Hislop, Nhu D. Le, Alan Hovan, Ken Berean, Hisae Nakamura, Scott Durham, Joel B. Epstein, Denise Laronde, Catherine F. Poh, Michele Williams, and Lewei Zhang
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Supplementary Table S1 from Toluidine Blue Staining Identifies High-Risk Primary Oral Premalignant Lesions with Poor Outcome
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- 2023
17. Clinical outcomes of dental implants in head and neck cancer patients: An overview
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Nelson Pereira Marques, Maria Eduarda Pérez-de-Oliveira, Ana Gabriela Costa Normando, Nádia Carolina Teixeira Marques, Joel B. Epstein, Cesar A. Migliorati, Hercílio Martelli-Júnior, Ana Carolina Prado Ribeiro, Andre Caroli Rocha, Thaís Bianca Brandão, Francisco Germán Villanueva Sánchez, Luiz Alcino Monteiro Gueiros, Marcio Ajudarte Lopes, and Alan Roger Santos-Silva
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Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,Pathology and Forensic Medicine - Published
- 2023
18. Head and neck cancer survivorship consensus statement from the American Head and Neck Society
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Jamie A. Ku, Amy M. Williams, Cherie-Ann Nathan, Evan M. Graboyes, D. Gregory Farwell, Andrew T. Day, Assuntina G. Sacco, Neerav Goyal, Ana P. Kiess, Joel B. Epstein, Carole Fakhry, Joseph F. Goodman, Nishant Agrawal, Vlad C. Sandulache, Scharukh Jalisi, Vijay A. Patel, Aru Panwar, Daniel G. Deschler, and Matthew C. Miller
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medicine.medical_specialty ,RD1-811 ,Statement (logic) ,business.industry ,General surgery ,Head and neck cancer ,consensus statement ,General Medicine ,medicine.disease ,humanities ,Otorhinolaryngology ,RF1-547 ,Survivorship curve ,medicine ,head and neck cancer ,Surgery ,Head and neck ,business ,survivorship - Abstract
Objectives To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. Methods Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. Results Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho‐oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. Conclusion Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post‐treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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- 2021
19. Extraoral photobiomodulation for prevention of oral and oropharyngeal mucositis in head and neck cancer patients: interim analysis of a randomized, double-blind, clinical trial
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Karina Gondim Moutinho da Conceição Vasconcelos, Alan Roger Santos-Silva, Adriana Franco Paes Leme, Natália Rangel Palmier, Leticia Rodrigues-Oliveira, Elisa Kauark-Fontes, Nathaniel S. Treister, Ana Carolina Prado-Ribeiro, Cesar A. Migliorati, Joel B. Epstein, Márcio Ajudarte Lopes, Gilberto de Castro, Karina Morais Faria, Carolina Guimarães Bonfim Alves, Luiz Alcino Monteiro Gueiros, Mariana de Pauli Paglioni, and Thaís Bianca Brandão
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Quality of life ,Mucositis ,medicine.medical_specialty ,medicine.medical_treatment ,Analgesic ,Placebo ,Oral mucositis ,Double-Blind Method ,Internal medicine ,medicine ,Humans ,Overall survival ,Low-Level Light Therapy ,Stomatitis ,Radiotherapy ,business.industry ,Incidence (epidemiology) ,fungi ,Head and neck cancer ,Photobiomodulation ,medicine.disease ,Interim analysis ,Radiation therapy ,Clinical trial ,Oncology ,Head and Neck Neoplasms ,Original Article ,business - Abstract
Purpose To assess the safety and efficacy of prophylactic extraoral photobiomodulation (PBM) for the prevention of oral and oropharyngeal mucositis (OM) on clinical outcomes and survival in patients with oral cavity and oropharyngeal squamous cell carcinoma (OOPSCC). Methods OOPSCC patients who received radiotherapy (RT) were prospectively randomized to two groups: prophylactic extraoral PBM and placebo. OM grade (NCI), pain (VAS), analgesia, and anti-inflammatory prescriptions were assessed weekly. Quality of life questionnaires (QoL) were performed at the first and last day of RT. Following RT, participants were evaluated quarterly for oncological outcomes follow-up. Results Fifty-five patients met the inclusion criteria. The first occurrence of OM was observed at week 1, for the placebo group (p = 0.014). Later, OM onset and severity was observed for the PBM group, with first occurrence at week 2 (p = 0.009). No difference in severe OM incidence was observed (p > 0.05). Lower mean pain score was noted at week 7 for the PBM group (2.1) compared to placebo group (4.5) (p = 0.009). Less analgesics (week 3; p = 0.009/week 7; p = 0.02) and anti-inflammatory prescription (week 5; p = 0.0346) were observed for the PBM group. Better QoL scores were observed for the PBM group at last day of RT (p = 0.0034). No difference in overall survival among groups was observed in 1 year of follow-up (p = 0.889). Conclusion Prophylactic extraoral PBM can delay OM onset, reduce pain, and reduce analgesic and anti-inflammatory prescription requirements. Extraoral PBM was associated with better QoL. There was no evidence of PBM impact on oncological outcomes. Trial registration TRN:RBR-4w4swx (date of registration: 01/20/2020). Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06625-8.
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- 2021
20. Transitioning the eating experience in survivors of head and neck cancer
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Joel B. Epstein, Rebecca Brody, Heidi Ganzer, Shristi Rawal, Pamela Rothpletz-Puglia, Jennifer Dalton, Riva Touger-Decker, and Laura Byham-Gray
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Coping (psychology) ,business.industry ,Taste (sociology) ,media_common.quotation_subject ,Nursing research ,digestive, oral, and skin physiology ,Identity (social science) ,Oncology ,Medicine ,Hofstede's cultural dimensions theory ,Worry ,business ,Social cognitive theory ,media_common ,Clinical psychology ,Meaning (linguistics) - Abstract
Applying the Social Cognitive Transition (SCT) Model of Adjustment as an interpretive framework, this mixed-methods case series explored how head and neck cancer (HNC) survivors participate in the dimensions of the eating experience (described as physiological, psychological, social, cultural). This was a sub-study of a primary study, “The Natural History and Impact of Taste Change in Oncology Care.” Qualitative interviews and quantitative data (questionnaires and exams) were intersected to examine and describe the complexities of transitioning the eating experience after treatment for HNC. Triangulation of qualitative and quantitative data within and across cases was examined to produce rich descriptions of the changes and transitions in the eating experience. Four case studies were detailed. All reported some taste and/or smell changes. Each case described worry about weight loss and the decreased ability to engage and finding meaning in the eating experience. Each expressed coping strategies that drew upon the social and cultural dimensions of their prior eating experience that brought meaning and purpose to the post-treatment eating experience. This case series explored the impact of taste and oral function and the participant’s pre- and post-treatment mental model of the eating experience. Application of the SCT Model of Adjustment to the eating experience in adults with HNC provided a deeper insight into how cognitive adaptation and coping strategies supported transition in identity related to the eating experience following cancer therapy.
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- 2021
21. A common infrastructure for real-world patient-reported symptoms: one size fits many
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Corina J G, van den Hurk, Stephen T, Sonis, and Joel B, Epstein
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- 2022
22. Carcinoma mistaken for periodontal disease: importance of careful consideration of clinical and radiographic findings
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Joel B. Epstein, Craig S. Miller, Rachad Kudsi, Mohanad Al-Sabbagh, Galal Omami, and Ahmad Hawasli
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Gingival Squamous Cell Carcinoma ,medicine.medical_specialty ,business.industry ,Radiography ,Cancer ,Signs and symptoms ,030206 dentistry ,medicine.disease ,Dermatology ,Pathology and Forensic Medicine ,stomatognathic diseases ,03 medical and health sciences ,0302 clinical medicine ,Periodontal disease ,030220 oncology & carcinogenesis ,medicine ,Carcinoma ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,business ,Standard therapy - Abstract
Awareness of signs and symptoms of oral cancer is important to every dental provider. However, oral cancer can produce features that hamper its recognition, which can lead to a delay in diagnosis and treatment. This report describes two cases of gingival squamous cell carcinoma masquerading as periodontal disease. The clinical and radiographic features of these two cases illustrate that a thorough evaluation for potentially underlying malignant process should be performed on patients whose conditions are refractory to standard therapy.
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- 2021
23. Author response for 'New Onset and Exacerbation of Oral Lichenoid Mucositis Following <scp>SARS‐CoV</scp> ‐2 Infection or Vaccination'
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null Lama Alabdulaaly, null Herve Sroussi, and null Joel B. Epstein
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- 2022
24. Cost-effectiveness of photobiomodulation therapy for the prevention and management of cancer treatment toxicities: a systematic review
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Leticia Rodrigues-Oliveira, Cesar A. Migliorati, Joel B. Epstein, Karina Morais Faria, Carolina Guimarães Bonfim Alves, Luiz Alcino Monteiro Gueiros, Patricia Burton, Thaís Bianca Brandão, Márcio Ajudarte Lopes, James D. Carroll, Natália Rangel Palmier, Alan Roger Santos-Silva, Ana Carolina Prado-Ribeiro, Anna Luíza Damaceno Araújo, Ramzi G. Salloum, and Elisa Kauark-Fontes
- Subjects
medicine.medical_specialty ,business.industry ,Cost effectiveness ,medicine.medical_treatment ,Cancer ,Context (language use) ,medicine.disease ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Lymphedema ,Breast cancer ,Systematic review ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Mucositis ,030212 general & internal medicine ,business ,Intensive care medicine ,health care economics and organizations - Abstract
To identify and summarize the evidence on the cost-effectiveness of photobiomodulation (PBM) therapy for the prevention and treatment of cancer treatment-related toxicities. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE). Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 1490 studies were identified, and after a two-step review, 4 articles met the inclusion criteria. The included studies analyzed the cost-effectiveness of PBM therapy used in the context of lymphedema for breast cancer and oral mucositis (OM) induced by chemotherapy and radiotherapy. Better outcomes were associated with PBM therapy. The incremental cost-effectiveness ratio ranged from 3050.75 USD to 5592.10 USD per grade 3–4 OM case prevented. PBM therapy cost 21.47 USD per percentage point reduction in lymphedema in comparison with 80.51 USD for manual lymph drainage and physical therapy. There is limited evidence that PBM therapy is cost-effective in the prevention and treatment of specific cancer treatment-related toxicities, namely, OM and breast cancer-related lymphedema. Studies may have underreported the benefits due to a lack of a comprehensive cost evaluation. This suggests a wider acceptance of PBM therapy at cancer treatment centers, which has thus far been limited by the number of robust clinical studies that demonstrate cost-effectiveness for the prevention and treatment of toxicities.
- Published
- 2021
25. Assessment of Oral Function and Food Product Preference in Patients with Head and Neck Cancers
- Author
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Joel B. Epstein, Dana Villines, Geena L. Epstein, Shristi Rawal, Jennifer Dalton, and Riva Touger-Decker
- Subjects
Taste ,Saliva ,Meal ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Oral hygiene ,Radiation therapy ,Internal medicine ,General Earth and Planetary Sciences ,Medicine ,Taste function ,Meal preparation ,Aftertaste ,business ,General Environmental Science - Abstract
Introduction: Taste and olfactory changes begin within days of initiating chemotherapy and radiation therapy for head and neck cancers (HNC) and may persist 12 months or longer post-treatment, affecting 50 to 75% of adults with HNC. In this study, we assess taste function and diet in addition to food product evaluation among patients with HNC. Methods: Ten patients with HNC were evaluated during (n=6) and following radiation therapy with/without chemotherapy (n=8). Oral examination measures included oral hygiene and whole saliva. Patients also completed the Scale of Subjective Total Taste Acuity (STTA), National Cancer Institute Diet History Questionnaire II (DHQII) and Vanderbilt Head and Neck Symptom survey (VHNSS) and evaluated Hormel Vital CuisineTM Products. Results: Taste changes were more pronounced in the acute treatment phase (60% moderate to severe loss) than in the post-treatment phase (50% no taste change and no severe taste loss). Half of the patients reported poor appetite during the study, although patients reported they were able to complete 75% of the Hormel Vital Cuisine meal during one sitting. More than 70% of these meals were rated favourably with no aftertaste or burning sensation. Conclusion: Considerations in meal preparation and food products during and following HNC therapy should recognize oral and taste changes from the acute treatment phase to survivorship. Differences are seen in oropharyngeal function and pain, saliva function and taste/flavor recognition. Implications: This exploratory study provides insight for diet and food product development for patients with HNC during and following treatment. Further research with a larger sample is needed to develop guidelines for product development.
- Published
- 2020
26. Oral chronic graft-versus-host disease
- Author
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F R Rozema, Iva I. Raghoebar, Thijs M. Haverman, Judith E. Raber-Durlacher, Joel B. Epstein, Mette D. Hazenberg, Nathaniel S. Treister, and W. M. H. Rademacher
- Subjects
medicine.medical_specialty ,Referral ,business.industry ,medicine.medical_treatment ,030206 dentistry ,Hematopoietic stem cell transplantation ,medicine.disease ,Trismus ,Oral hygiene ,Transplantation ,stomatognathic diseases ,03 medical and health sciences ,0302 clinical medicine ,Graft-versus-host disease ,stomatognathic system ,medicine ,medicine.symptom ,Intensive care medicine ,business ,General Dentistry ,Oral medicine ,Patient education - Abstract
Background Long-term survivors of allogeneic hematopoietic cell transplantation will increasingly seek care from dental providers. Methods The authors highlight the importance of minimizing oral symptoms and complications associated with oral chronic graft-versus-host-disease (cGVHD). Results Chronic GVHD is the result of an immune response of donor-derived cells against recipient tissues. Oral cGVHD can affect the mucosa and damage salivary glands and cause sclerotic changes. Symptoms include sensitivity and pain, dry mouth, taste changes, and limited mouth opening. Risk of developing caries and oral cancer is increased. Food intake, oral hygiene, and dental interventions can represent challenges. Oral cGVHD manifestations and dental interventions should be managed in close consultation with the medical team, as systemic treatment for cGVHD can have implications for dental management. Conclusions General dental practitioners can contribute substantially to alleviating oral cGVHD involvement and preventing additional oral health deterioration. Practical Implications Frequent examinations, patient education, oral hygiene reinforcement, dry mouth management, caries prevention, and management of dental needs are indicated. In addition, oral physical therapy might be needed. Invasive dental interventions should be coordinated with the transplantation team. Screening for oral malignancies is important even years after resolution of GVHD symptoms. Management of the oral manifestations of cGVHD might require referral to an oral medicine professional.
- Published
- 2020
27. To extract or not extract teeth prior to head and neck radiotherapy? A systematic review and meta-analysis
- Author
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Ana Gabriela Costa, Normando, Maria Eduarda, Pérez-de-Oliveira, Eliete Neves Silva, Guerra, Márcio Ajudarte, Lopes, André Caroli, Rocha, Thaís Bianca, Brandão, Ana Carolina, Prado-Ribeiro, Luiz Alcino Monteiro, Gueiros, Joel B, Epstein, César Augusto, Migliorati, Alan Roger, Santos-Silva, and Erin, Watson
- Subjects
Cross-Sectional Studies ,Osteoradionecrosis ,Head and Neck Neoplasms ,Tooth Extraction ,Humans - Abstract
Teeth with poor prognosis are generally recommended to be extracted prior to head and neck radiotherapy (RT) to reduce the risk of developing osteoradionecrosis (ORN), although controversies have been reported. The present systematic review aimed to determine whether tooth extraction prior to head and neck RT may be associated with a reduced risk of developing ORN compared to dental extraction during or after RT.The review protocol was registered in PROSPERO (CRD42021241631). The review was reported according to the PRISMA checklist and involved a comprehensive search of PubMed, Scopus, Embase, Cochrane Library, LILACS, and Web of Science, in addition to the gray literature. The selection of studies was performed in two phases by two reviewers independently. The risk of bias of individual studies was analyzed using the Joanna Briggs Institute checklist for cross-sectional studies, and the certainty of evidence was assessed using the GRADE tool.Twenty-eight observational studies were included in the qualitative synthesis, which showed substantial heterogeneity regarding the association between the timing of tooth extraction and ORN development. Twenty-seven of 28 studies were pooled in a meta-analysis that demonstrated a significant association between an increased risk of ORN and post-RT tooth extraction (odds ratio: 1.98; 95% CI: 1.17-3.35; p = 0.01).It was confirmed with moderate certainty that dental extractions should be performed prior to the start of head and neck RT to reduce the risk of ORN.
- Published
- 2022
28. Patterns of oral mucositis in advanced oral squamous cell carcinoma patients managed with prophylactic photobiomodulation therapy—insights for future protocol development
- Author
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Nathaniel S. Treister, Mariana de Pauli Paglioni, Alan Roger Santos-Silva, Ana Carolina Prado-Ribeiro, Thaís Bianca Brandão, Natália Rangel Palmier, Reinaldo Brito e Dias, Karina Morais Faria, Joel B. Epstein, Henrique da Graça Pinto, and Cesar A. Migliorati
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Analgesic ,030206 dentistry ,Dermatology ,medicine.disease ,Gastroenterology ,Radiation therapy ,stomatognathic diseases ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Parenteral nutrition ,Tongue ,Internal medicine ,Mucositis ,Medicine ,Surgery ,Basal cell ,Hard palate ,Oral mucosa ,business - Abstract
To characterize oral sites affected by radiation-induced oral mucositis (OM) and related clinical outcomes in oral cancer patients subjected to prophylactic photobiomodulation therapy (PBMT). This study included advanced oral squamous cell carcinoma (OSCC) patients treated with prophylactic PBMT for OM. The site distribution of OM, OM grading (CTCAE NCI, Version 4.0, 2010), OM-related pain (VAS), analgesic protocol (WHO Analgesic Ladder), and use of enteral nutrition were evaluated weekly during treatment. Data analysis was performed using descriptive statistics expressed as median values and percentages. A total of 145 OSCC patients were included. OM most frequently affected the lateral border of the tongue (44.1%), buccal mucosa (37.2%), and labial mucosa (33.8%). Keratinized oral mucosa sites, including the tongue dorsum (6.21%), retromolar trigone (8.3%), and hard palate (2.76%), were less frequently affected. Peak OM scores were observed at weeks 5, 6, and 7, with severe OM (NCI grades 3 and 4) rates of 11%, 20%, and 25%, respectively. The cumulative occurrence of severe OM was 23%, which developed as early as week 3 and as late as week 7. The highest mean value of OM-related pain (2.7) was observed at the sixth week, and 13.8% of the patients required feeding support. This study showed, compared with studies that did not provide PBMT, reduced severity of mucositis, reduced pain and analgesic use, and reduced tube feeding in patients treated with PBMT. OM involving keratinized and non-keratinized surfaces should be included in the prophylactic PBMT to reduce severe OM in future studies.
- Published
- 2020
29. Sicca Syndrome Induced by Immune Checkpoint Inhibitor Therapy: Optimal Management Still Pending
- Author
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Joel B. Epstein, Ariadna Ortiz Brugués, Carlos Gomez-Roca, Caroline de Bataille, Béatrice Herbault-Barres, Emmanuelle Vigarios, Iphigenie Korakis, Sarah Betrian, and Vincent Sibaud
- Subjects
Cancer Research ,genetic structures ,business.industry ,Immune checkpoint inhibitors ,education ,biochemical phenomena, metabolism, and nutrition ,Bioinformatics ,humanities ,Optimal management ,stomatognathic diseases ,Sjogren's Syndrome ,Oncology ,Sicca syndrome ,Humans ,bacteria ,Medicine ,Immunotherapy ,Letters to the Editor ,business - Abstract
Commenting on a recently published article on sicca syndrome linked to immune checkpoint inhibitor therapy, this letter to the editor shares another viewpoint on the management of this immune-related adverse event.
- Published
- 2019
30. The impact of the oral cavity in febrile neutropenia and infectious complications in patients treated with myelosuppressive chemotherapy
- Author
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Jan de Lange, Judith A. E. M. Zecha, A.M.G.A. Laheij, Joel B. Epstein, Anneke M. Westermann, Judith E. Raber-Durlacher, Ludi E. Smeele, Maxillofacial Surgery (AMC), Oral Medicine, MKA AMC (OII, ACTA), and Orale Geneeskunde (OII, ACTA)
- Subjects
Male ,Periodontium ,medicine.medical_specialty ,Fever ,Febrile neutropenia ,Physical examination ,Antineoplastic Agents ,Review Article ,Neutropenia ,Oral infection ,Salivary Glands ,Oral mucositis ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Internal medicine ,Neoplasms ,Dental health ,medicine ,Mucositis ,Dentition ,Humans ,Medical history ,030212 general & internal medicine ,Myelosuppressive Chemotherapy ,Mouth ,Stomatitis ,medicine.diagnostic_test ,business.industry ,Cancer ,medicine.disease ,Oncology ,030220 oncology & carcinogenesis ,Female ,Cancer chemotherapy ,business - Abstract
Febrile neutropenia (FN) is an inflammatory response causing fever that may develop during cancer therapy-induced neutropenia. FN may herald life-threatening infectious complications and should therefore be considered a medical emergency. Patients presenting with FN are routinely subjected to careful history taking and physical examination including X-rays and microbiological evaluations. Nevertheless, an infection is documented clinically in only 20–30% of cases, whereas a causative microbial pathogen is not identified in over 70% of FN cases. The oral cavity is generally only visually inspected. Although it is recognized that ulcerative oral mucositis may be involved in the development of FN, the contribution of infections of the periodontium, the dentition, and salivary glands may be underestimated. These infections can be easily overlooked, as symptoms and signs of inflammation may be limited or absent during neutropenia. This narrative review is aimed to inform the clinician on the potential role of the oral cavity as a potential source in the development of FN. Areas for future research directed to advancing optimal management strategies are discussed.
- Published
- 2019
31. State-of-the-science concepts of HPV-related oropharyngeal squamous cell carcinoma: a comprehensive review
- Author
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Brendo Vinicius Rodrigues Louredo, Ana Carolina Prado-Ribeiro, Thaís Bianca Brandão, Joel B. Epstein, Cesar Augusto Migliorati, Alicia Rumayor Piña, Luiz Paulo Kowalski, Pablo Agustin Vargas, Márcio Ajudarte Lopes, and Alan Roger Santos-Silva
- Subjects
Male ,Squamous Cell Carcinoma of Head and Neck ,Papillomavirus Infections ,Prognosis ,Pathology and Forensic Medicine ,Oropharyngeal Neoplasms ,Head and Neck Neoplasms ,Carcinoma, Squamous Cell ,Humans ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,Papillomaviridae - Abstract
High-risk (HR) human papillomavirus (HPV) infection is recognized as a primary etiologic factor of anogenital cancers and more recently of a subgroup of oropharyngeal squamous cell carcinomas (OPSCC). The incidence of HPV-related OPSCC has increased dramatically in several developed countries in the past 3 decades and is currently the most common cancer caused by HR-HPV in the United States and Germany, surpassing cervical cancer. Consequently, the patient's demographic and clinicopathologic profile has shifted to nonsmoking and nondrinking younger men with higher schooling level and with a history of multiple oral sex partners. Patients with HPV-related OPSCC often show better treatment outcomes and higher survival rates than their HPV-unrelated counterparts, which has led to a change in tumor staging for HPV-related cases. HPV vaccination is emerging as an effective primary prevention strategy, and systematic screening of HPV DNA in blood and salivary oral rinse samples of HR patients is being examined to determine if it may provide a surveillance method and support early diagnosis of HPV-related OPSCC. In this context, a narrative review was conducted to provide an overview of the state-of-the-art of HPV-related OPSCC, including epidemiology, risk factors, clinicopathologic and molecular features, screening, prevention, management, and prognosis.
- Published
- 2021
32. Consensus agreement to rename burning mouth syndrome and improve ICD-11 disease criteria: an international Delphi study
- Author
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Arwa M. Farag, Anura Ariyawardana, Charles R. Carlson, Rui Albuquerque, Milda Chmieliauskaite, Cibele Nasri-Heir, Andrea Sardella, Gary D. Klasser, Elisabeth Stelson, Barbara Carey, Joel B. Epstein, Lina Mejia, and Craig S. Miller
- Subjects
Response rate (survey) ,medicine.medical_specialty ,Consensus ,Descriptive statistics ,Delphi Technique ,business.industry ,MEDLINE ,Delphi method ,Disease ,Burning Mouth Syndrome ,Burning mouth syndrome ,Article ,Anesthesiology and Pain Medicine ,Neurology ,International Classification of Diseases ,Family medicine ,Surveys and Questionnaires ,medicine ,Humans ,Neurology (clinical) ,medicine.symptom ,Thematic analysis ,business ,Rename - Abstract
The International Classification of Diseases (ICD-11) proposes revisions in the nomenclature, disease definition, and diagnostic criteria for "burning mouth syndrome" (BMS). This process could benefit from additional systematically collected expert input. Thus, the purpose of this study was to use the Delphi method to (1) determine whether revision in nomenclature and alternative names for "BMS" are warranted and (2) identify areas of consensus among experts for changes to the disease description and proposed diagnostic criteria of "BMS," as described in the ICD-11 (World Health Organization). From 31 international invited experts, 23 who expressed interest were sent the survey. The study used 4 iterative surveys, each with a response rate of ≥82%. Consensus was predefined as 70% of participants in agreement. Data were summarized using both descriptive statistics and qualitative thematic analysis. Consensus indicated that BMS should not be classified as a syndrome and recommended instead renaming to "burning mouth disorder." Consensus included deletion of 2 diagnostic criteria: (1) emotional distress or functional disability and (2) the number of hours symptoms occur per day. Additional items that reached consensus clarified the disease definition and proposed more separate diagnostic criteria, including a list of local and systemic factors to evaluate as potential secondary causes of oral burning. Experts in this study recommended and came to consensus on select revisions to the proposed ICD-11 BMS nomenclature, diagnostic criteria, and disease definition. The revisions recommended have the potential to improve clarity, consistency, and accuracy of diagnosis for this disorder.
- Published
- 2021
33. Reply to Currie et al
- Author
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Milda, Chmieliauskaite, Elisabeth A, Stelson, Joel B, Epstein, Gary D, Klasser, Arwa, Farag, Barbara, Carey, Rui, Albuquerque, Lina, Mejia, Anura, Ariyawardana, Cibele, Nasri-Heir, Andrea, Sardella, Charles, Carlson, and Craig S, Miller
- Subjects
Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) ,Article - Published
- 2022
34. Transitioning the eating experience in survivors of head and neck cancer
- Author
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Jennifer, Dalton, Pamela, Rothpletz-Puglia, Joel B, Epstein, Shristi, Rawal, Heidi, Ganzer, Rebecca, Brody, Laura, Byham-Gray, and Riva, Touger-Decker
- Subjects
Adult ,Eating ,Head and Neck Neoplasms ,Adaptation, Psychological ,Quality of Life ,Humans ,Survivors ,Dysgeusia - Abstract
Applying the Social Cognitive Transition (SCT) Model of Adjustment as an interpretive framework, this mixed-methods case series explored how head and neck cancer (HNC) survivors participate in the dimensions of the eating experience (described as physiological, psychological, social, cultural).This was a sub-study of a primary study, "The Natural History and Impact of Taste Change in Oncology Care." Qualitative interviews and quantitative data (questionnaires and exams) were intersected to examine and describe the complexities of transitioning the eating experience after treatment for HNC. Triangulation of qualitative and quantitative data within and across cases was examined to produce rich descriptions of the changes and transitions in the eating experience.Four case studies were detailed. All reported some taste and/or smell changes. Each case described worry about weight loss and the decreased ability to engage and finding meaning in the eating experience. Each expressed coping strategies that drew upon the social and cultural dimensions of their prior eating experience that brought meaning and purpose to the post-treatment eating experience.This case series explored the impact of taste and oral function and the participant's pre- and post-treatment mental model of the eating experience. Application of the SCT Model of Adjustment to the eating experience in adults with HNC provided a deeper insight into how cognitive adaptation and coping strategies supported transition in identity related to the eating experience following cancer therapy.
- Published
- 2021
35. Orofacial Neuralgia Following Whiplash-Associated Trauma: Case Reports and Literature Review
- Author
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Joel B. Epstein and Firoozeh Samim
- Subjects
Orofacial pain ,medicine.medical_specialty ,business.industry ,Carbamazepine ,medicine.disease ,nervous system diseases ,body regions ,Nociception ,Trigeminal neuralgia ,medicine ,Whiplash ,Neuralgia ,Temporomandibular Joint Disorder ,Physical therapy ,medicine.symptom ,business ,Oxcarbazepine ,medicine.drug - Abstract
Whiplash-associated disorder (WAD) has a close relationship to and functional linkage with the neck and jaw. Studies show an association between orofacial pain and cervical pain and confirm intersegmental nociceptive connections between the trigeminal regions and the cervical spine. We present six cases of WAD-associated orofacial neuralgia. The objective of this study is to present a series of cases of neuralgia-like pain following WAD. Six cases of WAD-associated orofacial neuralgic pain are presented. Neuralgia was identified based upon history, examination, and successful pain management with specific medications for neuralgia. Five out of the six cases were initially diagnosed and treated with limited efficacy as temporomandibular joint disorder (TMD) with continuing pain and were subsequently diagnosed and treated with efficacy as trigeminal neuralgia. MRI and CT scan may suggest cervical spine changes mostly at C2–3, C3–4, and C5–6. Traditional therapy for musculoskeletal pain had no impact upon orofacial pain in patients with neuralgia-like pain following WAD. These cases show that development of neuralgia-like pain may have delayed onset following WAD. Clinical presentation and diagnosis of neuralgia were confirmed upon control of pain with use of carbamazepine or oxcarbazepine. To our knowledge, these cases represent the first report of WAD-related orofacial neuralgia and suggest the potential for neuralgia-like pain to occur following WAD and that clinical diagnosis is needed to lead to effective therapy.
- Published
- 2019
36. World Workshop on Oral Medicine VII: Non‐opioid pain management of head and neck chemo/radiation‐induced mucositis: A systematic review
- Author
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Michael Glick, Bella Dave, Janina Christoforou, Pedro Diz Dios, Jumana A. Karasneh, Joel B. Epstein, Lauren L. Patton, Navdeep Kumar, Jennifer S. Walker, Maddalena Manfredi, and Peter B. Lockhart
- Subjects
Mucositis ,Benzydamine ,medicine.medical_specialty ,Pain ,Antineoplastic Agents ,Placebo ,03 medical and health sciences ,0302 clinical medicine ,Diclofenac ,Internal medicine ,medicine ,Humans ,Pain Management ,General Dentistry ,Randomized Controlled Trials as Topic ,business.industry ,Head and neck cancer ,Chemoradiotherapy ,030206 dentistry ,Congresses as Topic ,Doxepin ,medicine.disease ,Otorhinolaryngology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,business ,Oral medicine ,medicine.drug - Abstract
Objective: To evaluate the current evidence regarding the effectiveness of non-opioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy. Materials and Methods: A literature search was conducted which included randomised controlled trials that assessed patient-related outcome of pain in patients with oral mucositis associated with radiation therapy only or chemoradiotherapy. Literature searches were conducted in MEDLINE via Pubmed, Embase, Scopus and CINAHL. Results: The electronic searches identified 846 articles. Screening revealed that six articles met all eligibility inclusion criteria. Interventions showing statistically significant benefits to reduce oral mucositis associated pain compared to placebo included doxepin (p
- Published
- 2019
37. Oral mucosal changes associated with primary diseases in other body systems
- Author
-
Yehuda Zadik, Jack G. Caton, Joel B. Epstein, and Sharon Elad
- Subjects
0301 basic medicine ,Systemic disease ,Kidney ,business.industry ,Mouth Mucosa ,Connective tissue ,030206 dentistry ,Oral cavity ,medicine.disease ,stomatognathic diseases ,03 medical and health sciences ,Malnutrition ,030104 developmental biology ,0302 clinical medicine ,medicine.anatomical_structure ,Immunology ,medicine ,Dermatologic diseases ,Humans ,Periodontics ,Endocrine system ,Oral mucosa ,Mouth Diseases ,business - Abstract
Systemic diseases may manifest in the oral cavity. This chapter reviews the oral mucosal pathology in blood diseases, gastrohepatic diseases, kidney diseases, immunologic and connective tissue diseases, endocrine diseases, pulmonary diseases, nutritional deficiencies, dermatologic diseases, as well as cancer-associated oral mucosal conditions. The oral mucosa is one of the most commonly affected tissues and may present with unique clinical appearances. Oral mucosal involvement may be the first presentation of the systemic disease or reflect activity or progression of the primary condition. Therefore, it is of importance to be familiar with oral mucosal manifestations of these systemic diseases.
- Published
- 2019
38. Recognition of Non-Hodgkin Lymphoma of the Maxilla
- Author
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Joel B. Epstein, Alexa Martin, Ali M.M. Sadeghi, and Dimitrios Tzachanis
- Subjects
General Medicine - Published
- 2018
39. Oral Assessment and Management of the Patient with Head and Neck Cancer
- Author
-
Herve Y. Sroussi, Maryam Jessri, and Joel B. Epstein
- Subjects
medicine.medical_specialty ,Oral health ,Oral cavity ,Oral assessment ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Treatment plan ,Humans ,Medicine ,Head and neck ,Intensive care medicine ,business.industry ,Diagnosis, Oral ,Head and neck cancer ,Stomatognathic Diseases ,Soft tissue ,030206 dentistry ,medicine.disease ,Otorhinolaryngology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Quality of Life ,Surgery ,Oral Surgery ,business - Abstract
Patients undergoing treatment of head and neck cancer risk developing significant acute and chronic changes that affect the hard and soft tissue of the oral cavity and the head and neck region. This article discusses considerations and recommendations for patients before, during, and after treatment of head and neck cancer. The objective of these recommendations is to maintain oral health, compensate for treatment- and disease-associated morbidities, and improve quality of life. To achieve this objective, treatment of head and neck cancer must include an oral evaluation and management plan well-integrated within the overall oncologic treatment plan from the initiation of therapy.
- Published
- 2018
40. Awareness of the risk of radiation-related caries in patients with head and neck cancer: A survey of physicians, dentists, and patients
- Author
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Natália Rangel Palmier, Alan Roger Santos-Silva, Beatriz Nascimento F. Lebre Martins, Mario Fernando de Goes, Thaís Bianca Brandão, César Rivera, Ana Carolina Prado-Ribeiro, Joel B. Epstein, Márcio Ajudarte Lopes, and Cesar A. Migliorati
- Subjects
medicine.medical_specialty ,Dental Caries Susceptibility ,medicine.medical_treatment ,Dentists ,MEDLINE ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Surveys and Questionnaires ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,In patient ,Oral Complication ,business.industry ,General surgery ,Head and neck cancer ,030206 dentistry ,medicine.disease ,Radiation therapy ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Surgery ,Oral Surgery ,Patient awareness ,business ,Complication ,Patient education - Abstract
Objectives Radiation-related caries (RRC) is one of the most aggressive complications of radiotherapy (RT) in survivors of head and neck cancer (HNC). Lack of RRC awareness may contribute to the occurrence of this oral cavity complication. RRC may be considered a “forgotten oral complication” by patients with HNC, oncologists, and dentists. The present study aimed to assess the level of awareness of RRC among physicians, dentists, and patients. Study Design Physicians (group 1, G1), dentists (group 2, G2), and patients with HNC undergoing RT (group 3, G3) answered questionnaires concerning their awareness of RRC. Physicians (G1) were divided into group 1A (oncological experience) and group 1B (general physicians/other specialties). Dentists (G2) were divided into group 2A (oncological experience) and group 2B (general dentists/other specialties). Personalized questionnaires were designed for each group. Results Recruitment was as follows: physicians (n = 124): 1A (n = 64), 1B (n = 60); dentists: (n = 280), 2A (n = 160), 2B (n = 120). In addition, 58 patients answered the questionnaire. In terms of RRC awareness, 46.77% of physicians, 81.78% of dentists, and 24.13% of patients had some knowledge of the problem. Conclusion Patient awareness of RRC was poor. The heterogeneity of answers among physicians and dentists suggests an opportunity to improve patient education and prevention of this serious oral complication of RT.
- Published
- 2021
41. Chronic oral graft-versus-host disease: induction and maintenance therapy with photobiomodulation therapy
- Author
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Judith E. Raber-Durlacher, Ricardo Spielberger, Geena L. Epstein, Joel B. Epstein, Dimitrios Tzachanis, Mette D. Hazenberg, Hematology, Hematology laboratory, Oral and Maxillofacial Surgery, Clinical Haematology, Oral Medicine, Maxillofacial Surgery (AMC), and Academic Centre for Dentistry Amsterdam
- Subjects
medicine.medical_specialty ,Oral graft-versus-host disease ,medicine.medical_treatment ,chemical and pharmacologic phenomena ,Induction therapy ,03 medical and health sciences ,0302 clinical medicine ,Maintenance therapy ,SDG 3 - Good Health and Well-being ,immune system diseases ,Internal medicine ,medicine ,In patient ,030212 general & internal medicine ,Low level laser therapy ,business.industry ,fungi ,Oncology ,030220 oncology & carcinogenesis ,Graft versus host disease induction ,Photobiomodulation therapy ,business - Abstract
This study presents follow-up of a prior study of patients with chronic symptomatic oral chronic graft-versus-host-disease (cGVHD) managed with photobiomodulation therapy (PBM therapy for 1 month. Here, we report long-term follow-up of a series of patients where PBM therapy in patients with oral cGVHD for maintenance follows the initial period of PBM therapy for continuing management. Patients and methods: We report continuing follow-up of 7 cases of oral cGVHD that were treated with PBM therapy. PBM therapy was continued in these patients with the goal of determining the best management schedule of PBM to maintain or improve control of each patient’s symptoms and signs of oral cGVHD. Results: Oral sensitivity and mucosal changes of cGVHD were controlled with a continuing schedule of PBM therapy of up to 6–8-week treatment intervals in patients with continuing GVHD. These findings suggest that PBM therapy represents an additional approach for continuing management of oral cGVHD and that the frequency of treatment should be individualized for each patient to provide best control of oral findings. In one case weekly PBM treatment was continued, while in others, management on a monthly or bimonthly basis was associated with control of the oral condition. PBM may be individualized and provided based upon best control of the symptoms and signs of oral GVHD.
- Published
- 2021
42. Oral Complications
- Author
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Erin Combs, Joel B. Epstein, and Kimberly Brennan Tyler
- Published
- 2021
43. Industry and MASCC-an opportunity not to be missed
- Author
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Joel B, Epstein, David R, Dean, and Stephen T, Sonis
- Subjects
Neoplasms ,Humans ,Febrile Neutropenia - Published
- 2020
44. Safety and efficacy of photobiomodulation therapy in oncology:A systematic review
- Author
-
Joel B. Epstein, Andrei Barasch, Raj G. Nair, Judith E. Raber-Durlacher, Jolien Robijns, René-Jean Bensadoun, Praveen R. Arany, Joy Lodewijckx, Nathaniel S. Treister, Cesar A. Migliorati, and Marie-Thérèse Genot-Klastersky
- Subjects
safety ,0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,MEDLINE ,Review ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,systematic review ,Neoplasms ,Internal medicine ,photobiomodulation ,medicine ,Animals ,Humans ,cancer ,Radiology, Nuclear Medicine and imaging ,In patient ,Tumor growth ,Low-Level Light Therapy ,Cell Proliferation ,Human studies ,business.industry ,Clinical Cancer Research ,Cancer ,Cell Differentiation ,SDG 10 - Reduced Inequalities ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Tumor Burden ,supportive care ,Clinical trial ,Treatment Outcome ,030104 developmental biology ,Systematic review ,030220 oncology & carcinogenesis ,Animal studies ,business - Abstract
We performed a systematic review of the current literature addressing the safety and efficacy of photobiomodulation therapy (PBMT) in cancer patients. In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were used. In vitro, in vivo, and clinical studies, which investigated the effect of PBMT on cell proliferation/differentiation, tumor growth, recurrence rate, and/or overall survival were included. The Medline/PubMed, EMBASE, and Scopus databases were searched through April 2020. A total of 67 studies met the inclusion criteria with 43 in vitro, 15 in vivo, and 9 clinical studies identified. In vitro studies investigating the effect of PBMT on a diverse range of cancer cell lines demonstrated conflicting results. This could be due to the differences in used parameters and the frequency of PBM applications. In vivo studies and clinical trials with a follow‐up period demonstrated that PBMT is safe with regards to tumor growth and patient advantage in the prevention and treatment of specific cancer therapy‐related complications. Current human studies, supported by most animal studies, show safety with PBMT using currently recommended clinical parameters, including in Head & Neck cancer (HNC) in the area of PBMT exposure. A significant and growing literature indicates that PBMT is safe and effective, and may even offer a benefit in patient overall survival. Nevertheless, continuing research is indicated to improve understanding and provide further elucidation of remaining questions regarding PBM use in oncology., We performed a systematic review of the current literature addressing the safety and efficacy of photobiomodulation therapy (PBMT) in cancer patients. A significant and growing literature indicates that PBMT is safe and effective, and may even offer a benefit in patient overall survival. Nevertheless, continuing research is indicated to improve understanding and provide further elucidation of remaining questions regarding PBM use in oncology.
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- 2020
45. COVID-19 Responses: Unintended and Undiscussed Potential Consequences
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Joel B, Epstein, primary, Sean, Mark, additional, and Richard G, Mathias, additional
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- 2021
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46. Photobiomodulation effects on head and neck squamous cell carcinoma (HNSCC) in an orthotopic animal model
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Andrei Barasch, James D. Carroll, Hongyan Li, Judith E. Raber-Durlacher, Joel B. Epstein, Vinagolu K. Rajasekhar, Adriana Haimovitz-Friedman, Oral Medicine, and Oral and Maxillofacial Surgery
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Mucositis ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Transplantation, Heterologous ,Mice, Nude ,Dermatitis ,chemical and pharmacologic phenomena ,Mice, SCID ,Oral cavity ,Article ,Mice ,03 medical and health sciences ,0302 clinical medicine ,Animal model ,SDG 3 - Good Health and Well-being ,Cell Line, Tumor ,Internal medicine ,medicine ,Animals ,Humans ,030212 general & internal medicine ,Low-Level Light Therapy ,Head and neck cancer ,Head and neck carcinoma ,Stomatitis ,Radiotherapy ,Squamous Cell Carcinoma of Head and Neck ,business.industry ,fungi ,Cancer ,Photobiomodulation ,medicine.disease ,Head and neck squamous-cell carcinoma ,Orthotopic mouse model ,Radiation therapy ,Disease Models, Animal ,030220 oncology & carcinogenesis ,business ,Neoplasm Transplantation - Abstract
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.Background: Photobiomodulation (PBM) has shown efficacy in preventing and treating cancer therapy-induced mucositis and dermatitis. However, there is contradictory information regarding the effect of PBM on (pre)malignant cells, which has led to questions regarding the safety of this technique. We address this issue using an orthotopic mouse model (Cal-33) with human squamous cell carcinoma of the oral cavity. Methods: Mice with actively growing orthotopic Cal-33 head and neck carcinoma tumors were divided into 4 groups: control, PBM only, radiation therapy (RT) only, and PBM + RT. We performed three experiments: (1) PBM at 660 nm, 18.4 J/cm2, and 5 RT × 4 Gy doses delivered daily; (2) PBM at 660 nm, 18.4 J/cm2, and 1 × 15 Gy RT; and (3) PBM at 660 nm + 850 nm, 45 mW/cm2, 3.4 J/cm2, and 1 × 15 Gy RT. Mice were weighed daily and tumor volumes were evaluated by IVIS. Survival time was also evaluated. Results: Animals treated with RT survived significantly longer and had significantly smaller tumor volume when compared with the control and PBM-only treatment groups. No significant differences were noted between the RT alone and PBM + RT groups in any of the experiments. Conclusion: Our results suggest that PBM at the utilized parameters does not provide protection to the tumor from the killing effects of RT.
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- 2020
47. Chronic oral graft-versus-host disease: induction and maintenance therapy with photobiomodulation therapy
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Joel B, Epstein, Judith E, Raber-Durlacher, Geena L, Epstein, Mette D, Hazenberg, Dimitrios, Tzachanis, and Ricardo T, Spielberger
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Adult ,Male ,Adolescent ,Chronic Disease ,Graft vs Host Disease ,Humans ,Female ,Low-Level Light Therapy ,Middle Aged ,Mouth Diseases ,Aged - Abstract
This study presents follow-up of a prior study of patients with chronic symptomatic oral chronic graft-versus-host-disease (cGVHD) managed with photobiomodulation therapy (PBM therapy for 1 month. Here, we report long-term follow-up of a series of patients where PBM therapy in patients with oral cGVHD for maintenance follows the initial period of PBM therapy for continuing management. PATIENTS AND METHODS: We report continuing follow-up of 7 cases of oral cGVHD that were treated with PBM therapy. PBM therapy was continued in these patients with the goal of determining the best management schedule of PBM to maintain or improve control of each patient's symptoms and signs of oral cGVHD. RESULTS: Oral sensitivity and mucosal changes of cGVHD were controlled with a continuing schedule of PBM therapy of up to 6-8-week treatment intervals in patients with continuing GVHD. These findings suggest that PBM therapy represents an additional approach for continuing management of oral cGVHD and that the frequency of treatment should be individualized for each patient to provide best control of oral findings. In one case weekly PBM treatment was continued, while in others, management on a monthly or bimonthly basis was associated with control of the oral condition. PBM may be individualized and provided based upon best control of the symptoms and signs of oral GVHD.
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- 2020
48. Cost-effectiveness of photobiomodulation therapy for the prevention and management of cancer treatment toxicities: a systematic review
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Elisa, Kauark-Fontes, Leticia, Rodrigues-Oliveira, Joel B, Epstein, Karina Morais, Faria, Anna Luiza Damaceno, Araújo, Luiz Alcino Monteiro, Gueiros, Cesar Augusto, Migliorati, Ramzi G, Salloum, Patricia, Burton, James, Carroll, Marcio Ajudarte, Lopes, Carolina Guimarães Bonfim, Alves, Natalia Rangel, Palmier, Ana Carolina, Prado-Ribeiro, Thaís Bianca, Brandão, and Alan Roger, Santos-Silva
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Cost-Benefit Analysis ,Neoplasms ,Humans ,Low-Level Light Therapy - Abstract
To identify and summarize the evidence on the cost-effectiveness of photobiomodulation (PBM) therapy for the prevention and treatment of cancer treatment-related toxicities.This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE). Scopus, MEDLINE/PubMed, and Embase were searched electronically.A total of 1490 studies were identified, and after a two-step review, 4 articles met the inclusion criteria. The included studies analyzed the cost-effectiveness of PBM therapy used in the context of lymphedema for breast cancer and oral mucositis (OM) induced by chemotherapy and radiotherapy. Better outcomes were associated with PBM therapy. The incremental cost-effectiveness ratio ranged from 3050.75 USD to 5592.10 USD per grade 3-4 OM case prevented. PBM therapy cost 21.47 USD per percentage point reduction in lymphedema in comparison with 80.51 USD for manual lymph drainage and physical therapy.There is limited evidence that PBM therapy is cost-effective in the prevention and treatment of specific cancer treatment-related toxicities, namely, OM and breast cancer-related lymphedema. Studies may have underreported the benefits due to a lack of a comprehensive cost evaluation. This suggests a wider acceptance of PBM therapy at cancer treatment centers, which has thus far been limited by the number of robust clinical studies that demonstrate cost-effectiveness for the prevention and treatment of toxicities.
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- 2020
49. Impact of radiation on tooth loss in patients with head and neck cancer: a retrospective dosimetric-based study
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Wagner Gomes-Silva, César Rivera, Joel B. Epstein, Gustavo Nader Marta, Gilberto de Castro, Karina Gondim Moutinho da Conceição Vasconcelos, Heloisa de Andrade Carvalho, Alan Roger Santos-Silva, Karina Morais-Faria, Gabriel Faria Najas, and Thaís Bianca Brandão
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Molar ,medicine.medical_treatment ,Dentistry ,Pathology and Forensic Medicine ,Tooth Loss ,stomatognathic system ,medicine ,Tooth loss ,Dosimetry ,Humans ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Adverse effect ,Radiometry ,Retrospective Studies ,Dentition ,business.industry ,Head and neck cancer ,Radiotherapy Dosage ,medicine.disease ,Confidence interval ,Radiation therapy ,stomatognathic diseases ,Osteoradionecrosis ,Head and Neck Neoplasms ,Tooth Extraction ,Surgery ,Oral Surgery ,medicine.symptom ,business - Abstract
To characterize the dental adverse events after head and neck radiation therapy (HNRT) and to investigate the impact of regional radiation dose upon tooth loss outcomes.A retrospective dosimetric-based analysis was conducted to assess dental events affecting post-HNRT extracted teeth and the impact of 3 different radiation doses (30 Gy, 30-60 Gy, and60 Gy) upon tooth loss. In addition, post-HNRT extractions outcomes and mean parotid glands dosimetry and salivary changes were analyzed.Sixty-six patients who underwent HNRT were included in the analysis. Radiation caries was the most frequent (67.8%) post-HNRT dental adverse event, and maxillary molars ipsilateral to the tumor were lost earlier compared with the others (P.001). The odds ratio for post-HNRT tooth extraction risk was approximately 3-fold higher for teeth exposed to60 Gy (confidence interval, 1.56-5.35; P.001), followed by an increased risk of delayed healing and osteoradionecrosis (ORN) in sites receiving doses above 50 Gy.Radiation caries was the major cause of dental extractions after HNRT, and the dosimetric analysis suggested that a high dose of radiation may negatively impact the dentition of survivors of head and neck cancer, increasing the risk of tooth loss and ORN.
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- 2020
50. Oral chronic graft-versus-host disease: What the general dental practitioner needs to know
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Thijs M, Haverman, Judith E, Raber-Durlacher, Iva I, Raghoebar, Willem M H, Rademacher, Frederik R, Rozema, Mette D, Hazenberg, Joel B, Epstein, and Nathaniel S, Treister
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Professional Role ,Chronic Disease ,Dentists ,Hematopoietic Stem Cell Transplantation ,Graft vs Host Disease ,Humans - Abstract
Long-term survivors of allogeneic hematopoietic cell transplantation will increasingly seek care from dental providers.The authors highlight the importance of minimizing oral symptoms and complications associated with oral chronic graft-versus-host-disease (cGVHD).Chronic GVHD is the result of an immune response of donor-derived cells against recipient tissues. Oral cGVHD can affect the mucosa and damage salivary glands and cause sclerotic changes. Symptoms include sensitivity and pain, dry mouth, taste changes, and limited mouth opening. Risk of developing caries and oral cancer is increased. Food intake, oral hygiene, and dental interventions can represent challenges. Oral cGVHD manifestations and dental interventions should be managed in close consultation with the medical team, as systemic treatment for cGVHD can have implications for dental management.General dental practitioners can contribute substantially to alleviating oral cGVHD involvement and preventing additional oral health deterioration.Frequent examinations, patient education, oral hygiene reinforcement, dry mouth management, caries prevention, and management of dental needs are indicated. In addition, oral physical therapy might be needed. Invasive dental interventions should be coordinated with the transplantation team. Screening for oral malignancies is important even years after resolution of GVHD symptoms. Management of the oral manifestations of cGVHD might require referral to an oral medicine professional.
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- 2020
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