Supervisors info:
Βύρων Χρ. Δρούκας: Ομότιμος Καθηγητής στη Φυσιολογία του Στοματογναθικού, Κλινική Αντιμετώπισης Στοματοπροσωπικού Πόνου, Οδοντιατρική Σχολή, ΕΚΠΑ
Τζάκης Μιχαήλ-Γεράσιμος: Καθηγητής στη Φυσιολογία του Στοματογναθικού, Κλινική Αντιμετώπισης Στοματοπροσωπικού Πόνου, Οδοντιατρική Σχολή, ΕΚΠΑ
Ψάρρας Βασίλειος: Επίκουρος Καθηγητής στη Φυσιολογία του Στοματογναθικού, Κλινική Αντιμετώπισης Στοματοπροσωπικού Πόνου, Οδοντιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: Oral cancer prevalence is increasing, the 5 year survival is about 50% and the patients who survive often develop chronic functional abnormalities after their oncological therapy. Those functional abnormalities and the related orofacial pain are associated with difficulties in food and liquides intake, swallowing, in the maintenance of good oral hygiene, in speech, in their work, in relations with family and others, and the overall mental, spiritual and physical health. The patient survives with reduced quality of life.
The purpose of the present study was to assess the function of the maxillofacial sturcture and quality of life in patients, with oral squamous cell carcinoma, before and after post operative radiotherapy or chemoradiotherapy.
We hypothesized that post operative radiotherapy or chemoradiotherapy may adversely affect the normal function of the maxillofacial system and will reduce the quality of life of the patients.
Patients: Ten patients with oral squamous cell carcinoma were included. All patients had been pretreated with surgical removal of their cancer.
Methods: All patients signed the informed consent form. Intraoral and extraoral clinical examination was performed, with palpation of the masseters and the other sturctures of the maxillofacial area. The findings were recorded in the special forms of the Clinic of OroFacial Pain. Patients completed the ten grade visual analogue scale to score pain and xerosotmia. The grades of oral mucositis were also recorded and patients completed the validated questionnaires of EORTC QLQ C-30 and Head and Neck35.
Results:
Epidemiological characteristics: Nine patients were men and one was a woman, with mean age 63,8 years (range 37-87 years). Mean dose of radiotherapy was 64,3 Gray. Concurrent chemotherapy was administered to 6 patients.
Mean maximum mouth opening: At the end of radiotherapy, mean maximum mouth opening was reduced by 12,1 mm (mean opening was 34 mm).
Radiation toxicity: At the end of radiotherapy or chemoradiotherapy clinically relevant oral mucositis, grade III was observed in six patients. Severe pain and xerostomia, grade 8-10, was recorded by five patients. Mean loss of weight was 4,3 kilograms in six patients, who were measured.
Quality of Life: QLQ C-30. At the end of therapy most patients recorded severe fatigue, pain, limitations in work, weakness, sad feelings, family problems, sleeping problems, anorexia, financial problems, anxiety, constipation. Nausea, vomiting and depression were recorded for the first time. Most patients recorded poor to medium quality of life. The total number of symptoms increased to 51 symptoms (6,3 symptoms per patient). Head and Neck 35: At the end of therapy the patients complained of severe oral, jaw and neck pain, problems in swallowing of solid and liquid food, taste alterations, sticky saliva and dry mouth, coarseness, dental problems, feeling sick and reduced interest in life. The total number of symptoms increased to 71 (8,8 symptoms per patient).
Discussion: The adverse effect of trismus in the different studies shows a wide variation and can be as high as 42%, depending on the (a) tumor location, (b) the preceding surgical therapy and (c) the oral/maxillofacial strucures and the muscles, which have been irradiated. In the present study a homogeneous group of patients was included: all had squamous cell carcinoma and all had been pretreated with surgical removal of their cancer. At the end of radiotherapy, all patients had trismus. The findings of our study are in agreement with other studies from the English literature, in patients with head and neck cancer, but not specifically limited to oral cancer and without separating the patients, who were first managed with surgery. Oral radiation toxicity was also in agreement with that reported in the literature.
The completion and assessment of the questionnaires C-30 and Head/Neck35 showed a worsening of symptoms, with an adverse effect of quality of life, at the end of therapy. Similar results were reported in the literature
Conclusions: We assessed, for the first time, a homogeneous group of patients with (a) oral squamous cell carcinoma, who (b) received postoperative radiotherapy or chemoradiotherapy. Reduction of the mouth opening was seen in all patients, for the first time, at the end or therapy, while the mean mouth opening reached the levels of trismus. Quality of life was reduced in all study patients.
Clinical relevance: The findings of the present study denote the need for support of the patients with oral cancer, with the contribution of the dentist and the administration of appropriate protocols for the maintenance of oral health after the oncological therapy, especially postoperative radiotherapy or chemoradiotherapy.
