Oral shedding of human herpesviruses in patients undergoing radiotherapy/chemotherapy for head and neck squamous cell carcinoma is not affected by xerostomia

Abstract

Background: Xerostomia is a very relevant and frequent complication of radiotherapy, causing the irradiated oral mucosa to be affected by bacterial, fungal and viral infections. Objective: The objective of this study was to evaluate a possible relationship between oral shedding of human herpesviruses and xerostomia in patients with squamous cell carcinoma of head and neck submitted to radio/chemotherapy. Methods: In this study, oral rinse samples were collected weekly from 20 patients during radiotherapy. The samples were submitted to PCR and enzymatic digestion for detection of human herpesviruses. Xerostomia was evaluated according to the Seminars in Radiation Oncology criteria. Results: There was a higher frequency of grade 1 xerostomia (51.4%), observed first in the 1st week of radiotherapy. In the 4th week of radiotherapy, all patients presented some degree of xerostomia. Analysis of herpesviruses showed oral shedding of EBV, HHV-6 and HHV-7 in all weeks. Considering all the periods, the highest frequency was in patients with EBV excretion (55.0%), which was significantly higher than that of other viruses. Conclusion: We observed that oral shedding of herpesviruses was not affected by xerostomia as there was a progression in their excretion, even with the evolution of xerostomia. This suggested that there is a local replication in the oral cavity that is not completely dependent of salivary excretion.

Frequency and Evolution of Acute Oral Complications in Patients Undergoing Radiochemotherapy Treatment for Head and Neck Squamous Cell Carcinoma

“…In the fourth week of RT, most of patients developed severe grades of dysphagia (grade ≥ 2) and they may only eat liquid food and may require tube feeding. 4,10,13,16,17,25 Similar findings were also observed in our study, where 50% of patients reported dysphagia in the first week of RT (25% with grade 1 and 25% with grade 3). Studies report that the severity of dysphagia may be associated with the cumulative dose of radiation, 12,17,26 -28 a finding corroborated by our study as this acute complication was more common and more severe along the weeks of RT.…”

“…15,16 The first stages of xerostomia are usually observed in the first weeks of RT. 4,10,13,16,21,23,24 In our group, 3 of 20 patients presented xerostomia in the first week and 9 of 20 in the second week of RT. A worsening of xerostomia occurred throughout the weeks of RT, with all patients (20/20) presenting some degree of xerostomia in the fourth week of RT as they had a reduction in their salivary flow rate.…”

“…4,12 -15 Xerostomia is reported in 100% of patients undergoing RT in the head and neck region, being commonly reported after the first week and becoming more severe along the weeks, peaking in the sixth week. 4,12 -16…”

“…4,[12][13][14][15] Xerostomia is reported in 100% of patients undergoing RT in the head and neck region, being commonly reported after the first week and becoming more severe along the weeks, peaking in the sixth week. 4,[12][13][14][15][16] Dysphagia is a swallowing disorder in which, in addition to causing discomfort, can trigger malnutrition and dehydration. Almost 60% of patients who receive RT develop some degree of dysphagia, where 20% of patients develop severe dysphagia (grades 3 and 4).…”

Cytokine Levels and Human Herpesviruses in Saliva from Clinical Periodontal Healthy Subjects with Peri-Implantitis: A Case-Control Study

“…Two primers, HSVP1/P2 and VZVP1/P2, were designed to flank a well-conserved region of the DNA polymerase gene, based on an alignment of DNA sequences from the eight known human herpesviruses as described by Johnson et al in 2000 [ 24 ]. The positive samples were submitted to enzymatic digestion with BamHI and BstUI restriction enzymes (New England Biolabs) for specific determination of each one of the eight herpesviruses, also described in previous works of our group [ 25 – 27 ].…”