Successful treatment of radiation-induced mucositis with proton pump inhibitor administration: A report of two laryngeal cancer cases

Eguchi, Kohtaro; Suzuki, Masami; Ida, Shota; Kudo, Shigehiro; Ando, Ken; Ebara, Takeshi; Higuchi, Keiko

doi:10.1016/j.anl.2016.05.006

Cited by 8 publications

(7 citation statements)

References 13 publications

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“…39,40 Small case series have shown improvement of radiation-induced mucositis using PPIs, although they seem to be helpful only in patients with severe reflux symptoms. 41 Although authors have cautioned against the use of PPIs without clear indication, 42 largely due to the risk of hypersensitivity and cutaneous reactions, [43][44][45][46] our findings illustrate the benefit of their use as first-line therapy for mild mucositis.…”

Section: Discussionmentioning

confidence: 68%

Clinical Characteristics and Outcomes of Oral Mucositis Associated With Immune Checkpoint Inhibitors in Patients With Cancer

Jacob

Dutra

Garcia-Rodriguez

et al. 2021

Journal of the National Comprehensive Cancer Network

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Background: Immune checkpoint inhibitor (ICI) therapy predisposes patients to immune-related adverse events (irAEs). Data are limited regarding the incidence, management, and outcomes of one such irAE: mucositis. In this study, we evaluated the clinical characteristics, disease course, treatment, and outcomes of ICI-mediated mucositis. Methods: This was a retrospective, single-center study of patients who received ICI therapy and developed oral mucositis at The University of Texas MD Anderson Cancer Center from January 2009 to September 2019. Inclusion criteria included age ≥18 years, a diagnosis of oral mucositis and/or stomatitis based on ICD-9 and ICD-10 codes, and therapy using CTLA-4 or PD-1/L1 inhibitors alone or combined with other agents. Results: We identified 152 patients with a mean age of 60 years, 51% of whom were men. Of the sample patients, 73% had stage IV cancer, with melanoma the most common (28%). Median time from ICI initiation to mucositis was 91 days. The most common clinical presentation of mucositis was odynophagia and/or oral pain (89%), 91% developed CTCAE grade 1–2 mucositis, and 78% received anti–PD-1/L1 monotherapy. Compared with anti–PD-1/L1–based therapy, anti–CTLA-4–based therapy was more frequently associated with earlier onset of mucositis (73 vs 96 days; P=.077) and a lower rate of symptom resolution (76% vs 92%; P=.029); 24% of patients required immunosuppressive therapy, which was associated with longer symptom duration (84 vs 34 days; P=.002) and higher mucositis recurrence rate (61% vs 32%; P=.006). ICI interruption was associated with worse survival (P=.037). Mucositis recurrence, immunosuppressant use, and presence of other irAEs did not affect survival. Conclusions: For ICI-mediated mucositis, a diagnosis of exclusion has not been well recognized and is understudied. Although the clinical symptoms of mucositis are mostly mild, approximately 25% of patients require immunosuppression. Mucositis recurrence can occur in approximately 39% patients. Our results showed that ICI interruption compromises overall survival.

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Section: Discussionmentioning

confidence: 68%

Clinical Characteristics and Outcomes of Oral Mucositis Associated With Immune Checkpoint Inhibitors in Patients With Cancer

Jacob

Dutra

Garcia-Rodriguez

et al. 2021

Journal of the National Comprehensive Cancer Network

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“…The modified Killian's method allows for better observation of the hypopharynx ( 18); however, it has not been adapted for weekly endoscopy during radiation therapy. In our previous study, strong mucositis was observed in the perilaryngeal areas, including the postcricoid area (8). If the modified Killian's method was performed in all cases, the frequency of grade 3 mucositis may have been higher, which may have influenced the results.…”

Section: Discussionmentioning

confidence: 94%

“…A previous report described that radiation-induced mucositis was successfully treated by PPIs, suggesting a link between LPR and radiation-induced mucositis (8). No other studies to date have explored the relationship between radiation-induced mucositis and either LPR or RFS.…”

Section: Discussionmentioning

confidence: 99%

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Association Between Laryngopharyngeal Reflux and Radiation-induced Mucositis in Head and Neck Cancer

Eguchi

Suzuki

Ida

et al. 2018

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“…Previously, Eguchi et al ( 24 ) reported that patients with a high RFS, indicating high LPR likelihood before radiation, were more susceptible to radiation damage and developed severe laryngeal mucositis earlier than patients with low LPR likelihood. When PPI therapy was administrated, the mucositis was quickly ameliorated ( 25 ). Therefore, we believe that under chronic stress of LPR, the laryngeal mucosa may be vulnerable to irradiation damage and may well facilitate radiation-related LCG formation after radiation.…”

Section: Discussionmentioning

confidence: 99%

Laryngeal contact granuloma after radiotherapy in patients with nasopharyngeal carcinoma: a case series

Mo¹,

Chen²,

Huang³

et al. 2023

Ann Transl Med

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Background Laryngeal contact granuloma (LCG) is a benign hypertrophic lesion and phonatory injury after abnormal vocal behavior is regarded as its major etiology. Patients receiving radiation for non-laryngeal head and neck tumors are troubled by persistent voice impairment. The occurrence of LCG after radiotherapy for nasopharyngeal carcinoma (NPC) in our practice has implored us to re-exam their underlying etiology. We hypothesize that a proportion of LCG results from voice change caused by non-laryngeal head and neck cancer radiotherapy and firstly describe a distinct LCG population originated after radiotherapy for NPC with respect to the clinical profile, presentation, prognosis and response to treatment of patients. Methods We retrospectively reviewed the laryngoscopic examination and tumor study findings to elucidate the common clinical features of patients who presented with LCG after radiotherapy for NPC. All patients were regularly monitored with telescopic examination until lesions disappeared. Data on age, sex, clinical presentation, telescopic findings, management, latency time of lesion formation, remission time and clinical outcome were reviewed. Results The medical review identified 27 cases of LCG secondary to radiotherapy for NPC. All lesions had been diagnosed during routine endoscopy following radiation. The interval between radiation onset and endoscopic diagnosis was 3.77 months (range, 0.67–11 months). 20 cases were resolved through simple observation, 4 cases were resolved with the administration of proton pump inhibitors (PPIs), and 3 cases with a poor response to PPI therapy required subsequent surgical resection. The mean remission time in the observation and PPI groups was 4.42 months (range, 0.73–18.9 months) and 5.78 months (range, 2.17–14.63 months), respectively. All patients recovered completely and none experienced recurrence during a mean follow-up of 32.44 months (range, 5.6–71.67 months). Conclusions Iatrogenic granulomas of vocal process are presenting after radiation for non-laryngeal head and neck cancers. In contrast with spontaneous granulomas, these granulomas can be cured at high remission rates and low recurrence trend without specific intervention. Thus, simple observation may be sufficient for radiation-induced LCG.

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Successful treatment of radiation-induced mucositis with proton pump inhibitor administration: A report of two laryngeal cancer cases

Cited by 8 publications

References 13 publications

Clinical Characteristics and Outcomes of Oral Mucositis Associated With Immune Checkpoint Inhibitors in Patients With Cancer

Clinical Characteristics and Outcomes of Oral Mucositis Associated With Immune Checkpoint Inhibitors in Patients With Cancer

Association Between Laryngopharyngeal Reflux and Radiation-induced Mucositis in Head and Neck Cancer

Laryngeal contact granuloma after radiotherapy in patients with nasopharyngeal carcinoma: a case series

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