CoDAS
https://codas.org.br/article/doi/10.1590/2317-1782/20192018176
CoDAS
Revisão Sistemática

Electrical stimulation in the treatment of radiotherapy-induced hyposalivation

Estimulação elétrica no tratamento da hipossalivação induzida pela radioterapia

Émille Dalbem Paim; Monalise Costa Batista Berbert; Virgilio Gonzales Zanella; Fabricio Edler Macagnan.

Downloads: 5
Views: 1948

Abstract

Purpose: To analyze the effects of electrical stimulation on the salivary flow of head and neck cancer patients with radiotherapy-induced hyposalivation. Research strategies: Searches were made in the Medline (via Pubmed), Cochrane Library, Scopus and Lilacs databases. Selection criteria: Selection included clinical trials that evaluated salivary flow objectively, published in the last 10 years in either Portuguese, English or Spanish. Data analysis: The PEDro scale was used for the methodological evaluation of the studies. Results: The search strategy resulted in 21 publications, 17 of which were excluded, hence there were 4 articles left. The included studies had a total of 212 participants, all of whom had an increase in salivary flow, both through the electroacupuncture method and direct application on the salivary glands. The score obtained through the PEDRo scale was low, evidencing questionable methodological quality and risk of bias. Conclusion: The included studies demonstrate the clinical potential of TENS to increase the salivary flow of head and neck cancer patients treated with RT.

Keywords

Xerostomia, Head and Neck Neoplasms, Radiotherapy, Speech, Language and Hearing Sciences, Oncology.

Resumo

Objetivo: Analisar os efeitos da eletroestimulação sobre o fluxo salivar de pacientes com hipossalivação induzida por radioterapia em região de cabeça e pescoço. Estratégia de pesquisa: Utilizaram-se as bases de dados Medline (via Pubmed), Cochrane Library, Scopus e Lilacs. Critérios de seleção: Foram selecionados os ensaios clínicos que avaliaram objetivamente o fluxo salivar, publicados nos últimos 10 anos em português, inglês ou espanhol. Análise dos dados: Para avaliação metodológica dos estudos, foi utilizada a escala PEDro. Resultados: A estratégia de busca resultou em 21 publicações, sendo que 17 foram excluídas, selecionando-se assim 4 artigos. Os estudos incluídos contaram com um total de 212 participantes, sendo que todos demonstraram aumento do fluxo salivar, tanto por meio do método de eletroacupuntura quanto pela estimulação aplicada diretamente sobre as glândulas salivares. A pontuação obtida por meio da escala PEDro foi baixa, evidenciando qualidade metodológica baixa e com consideráveis riscos de viés. Conclusão: os estudos incluídos demonstram o potencial clínico da TENS no aumento do fluxo salivar de pacientes com câncer de cabeça e pescoço tratados com RT

Palavras-chave

Xerostomia, Neoplasias de Cabeça e Pescoço, Radioterapia, Fonoaudiologia, Oncologia.

Referências

1 Chen AM, Li B, Farwell D, Marsano J, Vijayakumar S, Purdy J. Improved dosimetric and clinical outcomes with intensity-modulated radiotherapy for head-and-neck cancer of unknown primary origin. Int J Radiat Oncol Biol Phys. 2011;79(3):756-62. http://dx.doi.org/10.1016/j.ijrobp.2009.11.020. PMid:20421143. [ Links ]

2 Caccelli EMN, Rapoport A. Para-efeitos das irradiações nas neoplasias de boca e orofaringe. Rev Bras Cir Cabeça Pescoço. 2008;37(4):198-201. [ Links ]

3 Van Luijk P, Pringle S, Deasy JO, Moiseenko VV, Faber H, Hovan A, et al. Sparing the region of the salivary gland containing stem cells preserves saliva production after radiotherapy for head and neck cancer. Sci Transl Med. 2015;7(305):305ra147. http://dx.doi.org/10.1126/scitranslmed.aac4441. PMid:26378247. [ Links ]

4 Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008;26(22):3770-6. http://dx.doi.org/10.1200/JCO.2007.14.6647. PMid:18669465. [ Links ]

5 Dirix P, Nuyts S, Van den Bogaert W. Radiation-induced xerostomia in patients with head and neck cancer. Cancer. 2006;107(11):2525-34. http://dx.doi.org/10.1002/cncr.22302. PMid:17078052. [ Links ]

6 Brockstein BE, Vokes E. Head and neck cancer in 2010: maximizing survival and minimizing toxicity. Nat Rev Clin Oncol. 2011;8(2):72-4. http://dx.doi.org/10.1038/nrclinonc.2010.226. PMid:21278773. [ Links ]

7 Sciubba JJ, Goldenberg D. Oral complications of radiotherapy. Lancet Oncol. 2006;7(2):175-83. http://dx.doi.org/10.1016/S1470-2045(06)70580-0. PMid:16455482. [ Links ]

8 Chao KS, Majhail N, Huang CJ, Simpson JR, Perez CA, Haughey B, et al. Intensity-modulated radiation therapy reduces late salivary toxicity without compromising tumor control in patients with oropharyngeal carcinoma: a comparison with conventional techniques. Radiother Oncol. 2001;61(3):275-80. http://dx.doi.org/10.1016/S0167-8140(01)00449-2. PMid:11730997. [ Links ]

9 Konings AW, Coppes RP, Vissink A. On the mechanism of salivary gland radiosensitivity. Int J Radiat Oncol Biol Phys. 2005;62(4):1187-94. http://dx.doi.org/10.1016/j.ijrobp.2004.12.051. PMid:15990024. [ Links ]

10 Cooper JS, Fu K, Marks J, Silverman S. Late effects of radiation therapy in the head and neck region. Int J Radiat Oncol Biol Phys. 1995;31(5):1141-64. http://dx.doi.org/10.1016/0360-3016(94)00421-G. PMid:7713779. [ Links ]

11 Ramirez-Amador V, Silverman S Jr, Mayer P, Tyler M, Quivey J. Candidal colonization and oral candidiasis in patients undergoing oral and pharyngeal radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(2):149-53. http://dx.doi.org/10.1016/S1079-2104(97)90061-5. PMid:9269016. [ Links ]

12 Dirix P, Nuyts S, Van den Bogaert W. Radiation-induced xerostomia in patients with head and neck cancer: a literature review. Cancer. 2006;107(11):2525-34. http://dx.doi.org/10.1002/cncr.22302. PMid:17078052. [ Links ]

13 Campos RJDS, Leite ICG. Qualidade de vida e voz pós-radioterapia: repercussões para a fonoaudiologia. Rev CEFAC. 2010;12(4):671-7. http://dx.doi.org/10.1590/S1516-18462010005000038. [ Links ]

14 Fávaro RAA, Ferreira TNR, Martins WD. Xerostomia: etiologia, diagnóstico e tratamento. Clin. Pesq. Odontol. 2006;2(4):303-17. [ Links ]

15 Santos CP. Atuação fonoaudiológica durante a radioterapia em pacientes com câncer de cabeça e pescoço. Revista HUPE. 2015;14(1):73-9. http://dx.doi.org/10.12957/rhupe.2015.17930. [ Links ]

16 Lima AAS, Figueiredo MAS, Krapf SMR, Souza FR. Velocidade do fluxo e pH salivar após radioterapia da região de cabeça e pescoço. Rev Bras Cancerol. 2004;50(4):287-93. [ Links ]

17 Sousa NB, Freitas HV, Almeida-Junior LJS, Lopes FF, Cruz MCFN. Abordagem crítica sobre as terapias de estimulação do fluxo salivar (TEFS). Rev Pesq Saúde. 2014;15(1):245-8. [ Links ]

18 Alajbeg I, Falcão DP, Tran SD, Martín-Granizo R, Lafaurie GI, Matranga D, et al. Intraoral electrostimulator for xerostomia relief: a long-term, multicenter, open-label, uncontrolled, clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(6):773-81. http://dx.doi.org/10.1016/j.oooo.2012.01.012. PMid:22668705. [ Links ]

19 Dawes C, Cross HG, Baker CG, Chebib FS. The influence of gland size on the flow rate and composition of human parotid saliva. J Can Dent Assoc. 1978;44(1):21-5. PMid:272988. [ Links ]

20 Hargitai IA, Sherman RG, Strother JM. The effect of electrostimulation on parotid saliva flow: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(3):316-20. http://dx.doi.org/10.1016/j.tripleo.2004.06.080. PMid:15716838. [ Links ]

21 Weiss WW Jr, Brenman HS, Katz P, Bennett JA. Use of an electronic stimulator for the treatment of dry mouth. J Oral Maxillofac Surg. 1986;44(11):845-50. http://dx.doi.org/10.1016/0278-2391(86)90219-3. PMid:3490558. [ Links ]

22 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097. PMid:19621072. [ Links ]

23 Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro Scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-21. PMid:12882612. [ Links ]

24 Morton NA. The PEDro Scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129-33. http://dx.doi.org/10.1016/S0004-9514(09)70043-1. PMid:19463084. [ Links ]

25 Wong RK, Deshmukh S, Wyatt G, Sagar S, Singh AK, Sultanem K, et al. Acupuncture-like transcutaneous electrical nerve stimulation versus pilocarpine in treating radiation-induced xerostomia: results of RTOG 0537 phase 3 study. Int J Radiat Oncol Biol Phys. 2015;92(2):220-7. http://dx.doi.org/10.1016/j.ijrobp.2015.01.050. PMid:25841622. [ Links ]

26 Wong RK, Jones GW, Sagar SM, Babjak AF, Whelan T. A phase I-II study in the use of acupuncture-like Transcutaneous nerve stimulation in the treatment of Radiation-induced xerostomia in head-and-neck câncer Patients treated with radical radiotherapy. Int J Radiat Oncol Biol Phys. 2003;57(2):472-80. http://dx.doi.org/10.1016/S0360-3016(03)00572-8. PMid:12957259. [ Links ]

27 Lakshman AR, Babu GS, Rao S. Evaluation of effect of transcutaneous electrical nerve stimulation on salivary flow rate in radiation induced xerostomia patients: a pilot study. J Cancer Res Ther. 2015;11(1):229-33. http://dx.doi.org/10.4103/0973-1482.138008. PMid:25879367. [ Links ]

28 Vijayan A, Asha ML, Babu S, Chakraborty S. Prospective phase II study of the efficacy of transcutaneous electrical nerve stimulation in post-radiation patients. Clin Oncol (R Coll Radiol). 2014;26(12):743-7. http://dx.doi.org/10.1016/j.clon.2014.09.004. PMid:25262845. [ Links ]

29 Carvalho APV, Silva V, Grande AJ. Avaliação do risco de viés de ensaios clínicos randomizados pela ferramenta da colaboração Cochrane. Diagn Tratamento. 2013;18(1):38-44. [ Links ]

30 Vissink A, Mitchell JB, Baum BJ, Limesand KH, Jensen SB, Fox PC, et al. Clinical management of salivary gland hypofunction and xerostomia in head and neck cancer patients: successes and barriers. Int J Radiat Oncol Biol Phys. 2010;78(4):983-91. http://dx.doi.org/10.1016/j.ijrobp.2010.06.052. PMid:20970030. [ Links ]

31 Ekstrom J. Neural mechanisms of salivary gland secretion. Front Oral Biol. 1999;(11):94-130. [ Links ]

32 Schneyer CA, Humphreys-Beher MG, Hall HD, Jirakulsomchok D. Mitogenic activity of rat salivary glands after electrical stimulation of parasympathetic nerves. Am J Physiol. 1993;264(5 Pt 1):G935-8. PMid:7684568. [ Links ]

33 Proctor G, Carpenter G. Regulation of salivary gland function by autonomic nerves. Auton Neurosci. 2007;133(1):3-18. http://dx.doi.org/10.1016/j.autneu.2006.10.006. PMid:17157080. [ Links ]

34 Proctor G. The physiology of salivary secretion. Periodontol 2000. 2016;70(1):11-25. http://dx.doi.org/10.1111/prd.12116. PMid:26662479. [ Links ]

35 Malfertheiner P, Kemmer T. Neural regulation of salivary gland secretion. Z Gastroenterol. 1987;25(1, Suppl 1):15-20. PMid:3296502. [ Links ]

36 Proctor G, Carpenter G. Salivary secretion: mechanism and neural regulation. Monogr Oral Sci. 2014;24:14-29. http://dx.doi.org/10.1159/000358781. PMid:24862591. [ Links ]

37 Douglas C. Fisiologia aplicada à Fonoaudiologia. 2. ed. Rio de Janeiro: Guanabara Koogan; 2007. [ Links ]


Submetido em:
01/08/2018

Aceito em:
10/01/2019

5d757a380e88254e4c19fc7a codas Articles

CoDAS

Share this page
Page Sections