Personalization of supportive orofacial care in the context of high-technology head and neck radiotherapy: a case report

Breno Amaral Rocha; Alyne Simões; Mayra Mendes Soares Teixeira; Angel da Silva Martinez; Carlos Antônio Lopes Junior; Martinho Campolina Rebello Horta

doi:10.5327/2525-5711.436

Autores

Breno Amaral Rocha Pontifícia Universidade Católica de Minas Gerais, Graduate Program in Dentistry – Belo Horizonte (MG), Brazil. https://orcid.org/0000-0002-3695-9374
Alyne Simões Universidade de São Paulo, Department of Biomaterials and Oral Biology, School of Dentistry – São Paulo (SP), Brazil. https://orcid.org/0000-0002-4873-1393
Mayra Mendes Soares Teixeira Clínica Radialis Santa Casa, Department of Radiotherapy – Montes Claros (MG), Brazil. https://orcid.org/0000-0002-5113-5912
Angel da Silva Martinez Clínica Radialis Santa Casa, Department of Radiotherapy – Montes Claros (MG), Brazil. https://orcid.org/0000-0002-3852-0621
Carlos Antônio Lopes Junior Clínica Radialis Santa Casa, Department of Radiotherapy – Montes Claros (MG), Brazil. https://orcid.org/0009-0006-1616-4028
Martinho Campolina Rebello Horta Pontifícia Universidade Católica de Minas Gerais, Graduate Program in Dentistry – Belo Horizonte (MG), Brazil. https://orcid.org/0000-0003-0192-5614

DOI:

https://doi.org/10.5327/2525-5711.436

Palavras-chave:

Lip cancer, Radiation injuries, Dental care, Personalized intraoral device, Photobiomodulation therapy

Resumo

This case report describes the dental support provided to a patient undergoing radiotherapy for a malignant lip neoplasm, emphasizing the importance of tailoring orofacial care to specific patient needs. A 38-year-old male diagnosed with squamous cell carcinoma of the lip, presenting with anatomical and functional post-surgical sequelae, received dental care before, during, and after high-precision radiotherapy. Prophylactic and curative dental management was individualized, including a personalized intraoral device and photobiomodulation therapy. The patient achieved a favorable clinical outcome, maintaining oral hygiene and solid food intake throughout the treatment, with toxicities limited to grade 2 oral mucositis and grade 1 xerostomia. At the 9-month follow-up, there were no signs of tumor recurrence, xerostomia, or dysgeusia. Furthermore, the patient demonstrated improved mouth opening and no signs of radiation-induced caries. Within the limitations inherent to a case report, these findings suggest a potential role for personalized orofacial care in minimizing orofacial complications in the context of high-technology head and neck radiotherapy. Future studies with a higher level of evidence, such as randomized controlled clinical trials and systematic reviews are necessary to advance knowledge in this field.

Referências

1. Sciubba JJ, Goldenberg D. Oral complications of radiotherapy. Lancet Oncol. 2006;7(2):175-83. https://doi.org/10.1016/s1470-2045(06)70580-0

2. Samim F, Epstein JB, Zumsteg ZS, Ho AS, Barasch A. Oral and dental health in head and neck cancer survivors. Cancers Head Neck. 2016;1:14. https://doi.org/10.1186/s41199-016-0015-8

3. Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371(9625):1695-709. https://doi.org/10.1016/s0140-6736(08)60728-x

4. Chow LQM. Head and Neck Cancer. N Engl J Med. 2020;382(1):60-72. https://doi.org/10.1056/nejmra1715715

5. Mehanna H, West CML, Nutting C, Paleri V. Head and neck cancer--Part 2: Treatment and prognostic factors. BMJ. 2010;341:c4690. https://doi.org/10.1136/bmj.c4690

6. Elad S, Cheng KKF, Lalla RV, Yarom N, Hong C, Logan RM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423-31. https://doi.org/10.1002/cncr.33100

7. Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120(10):1453-61. https://doi.org/10.1002/cncr.28592

8. Sroussi HY, Epstein JB, Bensadoun R-J, Saunders DP, Lalla RV, Migliorati CA, et al. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med. 2017;6(12):2918-31. https://doi.org/10.1002/cam4.1221

9. El Hawari W, Bentahar O. Protective and positioning devices in maxillofacial prosthodontics and radiotherapy: Overview. Tech Innov Patient Support Radiat Oncol. 2022;24:118-23. https://doi.org/10.1016/j.tipsro.2022.11.001

10. Cleland S, Chan P, Chua B, Crowe SB, Dawes J, Kenny L, et al. Dosimetric evaluation of a patient-specific 3D-printed oral positioning stent for head-and-neck radiotherapy. Phys Eng Sci Med. 2021;44(3):887-99. https://doi.org/10.1007/s13246-021-01025-y

11. Kaanders JH, Fleming TJ, Ang KK, Maor MH, Peters LJ. Devices valuable in head and neck radiotherapy. Int J Radiat Oncol Biol Phys. 1992;23(3):639-45. https://doi.org/10.1016/0360-3016(92)90023-b

12. Brouwer CL, Steenbakkers RJHM, Bourhis J, Budach W, Grau C, Grégoire V, et al. CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol. 2015;117(1):83-90. https://doi.org/10.1016/j.radonc.2015.07.041

13. World Health Organization. WHO handbook for reporting results of cancer treatment. Geneva: World Health Organization; 1979.

14. Eisbruch A, Rhodus N, Rosenthal D, Murphy B, Rasch C, Sonis S, et al. How should we measure and report radiotherapy-induced xerostomia?. Semin Radiat Oncol. 2003;13(3):226-34. https://doi.org/10.1016/s1053-4296(03)00033-x

15. Wong RKS, Bensadoun R-J, Boers-Doets CB, Bryce J, Chan A, Epstein JB, et al. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Support Care Cancer. 2013;21(10):2933-48. https://doi.org/10.1007/s00520-013-1896-2

16. Walker MP, Wichman B, Cheng A-L, Coster J, Williams KB. Impact of radiotherapy dose on dentition breakdown in head and neck cancer patients. Pract Radiat Oncol. 2011;1(3):142-8. https://doi.org/10.1016/j.prro.2011.03.003

17. Lee H-J, Han D-H, Kim J-H, Wu H-G. The effect of comprehensive oral care program on oral health and quality of life in patients undergoing radiotherapy for head and neck cancer: A quasi-experimental case-control study. Medicine (Baltimore). 2021;100(16):e25540. https://doi.org/10.1097/md.0000000000025540

18. Morais MO, Martins AFL, de Jesus APG, Sousa Neto SS, Costa AWF, Pereira CH, et al. A prospective study on oral adverse effects in head and neck cancer patients submitted to a preventive oral care protocol. Support Care Cancer. 2020;28(9):4263-73. https://doi.org/10.1007/s00520-019-05283-1

19. Wardill HR, Sonis ST, Blijlevens NMA, Van Sebille YZA, Ciorba MA, Loeffen EAH, et al. Prediction of mucositis risk secondary to cancer therapy: a systematic review of current evidence and call to action. Support Care Cancer. 2020;28(11):5059-73. https://doi.org/10.1007/s00520-020-05579-7

20. Cleland S, Chan P, Chua B, Crowe SB, Dawes J, Kenny L, et al. Dosimetric evaluation of a patient-specific 3D-printed oral positioning stent for head-and-neck radiotherapy. Phys Eng Sci Med. 2021;44(3):887-99. https://doi.org/10.1007/s13246-021-01025-y

21. El Hawari W, Bentahar O. Protective and positioning devices in maxillofacial prosthodontics and radiotherapy: Overview. Tech Innov Patient Support Radiat Oncol. 2022;24:118-23. https://doi.org/10.1016/j.tipsro.2022.11.001

22. Rocha BA, Lima MC, Costa LM, Teixeira MMS, Martinez AS, Lopes Junior CA, et al. Personalized intraoral devices in the era of high-technology head and neck radiotherapy: A resource to be explored. Oral Oncol. 2024;159:107013. https://doi.org/10.1016/j.oraloncology.2024.107013

23. Pedroso CM, Migliorati CA, Epstein JB, Ribeiro ACP, Brandão TB, Lopes MA, et al. OVer 300 radiation caries papers: reflections from the rearview mirror. Front Oral Health. 2022;3:961594. https://doi.org/10.3389/froh.2022.961594

24. Scully C, Epstein J, Sonis S. Oral mucositis: a challenging complication of radiotherapy, chemotherapy, and radiochemotherapy. Part 2: diagnosis and management of mucositis. Head Neck. 2004;26(1):77-84. https://doi.org/10.1002/hed.10326

25. Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, et al. Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 2004;100(9 Suppl):1995-2025. https://doi.org/10.1002/cncr.20162

26. Iovoli AJ, Turecki L, Qiu ML, Khan M, Smith K, Yu H, et al. Severe oral mucositis after intensity-modulated radiation therapy for head and neck cancer. JAMA Netw Open. 2023;6(10):e2337265. https://doi.org/10.1001/jamanetworkopen.2023.37265

27. Jensen SB, Vissink A, Limesand KH, Reyland ME. Salivary Gland Hypofunction and Xerostomia in Head and Neck Radiation Patients. J Natl Cancer Inst Monogr. 2019;2019(53):lgz016. https://doi.org/10.1093/jncimonographs/lgz016

28. Mercadante V, Jensen SB, Smith DK, Bohlke K, Bauman J, Brennan MT, et al. Salivary Gland Hypofunction and/or Xerostomia Induced by Nonsurgical Cancer Therapies: ISOO/MASCC/ASCO Guideline. J Clin Oncol. 2021;39(25):2825-43. https://doi.org/10.1200/jco.21.01208

29. Elad S, Cheng KKF, Lalla RV, Yarom N, Hong C, Logan RM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423-31. https://doi.org/10.1002/cncr.33100

30. Camolesi GCV, Prado-Pena IB, Gomez-Caamano A, Victoria-Fernández C, Blanco-Carrion A, García-García A, et al. Photobiomodulation for the prevention of oral side effects secondary to head and neck cancer therapy: results of a randomised, single-blind clinical trial. Oral Oncology. 2025;164: 107266. https://doi.org/10.1016/j.oraloncology.2025.107266

31. Kauark-Fontes E, Migliorati CA, Epstein JB, Treister NS, Alves CGB, Faria KM, et al. Extraoral photobiomodulation for prevention of oral and oropharyngeal mucositis in head and neck cancer patients: interim analysis of a randomized, double-blind, clinical trial. Support Care Cancer. 2022;30(3):2225-36. https://doi.org/10.1007/s00520-021-06625-8

32. Gobbo M, Arany PR, Merigo E, Bensadoun RJ, Santos-Silva AR, Gueiros LA, et al. Quality assessment of PBM protocols for oral complications in head and neck cancer patients: part 2. Support Care Cancer. 2023;31(5):306. https://doi.org/10.1007/s00520-023-07749-9

33. Brandão TB, da Graça Pinto H, Vechiato Filho AJ, Faria KM, de Oliveira, MCQ, Prado-Ribeiro AC, et al. Are intraoral stents effective in reducing oral toxicities caused by radiotherapy? A systematic review and meta-analysis. J Prosthet Dent. 2022;128(6):1380-6. https://doi.org/10.1016/j.prosdent.2021.03.009

34. Laubach HJ, Robijns J. Laser- und Lichttherapie zur Behandlung der Strahlendermatitis [Laser and light therapy for treatment of radiation dermatitis]. Hautarzt. 2018;69(1):5-9. https://doi.org/10.1007/s00105-017-4091-4

35. Robijns J, Lodewijckx J, Mebis J. Photobiomodulation therapy for acute radiodermatitis. Curr Opin Oncol. 2019;31(4):291-8. https://doi.org/10.1097/cco.0000000000000511

36. Robijns J, Nair RG, Lodewijckx J, Arany P, Barasch A, Bjordal JM, et al. Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022. Front Oncol. 2022;12:927685. https://doi.org/10.3389/fonc.2022.927685

37. Nouri F, Sadeghi M, Ebrahimzadeh Zagami S. Light-emitting diode therapy for the prevention and treatment of radiodermatitis in women with breast cancer: systematic review. Lasers Med Sci. 2026;41(1):32. https://doi.org/10.1007/s10103-026-04803-w

38. Robijns J, Lodewijckx J, Claes S, Van Bever L, Pannekoeke L, Censabella S, et al. Photobiomodulation therapy for the prevention of acute radiation dermatitis in head and neck cancer patients (DERMISHEAD trial). Radiother Oncol. 2021;158:268-75. https://doi.org/10.1016/j.radonc.2021.03.002

39. Bensadoun R-J, Bollet MA, Liem X, Cao K, Magné N. New photobiomodulation device for prevention and cure of radiotherapy-induced oral mucositis and dermatitis: results of the prospective Safe PBM study. Support Care Cancer. 2022;30(2):1569-77. https://doi.org/10.1007/s00520-021-06574-2

40. Rocha BA, Simões A, Lima LMC, Teixeira MMS, Martinez ADS, de Melo Filho MR, Horta MCR. Treating acute cervical radiodermatitis with photobiomodulation therapy: a report of two cases. Photobiomodul Photomed Laser Surg. 2020;38(1):19-23. https://doi.org/10.1089/photob.2019.4698.