Comparable Efficacy of Submucosal Platelet-Rich Plasma and Combined Platelet-Rich Plasma Noncrosslinked Hyaluronic Acid Injections in Vulvovaginal Atrophy: A Cancer Survivorship Issue
Journal of women's health (2002). 2023
Background: Cancer survivors are often reluctant to discuss sexual complaints with their oncologists and treatment is frequently unsatisfactory due to paucity of controlled studies and inapplicability of vaginal estrogen. We aimed to evaluate efficacy and tolerability of platelet-rich plasma (PRP) injections alone or in combination with noncrosslinked hyaluronic acid compared with standard therapy with topical hyaluronic acid gel in the management of cancer therapy-induced or aggravated vulvovaginal atrophy. Materials and Methods: This prospective, parallel-group comparative study was conducted on 45 female patients with a history of cancer and complaining of symptoms of vulvovaginal atrophy either induced or aggravated by cancer treatment. Patients were randomly divided into three groups (A, B, and C). Group A patients received two submucosal vaginal PRP injections, group B patients received two similar injections of PRP combined with noncrosslinked hyaluronic acid, and group C received a topical vaginal hyaluronic acid gel applied three times weekly for 2 months. Main outcome measures were vulvovaginal atrophy symptom severity and vaginal health index (VHI) scores before treatment (v0), 1 month from baseline (v1), 2 months from baseline (v2), and 3 months after the last visit (v3). Results: Both groups A and B showed greater improvement of frequency of intercourse avoidance than group C. Group A showed greater improvement of dyspareunia than group C. Groups A and B demonstrated greater improvement of vaginal pH, fluid volume, and total VHI scores than group C. Short-term topical hyaluronic acid (HA) was not associated with any significant improvement of vaginal elasticity. Group B showed greater improvement of vaginal dryness and moisture scores than group C. Reported adverse events were injection-related pain in all patients of groups A and B and vaginal spotting in groups A and B. Conclusion: Both PRP and PRP-HA have comparable efficacy and patient-reported treatment satisfaction. PRP injections were better tolerated by patients than PRP-HA. Clinical trial registration number: NCT05782920.
Risk of thrombocytopenia with Platelet-derived Growth Factor Receptor Kinase Inhibitors (PDGFR-TKIs) in cancer patients: A systematic review and meta-analysis of phase II/III randomized controlled trials
Journal of clinical pharmacology. 2021
We performed a systematic review and meta-analysis to fully investigate the thrombocytopenia of Platelet-derived Growth Factor Receptor Kinase Inhibitors (PDGFR-TKIs) in cancer patients. Databases were searched for randomized controlled trials (RCTs) treated with PDGFR-TKIs till January 2021. The relevant RCTs in cancer patients treated with PDGFR-TKIs were retrieved and the systematic evaluation was conducted. Nineteen RCTs and 3962 patients were included. Our study suggests that PDGFR-TKIs significantly increased the risks of all-grade (RR, 5.72; 95%CI, 4.32-7.59;p<0.00001; I(2) = 32%) and high-grade (RR, 5.65; 95%CI, 3.28- 9.75; p<0.00001; I(2) = 0%) thrombocytopenia in cancer patients. Sunitinib tend to be associated with the highest risk of thrombocytopenia among the included PDGFR-TKIs. The RR of high-grade thrombocytopenia varies significantly according to treatment line and median age. The available data suggested that the use of PDGFR-TKIs were associated with a significantly increased risk of thrombocytopenia. This article is protected by copyright. All rights reserved.
Platelet-rich fibrin: an autologous biomaterial for healing assistance of pharyngeal repair in total laryngectomy
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2020
OBJECTIVES The aim of this study was to evaluate the potential role of platelet-rich fibrin (PRF) application on the pharyngeal repair on decreasing the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy. METHODS This randomized controlled clinical trial was conducted on 67 patients with advanced laryngeal carcinoma who underwent total laryngectomy, over 2 years in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. Patients were randomly assigned into two groups: PRF group (n = 35) and control group (n = 32). Risk factors for development of PCF as well as the incidence of PCF were studied in both groups. RESULTS There was no statistically significant difference between groups regarding demographic data, medical comorbidities, basal hemoglobin and albumin levels, data related to the tumor (location, grade and TNM staging) and surgical details (preoperative tracheotomy and neck dissection). However, regarding the incidence of PCF, there was a statistically significant difference between groups as shown in Table 2. PCF was detected in 2/35 patients (5.7%) in the PRF group and in 10/32 patients (31.3%) in the control group (p = 0.004). CONCLUSION PRF application on the pharyngeal repair after total laryngectomy enhances the healing process and consequently decreases the incidence of PCF.
Autologous platelet concentrates for bisphosphonate-related osteonecrosis of the jaw treatment and prevention. A systematic review of the literature
European Journal of Cancer. 2015;51((1):):62-74.
PURPOSE Bisphosphonate related osteonecrosis of the jaw (BRONJ) is an adverse drug reaction consisting of progressive bone destruction in the maxillofacial region of patients under current or previous treatment with a bisphosphonate. Autologous platelet concentrates (APC) demonstrated to enhance bone and soft tissue healing in oral surgery procedures. The present systematic review aimed at evaluating if APC may improve treatment and prevention of BRONJ in patients under bisphosphonate therapy. METHODS MEDLINE, Scopus and Cochrane databases were searched using terms like bisphosphonates, osteonecrosis, BRONJ, platelet concentrate, PRP, PRF, PRGF. No language, publication date and study design limitation was set. A hand search of the bibliographies of identified articles was also performed. The primary outcome was recurrence/onset of BRONJ after oral surgery procedures. RESULTS Eighteen studies were included, reporting on 362 patients undergoing oral surgery in combination with APC. The adjunct of APC in BRONJ treatment significantly reduced osteonecrosis recurrence with respect to control. APC was associated with a lower BRONJ incidence after tooth extraction, though not significant. Heterogeneity was found regarding bisphosphonate type, clinical indication, treatment duration, triggering factors, study design, follow-up duration, type of APC, outcomes adopted to evaluate treatment success. CONCLUSION Though the results of this review must be cautiously interpreted, due to the low evidence level of the studies included, and the limited sample size, they are suggestive of possible benefits of APC when associated with surgical procedures for treatment or prevention of BRONJ. To confirm such indication, prospective comparative studies with a large sample size are urgently needed.Copyright © 2014 Elsevier Ltd. All rights reserved.