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Background: Oral mucositis is one of the main complications of radiotherapy (RT) while treating head-and-neck cancers and can affect the patients' treatment process and life. Therefore, this study evaluated the effect of Aloe vera on the prevention and treatment of radiotherapy-induced oral mucositis (RIOM) in patients with head-and-neck cancer. Materials and Methods: This was a double-blind clinical trial performed in 2019 on 75 patients with head-and-neck cancer. Patients were randomly assigned to two groups receiving gargles of 5 cc Aloe vera and the same dose of placebo mouthwash three times a day, respectively. Then, the incidence and severity of RIOM were evaluated and compared between the two groups over 6 weeks of RT. Results: There was no significant difference between the two groups in terms of the severity of RIOM from the 1st to 3rd weeks of RT (P > 0.05). However, the severity of RIOM in the 4th, 5th, and 6th weeks of RT was significantly lower in the Aloe vera group compared with the placebo group (P < 0.05). Conclusion: According to the results of the present study, the long-term use of Aloe vera mouthwash can reduce the severity of RIOM.
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BACKGROUND: Taste abnormalities are common among cancer patients after starting radiotherapy or chemotherapy. Considering the role of zinc and reports on its beneficial effects in taste perception, we evaluated the preventive effects of zinc sulfate on radiation-induced taste alterations. MATERIALS AND METHODS: In a randomized, placebo-controlled trial, adult patients with head and neck cancers who were on schedule for radiotherapy, with or without chemotherapy, were allocated to receive zinc sulfate (50 mg, three times a day) or placebo; started with beginning of radiotherapy and continued for one month later. Taste acuity was determined by measuring detection and recognition thresholds for four taste qualities at baseline, at the end of radiotherapy, and a month later using the Henkin method. RESULTS: Thirty-five patients (mean age = 59.2 ± 16.5, 60% male) completed the trial. The two groups were similar at baseline. After radiotherapy, and one month later, there was a significant increase in taste perception threshold for bitter, salty, sweet, and sour tastes in the placebo group (P = 0.001). In those who received zinc, there was only slight increase in threshold for perception of the salty taste (P = 0.046). No relevant side effects due to zinc sulfate were reported. CONCLUSION: Zinc supplementation in head/neck cancer patients under radiotherapy can prevent radiation-induced taste alterations. Further studies with longer follow-ups and with different doses of zinc supplementation are warranted in this regard.
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Background: Considering the prevalence of cetuximab-induced rashes in colorectal cancer patients and its impact on patient's quality of life and treatment, this study aimed at investigating the effect of topical vitamin K1 on the treatment of skin rashes in metastatic colorectal cancer patients treated with cetuximab. Materials and Methods: This randomized, controlled, triple-blind, clinical trial was conducted on 49 metastatic colorectal cancer patients who were candidates for cetuximab treatment and referred to Omid Hospital in Isfahan during 2021-2022. Vitamin K1 cream with a concentration of 0.1% in the intervention group (n = 25) and placebo cream in the control group (n = 24) were prescribed twice a day (in the morning and before bedtime) for eight weeks. The rash grade was recorded based on common terminology criteria for adverse events-4 (CTCAE-4) criteria before the intervention and in the fourth and eighth weeks during the intervention. Results: During the intervention, skin rash grades in the fourth and eighth weeks with the means of 1.00 ± 0.64 and 0.84 ± 0.55, respectively, were significantly lower in the intervention group, as compared with the control group with the means of 1.42 ± 0.65 and 1.25 ± 0.68, respectively (P value < 0.05). Moreover, the severity of skin rashes decreased significantly in the intervention group over time during eight weeks (P value < 0.05); however, its decrease was not significant in the control group (P value > 0.05). Conclusion: Topical vitamin K1 cream had a significant effect on reducing the severity of cetuximab-induced skin rashes over eight weeks of treatment.
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Background: This study aimed to optimize efficiency in Monte Carlo (MC) simulation using sensitivity analysis of a beam model. Methods: The BEAMnrc-based model of 6 MV beam of a Siemens Primus linac was developed. For sensitivity analysis, the effect of the electron source, treatment head, and virtual phantom specifications on calculated percent depth dose (PDD) and lateral dose profiles was evaluated. Results: The optimum mean energy (E) and the full width at half maximum (FWHM) of the intensity distribution of the electron beam were calculated as 6.7 MeV and 3 mm, respectively. Increasing E from 6.1 to 6.7 MeV, increased the PDD in the fall-off region by 4.70% and decreased the lateral profile by 8.76%. Changing the FWHM had a significant effect on the buildup region of PDD and the horns and out-of-field regions of the lateral profile. Increasing the collimators opening by 0.5 mm, PDD increased by 2.13% and the central and penumbra regions of profiles decreased by 1.98% and 11.40% respectively. Collimator properties such as thickness and density were effective in changing the penumbra (11.32% for 0.25 cm increment) and the out-of-field (22.82% for 3 g/cm3) regions of the lateral profiles. Conclusion: Analysis of a 6 MV model showed that PDD profiles were more sensitive to changes in energy than to FWHM of the electron source. The lateral profiles were sensitive to E, FWHM, and collimator opening. The density of the collimator affected only the out-of-field region of lateral profiles. The findings of this study may be used to make benchmarking of an MC beam model more efficient.
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Background: Patients undergoing head-and-neck radiotherapy are susceptible to Candida colonization and infection. This study aimed to identify oral Candida species type (ST), colony count (CC), and oropharyngeal candidiasis (OPC) in head-and-neck cancer patients, undergoing radiotherapy, before and 2 weeks after radiation. Materials and Methods: In this quasi-experimental study, head-and-neck cancer patients undergoing radiotherapy (up to 6000 cGy) were recruited. Samples were taken before and 2 weeks after radiation therapy (RT). CC was assigned using Sabouraud dextrose agar culture medium and morphological studies were performed to confirm OPC. For identification, polymerase chain reaction-restriction fragment length polymorphism was performed. Data were analyzed using Chi-square-test and kappa coefficient. P < 0.05 was considered statistically significant. Results: Twenty-one of 33 patients were Candida positive. The detected fungal species included Candida albicans (60%), Candida tropicalis (22%), Candida glabrata (9%), and other species (9%). Following RT, OPC and CC changed significantly (P = 0.003 and P = 0.001, respectively), whereas ST did not significantly change (P = 0.081). Two new species (Candida krusei and Candida parapsilosis) were detected after the intervention. The OPC, CC, and ST changes after RT were not significantly related to malignancy site or radiation dose (P > 0.05). Conclusion: The present study showed that OPC, CC, and ST were not related to the malignancy site. Following RT, OPC and CC changed significantly, while ST showed no significant change. The radiation dose and malignancy site had no effects on the OPC, CC, or ST alterations following RT.
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Background: Head-and-neck radiotherapy can change oral Candida species and cause candidiasis resistance to common antifungals by making the changes to the oral cavity environment. Voriconazole is a synthetic azole with extensive antifungal activity. The current study aimed at comparing the antifungal activity of fluconazole and voriconazole on Candida species isolated from the oral cavity of patients undergoing head-and-neck radiotherapy. Materials and Methods: The present in vitro study was performed on samples isolated from patients undergoing head-and-neck radiotherapy, before and during radiotherapy. After the identification of the species, the antifungal effect of fluconazole and voriconazole was determined by the microdilution method, and the minimum inhibitory concentration (MIC), the minimum fungicidal concentration, and the antifungal susceptibility of the isolated strains were also measured. The data were analyzed by the Chi-squared and then two-sided Fisher's exact tests. P < 0.05 was considered statistically significant. Results: The study findings showed no significant difference in the susceptibility of Candida albicans to voriconazole and fluconazole before and during radiotherapy. Before radiotherapy, both voriconazole and fluconazole had similar effects on Candida tropicalis, but after radiotherapy, voriconazole was less effective. However, both before and during radiotherapy, fluconazole had a greater antifungal effect than voriconazole on Candida glabrata strains. The MICs of voriconazole and fluconazole for both Candida parapsilosis and Candida krusei isolates were within the susceptible or dose-dependent range. Conclusion: The current study results showed that voriconazole was not more effective than fluconazole in the treatment of oral candidiasis in patients undergoing head-and-neck radiotherapy.