A Meta-Analysis on the Efficacy of Zinc in Oral Mucositis during Cancer Chemo and/or Radiotherapy-An Evidence-Based Approach.

Zinc in various therapeutic doses was used on patients suffering from oral mucositis during cancer treatment. A meta-analysis was conducted to probe the role of oral zinc as a possible treatment option for oral mucositis. A literature search was done using PubMed, EBSCO, Cochrane, MedLine, ScienceDirect, ResearchGate and Google Scholar with key words. The analysis was directed to recognize and identify the use of zinc supplementations at a confidence interval (CI) 95% with p value significance taken as <0.05. A total number of 21,428 articles was retrieved. After thorough screening and assessment of the eligibility criteria, 10 articles were included in qualitative and quantitative analysis in the study. The 10 articles constituted a total sample size of 299 in the case group and 294 in the control group. Oral zinc doses used were 25 mg, 30 mg, 50 mg and 220 mg capsules and mouthwash of 0.2% zinc, as well as 0.5 g of granules dissolved in 5% sodium alginate solution. Two studies showed no significance, with the overall effect 1.61. Eight studies favored zinc over a placebo with an overall effect size of -0.89 at 95% CI of -1.08 and -0.70 which was statistically significant (Z=9.27, p<0.00001). This analysis suggests that zinc usage has shown significant reduction in the severity of oral mucositis but not prevention. The onset of the reaction was delayed and hastened healing. Pharyngeal mucositis, pain and quality of life of the individuals received no effect from zinc therapy.

Estudo da ação da romã (Punica granatum L. ) na cicatrização de úlceras induzidas por queimadura em dorso de língua de ratos Wistar (Rattus norvegicus) / Pomegranate action study (Punica granatum L. ) for the healing of ulcers induced by burns to the dorso-lingual mucosa in Wistar rats (Rattus norvegicus).

RESUMO O objetivo desse estudo foi observar a ação da romã (Punica granatum L.) em estomatites induzidas por queimaduras no dorso da língua de ratos Wistar. Foram utilizados 24 ratos Wistar machos adultos, provenientes do Biotério da UNIVASF. Foram formados quatro grupos (G1: Polpa da romã por gavagem; G2: Polpa da romã por gavagem + aplicação local do chá da casca do fruto; G3: aplicação local do chá da casca do fruto e G4: Controle negativo). As queimaduras foram confeccionadas com instrumental odontológico padrão. Os tratamentos foram realizados duas vezes ao dia, durante 14 dias. Metade dos animais de cada grupo (n=3) foi eutanasiada no sétimo dia de experimentação, enquanto o restante foi eutanasiado no 14º dia. As línguas foram removidas e fixadas com formaldeído a 10% tamponado, processadas com cortes de 5 µm e coradas em HE. Clinicamente, os animais do grupo G2 tiveram melhores resultados. Na análise histológica qualitativa foi avaliada a reepitelização e os graus de inflamação numa escala de 0 a 4. Na análise estatística, utilizou-se o teste Qui-quadrado de Pearson. Houve significância estatística (p=0,026 e p=0,023) quando se comparou o tratamento com os graus de reepitelização e inflamação nos quatro grupos estudados. O grupo G2 apresentou cicatrização completa com 14 dias. Os piores escores obtidos foram atribuídos ao Grupo G4 nos dois parâmetros de avaliação qualitativa. Diante dos resultados obtidos, observa-se que a romã (Punica granatum L.) possui ação cicatrizante na mucosa lingual de ratos Wistar.

ABSTRACT The objective of this study was to observe the action of pomegranate (Punica granatum L.) on stomatitis induced burns on the dorso-lingual musosa in Wistar rats. Twenty-four male, adult Wister albino rats were used, from the bioterium of UNIVASF. There were four groups (G1: Pomegranate juice by gavage; G2: Pomegranate juice by gavage + local application of fruit peel tea; G3: Local application of fruit peel tea only and G4: a negative control). The burns were made with standard dental instruments. The treatments were performed twice a day for 14 days. Half the animals in each group (n = 3) were euthanized on the seventh day of experimentation, while the remainder were euthanized on day 14. The tongues were removed and fixed with a 10% formaldehyde buffer, processed as 5µm sections and stained with HE. Clinically the animals treated with tea showed better healing. For statistical analysis the Pearson chi-squared test was used. There was a statistical significance (p = 0.026 and p = 0.023) when compared to treatment with the degree of re-epithelialization and inflammation of the four groups studied. The G2 group showed complete healing within 14 days. The worst scores were found in the G4 group in both qualitative assessment parameters. Based on these results, it was observed that pomegranate (Punica granatum L.) has a healing action on the lingual mucosa of Wistar rats.

Laser phototherapy as topical prophylaxis against head and neck cancer radiotherapy-induced oral mucositis: comparison between low and high/low power lasers.

BACKGROUND AND OBJECTIVE: Oral mucositis is a dose-limiting and painful side effect of radiotherapy (RT) and/or chemotherapy in cancer patients. The purpose of the present study was to analyze the effect of different protocols of laser phototherapy (LPT) on the grade of mucositis and degree of pain in patients under RT. PATIENTS AND METHODS: Thirty-nine patients were divided into three groups: G1, where the irradiations were done three times a week using low power laser; G2, where combined high and low power lasers were used three time a week; and G3, where patients received low power laser irradiation once a week. The low power LPT was done using an InGaAlP laser (660 nm/40 mW/6 J cm(-2)/0.24 J per point). In the combined protocol, the high power LPT was done using a GaAlAs laser (808 nm, 1 W/cm(2)). Oral mucositis was assessed at each LPT session in accordance to the oral-mucositis scale of the National Institute of the Cancer-Common Toxicity criteria (NIC-CTC). The patient self-assessed pain was measured by means of the visual analogue scale. RESULTS: All protocols of LPT led to the maintenance of oral mucositis scores in the same levels until the last RT session. Moreover, LPT three times a week also maintained the pain levels. However, the patients submitted to the once a week LPT had significant pain increase; and the association of low/high LPT led to increased healing time. CONCLUSIONS: These findings are desired when dealing with oncologic patients under RT avoiding unplanned radiation treatment breaks and additional hospital costs.

Chemotherapy-induced oral mucositis: new approaches to prevention and management.

Oral mucositis is a common and significant toxicity of cancer chemotherapy. It is under-reported and not well treated, particularly in patients that receive high-dose therapy with an autologous or allogenic stem cell transplant. Two recently published retrospective analyses of patient complaints following stem cell transplantation have identified oral mucositis as the worst toxicity reported by patients, and what is more important is that patients indicated that oncology healthcare team members do a poor job of managing and providing methods of symptom relief. Twenty percent of patients surveyed indicated they received no symptom relief at all.

A pilot study of concomitant radiation and chemotherapy in patients with locally advanced head and neck cancer.

Cisplatin and 5-fluorouracil act as radiosensitizers and are active cytotoxic drugs in head and neck cancer. Therefore, from May 1987 to June 1990, we gave a continuous course of radiotherapy (70 Gy/35 fractions/7 weeks) combined with the simultaneous administration, once a week, of cisplatin (40 mg/m2, i.v. bolus) and 5-fluorouracil (400 mg/m2, i.v. bolus) to 21 patients with locally advanced or recurrent tumors of the head and neck. The complete and partial response rates were 65% and 15%, respectively. With a median follow-up of 17 months (range: 4-42) and with 19/21 patients having stages III and IV tumors, 12 patients are NED (no evidence of disease), 8 died with tumor, and 1 died of bronchopneumonia during the treatment. The main toxicity was mucositis and the median length of therapy was higher than with irradiation alone. This regimen appears very encouraging and could be an improvement over radiation alone for patients with locally advanced head and neck cancer.

Development of a staging system for chemotherapy-induced stomatitis. Western Consortium for Cancer Nursing Research.

A staging system was developed to measure the progressive severity of chemotherapy-induced stomatitis. A panel of 15 experts from nursing, dentistry, and medicine were interviewed to elicit the criteria they used to evaluate progressive severity. This process was used to develop an instrument to measure the observable and functional dimensions of stomatitis. After pilot testing, the instrument was refined and evaluated with 53 cancer patients. Patients receiving stomatotoxic chemotherapy, or already exhibiting oral problems secondary to chemotherapy, were tested with three measures: the new Western Consortium for Cancer Nursing Research (WCCNR) Staging System, the Oral Assessment Guide (OAG), and the World Health Organization (WHO) Mucositis Grading System. Results indicated that the three scales were moderately correlated (0.57 to 0.76), indicating they were measuring the same general construct. The mean OAG scores were significantly different by WCCNR stage, and discriminant analysis demonstrated that the staging system did differentiate between the three stages of stomatitis as measured by the other two scales. The WCCNR Staging System is unique in that it reflects expert practice, encouraging clinicians to make a holistic assessment of the mouth's condition rather than summing scores on discrete aspects of the oral condition.