Prevention of oral mucositis in radiation therapy: A controlled study with benzydamine hydrochloride rinse

Epstein, Joel B.; Stevenson‐Moore, Peter; Jackson, Stewart M.; Mohamed, Jemal H.; Spinelli, John J.

doi:10.1016/0360-3016(89)90964-4

Cited by 125 publications

(41 citation statements)

References 10 publications

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“…Benzydamine, a non-steroid anti-inflammatory agent with anaesthetic and antimicrobial properties was tested in a double-blind placebocontrolled trial containing 43 patients. The degree of mucositis was statistically significantly reduced and there was a non-significant trend in the reduction of radiationinduced symptoms in favour of the active arm (Epstein et al, 1989). Other agents, in particular sucralfate, a coating agent which binds to ulcerated areas, have shown promise in small uncontrolled studies but have not been found to be effective when assessed more rigorously (Epstein and Wong, 1994).…”

Section: Methodsmentioning

confidence: 99%

The reduction of radiation mucositis by selective decontamination antibiotic pastilles: a placebo-controlled double-blind trial

Symonds

McIlroy²,

Khorrami³

et al. 1996

Br J Cancer

109

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Summary The aim of this study was to see if antibiotic pastilles could reduce radiation mucositis, pain, dysphagia and weight loss in patients undergoing radical radiotherapy for head and neck cancer. A total of 275 patients with T -T4 tumours entered the study; 136 were allocated to suck four times daily a pastille containing amphotericin, polymyxin and tobramycin. The During treatment, cells in the basal layers of the mucous membranes within the irradiated volume are unable to replace adequately cells lost through inactivation or exfoliation. The resultant mucosal damage may then be exacerbated by colonisation of the affected area by abnormal microbial flora. Mucositis has a number of manifestations that may be seen at different times depending on the volume irradiated, the total dose and the fractionation schedule. Initially, there may be a transient white discolouration, followed by deepening erythema and later a white pseudomembrane which may be patchy or confluent. The most severe manifestation is ulceration of the mucosa.In health, the very diverse oropharyngeal flora contains a marked preponderance of anaerobic bacteria together with a near universal presence of lesser numbers of viridans streptococci and Neisseria species. Irradiation, local tumour and surgery can all interfere with the mucosal defences important for the maintenance of this ecological balance. In consequence, there is frequent overgrowth of organisms rarely seen in health and then only at low concentrations. Overgrowth of yeasts and aerobic Gram-negative bacilli (in particular Enterobacteriaceae, Pseudomonads and Acinetobacter) has attracted particular attention in the context of irradiation mucositis (van Saene and Martin, 1990).There are no established effective measures to prevent or treat mucositis. Standard therapy is to maintain good oral hygiene and prescribe analgesics if necessary. A small study by Spijkervert et al. (1991) described a novel approach to this problem. Lozenges containing polymyxin E, tobramycin and amphotericin B were used to eradicate selectively aerobic Gram-negative bacteria (AGNB) and yeasts from the oropharynx while retaining the normal anaerobic and aerobic flora. This selective decontamination regimen was given to 15 patients with head and neck cancer treated by radiotherapy. An excellent microbiological result was obtained and mucositis was confined to erythema in all patients. By contrast, matched historical controls treated with a placebo or chlorhexidene showed an 80% incidence of more severe mucositis with pseudomembrane formation.The aim of the study was to use a placebo-controlled double-blind trial to test the hypothesis that the more severe forms of irradiation mucositis are associated with abnormal carriage of AGNB and yeasts and that selective reduction of these microbial populations with non-absorbable antibiotics would reduce both the signs and symptoms of mucositis. Materials and methodsPatients receiving potentially curative radiotherapy for T-4 head and neck cancer were entered into th...

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Section: Methodsmentioning

confidence: 99%

The reduction of radiation mucositis by selective decontamination antibiotic pastilles: a placebo-controlled double-blind trial

Symonds

McIlroy²,

Khorrami³

et al. 1996

Br J Cancer

109

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“…The patients also received a variety of systemic analgesics that were not allowed for in the analysis (Epstein et al, 1989).…”

Section: Traditional Remediesmentioning

confidence: 99%

Treatment-induced mucositis: an old problem with new remedies

Symonds

1998

Br J Cancer

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Summary Mucositis may be a painful, debilitating, dose-limiting side-effect of both chemotherapy and radiotherapy for which there is no widely accepted prophylaxis or effective treatment. The basis of management is pain relief, prevention of dehydration and adequate nutrition. When tested vigorously, most antiseptic mouthwashes and anti-ulcer agents are ineffective. Simple mechanical cleansing by saline is the most effective traditional measure. A variety of new agents are effective. Granulocyte macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) act outwith the haemopoeitic system and can reduce mucositis, but the best schedule, dosage and method of administration is not known or which is the best growth factor to prevent this side-effect. A placebo-controlled randomized trial of antibiotic pastilles has shown a significant reduction in mucositis and weight loss during radiotherapy for head and neck cancer. Another method to reduce radiation effects in normal tissue is to stimulate cells to divide before radiotherapy by silver nitrate or interleukin 1. These methods may be particularly effective when given along with hyperfractionated radiation treatment such as CHART.

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“…80% of patients with head and neck malignancies receiving radiotherapy and chemotherapy are prone to mucositis [12]. Clinically it may present as red or white lesion in the mucosa, pseudo membrane formation and ulceration in the initial stages although late changes include fibrosis of connective tissue and hypovascularity [13]. Fractionated dose of 180-220 cGy/day results in mucositis within 1-2 weeks and increases throughout the course of therapy to maximum in 4 to 5 weeks [14].…”

Section: Mucositis and Stomatitismentioning

confidence: 99%