Prophylactic management of radiation-induced mucositis using herbal mouthwash in patients with head and neck cancer: an assessor-blinded randomized controlled trial

Abstract

Background and objectives Radiation-induced mucositis (RIOM) is one of the most common side effects from head and neck radiotherapy. Several reagents have been introduced to manage the symptom; however, there is still a limited number of effective reagents. Herbal mouthwashes with payayor (Clinacanthus nutans Lindau) and fingerroot (Boesenbergia rotunda) were tested their efficacies in preventing and reducing severity of RIOM in comparison with normal saline with sodium bicarbonate. Methods One hundred twenty patients with head and neck cancer undergoing radiotherapy participated in the study and were randomly assigned into three treatment groups using block randomization method. The participants were assigned one of the three mouthwashes for use throughout their radiotherapy course and were assessed for their mucositis scores from week one to six into their radiotherapy course as well as at one-month follow-up. Body mass index was also measured for comparison of nutritional status. Results The two mouthwashes were similarly effective in prophylaxis of RIOM in term of severity. The averaged mucositis scores were less than two for all groups. For the onset of RIOM, both herbal mouthwashes could slightly delay the symptom but not statistically significant. Patients’ body mass index across the three treatment groups was also comparable. The patients were largely satisfied with all the mouthwashes with no clear preference on any of them. Conclusions Prophylactic treatment of RIOM using herbal mouthwashes could substitute the current standard of normal saline with bicarbonate. A different formulation of the two herbs could potentially improve the prophylactic outcome. Trial Registration No NCT03359187.

Management of Oral Hygiene in Head-Neck Cancer Patients Undergoing Oncological Surgery and Radiotherapy: A Systematic Review

“…In contrast, payayor and fingerroot mouthwashes analyzed by Kongwattanakul et al [ 11 ], Cystus tea mouthwash used by Ebert et al [ 15 ], green tea mouthwash used by Liao et al [ 16 ], propolis mouthwash by Hamzah et al [ 18 ], and curcumin mouthwash studied by Shah et al [ 21 ] have been shown to be equally effective compared to placebo mouthwash, especially when assisted with cryotherapy and laser or light therapy [ 16 ]. The multicenter study by De Sanctis et al [ 17 ] also found no differences in the onset and severity of radio-induced mucositis with Lactobacillus brevis CD2 supplementation.…”

Treatment Complications of Head and Neck Cancers and Rehabilitation Measures: A Narrative Review

“…Studies have also compared the effectiveness of plant extract and natural substance-based mouthwashes with saline, baking soda-based, or placebo mouthwashes. The effectiveness of these mouthwashes is often comparable to bicarbonate-based saline solution rinses [64][65][66]. Granulocyte-macrophage colonystimulating factor mouthwashes are the most studied for the prevention of mucositis [67].…”

The Effect of Honey Therapy on the Management of Oral Mucosites in Head and Neck Cancer Patients with Chemoradiotherapy: A Randomized Controlled Study

“…Its incidence among patients receiving chemotherapy and radiotherapy reaches 80%.5 50% of the patients who receive radiotherapy treatment to the head and neck area experience 3rd stage mucositis (4)(5). Ulcers caused by damage to the oral mucosa pose a serious risk for bacterial contamination and systemic infection (6). It is very painful, makes speech difficult, affects chewing, swallowing, and oral intake of medicines.…”

“…The correct management of oral mucositis means to take preventive approaches in a timely manner and to minimize the patient's distress by providing pain assessment and management (7). In addition to the granulocyte monocyte colony stimulating factor, topical corticosteroids used in mucositis management, honey is reported to be an effective approach to prevent oral mucositis (6,(8)(9)(10)(11)(12). Honey has been used since the Egyptian civilization, it is used in modern medicine for burn wounds, oral infections and surgical wound healing.…”

“…It has antibacterial properties and accelerates the wound healing by increasing epithelization (5). The reason for using honey to manage radiation mucositis is its rapid epithelization effect in tissue injuries (5)(6)13). The use of honey to manage radiation mucositis is its rapid epithelializing effect in tissue injuries.…”