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The use of MuGard™, Caphosol® and Episil® in patients undergoing chemoradiotherapy for squamous cell carcinoma of the head and neck

Published online by Cambridge University Press:  09 May 2013

L. Pettit ,
P. Sanghera ,
J. Glaholm  and
A. Hartley
L. Pettit*
Affiliation:
Hall-Edwards Research Radiotherapy Group, Queen Elizabeth Hospital, Birmingham, UK
P. Sanghera
Affiliation:
Hall-Edwards Research Radiotherapy Group, Queen Elizabeth Hospital, Birmingham, UK
J. Glaholm
Affiliation:
Hall-Edwards Research Radiotherapy Group, Queen Elizabeth Hospital, Birmingham, UK
A. Hartley
Affiliation:
Hall-Edwards Research Radiotherapy Group, Queen Elizabeth Hospital, Birmingham, UK
*
Correspondence to: Dr L. Pettit, The Cancer Centre, University Hospital Birmingham, B15 2TH, UK. Tel: +44 (0) 7779089066. E-mail: l.pettit@nhs.net
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Abstract

Introduction

Oral mucositis is common for patients undergoing chemoradiotherapy for squamous cell carcinoma of the head and neck (SCCHN). Despite the significant detrimental sequelae associated, there is no consensus on the optimum mouth care regimen. This prospective audit aims to record mucositis and dysphagia toxicity and the level of analgesia prescribed when recent products: MuGard™, Caphosol® and Episil® are compared with our standard departmental mouth care regimen.

Methods

Patients undergoing concurrent chemoradiotherapy for locally advanced SCCHN at University Hospital Birmingham, UK were prospectively audited weekly for 8 consecutive weeks starting from week 1 of chemoradiotherapy from June 2009 until January 2011. Patients received either standard oral care regimen of aspirin, glycerin and sucralfate, or, MuGard™, Caphosol® or Episil®. Grade of mucositis, dysphagia and analgesia score were prospectively recorded using the common toxicity criteria v3·0.

Results

One hundred and four patients were included. There was no difference in the grade and duration of mucositis (p = 0·82), dysphagia (p = 0·99) or analgesia score (p = 0·61) for either MuGard™, Caphosol® or Episil® compared with standard oral care.

Conclusion

There is no evidence from this audit that Mugard™, Caphosol® or Episil® improves mucositis and dysphagia toxicity or the level of analgesia prescribed compared with our standard departmental mouth care regimen. Randomised trials comparing these approaches are required to detect any meaningful clinical benefit.

Keywords

chemoradiotherapyoral mucositissquamous cell carcinoma of the head and neck
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 2 , June 2014 , pp. 218 - 225
Copyright
Copyright © Cambridge University Press 2013 

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References

1.Pignon, J P, le Maître, A, Maillard, Eet al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009; 92: 4–14.Google Scholar
2.Trotti, A, Bellm, L A, Epstein, J Bet al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 2003; 66: 253–262.Google Scholar
3.Bensinger, W, Schubert, M, Ang, K Ket al. NCCN Task Force Report. Prevention and management of mucositis in cancer care. J Natl Compr Canc Netw 2008; 6 (suppl 1), S1–S21.Google Scholar
4.Pico, J L, Avila-Garavito, A, Naccache, P. Mucositis: its occurrence, consequences, and treatment in the oncology setting. Oncologist 1998; 3 (6): 446–451.Google Scholar
5.Clarkson, J E, Worthington, H V, Eden, O B. Interventions for preventing oral mucositis for patients with cancer receiving treatment (Cochrane Review). Cochrane Library 2003; issue 3. Oxford: Update Software.Google Scholar
6.Worthington, H V, Clarkson, J E, Eden, O B. Interventions for treating oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2004; issue 2.Google Scholar
7.Stokman, M A, Spijkervet, F K L, Boezen, H Met al. Preventive intervention possibilities in radiotherapy- and chemotherapy-induced oral mucositis: results of meta-analyses. J Dent Res 2006; 85 (8): 690–700.Google Scholar
8.Baud, C M, Colon, L E, Gerberich, J et al. Protection from radiation-induced oral mucositis by MuGard™ oral rinse. A clinical study and in silico analysis. Poster presentation at the 18th International MASCC/ISOO Supportive Care in Cancer Symposium, June 22–24, 2006, Toronto, Canada.Google Scholar
9.Haas, M, Mercedes, T, Manyak, M J et al. Reduction of painful oral mucositis by supersaturated calcium phosphate oral rinse in head and neck cancer patients receiving chemotherapy and radiation. 50th ASTRO Congress 2008; abstract 2530.Google Scholar
10.Tiberg, F, Cavallin-Ståh, E, Linden, Met al. Treatment of oral mucositis pain by a bioadhesive barrier forming lipid solution. Support Care Cancer 2009; 17 (7): 918.Google Scholar
11.Sonis, S T, Eilers, J P, Epstein, J Bet al. Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis Study Group. Cancer 1999; 85 (10): 2103–2113.Google Scholar
12.Epstein, , Gorsky, , Guglietta, et al. The correlation between epidermal growth factor levels in saliva and the severity of oral mucositis during oropharyngeal radiation therapy. Cancer 2000; 89 (11): 2258–2265.Google Scholar
13.Camurus, A B 2008. A randomized, two period cross-over, multicenter, double blind placebo-controlled trial to assess the local analgesic effect of CAM2028 in head and neck cancer patients suffering from radiation induced oral mucositis. Intergrated Clinical and Statistical Report HS-05-161.Google Scholar
14.Sanghera, P, McConkey, C, Ho, K Fet al. Hypofractionated accelerated radiotherapy with concurrent chemotherapy for locally advanced squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2007; 67 (5): 1342–1351.Google Scholar
15.Madhava, K, Hartley, A, Wake, Met al. Carboplatin and hypofractionated accelerated radiotherapy: a dose escalation study of an outpatient chemoradiation schedule for squamous cell carcinoma of the head and neck. Clin Oncol 2006; 18 (1): 77–81.Google Scholar
16.Bonner, J A, Harari, P M, Giralt, Jet al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006; 354: 567–578.Google Scholar
17.Chan, A, Teoh, D, Sanghera, Pet al. Radiotherapy compliance is maintained with hypofractionation and concurrent cetuximab in locally advanced head and neck cancer. Radiother Oncol 2009; 93 (3): 654.Google Scholar
18.Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0, DCTD, NCI, NIH, DHHS March 31, 2003.Google Scholar
19.Sanghera, P, Arnfield, J, McConkey, Cet al. Gap compensation during accelerated hypofractionated radiotherapy in head and neck cancer. J Radiother Practice 2008; 7: 31–38.Google Scholar
20.Elting, L S, Cooksley, C D, Chambers, M Set al. Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head and neck malignancies. Int J Radiat Oncol Biol Phys 2007; 68 (4): 1110–1120.Google Scholar
21.Narayan, S, Lehmann, J, Coleman, M Aet al. Prospective evaluation to establish a dose response for clinical oral mucositis in patients undergoing head and neck conformal radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72 (3): 756–762.Google Scholar
22.Hartley, A, Sanghera, P, Kazi, Wet al. Correlation of currently used radiobiological parameters with local control and acute and late mucosal toxicity in randomised studies of altered fractionation for locally advanced head and neck cancer. Clin Oncol 2011; 23 (1): 29–33.Google Scholar
23.Bhide, S A, Gulliford, S, Schick, Uet al. Dose–response analysis of acute oral mucositis and pharyngeal dysphagia in patients receiving induction chemotherapy followed by concomitant chemo-IMRT for head and neck cancer. Radiother Oncol 2012; 103: 88–91.CrossRefGoogle ScholarPubMed
24.Ang, K K, Harris, J, Wheeler, Ret al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 2010; 363: 24–35.Google Scholar
25.Kazemian, A, Kamian, S, Aghili, Met al. Benzydamine for prophylaxis of radiation-induced oral mucositis in head and neck cancers: a double-blind placebo-controlled randomized clinical trial. Eur J Cancer Care 2009; 18 (2): 174–178.Google Scholar
26.Epstein, J B, Silverman, S Jr, Paggiarino, D Aet al. Benzydamine HCl for prophylaxis of radiation-induced oral mucositis: results from a multicenter, randomized, double-blind, placebo-controlled clinical trial. Cancer 2001; 92 (4): 875–885.Google Scholar
27.Rashad, U M, Al-Gezawy, S M, El-Gezawy, Eet al. Honey as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck cancer. J Laryngol Otol 2009; 123 (2): 223–228.Google Scholar
28.Bardy, J, Molassiotis, A, Ryder, W Det al. A double-blind, placebo-controlled, randomised trial of active manuka honey and standard oral care for radiation-induced oral mucositis. Br J Oral Maxillofac Surg 2012; 50 (3): 221–226.Google Scholar
29.Peterson, D E, Bensadoun, R J, Roila, F. Management of oral and gastrointestinal mucositis: ESMO clinical recommendations. Ann Oncol 2011; 122 (suppl 6): 78–84.Google Scholar
30.Franzen, L, Henriksson, R, Littbrand, Bet al. Effects of sucralfate on mucositis during and following radiotherapy of malignancies in the head and neck region. A double-blind placebo-controlled study. Acta Oncol 1995; 34: 219–223.Google Scholar
31.Epstein, J B, Wong, F L. The efficacy of sucralfate suspension in the prevention of oral mucositis due to radiation therapy. Int J Radiat Oncol Biol Phys 1994; 28: 693–698.Google Scholar
32.Gutschalk, C M, Herold-Mende, C C, Fusenig, N Eet al. Granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor promote malignant growth of cells from head and neck squamous cell carcinomas in vivo. Cancer Res 2006; 66 (16): 8026–8036.Google Scholar
33.Staar, S, Rudat, V, Stuetzer, Het al. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy – results of a multicentric randomized German trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001; 51 (5): 1161–1171.Google Scholar
34.Henke, M, Alfonsi, M, Foa, Pet al. Palifermin decreases severe oral mucositis of patients undergoing postoperative radiochemotherapy for head and neck cancer: a randomised, placebo-controlled trial. J Clin Oncol 2011; 29 (20): 2815–2820.Google Scholar
35.Thomson, M. Evaluating the effects of Caphosol in reducing oral mucositis in head and neck cancer patients undergoing chemo-radiotherapy or radiotherapy. Radiother Oncol 2011; 99 (suppl 1): S220–S221.Google Scholar
36.Scully, C, Epstein, J B. Oral health care for the cancer patient. Eur J Cancer B Oral Oncol 1996; 32B: 281–292.Google Scholar
37.Epstein, J B, Freilich, M M, Le, N D. Risk factors for oropharyngeal candidiasis in patients who receive radiation therapy for malignant conditions of the head and neck. Oral Surg Oral Med Oral Pathol 1993; 76: 169–174.Google Scholar
38.Finlay, P M, Richardson, M D, Robertson, A G. A comparative study of the efficacy of fluconazole and amphotericin B in the treatment of oropharyngeal candidosis in patients undergoing radiotherapy for head and neck tumours. Br J Oral Maxillofac Surg 1996; 34 (1): 23–25.Google Scholar