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A Retrospective Match Controlled Study of Supersaturated Calcium Phosphate Oral Rinse vs. Supportive Care for Radiation Induced Oral Mucositis

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DOI: 10.4236/jct.2012.35081    3,616 Downloads   5,887 Views   Citations

ABSTRACT

Oral mucositis is a common morbidity induced by radiation therapy and chemo-radiotherapy for head and neck malignancies. This often results in treatment delays, premature treatment cessation and increased cost. New treatments of oral mucositis are emerging but effective remedies remain limited. Between February 2007 and May 2008, 21 patients with head and neck malignancies were treated with a supersaturated calcium phosphate oral rinse (Caphosol) that was performed for 4-10 times daily, each consisting of two one-minute rinses. There were 21 matched patients who received supportive care without the oral rinse. All patients in the two groups were treated with intensity modulated radiation therapy (IMRT) for average prescription doses of 66 Gy in 33 fractions. The effects of this rinse vs. supportive care on mucositis, PEG tube requirements, hospitalization, xerostomia, analgesic requirements and weight was respectively evaluated. We have observed statistically significant decreases in the incidence of radiation induced oral mucositis (p=0.0002) with WHO grade 3 (38% vs. 52%) and 4 mucositis (0% vs. 19%), need for PEG tube placement (33% vs. 57%) and hospitalization (0% vs 19%). There was also a favorable impact on the incidence of grade 3 (29% vs. 43%) xerostomia in the treated patients but it was statistically insignificant (p=0.58). Incremental costs related to treatment of oral mucositis were reduced considerably. Our data suggest that use of a supersaturated calcium phosphate oral rinse is an effective treatment for mucositis in patients undergoing IMRT. It may also be helpful in the reduction of hospitalization and PEG tube requirements.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

C. Miyamoto, J. Wobb, B. Micaily, S. Li and M. Achary, "A Retrospective Match Controlled Study of Supersaturated Calcium Phosphate Oral Rinse vs. Supportive Care for Radiation Induced Oral Mucositis," Journal of Cancer Therapy, Vol. 3 No. 5, 2012, pp. 630-636. doi: 10.4236/jct.2012.35081.

References

[1] E. B. Rubenstein, D. E. Peterson, M. Schubert, D. Keefe, D. McGuire, J. Epstein, L. S. Elting, P. C. Fox, C. Cooksley and S. T. Sonis, “Clinical Practice Guidelines for the Prevention and Treatment of Cancer Therapy-Induced Oral and Gastrointestinal Mucositis,” Cancer, Vol. 100, Suppl. 9, 2004, pp. 2026-2046. doi:10.1002/cncr.20163
[2] E. B. Avritscher, C. D. Cooksley and L. S. Elting, “Scope and Epidemiology of Cancer Therapy-Induced Oral and Gastrointestinal Mucositis,” Seminars in Oncology Nursing, Vol. 20, No. 1, 2004, pp. 3-10. doi:10.1053/j.soncn.2003.10.002
[3] L. S. Elting, C. D. Cooksley, M. S. Chambers and A. S. Garden, “Risk, Outcomes, and Costs of Radiation-Induced Oral Mucositis among Patients with Head-and-Neck Malignancies,” International Journal of Radiation Oncology, Biology, Physics, Vol. 68, No. 4, 2007, pp. 1110-1120. doi:10.1016/j.ijrobp.2007.01.053
[4] N. J. Nonzee, N. A. Dandade, U. Patel, T. Markossian, M. Agulnik, A. Argiris, J. D. Patel, R. C. Kern, H. G. Munshi and C. L. Bennett, “Evaluating the Supportive Care Costs of Severe Radiochemotherapy-Induced Mucositis and Pharyngitis,” Cancer, Vol. 113, No. 6, 2008, pp. 1446-1452. doi:10.1002/cncr.23714
[5] S. T. Sonis, “Mucositis as a Biological Process: A New Hypothesis for the Development of Chemotherapy-Induced Stomatotoxicity,” Oral Oncology, Vol. 34, No. 1, 1998, pp. 39-43. doi:10.1016/S1368-8375(97)00053-5
[6] C. A. Squier and M. J. Kremer, “Biology of Oral Mucosa and Esophagus,” Journal of the National Cancer Institute, Vol. 29, No. 29, 2001, pp. 7-15. doi:10.1093/oxfordjournals.jncimonographs.a003443
[7] S. T. Sonis, L. S. Elting, D. Keefe, D. E. Peterson, M. Schubert, M. Hauer-Jensen, B. N. Bekele, J. Raber-Durlacher, J. P. Donnelly and E. B. Rubenstein, “Perspectives on Cancer Therapy-Induced Mucosal Injury: Pathogenesis, Measurement, Epidemiology, and Consequences for Patients,” Cancer, Vol. 100, No. , 2004, pp. 1995-2025. doi:10.1002/cncr.20162
[8] L. C. Pillitteri and R. E. Clark, “Comparison of a Patient-Controlled Analgesia System with Continuous Infusion for Administration of Diamorphine for Mucositis,” Bone Marrow Transplantation, Vol. 22, No, 5, 1998, pp. 495-498. doi:10.1038/sj.bmt.1701370
[9] L. S. Elting, C. Cooksley, M. Chambers, S. B. Cantor, E. Manzullo and E. B. Rubenstein, “The Burdens of Cancer Therapy: Clinical and Economic Outcomes of Chemotherapy-Induced Mucositis,” Cancer, Vol. 98, No. 7, 2003, pp. 1531-1539. doi:10.1002/cncr.11671
[10] World Health Organization, “Handbook for Reporting Results of Cancer Treatment,” World Health Organization, Geneva, 1979.
[11] S. M. Bentzen, M. I. Saunders, S. Dische and S. J. Bond, “Radiotherapy-Related Early Morbidity in Head and Neck Cancer: Quantitative Clinical Radiobiology as Deduced from the CHART Trial,” Radiotherapy & Oncology, Vol. 60, No. 2, 2001, pp. 123-135. doi:10.1016/S0167-8140(01)00358-9
[12] D. E. Peterson, R. J. Bensadoun and F. Roila, “On Behalf of the ESMO Guidelines Working Group, Management of Oral and Gastrointestinal Mucositis: ESMO Clinical Recommendations,” Annals of Oncology, Vol. 19, Suppl. 2, 2008, pp. 122-125. doi:10.1093/annonc/mdn109
[13] S. Sonis, A. Muska, J. O'Brien, A. Van Vugt, P. Langer-Safer and J. Keith, “Alteration in the Frequency, Severity and Duration of Chemotherapy-Induced Mucositis in Hamsters by Interleukin-11," European Journal of Cancer Part B: Oral Oncology, Vol. 31, No. 4, 1995, pp. 261-266. doi:10.1016/0964-1955(95)00015-A
[14] S. T. Sonis, L. Lindquist, A. Van Vugt, A. A. Stewart, K. Stam, G.-Y. Qu, K. K. Iwata and J. D. Haley, “Prevention of Chemotherapy-Induced Ulcerative Mucositis by Transforming Growth Factor Beta3,” Cancer Research, Vol. 54, No. 5, 1994, pp. 1135-1138.
[15] S. T. Sonis, J. W. Costa Jr, S. M. Evitts, L. E. Lindquist and M. Nicolson, “Effect of Epidermal Growth Factor on Ulcerative Mucositis in Hamsters That Receive Cancer Chemotherapy,” Oral Surgery, Oral Medicine, Oral Pathology, Vol. 74, No. 6, 1992, pp. 749-755. doi:10.1016/0030-4220(92)90402-C
[16] M. B. Tombes and B. Gallucci, “The Effects of Hydrogen Peroxide Rinses on the Normal Oral Mucosa,” Nursing Research, Vol. 42, No. 6, 1993, pp. 332-337. doi:10.1097/00006199-199311000-00003
[17] R. Spielberger, P. Stiff, W. Bensinger, T. Gentile, D. Weisdorf, T. Kewalramani, T. Shea, S. Yanovich, K. Hansen and C. Emmanouilides, “Palifermin for Oral Mucositis after Intensive Therapy for Hematologic Cancers,” The New English Journal of Mededicine, Vol. 351, No. 25, 2004, pp. 2590-2598. doi:10.1056/NEJMoa040125
[18] A. Due?as-Gonzalez, P. Sobrevilla-Calvo, M. Frias-Mendivil, D. Gallardo-Rincon, F. Lara-Medina, L. Aguilar-Ponce, E. Miranda-Lopez, J. Zinser-Sierra and E. Reynoso-Gomez, “Misoprostol Prophylaxis for High-Dose Chemotherapy-Induced Mucositis: A Randomized Double-Blind Study,” Bone Marrow Transplantation, Vol. 17, No. 5, 1996, pp. 809-812.
[19] A. Berger, M. Henderson, W. Nadoolman, V. Duffy, D. Cooper, L. Saberski and L. Bartoshuk, “Oral Capsaicin Provides Temporary Relief for Oral Mucositis Pain Secondary to Chemotherapy/Radiation Therapy,” Journal of Pain and Symptom Management, Vol. 10, No. 3, 1995, pp. 243-248. doi:10.1016/0885-3924(94)00130-D
[20] D. E. Peterson, “Pretreatment Strategies for Infection Prevention in Chemotherapy Patients,” In: NCI Monogram, Development Conference on Oral Complications of Cancer Therapies: Diagnosis, Prevention and Treatment, NCI Publication, Washington DC, 1990, pp. 61-71.
[21] H. V. Worthington, J. E. Clarkson and O. B. Eden, “Interventions for Preventing Oral Mucositis for Patients with Cancer Receiving Treatment,” Cochrane Database of Systematic Reviews, Vol. 4, 2007, Article ID: CD000978.
[22] J. Bowman and M. Haas, “Supersaturated Electrolyte Oral Rinse Alleviates Painful Oral Mucositis for Patients Receiving Chemotherapy and Radiation, Oncology Nursing Forum, Vol. 35, 2008, pp. 510-511.
[23] M. Haas, T. Mercedes and M. Manyak, “Reduction in Painful Oral Mucositis by Supersaturated Calcium Phosphate Oral Rinse in Head and Neck Cancer Patients Receiving Chemotherapy and Radiation,” International Journal of Radiation Oncology, Biology, Physics, Vol. 72, Suppl. 1, 2008, p. 406. doi:10.1016/j.ijrobp.2008.06.1297
[24] T. P. Bechtel and S. Devine, “Use of a Calcium/Phosphate Oral Rinse (Caphosol?) to Lessen the Mucositis Following Autologous Peripheral Blood Stem Cell Transplantation,” Biology of Blood and Marrow Transplantation, Vol. 15, No. 2, 2009, p. 154. www.abstracts2view.com/bmt
[25] A. S. Papas, G. Koobatian, S. Samiei, E. Noto and E. Johansen, “Effects Delas Soluciones de Calico y Fosfato en Pacientes Irradiados Terapeuticamente (Parte 1). Revista de la Asociación Odontológica Argentina, Vol. 80, 1992, pp. 88-92.
[26] A. S. Papas, E. Johansen and K. Miller, “An Oral Preventive Protocol for Bone Marrow Transplant Patients,” 11th MASCC International Symposium on Supportive Care in Cancer, Nice, 18-20 February 1999, (Abstract) CCJ11.
[27] A. S. Papas, R. E. Clark, G. Martuscelli, K. T. O’Loughlin, E. Johansen and K. B. Miller, “A Prospective, Randomized Trial for the Prevention of Mucositis in Patients Undergoing Hematopoietic Stem Cell Transplantation,” Bone Marrow Transplantation, Vol. 31, 2003, pp. 705-712. doi:10.1038/sj.bmt.1703870
[28] A. Wasko-Grabowska, P. Rzepecki, S. Oborska, J. Barzal, K. Gawroński, B. Mlot, C. Szczylik, “Efficiency of Su-Persaturated Calcium Phosphate Mouth Rinse Treatment in Patients Receiving High-Dose Melphalan or BEAM Prior to Autologous Blood Stem Cell Transplantation: A Single-Center Experience,” Transplant Proceedings, Vol. 43, No. 8, 2011, pp. 3111-3113. doi:10.1016/j.transproceed.2011.08.053
[29] A. Wasko-Grabowska, P. Rzepecki, S. Oborska, J. Barzal, B. Mlot, K. Gawroński, M. Wasko, C. Szczylik, “A Supersaturated Calcium Phosphate Solution Seems to Effectively Prevent and Treat Oral Mucositis in Haematopoietic Stem Cell Transplanted Cancer Patients—Single Centre Experience,” Journal of the Balkan Union of Oncology, Vol. 17, No. 2, 2012, pp. 363-368.
[30] H. G. Wu, S. Y. Song, Y. S. Kim, Y. T. Oh, C. G. Lee, K. C. Keum, Y. C. Ahn, S. W. Lee, “Therapeutic Effect of Recombinant Human Epidermal Growth Factor (RhEGF) on Mucositis in Patients Undergoing Radiotherapy, with or without Chemotherapy, for Head and Neck Cancer: A Double-Blind Placebo-Controlled Prospective Phase 2 Multi-Institutional Clinical Trial,” Cancer, Vol. 115, No. 16, 2009, pp. 3699-3708. doi:10.1002/cncr.24414
[31] Q. T. Le, H. E. Kim, C. J. Schneider, G. Murakozy, K. Skladowski, S. Reinisch, Y. Chen, M. Hickey, M. Mo, M. G. Chen, D. Berger, R. Lizambri and M. Henke, “Palifermin Reduces Severe Mucositis in Definitive Chemoradiotherapy of Locally Advanced Head and Neck Cancer: A Randomized, Placebo-Controlled Study,” Journal of Clinical Oncology, Vol. 29, No. 20, 2011, pp. 2808-2814. doi:10.1200/JCO.2010.32.4095

  
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