Oral Mucositis Induced by Chemoradiotherapy in Head and Neck Cancer—A Short Review about the Therapeutic Management and the Benefits of Bee Honey
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Incidence and Pathophysiology of Chemoradiotherapy-Induced Oral Mucositis
3.2. Risk Factors and Pathogenesis of Oral Mucositis
3.3. Tools Used to Assess OM
- The World Health Organization (WHO) scale evaluates OM as having 5 grades, from grade 0—normal mucosa, to grade 4 with deep lesions, when feeding the patient is not possible, making parenteral support necessary [28].
- The “Oral Assessment Guidelines” are used especially in pediatrics, where the degree of stomatitis and the condition of the oral cavity are assessed by inspecting the lips, oral commissures, tongue, the appearance of the oral mucosa membrane, saliva, gums, teeth, voice and swallowing process [29].
- The “Beck Assessment Scale”, in short BOAS, much similar to the previous one, is adapted, oral functionality being assessed with the help of local examination, registering scores from 5 to 20 [30].
- The “Oral Toxicity Scale” is used to evaluate the degree of oral stomatitis, similar to the previous ones. This instrument has been developed by Parulekar and uses symptomatic items for assessing the patients and sorting them by 5 grades [30].
3.4. Management of OM
3.5. Evidence Regarding the Effectiveness of Bee Honey in Preventing and Treating Chemoradiotherapy-Induced OM
3.6. Other Benefits of Honey
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Grade 0 | Grade 1 | Grade 2 | Grade 3 | Grade 4 | |
---|---|---|---|---|---|
WHO | erythema and soreness | ulcers, able to eat solids | ulcers, requires a liquid diet (due to mucositis) | ulcers, alimentation not possible (due to mucositis) | |
RTOG | (mild) irritation, mild pain, does not necessarily require analgesics | (moderate) patchy mucositis with inflammation and serosanguinal secretions, moderate pain may be present requiring analgesics | (severe) confluent or fibrinous stage of mucositis, with severe pain requiring narcotics | (life threatening) deep ulceration, bleeding, or necrosis | |
OMAS Erythema Ulceration | Normal | <1 cm2 Not severe | 1–3 cm2 Severe | >3 cm2 | |
NCI-CTCAE | erythema, painless ulcers or mild pain in the absence of lesions | edema, painful erythema, and ulcers, but patients may eat or swallow | severe ulcers present, the patient requires enteral/parenteral nutrition or prophylactic intubation | death caused by this toxicity |
Article Type; Authors | Number of Patients or Studies Used | Oncological Treatment | Objective | Type of Honey and How to Use It in the Study Group | Substances Used in the Control Group | Results |
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1. Prospective single-blind randomized control study; Howlader, D. et al. [39] | 40 patients divided into 2 arms | radiochemotherapy together with cisplatin-based chemotherapy 4 weeks after completion of induction chemotherapy | to assess clinical benefits and improve quality of life in patients with head and neck cancers after honey administration |
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2. Prospective randomized control study Mamgain, R. K. et al. [40] | 150 patients initially enrolled randomly assigned to 3 arms | local EBRT at 6 MV LINAC by conventional fractionation, average dose = 60 Gy × 5 days/week 6 weeks concurrent with cisplatin | to evaluate the efficacy of Ayurvedic preparation in oral mucositis in head and neck cancer patients receiving concurrent chemoradiotherapy |
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3. Murine model study Khanal, L. et al. [41] | 24 albino rats randomly assigned to 4 working arms | intraperitoneal methotrexate at a dose of 60 mg/kg | to demonstrate the efficacy of bee honey on chemotherapy-induced oral mucositis |
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4. Systematic review Yarom, N. et al. [42] | 78 papers: 49 were included in this review +9 publications reported in the previous update of the guidelines describing 26 different interventions falling within the honey field | radiotherapy with or without chemotherapy in patients with head cancer pediatric patients with hematological or solid cancers treated with chemotherapy | to update the clinical practice guidelines for OM management that have been developed by MASCC/ISOO. This part focuses on honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents |
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5. Systematic review Münstedt, K. et al. [19] | 17 randomized trials | radiotherapy or radiotherapy with combined chemotherapy | to evaluate the efficacy of conventional bee honey or Manuka honey on radiochemotherapy-induced OM |
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6. Systematic review Hunter, M. et al. [11] | 13 randomized controlled trials with 634 patients | chemotherapy or radiotherapy | to demonstrate the efficacy of bee honey on oral mucositis induced by chemotherapy or radiotherapy |
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7. A subspecialty review Tharakan, T. et al. [43] | 13 randomized controlled trials with 634 patients | chemotherapy or radiotherapy | to demonstrate the efficacy of bee honey on oral mucositis induced by chemotherapy or radiotherapy |
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8. A systematic review and network meta-analysis Yang, C. et al. [44] | 17 studies involving 1265 patients grouped into 13 arms | chemotherapy or radiotherapy | to demonstrate the efficacy of bee honey on oral mucositis induced by chemotherapy or radiotherapy |
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9. A meta-analysis of randomized controlled trials Liu, Tzu-Ming et al. [45] | 19 randomized controlled trials with 1276 patients | radiochemotherapy | reduction of OM |
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10. A network meta-analysis of randomized controlled trials Ya-Ying Yu et al. [46] | 28 randomized controlled trials with 1861 patients | radiochemotherapy | prevention and treatment of OM, evaluate the effect of different oral care solutions |
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11. New systematic review and update the clinical guidelines Sharon Elad et al. [37] | 1197 randomized controlled trials with 1861 patients | radiochemotherapy | prevention and treatment of OM |
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12. A Bayesiannetwork analysis Xu Zhang et al. [12] | 36 randomized controlled trials with 2594 patients | radiochemotherapy, total radiation dose =50 Gy | to compare the preventive effect of ten mouthwashes in intolerable OM |
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Jicman, D.; Sârbu, M.I.; Fotea, S.; Nechifor, A.; Bălan, G.; Anghele, M.; Vasile, C.I.; Niculeț, E.; Sârbu, N.; Rebegea, L.-F.; et al. Oral Mucositis Induced by Chemoradiotherapy in Head and Neck Cancer—A Short Review about the Therapeutic Management and the Benefits of Bee Honey. Medicina 2022, 58, 751. https://doi.org/10.3390/medicina58060751
Jicman D, Sârbu MI, Fotea S, Nechifor A, Bălan G, Anghele M, Vasile CI, Niculeț E, Sârbu N, Rebegea L-F, et al. Oral Mucositis Induced by Chemoradiotherapy in Head and Neck Cancer—A Short Review about the Therapeutic Management and the Benefits of Bee Honey. Medicina. 2022; 58(6):751. https://doi.org/10.3390/medicina58060751
Chicago/Turabian StyleJicman (Stan), Daniela, Mihaela Ionela Sârbu, Silvia Fotea, Alexandru Nechifor, Gabriela Bălan, Mihaela Anghele, Claudiu Ionuț Vasile, Elena Niculeț, Nicolae Sârbu, Laura-Florentina Rebegea, and et al. 2022. "Oral Mucositis Induced by Chemoradiotherapy in Head and Neck Cancer—A Short Review about the Therapeutic Management and the Benefits of Bee Honey" Medicina 58, no. 6: 751. https://doi.org/10.3390/medicina58060751