A morphometric study of the protective effect of cryotherapy on oral mucositis in cancer patients treated with 5-fluorouracil

Abstract

We investigated cytological changes in oral mucosa smears from patients treated with cryotherapy to determine whether cryotherapy prevented mucositis caused by 5-fluorouracil (5-FU) therapy. Patients with gastrointestinal malignancies were divided into four groups; control patients before 5-FU therapy, patients after 5-FU therapy without cryotherapy, patients with cryotherapy before 5-FU therapy and patients with cryotherapy after 5-FU therapy. Oral mucosa samples from all patients were assessed at the beginning and on day 14 of chemotherapy. We used exfoliative cytology to evaluate cellular changes in the oral mucosa that were caused by 5-FU. Smears from each patient were stained using the Papanicolaou method and analyzed using stereology. Smears were taken from each group before and after 5-FU infusion. We found that nuclear volume was decreased significantly in cells of the 5-FU therapy after cryotherapy patients compared to the 5-FU therapy before cryotherapy patients. We also found significantly decreased cytoplasmic volumes in the 5-FU therapy after cryotherapy patients compared to the 5-FU therapy before cryotherapy patients. The results of cytomorphometric estimations revealed that cryotherapy may be used to prevent damage to oral tissue and may decrease the frequency and duration of oral mucositis caused by 5-FU.

Effectiveness of Oral Cryotherapy for Oral Mucositis on Cancer Patient Undergoing Cancer Therapy: A Systematic Review

“…It was found that the OC decreased pain level of the patients oral mucositis [26], [31], shorter the duration and recovery of severe mucositis [24], [33], reduced the incidence of anorexia [25], and usage of parenteral narcotics [33]. Furthermore, the exfoliative cytology results on the oral mucosal layer showed a decrease in the nuclear and cytoplasmic volume in cells after the OC [32]. However, there were no significant differences between OC and controlled groups in term of the level of toxicity of infectious hematology, analgesic need, TPN [23], the neutrophil rate [30], and length of hospitalization [33].…”

“…The majority of studies applied OC procedures before cancer therapy interventions were carried out. Six studies started giving ice cube 5 min before cancer therapy was started [28], [29], [30], [31], [32], [33]. Another study started 10 min [25] and 30 min before cancer therapy was given [23].…”

“…The majority of the reviewed studies described that OC intervention was effective in reducing the degree and severity of oral mucositis in patients undergoing cancer therapy, either HSCT or chemotherapy. Based on the mucositis grading assessment instruments, these studies found mucositis grade reduction in the OC group [25], [26], [27], [28], [29], [30], [31], [32]. Meanwhile, three studies reported that the incidence of oral mucositis on different grades was significantly lower in the group of patients receiving OC than the non-OC group [25], [26], [31].…”

Effects of oral supplementation in the management of oral mucositis in cancer patients: A meta‐analysis of randomized clinical trials

“…Oral mucositis usually appears in the second week of RT with fractionated doses of 2 Grays (Gy), and 3‐5 days after bolus or continuous infusions of CH. This side effect causes a loss in the protective function of the mucosal barrier, leading to destruction and breakage of the mucosa, increasing the risk of a local infection due to the colonization of resident microflora, bacteremia, and sepsis . Severe mucositis may be responsible for premature interruption of RT and the reduction in CH dose .…”

“…Severe mucositis may be responsible for premature interruption of RT and the reduction in CH dose . Factors that increase OM occurrence are ineffective oral hygiene, nutritional status, alterations in salivary immunoglobulins, and the association of CH and RT …”