Adjunctive Treatments for the Prevention of Chemotherapy- and Radiotherapy-Induced Mucositis

Abstract

Background: Chemoradiotherapy-associated mucositis can manifest as pain, inflammation, dysphagia, diarrhea, weight loss, rectal bleeding, and infection. Mucositis is a major dose-limiting side effect of chemotherapy, affecting nutritional intake and oral and intestinal function. Despite several interventions being available, there is a need for safe and effective preventative and treatment options for treatment-induced mucositis. The goals of this review are to discuss interventions based on foods and natural products and present the research to date. Methods: A narrative literature review identified 60 clinical studies examining various nutritional compounds and 20 examining probiotics. 9 studies on probiotics for the prevention of diarrhea were also assessed on methodological quality and limitations identified. Results: Several compounds have been posited as useful adjuvants for cancer treatment–related mucositis. Probiotics demonstrate efficacy for the prevention and treatment of chemoradiotherapy-induced gastrointestinal toxicity without significant side effects. Glutamine and activated charcoal were reported to reduce chemotherapy-induced diarrhea but not radiation-induced intestinal mucositis. Honey has been reported to decrease treatment interruptions, weight loss, and delays the onset of oral mucositis. Zinc, glutamine, and topical vitamin E were demonstrated efficacy for oral mucositis. Conclusion: There is plausible clinical evidence for the administration of several adjunctive treatments for the prevention and treatment of mucositis. Probiotics were reported to reduce the burden of intestinal mucositis and treatment-induced diarrhea. Activated charcoal and glutamine are beneficial for chemotherapy-induced diarrhea, whereas the administration of honey, zinc, and glutamine reduce the risk of developing oral mucositis during chemotherapy or radiotherapy.

A case of severe megacolon due to acquired isolated hypoganglionosis after low anterior resection for lower rectal cancer

“…With respect to cancer treatment including chemotherapy and radiotherapy, a recent study has reported that over 80% of patients treated with 5-fluorouracil developed gastrointestinal mucositis [28]. It is well documented that both radiotherapy and chemotherapy including 5-fluorouracil or oxaliplatin could cause gastrointestinal toxicities such as direct epithelial injury, tissue ischemia, villi shortening, increased crypt depth, apoptosis of intestinal epithelial cells, and bacterial translocation [28][29][30][31][32][33]. In addition, cancer treatment might have a marked effect on gut microbiota, leading to intestinal dysbiosis, mucositis, and bacterial translocation [34].…”

Oral Zinc Sulfate for Prevention and Treatment of Chemotherapy-Induced Oral Mucositis: A Meta-Analysis of Five Randomized Controlled Trials

“…Thus, efficacy and safety of oral zinc sulfate for chemotherapy-induced oral mucositis remain controversial. It must be noted, however, that it is essential to investigate separately the efficacy of oral zinc sulfate in the prevention and treatment of chemotherapy-induced oral mucositis because differences between radiotherapy and chemotherapy cannot be ignored ( 14 ). We consequently performed this systematic review and meta-analysis to comprehensively assess the efficacy and safety of zinc sulfate for chemotherapy-induced oral mucositis.…”

Therapeutic bacteria to combat cancer; current advances, challenges, and opportunities

“…Some of the recent studies have investigated the positive effects of Lactobacillus brevis CD2 lozenges on the severity and prevalence of mucositis, as well as the tumor resistance to radiotherapy. It was observed that patients who received Lactobacillus during chemotherapy had fewer intestinal problems than the others, resulting in shortening the course of chemotherapy and lower doses . Another method to reduce the side effects of chemotherapy is the COBALT strategy (combination bacteriolytic therapy; simultaneous use of C novyi ‐ NT spores with conventional chemotherapeutic agents).…”