Assessing Role of Oral Glutamine Supplementation in Radiation Induced Oral Mucositis in Head and Neck Cancers

Abstract

Background: Radiotherapy with or without concurrent chemotherapy forms the mainstay of treatment of head and neck cancers. Oral mucositis is one of the most common complications of Chemo Radio-Therapy(CRT) which outweighs the systemic complaints both in terms of severity and difficulty in management. The aim of our study was to assess the role of oral glutamine supplementation in prevention of oral mucositis in patients receiving CRT to the head and neck. Methods: This was a Prospective Randomized study performed between April 2017 to November 2017.Total 60 patients (30 in each arm) were enrolled. Patients in ARM A were advised to take Glutamine crystalline powder dissolved in water to be consumed daily within 1 hour before radiation and were again asked to repeat the same dose 7 to 8 hours post radiation. Glutamine Treatment was 5 days/week on Radio-therapy days only. Patients in ARM B were given Placebo twice a day in same fashion as ARM A.Weekly Cisplatin was given in both arms. Results: Average no of days for onset of mucositis in glutamine arm was 17 days vs 32 days in control arm. 26.67% of patients in the glutamine arm developed mucositis in the 5th to 6th week, whereas 60% patients in the control arm developed mucositis as early as the 3rd week. 13% of the patients in the glutamine arm developed G3 mucositis whereas 23.3% of patients in the control arm developed G3 mucositis. 46.6% percent of patients in the glutamine arm received complete six cycles of chemotherapy, whereas only 13.33% of the patients in the control arm could complete six cycles of chemotherapy(p<0.001) 93.3% of patients in the glutamine arm completed treatment within the stipulated period of 7 weeks, whereas only 33.3% patients in the control arm completed treatment within 7 weeks.(p<0.05). Conclusion: Glutamine significantly decreases the onset as well as the severity of mucositis in patients receiving CRT to the head and neck thus translating into lesser treatment gaps and improvement in patient quality of life.

Oral Glutamine May Have No Clinical Benefits to Prevent Radiation-Induced Oral Mucositis in Adult Patients With Head and Neck Cancer: A Meta-Analysis of Randomized Controlled Trials

“…A total of 322 studies were captured at the first literature retrieval stage. Finally only 6 studies (19)(20)(21)(22)(23)(24) involving 441 patients were eligible for qualitative analysis, and 5 studies involving 279 patients were included in meta-analysis (19,20,(22)(23)(24). The flow diagram of retrieval and selection of literature was delineated in Figure 1.…”

“…The doses and frequency of oral glutamine were slightly different. Moreover, four studies (20,(22)(23)(24) used CTCAE to evaluate the grade of OM and only one study (19) used WHO method, the other one (21) did not reported the method of evaluating OM. All studies reported that the baseline information between the glutamine group and the control group was not statistically significant.…”

“…The five eligible studies (19,20,(22)(23)(24) involving 279 patients reported the incidence of OM at the six week of RT. The metaanalysis suggested that the incidence of OM was not statistically significant between the two groups (RR, 0.98; 95% CIs, 0.94 -1.02; P = 0.39; I 2 = 0%; seen as Figure 3).…”

“…To date, there are several randomized controlled trials (RCTs) evaluating the effect of oral glutamine on preventing RTinduced OM in HNC patients. Among these trials, four studies demonstrated oral glutamine was effective for decreasing the onset and the severity of OM in HNC patients (19)(20)(21)(22). But Huang et al and Lopez-Vaquero et al find no beneficial effects of oral glutamine in decreasing the incidence, onset and severity of OM (23,24).…”

“…Although four published systematic reviews (25)(26)(27)(28) explored the impact of glutamine use on OM induced by cancer treatment, the definitive conclusion has not yet been generated due to several limitations. More importantly, additional eligible studies have been recently published (20,23,24). So it is necessary to perform an updated systematic review and metaanalysis to combine all evidence to further investigate the role of oral glutamine in preventing RT-induced OM in HNC patients receiving RT alone or concurrent with CT.…”