Hypericum perforatum and neem oil for the management of acute skin toxicity in head and neck cancer patients undergoing radiation or chemo-radiation: a single-arm prospective observational study

Abstract

BackgroundRadiation dermatitis is common in patients treated with combined radiotherapy and chemotherapy for head and neck malignancies. Its timely and adequate management is of uttermost importance for both oncological outcomes and global quality of life. We prospectively evaluated the role of hypericum perforatum and neem oil (Holoil®; RIMOS srl, Mirandola, Italy) in the treatment of acute skin toxicity for patients undergoing radiotherapy or chemo-radiotherapy for head and neck cancer.MethodsA consecutive series of 28 head and neck cancer patients submitted to radiotherapy (RT) was enrolled onto this mono-institutional single-arm prospective observational study. Patients undergoing both definitive or post-operative radiotherapy were allowed, either as exclusive modality or combined with (concomitant or induction) chemotherapy. We started Holoil treatment whenever bright erythema, moderate oedema or patchy moist desquamation were observed. Holoil® was used during all RT course and during follow up time, until acute skin toxicity recovery.ResultsThe maximum detected acute skin toxicity was Grade 1 in 7% of patients, Grade 2 in 68%, Grade 3 in 25%, while at the end of RT was Grade 0 in 3.5%, Grade 1 in 32%, Grade 2 in 61%, Grade 3 in 3.5%. For patients having G2 acute skin toxicity, it mainly started at weeks 4-5; for those having G3, it began during weeks 5-6. Median times spent with G2 or G3 toxicity were 17.5 and 11 days. Patients having G2 acute skin toxicity had a dermatitis worsening in 27% of case (median occurrence time: 7 days). G3 events were reconverted to a G2 profile in all patients (median time: 7 days). Those experiencing a G2 skin event were converted to a G1 score in 23% of cases (median time: 14 days). Time between maximum acute skin toxicity and complete skin recovery after RT was 27 days.ConclusionsHoloil® proved to be a safe and active option in the management of acute skin toxicity in head and neck cancer patients submitted to RT or chemo-radiotherapy. A prophylactic effect in the prevention of moist desquamation may be hypothesized for hypericum and neem oil and need to be tested within a prospective controlled study.

Prospective assessment of oral mucositis and its impact on quality of life and patient-reported outcomes during radiotherapy for head and neck cancer

“…For patients that underwent surgical excision as first-line treatment strategy, the type of surgery to the site of primary tumor and cervical nodes was selected accounting for disease presentation and eventual neck involvement, as previously described [12]. Patients were submitted to oral cavity excisions with partial mandibulectomies, partial or emi-glossectomy, pharyngectomy and partial or total laryngectomy.…”

Use of Neem oil and Hypericum perforatum for treatment of calcinosis-related skin ulcers in systemic sclerosis

“…Thanks to the presence of limonoids, Neem could represent a safe tool for local treatment of acute skin toxicity in patients undergoing radiotherapy or chemoradiotherapy for head and neck malignancies. 32 In addition, Holoil V R shows cicatrizing and bacteriostatic effects that contribute to wound repair. 12,13 The two active components of Holoil V R potentiate one another to achieve infection control, inhibition of inflammation, and induction of epithelization.…”

Intervenções tópicas para prevenção da radiodermatite aguda em pacientes com câncer de cabeça e pescoço: revisão sistemática e metanálise

“…A radiodermatite ocorre frequentemente em pacientes submetidos à RT para CCP (FRANCO et al, 2014), acometendo cerca de 80-90% desses pacientes (HÄFNER et al, 2013), nos quais, a toxicidade pode variar de leve a moderada, podendo chegar a grave em 25% dos casos (CABEZÓN-GUTIÉRREZ, KHOSRAVI-SHAHI, ESCOBAR-ÁLVAREZ, 2012).…”

“…A radiodermatite aguda pode variar entre eritema leve e intenso, descamação seca, descamação úmida e, raramente, necrose (Figura 5) (FRANCO et al, 2014;O'DONOVAN et al, 2015). Dependendo da dose de radiação recebida, pode-se observar, edema progressivo, hipercromia e ulceração.…”

“…Uma grande variedade de medicamentos tópicos, endovenosos e orais são utilizados na prática clínica para prevenção ou tratamento da radiodermatite (FRANCO et al, 2014;SALVO et al, 2010). No entanto, segundo Harris et al (2012), a qualidade e a quantidade de estudos que avaliam agentes tópicos parecem ser insuficientes para suportar ou refutar qualquer produto específico, indicando ainda que são mínimas as avaliações em curso de produtos para cuidados da pele.…”