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. 2018 Dec;17(4):1027-1047.
doi: 10.1177/1534735418794885. Epub 2018 Aug 23.

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

Michael Thomsen  1 , Luis Vitetta  1   2
Affiliations

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

Michael Thomsen et al. Integr Cancer Ther. 2018 Dec.

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.

Keywords: adjunctive compounds; chemotherapy; diarrhea; mucositis; probiotics; radiotherapy.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Luis Vitetta has received National Institute of Complementary Medicine and National Health and Medical Research Council of Australia competitive funding and industry support for research into probiotics and other compounds and is currently Director of Medical Research at Medlab Clinical and with Michael Thomsen investigating the formulation and administration of probiotics. Michael Thomsen is funded by the Francis M Hooper scholarship, Sydney Medical School Foundation.

Figures

Figure 1.
Figure 1.
Forest plot of RCTs of chemotherapy-/radiotherapy-induced diarrhea. RCT, randomized controlled trials; RT, radiotherapy; CT, chemotherapy; CRT, chemoradiotherapy; RR, relative risk, risk ratio.
See this image and copyright information in PMC

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