The Benefit of Zinc Sulfate in Oropharyngeal Mucositis during Hyperfractionated Accelerated Concomitant Boost Radiotherapy with Concurrent Cisplatin for Advanced-Stage Oropharyngeal and Hypopharyngeal Cancers

Abstract

Background: Radiation-induced oropharyngeal mucositis is a major problem causing widespread clinical symptoms and may interfere with treatment plans, ultimately jeopardizing patient outcome. Zinc supplementation may be considered beneficial in preventing acute toxicity during chemoradiation.

Aims and objective: The aim of the study is to determine the effect of zinc supplementation on radiation-induced oropharyngeal mucositis in Stage III and IV-A oropharynx and hypopharynx cancers treated by hyperfractionated accelerated concomitant boost radiotherapy with weakly cisplatin. The objective behind the study is to know any changes in the onset, duration, and severity of oropharyngeal mucositis by implementation of oral zinc sulfate.

Materials and methods: The study is double-blinded randomized controlled assessment involving 120 patients (60 - control and 60 - experimental) treated with chemoradiation for oropharyngeal and hypopharyngeal cancers. The experimental group received oral zinc sulfate 150 mg once daily during and after treatment, whereas the control group patients were given placebo. The categorical data were analyzed using the Chi-square test and Pearson correlation. The Friedman test was used for comparison of oral mucositis grading between the groups.

Results: A statistically significant difference was found in the zinc-supported experimental group showing delay in onset, decrease in severity, and duration of oropharyngeal mucositis.

Conclusion: Zinc supplementation could be beneficial in managing oropharyngeal mucositis during chemoradiation of head-and-neck cancers with no untoward side effects.

Keywords: Chemoradiotherapy; head-and-neck cancers; hyperfractionated radiotherapy with concomitant boost; oral mucositis; zinc supplementation.

Figure 1

The changes in mucositis grade between the control and experimental groups of both oropharyngeal and hypopharyngeal cancers

Figure 2

Different grades of oral mucositis (Radiotherapy Oncology Group scoring criteria), (a) Grade 1 mucositis showing mild changes in the lining mucosa, (b) Grade 2 patchy mucositis that produces inflammatory serosanguinous discharge in the buccal mucosa, (c) Grade 3 confluent mucositis involving buccal mucosa, lip, and tongue, (d) Grade 4 mucositis showing ulceration and hemorrhage alimentation not possible