Cryopreventive temperatures prior to chemotherapy

Abstract

The superiority of oral cryotherapy (OC) for prevention of chemotherapy-induced oral mucositis (OM) has been demonstrated in several trials. In clinical settings, cooling is usually initiated prior to the chemotherapy infusion. It then continues during the infusion, and for a period after the infusion has been completed. While the cooling period post-infusion depends on the half-life of the chemotherapeutic drug, there is no consensus on when cooling should be initiated prior to the infusion. The lowest achieved temperature in the oral mucosa is believed to provide the best condition for OM prevention. Given this, it was of interest to investigate when along the course of intraoral cooling this temperature is achieved. In total, 20 healthy volunteers participated in this randomized crossover trial. Each subject attended three separate cooling sessions of 30 min each, with ice chips (IC) and the intraoral cooling device (ICD) set to 8 and 15 °C, respectively. At baseline and following 5, 10, 15, 20 and 30 min of cooling, intraoral temperatures were registered using a thermographic camera. The greatest drop in intraoral temperature was seen after 5 min of cooling with IC, ICD^8°C and ICD^15°C, respectively. A statistically significant difference, corresponding to 1.4 °C, was seen between IC and the ICD^15°C (p < 0.05). The intraoral temperature further declined throughout the 30 min of cooling, showing an additional temperature reduction of 3.1, 2.2, and 1.7 °C for IC, ICD^8°C and ICD^15°C, respectively.

Keywords: Cryotherapy; Intraoral cooling device; Oral mucositis; Tolerability.

Fig. 1

The Cooral® System. a schematic illustration of the intraoral cooling device; b the portable thermostat unit. Reprinted and modified with permission from Walladbegi J., Gellerstedt M., Svanberg A., Jontell M. Innovative intraoral cooling device better tolerated and equally effective as ice cooling. Cancer Chemother Pharmacol. 2017 Nov; 80(5):965–72. (http://creativecommons.org/licenses/by/4.0/)

Fig. 2

Intraoral mucosal temperatures at baseline and following 5, 10, 15, 20, and 30 min of cooling with ice chips (IC), and the intraoral cooling device (ICD) set to 8 and 15 °C, respectively

Fig. 3

The difference in intraoral mucosal temperature reduction between 5 and 30 min of cooling within each cooling method, ice chips (IC), intraoral cooling device (ICD) set to 8 and 15 °C, respectively. ***p ≤ .001

Fig. 4

Intraoral temperatures for risk surfaces, i.e., right, and left buccal mucosae, upper and lower labial mucosae at baseline and following 5, 10, 15, 20, and 30 min of cooling with ice chips (IC), and the intraoral cooling device (ICD) set to 8 and 15 °C, respectively