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  3. Investigating the effect of propolis mouthwash in the prevention and treatment of mucosal inflammation caused by radiation therapy in head and neck cancers.

Investigating the effect of propolis mouthwash in the prevention and treatment of mucosal inflammation caused by radiation therapy in head and neck cancers.

Number of pages: 125 File Format: word File Code: 31920
Year: 2011 University Degree: Master's degree Category: Medical Sciences
Tags/Keywords: cancer - Head and neck cancers - Inflammation of the mucosa - mucositis - Oral diseases - Propolis - propolis - radiation therapy - Radiotherapy - The effect of mouthwash
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  • Summary of Investigating the effect of propolis mouthwash in the prevention and treatment of mucosal inflammation caused by radiation therapy in head and neck cancers.

    Dissertation to receive a specialized doctorate degree in the field of oral diseases

    Abstract:

    Mucositis or mucosal inflammation is one of the early side effects of radiation therapy, which can cause ulcers in the oral mucosa and sometimes the inability to eat despite common treatments. Therefore, the use of compounds with a pleasant and acceptable smell and taste and with minimal side effects on the tissues of the mouth and teeth and at a reasonable cost and can be produced from natural resources within the country is completely logical and justified.

    Materials and methods: In a double-blind pilot study of a clinical trial, 20 patients in need of radiation therapy for the treatment of head and neck cancer were randomly selected into two groups of cases and controls. In the case group, 15 ml of propolis and in the control group, 20 ml of placebo (placebo) were administered in the form of 3 doses of mouthwash for 5 minutes, which were then swallowed, and the patients were evaluated every other day to check the incidence rate, mucositis and its progress or improvement through the NCI-CTC scale and dry mouth with the relevant criteria. The results were analyzed with the help of T-Test, Man Whitney, Chi Square and Fridman tests.

    Findings: In the case group, the intensity of mucositis in all sessions was significantly less than the control group, and the patients using propolis for 3 weeks, which was longer than the control group, had no lesions. Except for the fourth week, there was no significant difference between the two groups in terms of dry mouth. No special complications caused by the use of propolis were observed in the patients.

    Conclusion: According to the results of this pilot study, propolis mouthwash has preventive and therapeutic properties on mucosal inflammation caused by radiation therapy in head and neck cancers and can be used in the prevention and treatment of mucositis.

    Keywords: propolis, mucositis, radiotherapy, cancer

    Introduction:

    Every year, millions of people around the world experience cancer or malignancy. do Cancers are the second cause of death in developed countries (1). Head and neck malignancies are among the most common cancers in humans that involve many anatomical points of the head and neck. Oropharyngeal cancers are more common in developing countries. (2,3) The goal of treating cancer patients is to cure the disease definitively and improve the patient's quality of life during the disease. The treatment of head and neck cancers in the last three decades has undergone many changes in all three types of treatment, surgery, radiation therapy and chemotherapy, but on the other hand, more use of chemotherapy and radiation therapy has led to an increase in many complications caused by these treatments, including mucositis or inflammation of the oral mucosa. (4) The amount of problems caused by radiation therapy depends on the type, dose and method of treatment. Oral and pharyngeal mucosa causes inflammation of the epithelium, especially in the second and third week. Severe mucositis appears with sores in the mouth and throat and very painful swallowing, which can even cause the treatment to be stopped due to a decrease in the quality of life. Also, mucositis may cause problems during treatment, such as incomplete treatment due to the patient's intolerance, weight loss, eating disorders and the need to take multiple medications. (7) These lesions, which are caused by the local effect of ionizing radiation on the oral mucosa, can differ from one disease to another based on risk factors such as patients' age, gender, oral health status, dose or amount of radiation and radiation therapy technique, having a specific underlying disease or smoking addiction (7).. Various methods have been considered for the treatment of this condition, but unfortunately none of them have been superior to the others.

    The incidence and severity of oral mucosal inflammation have been mentioned differently in the studies. These differences are due to the characteristics of the patients, the type of malignancy, drug regimens and treatment protocol. In general, the prevalence of this complication has been reported from 20 to 90% according to the type of treatment, and it occurs on average in 40% of cases. With inflammation of the oral mucosa, the risk of infection increases in the body of patients. (6,7)

    The oral environment is rich in all kinds of bacteria and fungi, and the oral mucosa acts as a physical barrier to prevent the pathogenicity of these factors. With the creation of ulcers in the mouth and the disintegration of the mucosa, the possibility of the invasion of opportunistic pathogens and the risk of secondary infections increases. At least half of those treated with a dose of 60 to 70 Gy in 6 to 7 weeks develop Grade 3 mucositis. (6) Cancer is a disease characterized by the uncontrolled proliferation of abnormal neoplastic cells. From:

    1 - Genetic and acquired mutations such as cigarette smoke and alcohol

    2 - Chromosomal disorders

    3 - The presence of oncogenic factors

    4 - Using immunosuppressive drugs or suffering from immunosuppressive diseases due to the reduction of Natural Killer cells that directly affect It affects cancer cells. At least 3 to 6 somatic mutations are required to transform a normal cell into a cancer cell. (7)

    Clinical manifestations of head and neck cancers are usually as:

    1 - Palpable mass

    2 - Color change of the skin or mucous membrane that are exposed

    3 - Increase in the volume of lymph nodes

    4- Disturbances in the functioning of organs have been seen.

    head and neck cancers

    About 2.9% of the new diagnosed cancers include types of head and neck cancers, and one third of these cases occur in women, except Salivary and nasopharyngeal tumors. Other cases usually occur after the age of 40. Smoking, alcohol and viruses such as human papilloma are the main risk factors. Most head and neck cancers originate from the epithelium, the most common of which is squamous cell tumor [1] (SCC). (8)

    Cancer treatments

    Generally, the basis of treatment for all cancers includes surgery, radiation therapy, chemotherapy, and hormonal drugs and possibly bone marrow transplantation, which inevitably exposes the patient to many complications. (7)

    Radiotherapy of the head and neck

    Radiotherapy alone is used in the treatment of radiation-sensitive malignancies such as lymphoma or Kaposi's sarcoma. Some cancers, such as epithelial cancers of the gastrointestinal tract, including the oral cavity, are moderately radiosensitive, in these areas, radiation therapy alone is used in tumors with a diameter of 3 cm or less and inoperable tumors, due to their serious or Systemic diseases preventing the use of anesthesia. (9)

    Ionizing radiation is performed as an external beam or direct electron radiation to the tumor or by local implantation (brachytherapy) of radioactive needles made of cesium, radium, gold, palladium or other metals that emit x-rays or gamma. In most radiation treatments of the head and neck, the total dose is from 50 to 80 Gy, which is done in fractions of 10 Gy per week for five weeks and 2 Gy daily in a period of five days per week.

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    List:

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Investigating the effect of propolis mouthwash in the prevention and treatment of mucosal inflammation caused by radiation therapy in head and neck cancers.
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