Supportive Care in Cancer

, Volume 13, Issue 1, pp 42–48 | Cite as

Clinical effects of flurbiprofen tooth patch on radiation-induced oral mucositis. A pilot study

  • M. A. Stokman
  • F. K. L. Spijkervet
  • F. R. Burlage
  • J. L. N. Roodenburg
Original Article

Abstract

Background

Mucositis is an oral sequela of radiotherapy. In the development of mucositis several mechanisms play a role, such as inflammation and the effect of radiation on the high proliferation rate of oral basal epithelial cells. Therefore, administration of a drug with antiinflammatory and antiproliferative properties might delay the disorder and/or alleviate the severity of oral mucositis. The aim of this pilot study was to evaluate the effect of flurbiprofen in a tooth patch on the development, severity and duration of pseudomembranous mucositis in patients treated with curative head and neck radiotherapy.

Methods

The study group comprised 12 patients with a malignant tumor in the head and neck region to be treated with primary curative or postoperative radiotherapy. Patients applied once a day before sleep a flurbiprofen tooth patch to a natural tooth or upper denture during the full course of radiotherapy, starting 1 week before the onset of radiotherapy. Oral mucositis, pain, feeding, body weight and viability and maturation of epithelial cells were assessed. The results were compared with the findings in a historical control group.

Results

No differences were found for severity and duration of pseudomembranous mucositis between the two groups. The onset of pseudomembranous/ulcerative mucositis occurred later in the flurbiprofen group (14.6±3.8 days, mean±SD) than in the historical control group (11±3.5 days; P<0.05).

Conclusion

This study shows that the flurbiprofen 15 mg tooth patch cannot prevent the development of pseudomembranous mucositis and has no influence on the duration of oral mucositis.

Keywords

Mucositis Head and neck cancer Radiotherapy Flurbiprofen NSAID 

References

  1. 1.
    Anonymous (1989) Oral complications of cancer therapies: diagnosis, prevention, and treatment. National Institutes of Health. Conn Med 53:595–601PubMedGoogle Scholar
  2. 2.
    Anonymous (1993) Prescribing, recording and reporting photon beam therapy (ICRU report no. 50). ICRU Publications, Bethesda, MDGoogle Scholar
  3. 3.
    Baker DG (1982) The radiobiological basis for tissue reactions in the oral cavity following therapeutic X-irradiation. A review. Arch Otolaryngol 108:21–24PubMedGoogle Scholar
  4. 4.
    Buntzel J, Kuttner K, Frohlich D, Glatzel M (1998) Selective cytoprotection with amifostine in concurrent radiochemotherapy for head and neck cancer. Ann Oncol 9:505–509CrossRefPubMedGoogle Scholar
  5. 5.
    Clarkson JE, Worthington HV (2004) Interventions for preventing oral mucositis for patients with cancer receiving treatment (Cochrane Review). Cochrane Library, John Wiley & Sons, Chichester, UKGoogle Scholar
  6. 6.
    Dorr W (1998) Radiobiological models of normal tissue reactions. Strahlenther Onkol 174 [Suppl 3]:4–7Google Scholar
  7. 7.
    Dubois RN, Abramson SB, Crofford L, Gupta RA, Simon LS, Van De Putte LBA, Lipsky PE (1998) Cyclooxygenase in biology and disease. FASEB J 12:1063–1073PubMedGoogle Scholar
  8. 8.
    Epstein JB, Silverman S Jr, Paggiarino DA, Crockett S, Schubert MM, Senzer NN, Lockhart PB, Gallagher MJ, Peterson DE, LeVeque FG (2001) Benzydamine HCl for prophylaxis of radiation-induced oral mucositis: results from a multicenter, randomized, double-blind, placebo-controlled clinical trial. Cancer 92:875–885CrossRefPubMedGoogle Scholar
  9. 9.
    Lozanski G, Ballou SP, Kushner I (1992) Effect of flurbiprofen on cytokine production by human monocytes and U-937 and THP-1 cell lines. J Rheumatol 19:921–926PubMedGoogle Scholar
  10. 10.
    Matejka M, Nell A, Kment G, Schein A, Leukauf M, Porteder H, Mailath G, Sinzinger H (1990) Local benefit of prostaglandin E2 in radiochemotherapy-induced oral mucositis. Br J Oral Maxillofac Surg 28:89–91PubMedGoogle Scholar
  11. 11.
    Meredith R, Salter M, Kim R, Spencer S, Weppelmann B, Rodu B, Smith J, Lee J (1997) Sucralfate for radiation mucositis: results of a double-blind randomized trial. Int J Radiat Oncol Biol Phys 37:275–279CrossRefPubMedGoogle Scholar
  12. 12.
    Miralbell R, Allal AS, Mermillod B, Pastoors B (1999) The influence of field size and other radiotherapy parameters on acute toxicity in pharyngolaryngeal cancers. Strahlenther Onkol 175:74–77Google Scholar
  13. 13.
    Papanicolaou GN, Traut HF (1943) Diagnosis of uterine cancer by the vaginal smears. Commonwealth Fund, New YorkGoogle Scholar
  14. 14.
    Rahn R, Adamietz IA, Boettcher HD, Schaefer V, Reimer K, Fleischer W (1997) Povidone-iodine to prevent mucositis in patients during antineoplastic radiochemotherapy. Dermatology 195 [Suppl 2]:57–61Google Scholar
  15. 15.
    Rubenstein EB, Peterson DE, Schubert M, Keefe D, McGuire D, Epstein J, Elting LS, Fox PC, Cooksley C, Sonis ST (2004) Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 100:2026–2046Google Scholar
  16. 16.
    Saarilahti K, Kajanti M, Joensuu T, Kouri M, Joensuu H (2002) Comparison of granulocyte-macrophage colony-stimulating factor and sucralfate mouthwashes in the prevention of radiation-induced mucositis: a double-blind prospective randomized phase III study. Int J Radiat Oncol Biol Phys 54:479–485CrossRefPubMedGoogle Scholar
  17. 17.
    Sonis ST (2004) The pathobiology of mucositis. Nat Rev Cancer 4:277–284Google Scholar
  18. 18.
    Sonis ST, Eilers JP, Epstein JB, LeVeque FG, Liggett WH Jr, Mulagha MT, Peterson DE, Rose AH, Schubert MM, Spijkervet FKL, Wittes JP (1999) Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis Study Group. Cancer 85:2103–2113CrossRefPubMedGoogle Scholar
  19. 19.
    Sonis ST, O’Donnell KE, Popat R, Bragdon C, Phelan S, Cocks D, Epstein JB (2004) The relationship between mucosal cyclooxygenase-2 (COX-2) expression and experimental radiation-induced mucositis. Oral Oncol 40:170–176CrossRefPubMedGoogle Scholar
  20. 20.
    Spijkervet FKL, Panders AK, Vermey A, Mehta DM (1989) Scoring irradiation mucositis in head and neck cancer patients. J Oral Pathol Med 18:167–171PubMedGoogle Scholar
  21. 21.
    Stokman MA, Spijkervet FKL, Wymenga ANM, Burlage FR, Timens W, Roodenburg JLN, de Vries EGE (2002) Quantification of oral mucositis due to radiotherapy by determining viability and maturation of epithelial cells. J Oral Pathol Med 31:153–157CrossRefPubMedGoogle Scholar
  22. 22.
    Stokman MA, Spijkervet FKL, Burlage FR, Dijkstra PU, Manson WL, de Vries EGE, Roodenburg JLN (2003) Oral mucositis and selective elimination of oral flora in head and neck cancer patients receiving radiotherapy: a double-blind randomised clinical trial. Br J Cancer 88:1012–1016CrossRefPubMedGoogle Scholar
  23. 23.
    Sutherland SE, Browman GP (2001) Prophylaxis of oral mucositis in irradiated head-and-neck cancer patients: a proposed classification scheme of interventions and meta-analysis of randomized controlled trials. Int J Radiat Oncol Biol Phys 49:917–930CrossRefPubMedGoogle Scholar
  24. 24.
    Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, Komaroff E, Nalysnyk L, Zilberberg MD (2003) Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 66:253–262CrossRefPubMedGoogle Scholar
  25. 25.
    Vane JR, Botting RM (1998) Anti-inflammatory drugs and their mechanism of action. Inflamm Res 47:S78–S87CrossRefPubMedGoogle Scholar
  26. 26.
    Vissink A, Burlage FR, Spijkervet FKL, Jansma J, Coppes RP (2003) Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med 14:213–225PubMedGoogle Scholar
  27. 27.
    Zevin S, Swed E, Cahan C (2003) Clinical effects of locally delivered nicotine in obstructive sleep apnea syndrome. Am J Ther 10:170–175CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • M. A. Stokman
    • 1
  • F. K. L. Spijkervet
    • 1
  • F. R. Burlage
    • 2
  • J. L. N. Roodenburg
    • 1
  1. 1.Department of Oral and Maxillofacial SurgeryUniversity Hospital GroningenRB GroningenThe Netherlands
  2. 2.Department of RadiotherapyUniversity Hospital GroningenThe Netherlands

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