Medical Oncology

, 34:30 | Cite as

Management of acute skin toxicity with Hypericum perforatum and neem oil during platinum-based concurrent chemo-radiation in head and neck cancer patients

  • Pierfrancesco FrancoEmail author
  • Monica Rampino
  • Oliviero Ostellino
  • Marina Schena
  • Giancarlo Pecorari
  • Paolo Garzino Demo
  • Massimo Fasolis
  • Francesca Arcadipane
  • Stefania Martini
  • Chiara Cavallin
  • Mario Airoldi
  • Umberto Ricardi
Original Paper


Acute skin toxicity is a frequent finding during combined radiotherapy and chemotherapy in head and neck cancer patients. Its timely and appropriate management is crucial for both oncological results and patient’s global quality of life. We herein report clinical data on the use of Hypericum perforatum and neem oil in the treatment of acute skin toxicity during concurrent chemo-radiation for head and neck cancer. A consecutive series of 50 head and neck cancer patients undergoing concomitant radio-chemotherapy with weekly cisplatin was analyzed. Treatment with Hypericum perforatum and neem oil was started in case of G2 acute skin toxicity according to the RTOG/EORTC scoring scale and continued during the whole treatment course and thereafter until complete recovery. The maximum detected acute skin toxicity included Grade 2 events in 62% of cases and G3 in 32% during treatment and G2 and G3 scores in 52 and 8%, respectively, at the end of chemo-radiation. Grade 2 toxicity was mainly observed during weeks 4–5, while G3 during weeks 5–6. Median times spent with G2 or G3 toxicity were 23.5 and 14 days. Patients with G3 toxicity were reconverted to a G2 profile in 80% of cases, while those with a G2 score had a decrease to G1 in 58% of cases. Time between maximum acute skin toxicity and complete skin recovery was 30 days. Mean worst pain score evaluated with the Numerical Rating Scale-11 was 6.9 during treatment and 4.5 at the end of chemo-radiotherapy. Hypericum perforatum and neem oil proved to be a safe and effective option in the management of acute skin toxicity in head and neck cancer patients submitted to chemo-radiation with weekly cisplatin. Further studies with a control group and patient-reported outcomes are needed to confirm this hypothesis.


Head and neck cancer Concomitant chemo-radiotherapy Skin toxicity Hypericum perforatum Neem oil 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Pierfrancesco Franco
    • 1
    Email author
  • Monica Rampino
    • 2
  • Oliviero Ostellino
    • 3
  • Marina Schena
    • 4
  • Giancarlo Pecorari
    • 5
  • Paolo Garzino Demo
    • 6
  • Massimo Fasolis
    • 6
  • Francesca Arcadipane
    • 1
  • Stefania Martini
    • 1
  • Chiara Cavallin
    • 1
  • Mario Airoldi
    • 2
  • Umberto Ricardi
    • 1
  1. 1.Department of Oncology, Radiation OncologyUniversity of TurinTurinItaly
  2. 2.Department of Oncology, Radiation OncologyAOU Citta’ della Salute e della ScienzaTurinItaly
  3. 3.2nd Medical Oncology Division, Department of OncologyAOU Città della Salute e della ScienzaTurinItaly
  4. 4.1st Medical Oncology Division, Department of OncologyAOU Città della Salute e della ScienzaTurinItaly
  5. 5.1st ENT Division, Department of Surgical SciencesUniversity of TurinTurinItaly
  6. 6.Maxillofacial Surgery Division, Department of Surgical SciencesUniversity of TurinTurinItaly

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