Use of Curcumin in Radiochemotherapy Induced Oral Mucositis Patients: A Control Trial Study

Authors: Shivayogi Charantimath

Abstract:

Radiotherapy and chemotherapy are effective for treating malignancies but are associated with side effects like oral mucositis. Chlorhexidine gluconate is one of the most commonly used mouthwash in prevention of signs and symptoms of mucositis. Evidence shows that chlorhexidine gluconate has side effects in terms of colonization of bacteria, bad breadth and less healing properties. Thus, it is essential to find a suitable alternative therapy which is more effective with minimal side effects. Curcumin, an extract of turmeric is gradually being studied for its wide-ranging therapeutic properties such as antioxidant, analgesic, anti-inflammatory, antitumor, antimicrobial, antiseptic, chemo sensitizing and radio sensitizing properties. The present study was conducted to evaluate the efficacy and safety of topical curcumin gel on radio-chemotherapy induced oral mucositis in cancer patients. The aim of the study is to evaluate the efficacy and safety of curcumin gel in the management of oral mucositis in cancer patients undergoing radio chemotherapy and compare with chlorhexidine. The study was conducted in K.L.E. Society’s Belgaum cancer hospital. 40 oral cancer patients undergoing the radiochemotheraphy with oral mucositis was selected and randomly divided into two groups of 20 each. The study group A [20 patients] was advised Cure next gel for 2 weeks. The control group B [20 patients] was advised chlorhexidine gel for 2 weeks. The NRS, Oral Mucositis Assessment scale and WHO mucositis scale were used to determine the grading. The results obtained were calculated by using SPSS 20 software. The comparison of grading was done by applying Mann-Whitney U test and intergroup comparison was calculated by Wilcoxon matched pairs test. The NRS scores observed from baseline to 1^st and 2^nd week follow up in both the group showed significant difference. The percentage of change in erythema in respect to group A was 63.3% for first week and for second week, changes were 100.0% with p = 0.0003. The changes in Group A in respect to erythema was 34.6% for 1^st week and 57.7% in second week. The intergroup comparison was significant with p value of 0.0048 and 0.0006 in relation to group A and group B respectively. The size of the ulcer score was measured which showed 35.5% [P=0.0010] of change in Group A for 1^st and 2^nd week showed totally reduction i.e. 103.4% [P=0.0001]. Group B showed 24.7% change from baseline to 1^st week and 53.6% for 2^nd week follow up. The intergroup comparison with Wilcoxon matched pair test was significant with p=0.0001 in group A. The result obtained by WHO mucositis score in respect to group A shows 29.6% [p=0.0004] change in first week and 75.0% [p=0.0180] change in second week which is highly significant in comparison to group B. Group B showed minimum changes i.e. 20.1% in 1^st week and 33.3% in 2^nd week. The p value with Wilcoxon was significant with 0.0025 in Group A for 1^st week follow up and 0.000 for 2^nd week follow up. Curcumin gel appears to an effective and safer alternative to chlorhexidine gel in treatment of oral mucositis.

Keywords: Curcumin, chemotherapy, mucositis, radiotherapy.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1124161

References:

[1] Reason Wilken, Mysore S Veena, arilene B Wang and Eri S Srivatsan Curcumin: A review of anti-cancer properties and therapeutic activity in head and neck squamous cell carcinoma Molecular Cancer 2011.
[2] Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Littlewood A, et al. Interventions for preventing oral mucositis for patients with cancer receiving treatment (Review). The Cochrane Library. 2013; 2:1-263.
[3] Bensinger W, Schubert M, Ang KK, Brizel D; Brown E, Eilers JG, et al. NCCN task force report: prevention and management of mucositis in cancer care. Journal of the National Comprehensive Cancer Network. 2008;6(1): S1-24.
[4] Barasch A, Elad S, Altman A, Damato K, Epstein J. Antimicrobials, mucosal coating agents, anesthetics, analgesics, and nutritional supplements for alimentary tract mucositis. Support Care Cancer. 2006; 14: 528–32.
[5] Hodgkinson B, Long L, Evans D. Prevention and treatment of oral mucositis in cancer patients. Best Practice. 1998;2(3):1-6.
[6] Sharmila Devi, Prsanna Neelkantan Curcumin- Pharmacological Actions and Its Role in Dentistry Asian J Pharmaceut Res Health Care: 6: 119-22.
[7] Chaturvedi TP. Uses of turmeric in dentistry: An update. Indian J Dent Res. 2009;20 (1): 107-09.
[8] Nagpal M, Sood S. Role of curcumin in systemic and oralhealth. Journal of Natural Science, Biology and Medicine. 2013;4(1):3-7.
[9] Mimeault M, Batra SK. Potential applications of curcumin and its novel synthetic analogs and nanotechnology-based formulations in cancer prevention and therapy. Chinese Medicine. 2011;6(31):1-19
[10] Bensinger W, Schubert M, Ang KK, Brizel D; Brown E, Eilers JG, et al. NCCN task force report: prevention and management of mucositis in cancer care. Journal of the National Comprehensive Cancer Network. 2008;6(1): S1-24.
[11] Sonis ST. Pathobiology of Oral Mucositis: novel insights and opportunities. J Support Oncol. 2007; 5: 3–11.
[12] Ferretti GA, Raybould TP, Brown AT, Macdonald JS, Greenwood M, Maruyama Y, et al. Chlorhexidine prophylaxis for chemotherapy- and radiotherapy-induced stomatitis: a randomized double-blind trial. Oral Surg Oral Med Oral Pathol. 1990;69: 331-38.
[13] Soares AF, Aquino ARL, Carvalho CHP, Nonaka CFW, Almeida D, Pinto P. Frequency of oral mucositis and microbiological analysis in children with acute lymphoblastic leukemia treated with 0.12% Chlorhexidine gluconate. Braz Dent J. 2011;22 (4):312-16.
[14] Foote RL, Loprinzi CL, Frank AR, O'Fallon JR, Gulavita S, Tewfik HH, et al. Randomized trial of a chlorhexidine mouthwash for alleviation of radiation induced mucositis. J Clin Oncol. 1994;12: 2630-33.
[15] Karthekey Patil, Mahimaa Guled Gud, Pk Kulkarni, Deepika Keshari, Shristi Tayal Use of Curcumin Mouth Rine in Radio-Chemotheraphy Induces Oral Mucositis: A Pilot Study. Journal of Clinical and Diagnostic Research. 2015 Aug, 9(8): ZC59-ZC62.
[16] Dr Radha, Dr Anjana Bagewadi Comparison of effectiveness of curcumin with triamcinolone acetonide in the gel form in treatment of minor recurrent aphthous stomatitis: A randomized clinical trial J Pharma Invest 2014 July –Sept;4(3):138-147.
[17] Aggarwal, et al. Anticancer potential of curcumin (Review). Anticancer Research.2003;23: 363-98.
[18] Land B, Blijlevens NMA, Marteijn J, Timal S, Donnelly JP, Witte TJM, et al. Role of curcumin and the inhibition of NF-ķB in the onset of chemotherapy-induced mucosal barrier injury. Leukemia. 2004; 18: 276–84.
[19] Elad S, Meidan I, Sellam G, et al. Topical curcumin for the prevention of oral mucositis in paediatric patients: case series. Altern Ther Health Med. 201319(3):21-24.