Clinical results of acetylcysteine use for pathogenetic prevention of oral mucositis induced by chemotherapy in children

Abstract

Nowadays hypothesis of the pathogenesis of oral mucositis, that complicates anti-cancer treatment, gives a major role in tissue injury and inflammation to free radicals. This suggests the possibility of control with antioxidants for not only a radiomucositis, but also chemotherapy-induced mucositis. The purpose. To evaluate the clinical efficacy of antioxidant as a potential agent for pathogenetic prevention of chemotherapy mucositis accompanying use of high-dose methotrexate. Methods. Twenty-nine children and adolescents with oncohematological pathology in 87 episodes of chemotherapy with high-dose methotrexate participated in a randomized controlled longitudinal study. Fourteen patients had been receiving acetylcysteine in standard dosages in addition to standard treatment from 1 st to 10 th days of 41 chemotherapy episodes; other cases formed the control group. Dentist examined oral cavity of each patient daily in each episode of chemotherapy during two weeks after the administration of methotrexate for mucositis detection. Status of the oral mucosa was evaluated according with the criteria of the WHO oral toxicity index (iWHO), that were used to record the presence, severity and duration of mucositis. The average rate of mucositis for each patient was calculated as the proportion of high-dose chemotherapy episodes, which are complicated with mucositis, in the total number of episodes of the patient passed (one to four). Statistic data were analyzed by methods of nonparametric statistics using Pearson criterion, Fisher and Mann—Whitney; critical significance level adopted p<0,05. Results. During the research period, we have observed 53 cases of oral mucositis (including 15 severe cases) in 24 patients with duration of episodes from 2 to 25 days. There were not found any statistically significant differences between two groups in the average frequency, severity and in duration of oral mucositis episodes. Conclusion. The results of the research do not provide grounds to confirm the efficacy of antioxidant (acetylcysteine) for the pathogenic prevention of oral mucositis induced by chemotherapy.