PROPHYLAXIS WITH POVIDONE-IODINE AGAINST INDUCTION OF ORAL MUCOSITIS BY RADIOCHEMOTHERAPY

Oral mucositis is a frequent complication of radiochemotherapy. The or igin of radiation-induced mucosal lesions is iatrogenic in nature, alt hough further development of mucositis is essentially influenced by in fection. It can be assumed that disinfection measures should decrease the severity of mucositis induced by radiochemotherapy, Therefore, in a prospective randomised study the efficacy of prophylactic oral rinsi ng with a disinfection agent was investigated. A randomised, prospecti ve comparative trial was conducted with 40 patients undergoing radioch emotherapy of the head and neck region because of malignant disease. T he treatment scheme consisted of irradiation to the tumour region and adjacent lymph nodes, with a total dose of 71.3 Gy, and simultaneous c hemotherapy with carboplatin (60 mg/m(2)) on days 1-5 and 29-34. In al l patients mucositis prophylaxis with nystatin, rutosides, panthenol a nd immunoglobulin was undertaken. In addition, 20 patients rinsed the oral cavity 4 times daily with povidone-iodine solution, while the gro up for comparison rinsed with sterile water, Clinical examination of t he oral mucosa was performed weekly, Onset, grading and duration of mu cositis were used as the main variables. Clinically manifest oral muco sitis was observed in 14 patients in the iodine group (mean grading: 1 .0) and in all 20 patients in the control group (mean grading: 3,0), T he total duration (mean) of clinically observed mucositis was 2.75 wee ks in treatment patients and 9.25 weeks in control patients. Median AU C (area under curve for grade vs duration) was 2.5 in the iodine rinsi ng patients and 15.75 in control patients. All differences found betwe en the two groups were statistically significant, Increased iodine inc orporation was not observed. A pathologic rise in thyroid hormone leve ls was not found in the iodine group. The results obtained indicate th at in and duration of radiochemotherapy-induced mucositis can be signi ficantly reduced by oral rinsing with povidone-iodine in addition to t he standard prophylaxis scheme, It can be concluded that rinsing with povidone-iodine is an easy, cheap and safe prophylactic method and can be recommended as a supportive treatment during antineoplastic treatm ent of the head and neck region.