PROPHYLAXIS OF RADIOCHEMOTHERAPY-INDUCED MUCOSITIS - EFFICACY OF THE PROPHYLACTIC ORAL RINSING WITH POVIDONE-IODINE SOLUTION

Background: Oral mucositis is a frequent complication of radiochemothe rapy. The origin of radiation-induced mucosa lesions is of iatrogenic nature although further development of mucositis is essentially influe nced by infection. It can be assumed that disinfection measures should decrease the severity of mucositis induced by radiochemotherapy. Ther efore, in a prospective randomised study the efficacy of prophylactic oral rinsing with a disinfection agent was investigated. Patients and Method: An open, randomised, prospective comparative trial was conduct ed with 40 patients undergoing radiochemotherapy of head and neck regi on due to malignant disease. The treatment scheme consisted of irradia tion to tumor region and adjacent lymph nodes with a total dose of 71. 3 Gy and simultaneous chemotherapy with carboplatin (60 mg/m(2)) on da ys 1 to 5 and 29 to 34. In all patients, a prophylaxis of mucositis wi th nystatine, rutosides, panthenol and immunoglobulin was undertaken. In addition, 20 patients rinsed oral cavity 4 times daily with povidon e-iodine-solution, the comparative group rinsed with sterile water. Cl inical examination of the oral mucosa was performed weekly. Onset, gra ding and duration of mucositis were used as main variables. Results: C linically manifested oral mucositis was observed in 14 patients of the iodine group (mean grading: 1.0) and all 20 patients of the control g roup (mean grading: 3.0). Total duration (mean) of clinically observed mucositis was 2.75 weeks in treatment patients and 9.25 in control pa tients. Median AUC (area under curve for grade vs duration) was 2.5 in iodine rinsing patients and 15.75 in control patients. All difference s found between the 2 groups were statistically significant. Increased iodine incorporation was not observed. A pathological increase of thy roid hormone levels in the iodine group was not found.Conclusions: The gained results indicate that incidence, severity and duration of radi ochemotherapy-induced mucositis can be significantly reduced by oral r insing with povidone-iodine performed additionally to the standard pro phylaxis scheme.