Oral glutamine to alleviate radiation-induced oral mucositis: A pilot randomized trial

Purpose: To evaluate the influence of oral glutamine on radiation induced o ral mucositis in the radiotherapy of head and neck cancer. Methods and Materials: From July 1997 through June 1998, 17 patients with h ead and neck cancer receiving primary or adjuvant irradiation were randomiz ed to either glutamine suspension (16 g in 240 ml normal saline) (n = 8) or placebo (normal saline) (n = 9) arm. Patients were instructed to swish the test solutions (30 ml) four times per day. All patients received half-mout h irradiation at least. Patients were treated 1.8 Gy per fraction daily, 5 days a week. We evaluated the grading of oral mucositis daily fraction at e ach day of treatment until 45 Gy/25 fractions. World Health Organization (W HO) step analgesic medication and body weight change were compared between the two arms, Results: The duration of objective oral mucositis 5 greater than or equal t o Grade 1 (p = 0.0097), Grade 2 (p = 0.0232), and Grade 3 (p 0.0168) was sh orter in the glutamine arm. Mean maximum grade of objective oral mucositis was less severe in the glutamine arm (1.6 vs, 2.6) (p = 0.0058). Glutamine did not reduce the duration and severity of subjective oral mucositis excep t for duration greater than or equal to Grade 3 (p = 0.0386), In the analys is of mean maximum WHO step of analgesic medication, there was no statistic al difference (p = 0.5374) between the two arms. Mean body weight change wa s also not significantly different (p = 0.8070), Conclusions: Oral glutamine may significantly reduce the duration and sever ity of objective oral mucositis during radiotherapy. It may shorten the dur ation of 1 Grade 3 subjective mucositis, (C) 2000 Elsevier Science Inc.