Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of elemental diet on prevention for chemoradiotherapy-induced oral mucositis in patients with oral squamous cell carcinoma

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Oral mucositis induced by radiation or chemoradiation can compromise the quality of life of oral squamous cell carcinoma (OSCC) patients. The present study was designed to evaluate the preventive effects of elemental diet (ED), Elental®, on radiotherapy- or chemoradiotherapy-induced mucositis in OSCC patients.

Patients and methods

Seventy-four patients who underwent radiation (60–70 Gy) with/without chemotherapy [S-1, cisplatin (CDDP), CDDP plus S-1] were enrolled in this retrospective study; 37 had received Elental® during treatment (Elental® group) and 37 had not (control group). Factors related to alleviation of oral mucositis were identified by multivariate logistic regression analysis. Rates of completion of chemoradiation treatments were compared between Elental® and control groups according to the treatment regimen. The comparison of the nutritional status between groups was also performed.

Results

Multivariate analysis indicated that the administration of Elental® and no combined chemotherapy (radiation alone) were significant factors associated with the degree of oral mucositis, i.e., most of the patients who consumed Elental® suffered from a lower degree of mucositis compared to the control group. Elental® was associated with a significantly improved rate of completion of chemoradiation (no interruption). There was no significant difference between Elental® group and control group in terms of mean change of body weight or total protein and albumin levels in blood serum before and after (chemo)radiation.

Conclusions

The present study indicates that Elental® is effective for ameliorating oral mucositis induced by (chemo)radiation in OSCC patients. Elental® was also associated with improved completion rates of (chemo)radiotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rautava J, Luukkaa M, Heikinheimo K, Alin J, Grenman R, Happonen RP (2007) Squamous cell carcinomas arising from different types of oral epithelia differ in their tumor and patient characteristics and survival. Oral Oncol 43:911–919

    Article  PubMed  CAS  Google Scholar 

  2. Funk GF, Karnell LH, Robinson RA, Zhen WK, Trask DK, Hoffman HT (2002) Presentation, treatment, and outcome of oral cavity cancer: a national cancer data base report. Head Neck 24:165–180

    Article  PubMed  Google Scholar 

  3. Mehrotra R, Singh MK, Pandya S, Singh M (2008) The use of an oral brush biopsy without computer-assisted analysis in the oral lesions: a study of 94 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:246–253

    Article  PubMed  Google Scholar 

  4. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  5. Lawoyin JO, Lawoyin DO, Aderinokun G (1997) Intra-oral squamous cell carcinoma in Ibadan: a review of 90 cases. Afr J Med Med Sci 26:187–188

    PubMed  CAS  Google Scholar 

  6. Sonis ST (2011) Oral mucositis. Anti-Cancer Drugs 22:607–612

    Article  PubMed  CAS  Google Scholar 

  7. Robertson C, Robertson AG, Hendry JH, Roberts SA, Slevin NJ, Duncan WB, MacDougall RH, Kerr GR, O’Sullivan B, Keane TJ (1998) Similar decreases in local tumor control are calculated for treatment protraction and for interruptions in the radiotherapy of carcinoma of the larynx in four centers. Int J Radiat Oncol Biol Phys 40:319–329

    Article  PubMed  CAS  Google Scholar 

  8. Bese NS, Hendry J, Jeremic B (2007) Effects of prolongation of overall treatment time due to unplanned interruptions during radiotherapy of different tumor sites and practical methods for compensation. Int J Radiat Oncol Biol Phys 68:654–666

    Article  PubMed  Google Scholar 

  9. Withers HR, Taylor JM, Maciejewski B (1998) The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 27:131–146

    Article  Google Scholar 

  10. Herrmann T, Jakubek A, Trott KR (1994) The importance of the timing of a gap in radiotherapy of squamous cell carcinomas of the head and neck. Strahlenther Onkol 170:545–549

    PubMed  CAS  Google Scholar 

  11. Suwinski R, Sowa A, Rutkowski T, Wydmanski J, Tarnawski R and Maciejewski B (2003) Time factor in postoperative radiotherapy: a multivariate locoregional control analysis in 868 patients. Int J Radiat Oncol Biol Phys 56:399–412, 2003.

  12. Russo G, Haddad R, Posner M, Machtay M (2008) Radiation treatment breaks and ulcerative mucositis in head and neck cancer. Oncologist 13:886–898

    Article  PubMed  Google Scholar 

  13. Sonis ST, Oster G, Fuchs H, Bellm L, Bradford WZ, Edelsberg J, Hayden V, Eilers J, Epstein JB, LeVeque FG, Miller C, Peterson DE, Schubert MM, Spijkervet FK, Horowitz M (2001) Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol 19:2201–2205

    PubMed  CAS  Google Scholar 

  14. Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, Migliorati CA, DB MG, Hutchins RD, Peterson DE, Mucositis Study Section of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109:820–831

    Article  PubMed  CAS  Google Scholar 

  15. Peterson DE, Bensadoun RJ, Roila F, ESMO Guidelines Working Group (2009) Management of oral and gastrointestinal mucositis: ESMO clinical recommendations. Ann Oncol 20(Suppl 4):174–177

    PubMed  Google Scholar 

  16. Quinn B, Potting CM, Stone R, Blijlevens NM, Fliedner M, Margulies A, Sharp L (2008) Guidelines for the assessment of oral mucositis in adult chemotherapy, radiotherapy and haematopoietic stem cell transplant patients. Eur J Cancer 44:61–72

    Article  PubMed  Google Scholar 

  17. Henke M, Alfonsi M, Foa P, Giralt J, Bardet E, Cerezo L, Salzwimmer M, Lizambri R, Emmerson L, Chen MG, Berger D (2011) Palifermin decreases severe oral mucositis of patients undergoing postoperative radiochemotherapy for head and neck cancer: a randomized, placebo-controlled trial. J Clin Oncol 29:2815–2820

    Article  PubMed  CAS  Google Scholar 

  18. Bensinger W, Schubert M, Ang KK, Brizel D, Brown E, Eilers JG, Elting L, Mittal BB, Schattner MA, Spielberger R, Treister NS, Trotti 3rd AM (2008) NCCN Task Force Report. Prevention and management of mucositis in cancer care. J Natl Compr Canc Netw 6(Suppl 1):S1–21 quiz S22–24

    PubMed  CAS  Google Scholar 

  19. Svanberg A, Ohrn K, Birgegard G (2010) Oral cryotherapy reduces mucositis and improves nutrition—a randomised controlled trial. J Clin Nurs 19:2146–2151

    Article  PubMed  Google Scholar 

  20. Scully C, Epstein J, Sonis S (2004) Oral mucositis: a challenging complication of radiotherapy, chemotherapy, and radiochemotherapy. Part 2: diagnosis and management of mucositis. Head Neck 26:77–84

    Article  PubMed  Google Scholar 

  21. Cowen D, Tardieu C, Schubert M, Peterson D, Resbeut M, Faucher C, Franquin JC (1997) Low energy helium-neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: results of a double blind randomized trial. Int J Radiat Oncol Biol Phys 38:697–703

    Article  PubMed  CAS  Google Scholar 

  22. Online Ajinomoto Products Information, Elental®. http://www.ajinomoto.com/en/aboutus/history/chronicle_2014/09.html

  23. Ikeura T, Takaoka M, Uchida K, Miyoshi H, Okazaki K (2014) Beneficial effect of low-fat elemental diet therapy on pain in chronic pancreatitis. Int J Chronic Dis:1–5, Article ID 862091.

  24. Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K (2006) Acute duodenal Crohn’s disease successfully managed with low-speed elemental diet infusion via nasogastric tube: a case report. World J Gastroenterol 12:649–651

    PubMed  PubMed Central  Google Scholar 

  25. Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K (2005) Impact of elemental diet on mucosal inflammation in patients with active Crohn’s disease: cytokine production and endoscopic and histological findings. Inflamm Bowel Dis 11:580–588

    Article  PubMed  Google Scholar 

  26. Nakayama G, Morioka D, Murakami T, Takakura H, Miura Y, Togo S (2012) Chylous ascites occurring after low anterior resection of the rectum successfully treated with an oral fat-free elemental diet (Elental(®)). Clin J Gastroenterol 5:216–219

    Article  PubMed  PubMed Central  Google Scholar 

  27. Choi K, Lee SS, Oh SJ, Lim SY, Lim SY, Jeon WK, Oh TY, Kim JW (2007) The effect of oral glutamine on 5-fluorouracil/leucovorin-induced mucositis/stomatitis assessed by intestinal permeability test. Clin Nutr 26:57–62

    Article  PubMed  CAS  Google Scholar 

  28. Savarese DM, Savy G, Vahdat L, Wischmeyer PE, Corey B (2003) Prevention of chemotherapy and radiation toxicity with glutamine. Cancer Treat Rev 29:501–513

    Article  PubMed  CAS  Google Scholar 

  29. Shou J, Lieberman MD, Hofmann K, Leon P, Redmond HP, Davies H, Daly JM (1991) Dietary manipulation of methotrexate-induced enterocolitis. JPEN J Parenter Enteral Nutr 15:307–312

    Article  PubMed  CAS  Google Scholar 

  30. Ziegler TR, Young LS, Benfell K, Scheltinga M, Hortos K, Bye R, Morrow FD, Jacobs DO, Smith RJ, Antin JH, Wilmore DW (1992) Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study. Ann Intern Med 116:821–828

    Article  PubMed  CAS  Google Scholar 

  31. Ogata Y, Takeuchi M, Ishibashi N, Kibe S, Takahashi K, Uchida S, Murakami N, Yahara T, Shirouzu K (2012) Efficacy of Elental on prevention for chemotherapy-induced oral mucositis in colorectal cancer patients. Gan To Kagaku Ryoho 39:583–587 Japanese

    PubMed  Google Scholar 

  32. Fukui T, Itoh Y, Orihara M, Yoshizawa K, Takeda H, Kawada S, Yoshioka T (2011) Elental prevented and reduced oral mucositis during chemotherapy in patients esophageal cancer. Gan To Kagaku Ryoho 38:2597–2601 Japanese

    PubMed  Google Scholar 

  33. Online Nestle Products Information, VIVONEX® T.E.N. http://www.nestle-nutrition.com/products/Product.aspx?ProductId=a3bc4b10-3701-4020-9742-d947a30ed612

  34. Bieri S, Bentzen SM, Huguenin P, Allal AS, Cozzi L, Landmann C, Monney M, Bernier J (2003) Early morbidity after radiotherapy with or without chemotherapy in advanced head and neck cancer. Experience from four non-randomized studies. Strahlenther Onkol 179:390–395

    PubMed  Google Scholar 

  35. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, Van Glabbeke M, European Organization for Research and Treatment of Cancer Trial 22931 (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952

    Article  PubMed  CAS  Google Scholar 

  36. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK, Radiation Therapy Oncology Group 9501/Intergroup (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944

    Article  PubMed  Google Scholar 

  37. Lin A, Jabbari S, Worden FP, Bradford CR, Chepeha DB, Teknos TN, Liao JJ, Nyquist GG, Tsien C, Schipper MJ, Urba S, Wolf GT, Eisbruch A (2005) Metabolic abnormalities associated with weight loss during chemoirradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 63:1413–1418

    Article  PubMed  CAS  Google Scholar 

  38. Gibson RJ, Keefe DM, Lalla RV, Bateman E, Blijlevens N, Fijlstra M, King EE, Stringer AM, Van der Velden WJ, Yazbeck R, Elad S, Bowen JM, Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) (2013) Systematic review of agents for the management of gastrointestinal mucositis in cancer patients. Support Care Cancer 21:313–326

    Article  PubMed  Google Scholar 

  39. Hensley ML, Hagerty KL, Kewalramani T, Green DM, Meropol NJ, Wasserman TH, Cohen GI, Emami B, Gradishar WJ, Mitchell RB, Thigpen JT, Trotti 3rd A, Von Hoff D, Schuchter LM (2009) American Society of Clinical Oncology 2008 clinical practice guideline update: use of chemotherapy and radiation therapy protectants. J Clin Oncol 27:127–145

    Article  PubMed  CAS  Google Scholar 

  40. Peterson DE, Bensadoun RJ, Roila F, ESMO Guidelines Working Group (2011) Management of oral and gastrointestinal mucositis: ESMO clinical practice guidelines. Ann Oncol 22:vi78–vi84

    Article  PubMed  PubMed Central  Google Scholar 

  41. Le QT, Kim HE, Schneider CJ, Muraközy G, Skladowski K, Reinisch S, Chen Y, Hickey M, Mo M, Chen MG, Berger D, Lizambri R, Henke M (2011) Palifermin reduces severe mucositis in definitive chemoradiotherapy of locally advanced head and neck cancer: a randomized, placebo-controlled study. J Clin Oncol 29:2808–2814

    Article  PubMed  CAS  Google Scholar 

  42. Bossi P, Locati LD, Licitra L (2012) Palifermin in prevention of head and neck cancer radiation-induced mucositis: not yet a definitive word on safety and efficacy profile. J Clin Oncol 30:565–567

    Article  Google Scholar 

Download references

Conflict of interest

There is no financial support for the present study, and the authors declare that there are no competing interests. The authors are fully responsible for the content of this paper. All authors reviewed and approved the paper.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, 755-8505, Japan

    Koji Harada, Tarannum Ferdous, Daiju Horinaga, Kenichiro Uchida, Takamitsu Mano, Katsuaki Mishima & Yoshiya Ueyama

  2. Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, 755-8505, Japan

    SungChul Park, Hideki Hanazawa, Shotaro Takahashi & Keiko Shibuya

  3. Department of Nursing, Yamaguchi University Hospital, 1-1-1, Minamikogushi, Ube, 755-8505, Japan

    Atsumi Okita, Misaki Fukunaga, Junko Maruta & Naoko Kami

Authors
  1. Koji Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tarannum Ferdous
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daiju Horinaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenichiro Uchida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takamitsu Mano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katsuaki Mishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. SungChul Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideki Hanazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shotaro Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Atsumi Okita
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Misaki Fukunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Junko Maruta
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Naoko Kami
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Keiko Shibuya
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yoshiya Ueyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koji Harada.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harada, K., Ferdous, T., Horinaga, D. et al. Efficacy of elemental diet on prevention for chemoradiotherapy-induced oral mucositis in patients with oral squamous cell carcinoma. Support Care Cancer 24, 953–959 (2016). https://doi.org/10.1007/s00520-015-2866-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-2866-7

Keywords

Search

Navigation