|Year : 2013 | Volume
| Issue : 4 | Page : 761-762
Phytochemicals: The future of radiation induced mucositis prevention
Trinanjan Basu, Sarbani G Laskar, Tejpal Gupta, Ashwini Budrukkar, Vedang Murthy, Jai P Agarwal
Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
|Date of Web Publication||11-Feb-2014|
Sarbani G Laskar
Department of Radiation Oncology, Room no 128, Ground Floor, Main building, Tata Memorial Hospital, Parel, Mumbai - 400 012, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Basu T, Laskar SG, Gupta T, Budrukkar A, Murthy V, Agarwal JP. Phytochemicals: The future of radiation induced mucositis prevention. J Can Res Ther 2013;9:761-2
|How to cite this URL:|
Basu T, Laskar SG, Gupta T, Budrukkar A, Murthy V, Agarwal JP. Phytochemicals: The future of radiation induced mucositis prevention. J Can Res Ther [serial online] 2013 [cited 2020 Jun 1];9:761-2. Available from: http://www.cancerjournal.net/text.asp?2013/9/4/761/126494
The dilemma in management of radiation-induced mucositis has always been a challenge for the treating radiation oncologist. Several approaches have been tried with varying result. One major step in the management being use of radioprotective compounds. In recent years, it has become well-known that antioxidant phytochemicals present in plants, fruits, and vegetables have potential radioprotective properties.
The herb Tinospora Cordifolia (Guduchi) being evaluated for prevention of radiation-induced mucositis in a placebo-controlled randomized trial. The patients were randomly allocated to receive either 20 gms of the herb with honey or millet syrup as placebo. The trial showed statistically significant reduction in severity of mucositis as per WHO grading. Though had a very small sample size, this pilot study can serve as a guide for future management in this regard. 
Another feasibility study conducted in randomized placebo-controlled setting using gargle containing two drops of a 1:1 mix of the essential oils of manuka (Leptospermum scoparium) and kanuka (Kunzea ericoides) in water. The results showed delayed onset of mucositis and reduced pain and oral symptoms relative to placebo and the control groups. 
Clinicians have also tried to evaluate the effect of indigowood root (Isatis indigotica Fort.) on acute mucositis. The clinical trial showed that application of indigowood root can reduce the severity of radiation mucositis, anorexia and swallowing difficulty, and anti-inflammatory ability of indirubin actually reduce the mucosal damage caused by radiation. This can form the pathway for future clinical trial with indirubin as a potential pharmaceutical agent. 
The various other phytochemicals and isolated reports regarding their benefit have been summarized in [Table 1].
Herbal medicine and phytochemicals are definitely an option to look out for in future in preventing radiation mucositis. There is an ongoing phase 1 trial of grape powder (grape exosome) to prevent oral mucositis in patients with head and neck cancer receiving chemo radiation. This might as well answer a few questions regarding the role of phytochemicals in oral mucositis.  But at this moment, we completely agree with the authors that only well-conducted clinical data can decide the future course of phytochemicals.
| > Acknowledgement|| |
We wish to thank all the authors and their articles from which the references being considered in our article. The students, staff members, residents, and senior faculty members of the Department of Radiation Oncology, Tata Memorial Hospital were of paramount help in writing this review article. Last but never the least, our patients and their sufferings were the key motivating factor behind writing this practical approach.
| > References|| |
|1.||Amruthesh S, Mubeen, Pramod KPR, Venkatesh BA, Ramesh C. Evaluation of radioprotective effects of Tinospora Cordifolia in patients on radiotherapy for squamous cell carcinoma of the Head and Neck- A Pilot Study. Int. Journal of Clinical Dental Sciences IJCDS 2010;1:24-30. |
|2.||Maddocks-Jennings W, Wilkinson JM, Cavanagh HM, Shillington D. Evaluating the effects of the essential oils Leptospermum scoparium (manuka) and Kunzea ericoides (kanuka) on radiotherapy induced mucositis: A randomized, placebo controlled feasibility study. Eur J Oncol Nurs 2009;13:87-93. |
|3.||You WC, Hsieh CC, Huang JT. Effect of extracts from indigowood root (Isatis indigotica Fort.) on immune responses in radiation-induced mucositis. J Altern Complement Med 2009;15:771-8. |
|4.||Chang,Y.S., Pack, C.I. and Noh, H.I. (1980) The effect of Panax ginseng on the postoperative radiation complication in cervical cancer. In Proceedings of the Third International Ginseng Symposium, Korea, September 8-10, pp. 197-205. |
|5.||Kitts DD, Wijewickreme AN, Hu C. Antioxidant properties of a North American ginseng extract. Mol Cell Biochem 2000;203:1-10. |
|6.||Kitts DD, Hu C. Efficacy and safety of ginseng. Pub Health Nut 2000;4:473-85. |
|7.||Abdulrhman M, El Barbary NS, Ahmed AD, Saeid ER. Honey and a mixture of honey, beeswax, and olive oil-propolis extract in treatment of chemotherapy-induced oral mucositis: A randomized controlled pilot study. Pediatr Hematol Oncol 2012;29:285-92. |
|8.||Dörr W, Schlichting S, Bray MA, Flockhart IR, Hopewell JW. Effects of dexpanthenol with or without Aloe vera extract on radiation-induced oral mucositis: Preclinical studies. Int J Radiat Biol 2005;81:243-50. |
|9.||Edible Plant Exosome Ability to Prevent Oral Mucositis Associated With Chemoradiation Treatment of Head and Neck Cancer posted under clinicalTrials.gov identifier: NCT01668849. |