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Published in: Supportive Care in Cancer 4/2003

01-04-2003 | Original Article

Topical application of honey in the management of radiation mucositis. A Preliminary study

Authors: Biswa Mohan Biswal, Ahmad Zakaria, Nik Min Ahmad

Published in: Supportive Care in Cancer | Issue 4/2003

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Abstract

Background

The aim of this study was to evaluate the effect of pure natural honey on radiation-induced mucositis.

Patients and methods

Forty patients diagnosed with head and neck cancer requiring radiation to the oropharyngeal mucosal area were divided in to two groups to receive either radiation alone or radiation plus topical application of pure natural honey. Patients were treated using a 6-MV linear accelerator at a dose rate of 2 Gy per day five times a week up to a dose of 60–70 Gy. In the study arm, patients were advised to take 20 ml of pure honey 15 min before, 15 min after and 6 h post-radiation therapy. Patients were evaluated every week for the development of radiation mucositis using the Radiation Therapy Oncology Group (RTOG) grading system.

Main results

There was significant reduction in the symptomatic grade 3/4 mucositis among honey-treated patients compared to controls; i.e. 20% versus 75% (p 0.00058). The compliance of honey-treated group of patients was better than controls. Fifty-five percent of patients treated with topical honey showed no change or a positive gain in body weight compared to 25% in the control arm (p 0.053), the majority of whom lost weight.

Conclusions

Topical application of natural honey is a simple and cost-effective treatment in radiation mucositis, which warrants further multi-centre randomised trials to validate our finding.
Literature
1.
go back to reference Greenlee RT, Murray T, Bolden S, Wingo PA (2000) Cancer statistics 2000. CA Cancer J Clin 50:7–33PubMed Greenlee RT, Murray T, Bolden S, Wingo PA (2000) Cancer statistics 2000. CA Cancer J Clin 50:7–33PubMed
2.
go back to reference Trotti A (2000) Toxicity in head and neck cancer: a review of trends and issues. Int J Radiat Oncl Biol Phys 47:1–12CrossRef Trotti A (2000) Toxicity in head and neck cancer: a review of trends and issues. Int J Radiat Oncl Biol Phys 47:1–12CrossRef
3.
go back to reference Lee DJ, Cosmatos D, Marcial VA et al (1995) Results of an RTOG phase III trial (RTOG 85–27) comparing radiotherapy plus etanidazole with radiotherapy alone for locally advanced head and neck carcinomas . Int J Radiat Oncol Biol Phys 32:567–576PubMed Lee DJ, Cosmatos D, Marcial VA et al (1995) Results of an RTOG phase III trial (RTOG 85–27) comparing radiotherapy plus etanidazole with radiotherapy alone for locally advanced head and neck carcinomas . Int J Radiat Oncol Biol Phys 32:567–576PubMed
4.
go back to reference Fu KK (1993) RTOG (90–03): A phase III randomized study to compare twice daily hyperfractionation, accelerated fractionation with concomitant boost to standard fractionation radiotherapy for squamous cell carcinoma of the head and neck. Data on file, Radiation Treatment Oncology Group, Philadelphia Fu KK (1993) RTOG (90–03): A phase III randomized study to compare twice daily hyperfractionation, accelerated fractionation with concomitant boost to standard fractionation radiotherapy for squamous cell carcinoma of the head and neck. Data on file, Radiation Treatment Oncology Group, Philadelphia
5.
go back to reference Horiot K, Le Fur R, N'Guyen T et al (1992) Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol 25:231–241 Horiot K, Le Fur R, N'Guyen T et al (1992) Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol 25:231–241
6.
go back to reference Dische S, Saunders M, Barrett A et al (1997) Accelerated fractionation (AF) compared to conventional fractionation (CF) Improve loco-regional control in the radiotherapy of advanced head and neck cancers: results of the EORTC 22851 trial. Radiother Oncol 44:123–136CrossRef Dische S, Saunders M, Barrett A et al (1997) Accelerated fractionation (AF) compared to conventional fractionation (CF) Improve loco-regional control in the radiotherapy of advanced head and neck cancers: results of the EORTC 22851 trial. Radiother Oncol 44:123–136CrossRef
7.
go back to reference Trotti A, Mocharnuk RS (2001) Management of radiation-induced toxicity in patients with head and neck cancer. Medscape 6:1–14 Trotti A, Mocharnuk RS (2001) Management of radiation-induced toxicity in patients with head and neck cancer. Medscape 6:1–14
8.
go back to reference Epstein JB, Wong FL (1994) The efficacy of sucralfate suspension in the prevention of mucositis due to radiation therapy. Int J Radiat Oncol Biol Phys 28:693–698 Epstein JB, Wong FL (1994) The efficacy of sucralfate suspension in the prevention of mucositis due to radiation therapy. Int J Radiat Oncol Biol Phys 28:693–698
9.
go back to reference DeVries A, Sprinzl G, Reich K, Gunczler P, Thumfart W, Lukas P (2001) GM-CSF-mouth wash for treatment of chemotherapy patients with advanced head and neck cancer: A clinical trial. Annals Oncol 11 [Suppl 4]:409PD DeVries A, Sprinzl G, Reich K, Gunczler P, Thumfart W, Lukas P (2001) GM-CSF-mouth wash for treatment of chemotherapy patients with advanced head and neck cancer: A clinical trial. Annals Oncol 11 [Suppl 4]:409PD
10.
go back to reference Throuvales N, Antonadou D, Pullizi M et al (1997) Evaluation of efficacy and safety of GM-CSF in the prophylaxis of mucositis in patients with head and neck cancer patients treated radiation therapy. Eur J Cancer 41A [Suppl 7]:431 Throuvales N, Antonadou D, Pullizi M et al (1997) Evaluation of efficacy and safety of GM-CSF in the prophylaxis of mucositis in patients with head and neck cancer patients treated radiation therapy. Eur J Cancer 41A [Suppl 7]:431
11.
go back to reference Hanson WR, Marks JE, Reddy SP, et al (1997). Protection from radiation induced oral mucositis by a mouth rinse containing prostaglandin E analogue, misoprostol: a placebo controlled. Double blind clinical trial. Adv Exp Med Biol 400B:811–818PubMed Hanson WR, Marks JE, Reddy SP, et al (1997). Protection from radiation induced oral mucositis by a mouth rinse containing prostaglandin E analogue, misoprostol: a placebo controlled. Double blind clinical trial. Adv Exp Med Biol 400B:811–818PubMed
12.
go back to reference Leborgne JH, Leborgne F, Zubizarreta E, Ortega B, Mezzera J (1997) Corticosteroids and radiation mucositis in head and neck cancer. A double-blind placebo-controlled randomised trial. Radiother Oncol 47:145–148CrossRef Leborgne JH, Leborgne F, Zubizarreta E, Ortega B, Mezzera J (1997) Corticosteroids and radiation mucositis in head and neck cancer. A double-blind placebo-controlled randomised trial. Radiother Oncol 47:145–148CrossRef
13.
go back to reference Tannehill SP, Mehta MP (1996) Amifostine and radiation therapy: past, present and future. Semin Oncol 23 [Suppl 8]:69–77 Tannehill SP, Mehta MP (1996) Amifostine and radiation therapy: past, present and future. Semin Oncol 23 [Suppl 8]:69–77
14.
go back to reference Moore OA, Smith LA, Campbell F, Seers Kate, McQuay, Moore RA (2001) Systematic review of the use of honey as a wound dressing. BMC Compliment Altern Med 1(1):2CrossRef Moore OA, Smith LA, Campbell F, Seers Kate, McQuay, Moore RA (2001) Systematic review of the use of honey as a wound dressing. BMC Compliment Altern Med 1(1):2CrossRef
15.
go back to reference Ovington LG. Honey(1999) Ancient cure or modern alternative? Wound Care Institute Newsletter, vol 4/1, January/February, Altanta Ovington LG. Honey(1999) Ancient cure or modern alternative? Wound Care Institute Newsletter, vol 4/1, January/February, Altanta
16.
go back to reference Vardi A, Barzilay Z, Linder N, Cohen HA, Paret G, Brazilai A (1998) Local application of honey for the treatment of neonatal postoperative wound infection. Acta Paediatrica 87:429–432CrossRefPubMed Vardi A, Barzilay Z, Linder N, Cohen HA, Paret G, Brazilai A (1998) Local application of honey for the treatment of neonatal postoperative wound infection. Acta Paediatrica 87:429–432CrossRefPubMed
17.
go back to reference Efem SEE, Udoh KT, Iwara CI (1992) The antimicrobial spectrum of honey and its clinical significance. Infection 20:227–229PubMed Efem SEE, Udoh KT, Iwara CI (1992) The antimicrobial spectrum of honey and its clinical significance. Infection 20:227–229PubMed
18.
go back to reference Sela M, Maroz D, Gedalia I (2000) Streptococcus mutant in saliva of normal subjects and neck and head irradiated cancer subjects after consumption of honey. J Oral Rehab 27:269–270CrossRef Sela M, Maroz D, Gedalia I (2000) Streptococcus mutant in saliva of normal subjects and neck and head irradiated cancer subjects after consumption of honey. J Oral Rehab 27:269–270CrossRef
19.
go back to reference Al-Waili NS, Saloom KY (1999) Effect of topical honey on postoperative wound infections due to gram positive and gram negative bacteria following caesarean section and hysterectomies. Eur J Med Res 26:126–130 Al-Waili NS, Saloom KY (1999) Effect of topical honey on postoperative wound infections due to gram positive and gram negative bacteria following caesarean section and hysterectomies. Eur J Med Res 26:126–130
20.
go back to reference Rao CV, Desai D, Rivenson A, Simi B, Amin S, Reddy BS (1995) Chemoprevention of colon carcinogenesis by phenylethyl-3-methylcaffeate. Cancer Res 55:2310–2315PubMed Rao CV, Desai D, Rivenson A, Simi B, Amin S, Reddy BS (1995) Chemoprevention of colon carcinogenesis by phenylethyl-3-methylcaffeate. Cancer Res 55:2310–2315PubMed
21.
go back to reference Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of Radiation Therapy Oncology Group (RTOG) and European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346 Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of Radiation Therapy Oncology Group (RTOG) and European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346
22.
go back to reference Rahn R, Adamietz IA, Boettcher et al (1997) Povidone-iodine to prevent mucositis in patients during antineoplastic radiochemotherapy. Dermatology 195 [Suppl 2]: 57–61 Rahn R, Adamietz IA, Boettcher et al (1997) Povidone-iodine to prevent mucositis in patients during antineoplastic radiochemotherapy. Dermatology 195 [Suppl 2]: 57–61
23.
go back to reference Al-Tikriti U, Martin MV, Bramley PA (1984) A pilot study of the clinical effects of irradiation on the oral tissues. Br J Oral Maxillofac Surg 22:77–86PubMed Al-Tikriti U, Martin MV, Bramley PA (1984) A pilot study of the clinical effects of irradiation on the oral tissues. Br J Oral Maxillofac Surg 22:77–86PubMed
24.
go back to reference Bernhoft CH, Skaug N (1985) Oral findings in irradiated edentulous patients. Int J Oral Surg 14:416PubMed Bernhoft CH, Skaug N (1985) Oral findings in irradiated edentulous patients. Int J Oral Surg 14:416PubMed
25.
go back to reference Miller AB. Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:1–12PubMed Miller AB. Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:1–12PubMed
26.
go back to reference Machteld Wymenga AN, Van der Graaf WTA, Hofstra LS et al (1999) Phase I study of Transforming growth factor β3 mouthwash for prevention of chemotherapy induced mucositis. Clin Cancer Res 5:1363–1368PubMed Machteld Wymenga AN, Van der Graaf WTA, Hofstra LS et al (1999) Phase I study of Transforming growth factor β3 mouthwash for prevention of chemotherapy induced mucositis. Clin Cancer Res 5:1363–1368PubMed
27.
go back to reference Dorr W, Noack R, Spekl K, Forrell CL (2001) Modification of oral mucositis by keratinocyte growth factor: single radiation exposure. Int J Radiat Biol 77:341–347CrossRefPubMed Dorr W, Noack R, Spekl K, Forrell CL (2001) Modification of oral mucositis by keratinocyte growth factor: single radiation exposure. Int J Radiat Biol 77:341–347CrossRefPubMed
28.
go back to reference Schuchter LM, Luginbuhl WE, Meropol NH (1992) The current status of toxicity protectants in cancer therapy. Semin Oncol 19:742–751PubMed Schuchter LM, Luginbuhl WE, Meropol NH (1992) The current status of toxicity protectants in cancer therapy. Semin Oncol 19:742–751PubMed
29.
go back to reference Schonekas KG, Wagner W, Prott FJ (1999) Amifostine a radioprotector in locally advanced head and neck tumors. Strahlenther Onkol 175 [Suppl 4]:30–33 Schonekas KG, Wagner W, Prott FJ (1999) Amifostine a radioprotector in locally advanced head and neck tumors. Strahlenther Onkol 175 [Suppl 4]:30–33
30.
go back to reference Perch SJ, Machtay M, Markiewicz DA, Kligerman MM (1995) Decreased acute toxicity by using midline mucosal sparing block during radiation therapy for carcinoma of the oral cavity, oropharynx and nasopharynx. Radiology 197:863–866PubMed Perch SJ, Machtay M, Markiewicz DA, Kligerman MM (1995) Decreased acute toxicity by using midline mucosal sparing block during radiation therapy for carcinoma of the oral cavity, oropharynx and nasopharynx. Radiology 197:863–866PubMed
31.
go back to reference Bensadoun RJ, Franquin JC, Ciais G et al (1999) Low energy He/Ni laser in the prevention of radiation mucositis: A multicenter phase III randomised study in patients with head and neck cancer. Support Care Cancer 7:217–218CrossRefPubMed Bensadoun RJ, Franquin JC, Ciais G et al (1999) Low energy He/Ni laser in the prevention of radiation mucositis: A multicenter phase III randomised study in patients with head and neck cancer. Support Care Cancer 7:217–218CrossRefPubMed
32.
go back to reference Petrovic ZT, Mandic ML, Grgic J, Grgic Z (1994) Ash and chromium levels of some type of honey. Z Lebensm Unters Forsch 198:36–39PubMed Petrovic ZT, Mandic ML, Grgic J, Grgic Z (1994) Ash and chromium levels of some type of honey. Z Lebensm Unters Forsch 198:36–39PubMed
33.
go back to reference Qiu PY, Ding HB, Tang YK, Xu RJ (1999) Determination of chemical composition of commercial honey by near-infrared spectroscopy. J Agric Food Chem 47:2760–2765CrossRefPubMed Qiu PY, Ding HB, Tang YK, Xu RJ (1999) Determination of chemical composition of commercial honey by near-infrared spectroscopy. J Agric Food Chem 47:2760–2765CrossRefPubMed
34.
go back to reference Liza G, Ovington CWS (1999) Honey: Ancient cure or modern alternative. Wound Care Institute News Letter 4:1–3 Liza G, Ovington CWS (1999) Honey: Ancient cure or modern alternative. Wound Care Institute News Letter 4:1–3
35.
go back to reference Bergman A, Yanai J, Weiss J, Bell D, Menachem PD (1983) Acceleration of wound healing by topical application of honey. An animal model. Am J Surg 145:374–376PubMed Bergman A, Yanai J, Weiss J, Bell D, Menachem PD (1983) Acceleration of wound healing by topical application of honey. An animal model. Am J Surg 145:374–376PubMed
36.
go back to reference Oryan A, Zaker SR (1998) Effect of topical application of honey on cutaneous wound healing in rabbits. Zentralbl Veterinarmed A 45:181–188PubMed Oryan A, Zaker SR (1998) Effect of topical application of honey on cutaneous wound healing in rabbits. Zentralbl Veterinarmed A 45:181–188PubMed
37.
go back to reference Molan PC (1999) The role of honey in the management of wound. J Wound Care 8:423–426 Molan PC (1999) The role of honey in the management of wound. J Wound Care 8:423–426
38.
go back to reference Archer HG, Bernett S, Irving S, Middleton KR, Seal DV (1990) A controlled model of moist wound healing: comparison between semi-permeable film antiseptic and sugar paste. J Exp Pathol 71:155–170 Archer HG, Bernett S, Irving S, Middleton KR, Seal DV (1990) A controlled model of moist wound healing: comparison between semi-permeable film antiseptic and sugar paste. J Exp Pathol 71:155–170
39.
go back to reference Knutson RA, Merbitz LA, Creekmore MA, Snipes HG (1981) Use of sugar and povidone iodine to enhance the wound healing: five year's experience. South Med J 74:1329–1335PubMed Knutson RA, Merbitz LA, Creekmore MA, Snipes HG (1981) Use of sugar and povidone iodine to enhance the wound healing: five year's experience. South Med J 74:1329–1335PubMed
40.
go back to reference Sela MO, Shapira L, Grizim I, et al (1998) Effects of honey consumption on enamel microhardness in normal versus xerostomic patients. J Oral Rehabil 25:630–634CrossRefPubMed Sela MO, Shapira L, Grizim I, et al (1998) Effects of honey consumption on enamel microhardness in normal versus xerostomic patients. J Oral Rehabil 25:630–634CrossRefPubMed
41.
go back to reference Smirnova H, Filatova EI, Suvorov AN, Bylinskaia EN (2002) The use of therapeutic/prophylactic dragee "honey laminolact" in radiotherapy of uterine tumours. Vopr OnKol 46:748–750 Smirnova H, Filatova EI, Suvorov AN, Bylinskaia EN (2002) The use of therapeutic/prophylactic dragee "honey laminolact" in radiotherapy of uterine tumours. Vopr OnKol 46:748–750
Metadata
Title
Topical application of honey in the management of radiation mucositis. A Preliminary study
Authors
Biswa Mohan Biswal
Ahmad Zakaria
Nik Min Ahmad
Publication date
01-04-2003
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 4/2003
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-003-0443-y

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