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Use of topical misoprostol to reduce radiation-induced mucositis: results of a randomized, double-blind, placebo-controlled trial.
Australas Radiol. 2006 Oct; 50(5):468-74.AR

Abstract

Radiation-induced mucositis is an acute reaction of the mucosa of patients undergoing head and neck radiotherapy. It can have debilitating and dose-limiting consequences. There is no consensus on an accepted intervention that significantly reduces its severity. Misoprostol is a synthetic prostaglandin E1 analogue, with properties of a mucosal cytoprotectant. We designed a randomized, double-blind, placebo-controlled trial of misoprostol in patients with head and neck cancer. The aim of this study was to determine if topical misoprostol was effective in reducing the severity of radiation-induced mucositis in patients receiving radical dose radiotherapy. The effect of this intervention on a patient's general well-being was also investigated. The primary end-point of the study was the incidence of Radiation Therapy Oncology Group grade 3 mucositis. Between 1999 and 2002, 83 patients were recruited into the study at Westmead and Nepean Hospitals, Sydney. Forty-two patients were randomized to receive misoprostol and 41 to receive a placebo. Most patients received radiotherapy in the adjuvant setting (52 of the 83) and had either an oral cavity (42 of the 83) or an oropharyngeal (16 of the 83) cancer. We could not identify any significant difference in the incidence of severe mucositis based on whether patients were allocated to receive misoprostol or placebo. There was no significant difference in the mean area under the mucositis curve (13.2 vs 16.6; P = 0.1). Patients allocated to misoprostol did report slightly increased soreness (7.6 vs 6.9; P = 0.04) and a greater use of analgesics. However, this difference did not translate into a worse feeling of general well-being as measured by a simple visual analogue scale (5.8 vs 5.2; P = 0.3). In conclusion, we were unable to identify a reduction in radiation-induced mucositis in patients receiving misoprostol. There is a paucity of high-level evidence on potentially useful interventions and a continued need for new and innovative research, incorporating quality-of-life measurements, in patients experiencing radiation-induced mucositis.

Authors+Show Affiliations

Head and Neck Cancer Service, University of Sydney, Westmead and Nepean Hospitals, Sydney, New South Wales, Australia. michael@radonc.wsahs.nsw.gov.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16981945

Citation

Veness, M J., et al. "Use of Topical Misoprostol to Reduce Radiation-induced Mucositis: Results of a Randomized, Double-blind, Placebo-controlled Trial." Australasian Radiology, vol. 50, no. 5, 2006, pp. 468-74.
Veness MJ, Foroudi F, Gebski V, et al. Use of topical misoprostol to reduce radiation-induced mucositis: results of a randomized, double-blind, placebo-controlled trial. Australas Radiol. 2006;50(5):468-74.
Veness, M. J., Foroudi, F., Gebski, V., Timms, I., Sathiyaseelan, Y., Cakir, B., & Tiver, K. W. (2006). Use of topical misoprostol to reduce radiation-induced mucositis: results of a randomized, double-blind, placebo-controlled trial. Australasian Radiology, 50(5), 468-74.
Veness MJ, et al. Use of Topical Misoprostol to Reduce Radiation-induced Mucositis: Results of a Randomized, Double-blind, Placebo-controlled Trial. Australas Radiol. 2006;50(5):468-74. PubMed PMID: 16981945.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of topical misoprostol to reduce radiation-induced mucositis: results of a randomized, double-blind, placebo-controlled trial. AU - Veness,M J, AU - Foroudi,F, AU - Gebski,V, AU - Timms,I, AU - Sathiyaseelan,Y, AU - Cakir,B, AU - Tiver,K W, PY - 2006/9/20/pubmed PY - 2006/12/23/medline PY - 2006/9/20/entrez SP - 468 EP - 74 JF - Australasian radiology JO - Australas Radiol VL - 50 IS - 5 N2 - Radiation-induced mucositis is an acute reaction of the mucosa of patients undergoing head and neck radiotherapy. It can have debilitating and dose-limiting consequences. There is no consensus on an accepted intervention that significantly reduces its severity. Misoprostol is a synthetic prostaglandin E1 analogue, with properties of a mucosal cytoprotectant. We designed a randomized, double-blind, placebo-controlled trial of misoprostol in patients with head and neck cancer. The aim of this study was to determine if topical misoprostol was effective in reducing the severity of radiation-induced mucositis in patients receiving radical dose radiotherapy. The effect of this intervention on a patient's general well-being was also investigated. The primary end-point of the study was the incidence of Radiation Therapy Oncology Group grade 3 mucositis. Between 1999 and 2002, 83 patients were recruited into the study at Westmead and Nepean Hospitals, Sydney. Forty-two patients were randomized to receive misoprostol and 41 to receive a placebo. Most patients received radiotherapy in the adjuvant setting (52 of the 83) and had either an oral cavity (42 of the 83) or an oropharyngeal (16 of the 83) cancer. We could not identify any significant difference in the incidence of severe mucositis based on whether patients were allocated to receive misoprostol or placebo. There was no significant difference in the mean area under the mucositis curve (13.2 vs 16.6; P = 0.1). Patients allocated to misoprostol did report slightly increased soreness (7.6 vs 6.9; P = 0.04) and a greater use of analgesics. However, this difference did not translate into a worse feeling of general well-being as measured by a simple visual analogue scale (5.8 vs 5.2; P = 0.3). In conclusion, we were unable to identify a reduction in radiation-induced mucositis in patients receiving misoprostol. There is a paucity of high-level evidence on potentially useful interventions and a continued need for new and innovative research, incorporating quality-of-life measurements, in patients experiencing radiation-induced mucositis. SN - 0004-8461 UR - https://www.unboundmedicine.com/medline/citation/16981945/Use_of_topical_misoprostol_to_reduce_radiation_induced_mucositis:_results_of_a_randomized_double_blind_placebo_controlled_trial_ L2 - https://doi.org/10.1111/j.1440-1673.2006.01628.x DB - PRIME DP - Unbound Medicine ER -