The novel treatments healing ulcers from chemoradiotherapy.

Chemotherapy is a cancer treatment that uses specific pharmaceuticals to kill cancer cells. It can be given orally or through a vein. Oral mucositis is a common side effect of chemotherapy, and it can cause pain, inflammation, and ulcers in the mouth.

In this article, we will discuss how to prevent oral mucositis from chemotherapy, what you can do to relieve oral mucositis pain, and how to heal mouth ulcers from chemotherapy.

What is oral mucositis and what are the symptoms?

Oral mucositis is a fairly common complication of cancer treatment that results in the inflammation and destruction of the mucous membranes lining the mouth and throat. Symptoms can include pain, burning, dryness, ulcers, swelling and redness.

What causes oral mucositis and how can it be prevented?

Oral mucositis is a common, often debilitating complication of cancer treatment that can occur in any area of the mouth. It is characterized by inflammation and ulceration of the mucous membranes lining the mouth. Oral mucositis can cause pain and difficulty eating, drinking and speaking which is linked to nutrient deficiencies.[1] It can also lead to infection and increased morbidity. Oral mucositis is caused by the direct toxicity of cancer treatment on the mucous membranes of the mouth.

There are many ways to prevent or reduce the severity of oral mucositis. These include the use of prophylactic oral care regimens, cryotherapy, soft food diets and the use of certain medications. In addition, new technologies such as low-level laser therapy are being investigated as potential treatments for oral mucositis.

How can you relieve the pain of oral mucositis?

Laser therapy is a relatively new treatment for oral mucositis. It involves using a laser to target cells of the mouth to help to relieve pain and inflammation, and may also help to promote healing. Laser therapy is generally safe and well-tolerated, and can be used alongside other treatments

The power of light. How to heal mouth ulcers from chemotherapy

From the perspective of your ND, there are two therapies that might be considered. L-glutamine and low-level laser therapy (LLLT), also referred to as photobiomodulation (PBM).

LLLT is a type of light therapy that uses low-level lasers or light-emitting diodes (LEDs) to stimulate healing in the body. LLLT is also sometimes called photobiomodulation therapy or biostimulation due to its ability to influence cell function. LLLT is thought to work by helping to repair damaged cells and reduce inflammation and is considered safe when used as directed by a licensed practitioner. The only contraindication is over an active tumour site because of the ability of laser to increase blood flow.

This is why you get screened to determine if there are residual cancer cells.

There was a systematic review published in a special issue of The Scientific World Journal titled, Oral Tissues Interactions with Lights and Matters. They assessed the use of laser therapy for recurrent aphthous ulcers, lesions that appear in the mouth and can make it difficult to eat and drink. Some of the other contributing factors besides chemotherapy[2] include stress and genetics, nutrient deficiencies in folic acid [3], iron or vitamin B12 [4], impaired immunity and endocrine imbalances.[2]

The review showed laser therapy could reduce pain and lesion size, as well as improving healing time.[5] The laser is typically moved in a continuous circular motion to cover the surface of any lesions and ulcers.

A phase III randomized study looked at the use of laser therapy to prevent radiation-induced mucositis in those with head-and-neck-cancer. In the group using LLLT, pain was reduced by 21.9% and and frequency of Grade 3 mucositis dropped by 27.6%. The authors concluded,

"LEL therapy is capable of reducing the severity and duration of oral mucositis associated with radiation therapy. In addition, there is a tremendous potential for using LEL in combined treatment protocols utilizing concomitant chemotherapy and radiotherapy." [6]

Other scientists actually determined a preventive and curative dose of 2 J/cm^2 and 4J/cm^2 respectively. The results were so promising that they even suggested LLLT could become a standard of care according the the multinational Association of Supportive Care in Cancer (MASCC) criteria. [7] The Mucositis Study Group of the MASCC reviewed the evidence in 2013 and based on their review of the evidence suggested low-level laser (wavelength around 632.8 nm) for the prevention of oral mucositis in patients undergoing radiotherapy, without concomitant chemotherapy, for head and neck cancer.[8] This standard of care has also been recognized by the International Society of Oral Oncology (ISOO).

"Despite varied parameters and diverse conditions, the assessed articles indicate that application of LLLT on oral mucositis using near-infrared wavelengths is prophylactic, reduces pain, and enables a rapid recovery." [9]

Examples of oral mucositis lesions in patients undergoing chemotherapy with 5-FU, according to three exper- imental groups, before and after treatment instituted. a and b OM lesion on lateral edge of tongue, which developed into more widespread ulcerations in the lingual mucosa after 5 days of follow-up. c and d Extensive lesion, with pseudomembrane and areas of ulceration in the lingual mucosa, which exhibits improvement after irradiation with red laser. e and f Multiple mucositis lesions in the jugal mucosa, which also exhibit reduction in severity after 5 days of irradiation with red laser associated with infrared laser

It has also been assessed in childhood cancer treatment to reduce oral mucositis, though it is noted that further research is required.[10]

Amino acids to the rescue

L-glutamine is an essential amino acid that helps the body maintain muscle mass and strength. It is also necessary for the production of glutathione, a powerful antioxidant that helps protect cells from damage. As a nutrient, it is especially important for people who are ill or recovering from surgery or an injury. Supplementing with L-glutamine can help improve recovery time and reduce inflammation.

A double-blind, randomized, placebo-controlled trial compared a group taking 10g of L-glutamine three times daily to a placebo. They observed that the amino acid significantly reduced the severity of oral mucositis induced by chemoradiotherapy in people with head-and-neck-cancer. Patients reported less pain by weeks four through six and physicians observed lowed Grades of mucositis.[11]

Another study showed 92.53% of those taking a placebo went on to develop Grade 3 mucositis compared to 0% in the the glutamine arm.[12]

"Hence, the findings emphasize the use of oral glutamine supplementation as a feasible and affordable treatment option for mucositis in patients with head and neck cancers who are receiving chemoradiation."

The amino acid is found naturally in many foods, including meats, beans, and dairy products. It is also available in supplement form. The recommended dose is typically between 1 and 5 grams per day. When taken in the recommended doses, L-glutamine is generally considered safe. It has also been shown to help with cachexia [13], fluorouracial-induced GI toxicity [14] and even reduce radiation morbidity in those battling breast cancer.[15]

Side effects are extremely rare but certain preparations may induce headache, fever or peripheral edema.

If you are looking for a way to improve your recovery time and reduce inflammation, let's chat about adding L-glutamine and using laser therapy to your post-oncology recovery.

Nutrition while receiving chemotherapy

There are many foods that are considered to be beneficial for those who are receiving chemotherapy. Speaking to your dietician, nutritionist or ND is a great way to determine the best meal plan for you. Chemotherapy can alter your taste and smell, making it difficult to enjoy the foods you once did. That can lead to malnutrition and exacerbate the cachexia already experienced by many battling cancer. Protein-rich, plant-focused diets can reduce the impacts of chemoradiotherapy and keep you feeling healthier, longer.

Chemotherapy can be a difficult process, both physically and emotionally. However, by following a healthy diet, strategically supplementing with L-glutamine, and including photobiomodulation in your treatment plan, you can help to reduce the impacts of oral mucositis and improve your overall health.

References

  1. García-Gozalbo, Balma, and Luis Cabañas-Alite. "A Narrative Review about Nutritional Management and Prevention of Oral Mucositis in Haematology and Oncology Cancer Patients Undergoing Antineoplastic Treatments." Nutrients 13.11 (2021): 4075.

  2. Edgar, Natalie Rose, Dahlia Saleh, and Richard A. Miller. "Recurrent aphthous stomatitis: a review." The Journal of clinical and aesthetic dermatology 10.3 (2017): 26.

  3. Kozlak, Scott T., Stephen J. Walsh, and Rajesh V. Lalla. "Reduced dietary intake of vitamin B12 and folate in patients with recurrent aphthous stomatitis." Journal of oral pathology & medicine 39.5 (2010): 420-423.

  4. Palopoli, J., and J. Waxman. "Recurrent aphthous stomatitis and vitamin B12 deficiency." Southern medical journal 83.4 (1990): 475-477.

  5. Aggarwal, Hersheal, et al. "Efficacy of low-level laser therapy in treatment of recurrent aphthous ulcers–a sham controlled, split mouth follow up study." Journal of clinical and diagnostic research: JCDR 8.2 (2014): 218.

  6. Bensadoun, R. J., et al. "Low-energy He/Ne laser in the prevention of radiation-induced mucositis." Supportive care in cancer 7.4 (1999): 244-252.

  7. Jadaud, E., and Bensadoun RJ. "Low-level laser therapy: a standard of supportive care for cancer therapy-induced oral mucositis in head and neck cancer patients?." Laser therapy 21.4 (2012): 297-303.

  8. Migliorati, Cesar, et al. "Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients." Supportive Care in Cancer 21.1 (2013): 333-341.

  9. Ryu, Hyun Seok, et al. "Decade Long Survey of Low-level Laser Therapy/Photobiomodulation (LLLT/PBM) Therapy for Oral Mucositis Treatment." Medical Lasers; Engineering, Basic Research, and Clinical Application 10.3 (2021): 138-145.

  10. Redman, Melody Grace, Katherine Harris, and Bob S. Phillips. "Low-level laser therapy for oral mucositis in children with cancer." Archives of Disease in Childhood 107.2 (2022): 128-133.

  11. Tsujimoto, Takae, et al. "L-glutamine decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: a double-blind, randomized, placebo-controlled trial." Oncology Reports 33.1 (2015): 33-39.

  12. Pattanayak, Lucy, et al. "Management of chemoradiation-induced mucositis in head and neck cancers with oral glutamine." Journal of Global Oncology 2.4 (2016): 200-206.

  13. May, Patricia Eubanks, et al. "Reversal of cancer-related wasting using oral supplementation with a combination of β-hydroxy-β-methylbutyrate, arginine, and glutamine." The American journal of surgery 183.4 (2002): 471-479.

  14. Daniele, B., et al. "Oral glutamine in the prevention of fluorouracil induced intestinal toxicity: a double blind, placebo controlled, randomised trial." Gut 48.1 (2001): 28-33.

  15. Rubio, Isabel, et al. "Oral glutamine reduces radiation morbidity in breast conservation surgery." Journal of Parenteral and Enteral Nutrition 37.5 (2013): 623-630.

The content of this website is intended for informational purposes. The information presented does not replace medical advice given to you by your own provider. Information on this site should not be used to diagnose or treat. Before starting any new dietary, exercise or lifestyle regimens you should consult your primary care provider.

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