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Keywords:

  • radiotherapy;
  • mucositis;
  • prevention;
  • gram-negative bacilli;
  • head and neck cancer

Abstract

The value of topical administration of antimicrobial agents to prevent irradiation mucositis of the oral cavity and oropharynx was investigated in this pilot study. Thirty-six patients receiving radiotherapy for head and neck cancer were included. Lozenges containing polymyxin E, tobramycin, and amphotericin B (PTA-lozenges) were administered during and after the course of irradiation to eradicate gram-negative bacilli and yeasts. Mucosal reactions and dysphagia were assessed and oropharyngeal cultures were obtained. Thirty-six patients treated in a previous period served as controls. Sixteen of the 36 patients in each group received irradiation predominantly to the oral mucosa. Confluent mucositis was observed in only 1 of 16 patients receiving PTA-lozenges but in 10 of the 16 patients of the control group (P = 0.001). Average duration of mucositis was also less with PTA-lozenges as well as dysphagia. Mucosal reactions and dysphagia in the patients who had mainly oropharyngeal mucosa in the treatment volume were not reduced. Persistent colonization by gram-negative bacilli occurred in only three patients. It is concluded that topical administration of polymyxin E, tobramycin, and amphotericin B may reduce irradiation mucositis of the oral cavity. The underlying mechanism must be further elucidated. © 1995 Wiley-Liss, Inc.