Prevention of Oral Mucositis Due to 5-Fluorouracil Treatment with Oral Cryotherapy: MATERIAL AND METHODS

In a total of 99 courses, 5-FU and folinic acid combination chemotherapy was given to 40 patients. The mean age of these patients was 54.17 ± 14.19 years (ranged 20-77 years). The cases were carcinomas of the colon, rectum, stomach, head of pancreas, cecum, sigmoid, neuroendocrine tumors, and metastatic tumors of unknown origin of the liver. Every chemotherapy course was considered a single case, and mucositis was judged by a physician on the fifth, 10th, 15th and 21st days of the course according to the World Health Organization’s (WHO) toxicity criteria. The manifestations of mucositis rank from 0 to IV Grade 0: no symptoms; Grade I: painless ulcers, erythema or mild soreness; Grade II: painful erythema, edema or ulcers, but the patient can eat solid meal; Grade III: painful erythema, edema or ulcers, and the patient cannot eat solid meal; Grade IV: requires parenteral or enteral support.

Cryotherapy was administered in a random pattern of 99 courses of chemotherapy. If cryotherapy was instituted in the first course, it was not instituted in the latter and vice versa. Therefore, treatment was completed by consecutive courses with or without cryotherapy. 5-FU was given at a dose of450 mg/m2 in 10 minutes. Folinic acid was also given in 10 minutes at a dose of 20 mg/m2 and 30 minutes prior to 5-FU administration.
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Patients kept ice pieces in their mouth from the beginning of intravenous 5-FU until 10 minutes after the treatment. This time, interval is consistent with the half-life of 5-FU. Although patients’ mouth temperatures were not measured to assure that cryotherapy was evenly maintained, the procedure was conducted under supervision of a chemotherapy nurse who guided the patients. Patients were also evaluated for complications other than mucositis, like fever, diarrhea, nausea and vomiting.

Complete blood counts were obtained prior to every course of chemotherapy. Chemotherapy was administered when the white blood cell and platelet count were above 4.000/mm3 and 100.000/mm3, respectively. Patients were questioned for the presence of dentures, history of drug usage and accompanying diseases. Patients having dentures took them off during the chemotherapy sessions. Three patients were found to have type-2 diabetes mellitus. Two of them were using insulin and the third one was on oral treatment.


Chi-square, McNemar and logistic regression tests were used in the analysis of the results.


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