Recombinant human epidermal growth factor treatment of radiation-induced severe oral mucositis in patients with head and neck malignancies

J P Hong, S-W Lee, S Y Song, S D Ahn, S S Shin, E K Choi, J H Kim, J P Hong, S-W Lee, S Y Song, S D Ahn, S S Shin, E K Choi, J H Kim

Abstract

Mucositis of the oral cavity and pharynx is a major dose-limiting factor in the application of radiotherapy (RT) to patients with head and neck cancer. Therefore, we evaluated the wound healing effect of human recombinant epidermal growth factor (rhEGF) in head and neck cancer and lymphoma patients with irradiation (with or without combined chemotherapy-induced oral mucositis). Patients at Asan Medical Center who had undergone definitive RT of the head and neck region with or without combined chemotherapy and who had developed severe oral mucositis (higher than the Radiation Therapy Oncology Group grade 3) were treated with topical rhEGF twice daily for 7 days. The evaluation of response with regard to oral mucositis was performed 1 week later. Of the 11 treated patients, three had nasopharyngeal carcinoma, three had carcinoma of the oropharynx, two had carcinoma of the oral cavity, one had carcinoma of the hypopharynx and two had lymphoma of the head and neck. Six patients received RT only, and five patients received concurrent chemoradiotherapy. All patients showed improvements in their oral mucositis after topical treatment with rhEGF in that the Radiation Therapy Oncology Group grade was significantly decreased (P = 0.0000). This finding suggests that rhEGF is effective and safe for the treatment of radiation-induced mucositis. Further studies are needed to determine the optimal dosage and fractionation schedule.

Figures

Figure 2
Figure 2
Photograph showing a representative patient with improved oral mucositis. Left panel, RTOG grade 4 mucositis prior to treatment with rhEGF; right panel, improvement to RTOG grade 2 after 1 week of treatment with rhEGF. RTOG, Radiation Therapy Oncology Group; rhEGF, human recombinant epidermal growth factor.
Figure 1
Figure 1
Improved RTOG grades for oral mucositis following topical treatment of the oral mucosa with rhEGF. RTOG, Radiation Therapy Oncology Group; rhEGF, human recombinant epidermal growth factor.

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