Phytochemical-rich vegetable and fruit juice alleviates oral mucositis during concurrent chemoradiotherapy in patients with locally advanced head and neck cancer

10.1016/j.jtcme.2022.03.004

Hui-Ping Chang；Meng-Chuan Huang；Yen-Ping Lei；Yu-Ju Chuang；Chun-Wei Wang；Lee-Yan Sheen

Chemoradiotherapy ； Phytochemicals ； Polyphenols ； Carotenoids ； Oral mucositis

Journal of Traditional and Complementary Medicine

12卷5期（2022 / 09 / 01）

488 - 498

英文

Background: Concurrent chemoradiotherapy (CCRT)-induced oral mucositis (OM) causes oral pain, malnutrition, and impaired quality of life in patients with head and neck cancer (HNC). Phytochemicals play a potential role in eliminating cancer therapy toxicity. Objective: To evaluate the effect of phytochemical-rich vegetable and fruit juice (VFJ) consumption in preventing CCRT-induced OM among patients with locally advanced HNC. Methods: Forty-nine patients with HNC undergoing CCRT were enrolled. All patients received nutritional counseling before CCRT and weekly follow-up. The VFJ group (25 patients) received 600 mL/day VFJ, 5 days/week for two weeks preceding CCRT and during CCRT, and the control group (24 patients) did not. The contents of total polyphenols and carotenoids in the VFJ were determined. Changes in anthropometric, dietary, and laboratory profiles were compared. Assessment of OM was based on the World Health Organization (WHO) scoring system. Results: Total polyphenols content was 64.6 mg gallic acid equivalents per 100 mL of the VFJ, and the main carotenoids were β-carotene and lycopene. The mean daily consumption of the VFJ was 538 mL for VFJ group. Changes in body weight, albumin, and energy intake were not significantly different between the two groups. The incidence of ulcerative OM was significantly lower in VFJ (64.0%) than in control (95.8%) subjects at week 6 of CCRT. Multiple logistic regressions revealed that VFJ consumption correlated significantly with lower risks of ulcerative OM. Conclusion: Consumption of VFJ rich in phytochemicals including total polyphenols and carotenoids effectively alleviates the severity of CCRT-induced OM among patients with locally advanced HNC. Section: Preventive Medicine; Dietary Therapy/Nutrition Supplements Taxonomy: (classification by EVISE)Preventive medicine, dietary therapy, nutrition supplements.

1. Abachi, S,Lee, S,Rupasinghe, HP(2016).Molecular mechanisms of inhibition of Streptococcus species by phytochemicals.Molecules,21(2),215.
2. Azam, F,Latif, MF,Farooq, A(2019).Performance status assessment by using ECOG (Eastern Cooperative Oncology Group) score for cancer patients by oncology healthcare professionals.Case Rep Oncol,12(3),728-736.
3. Beck, A-JCC,Kieffer, JM,Retel, VP(2019).Mapping the EORTC QLQ-C30 and QLQ-H&N35 to the EQ-5D for head and neck cancer: can disease-specific utilities be obtained?.PLoS One,14(12),e0226077.
4. Biehler, E,Mayer, F,Hoffmann, L,Krause, E,Bohn, T(2010).Comparison of 3 spectro-photometric methods for carotenoid determination in frequently consumed fruits and vegetables.J Food Sci.,75(1),C55-C61.
5. Blakaj, A,Bonomi, M,Gamez, ME,Blakaj, DM(2019).Oral mucositis in head and neck cancer: evidence-based management and review of clinical trial data.Oral Oncol,95,29-34.
6. Bonvehí, JS,Coll, FV,Jordà, RE(1994).The composition, active components and bacteriostatic activity of propolis in dietetics.J Am Oil Chem Soc.,71(5),529-532.
7. Cao, G,Russell, RM,Lischner, N,Prior, RL(1998).Serum antioxidant capacity is increased by consumption of strawberries, spinach, red wine or vitamin C in elderly women.J Nutr,128(12),2383-2390.
8. Cereda, E,Cappello, S,Colombo, S(2018).Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy.Radiother Oncol,126(1),81-88.
9. Chang, HP,Sheen, LY,Lei, YP(2015).The protective role of carotenoids and polyphenols in patients with head and neck cancer.J Chin Med Assoc.,78(2),89-95.
10. Chen, BH,Chuang, JR,Lin, JH,Chiu, CP(1993).Quantification of provitamin A compounds in Chinese vegetables by high-performance liquid chromatography.J Food Protect,56(1),151-54.
11. Chen, C,Zhang, Q,Yu, W,Chang, B,Le, AD(2020).Oral mucositis: an update on innate immunity and new interventional targets.J Dent Res.,99(10),1122-1130.
12. Chethana Rao, PS,Madathil, LP,Rao, S,Shetty, P,Patidar, M(2015).Quantitative analysis of acute phase proteins in post chemo-radiation mucositis.J Clin Diagn Res,9(10)
13. Chow, LQM(2020).Head and neck cancer.N Engl J Med.,382(1),60-72.
14. Cinausero, M,Aprile, G,Ermacora, P(2017).New frontiers in the pathobiology and treatment of cancer regimen-related mucosal injury.Front Pharmacol,8,354.
15. Crowder, SL,Douglas, KG,Yanina Pepino, M,Sarma, KP,Arthur, AE(2018).Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review.J Cancer Surviv.,12(4),479-494.
16. Edge, SB,Compton, CC(2010).The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.Ann Surg Oncol,17(6),1471-1474.
17. Elting, LS,Cooksley, CD,Chambers, MS,Garden, AS(2007).Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies.Int J Radiat Oncol Biol Phys.,68(4),1110-1120.
18. Feng, G,Klein, MI,Gregoire, S,Singh, AP,Vorsa, N,Koo, H(2013).The specific degree-of-polymerization of A-type proanthocyanidin oligomers impacts Streptococcus mutans glucan-mediated adhesion and transcriptome responses within bio-films.Biofouling,29(6),629-640.
19. Ginsburg, I,Koren, E,Shalish, M,Kanner, J,Kohen, R(2012).Saliva increases the availability of lipophilic polyphenols as antioxidants and enhances their retention in the oral cavity.Arch Oral Biol,57(10),1327-1334.
20. Gutiérrez-Vargas, R,Díaz-García, ML,Villasís-Keever, MÁ,Portilla-Robertson, J,Zapata-Tárres, M(2016).Instruments to measure the quality of life in patients with oral mucositis undergoing oncological treatment: a systematic review of the literature.Bol Med Hosp Infant Mex,73(6),457-466.
21. Harasym, J,Oledzki, R(2014).Effect of fruit and vegetable antioxidants on total antioxidant capacity of blood plasma.Nutrition,30(5),511-517.
22. Hayes, CS,Williamson, H, Jr(2001).Management of Group A beta-hemolytic streptococcal pharyngitis.Am Fam Physician,63(8),1557-1564.
23. Hong, BY,Sobue, T,Choquette, L(2019).Chemotherapy-induced oral mucositis is associated with detrimental bacterial dysbiosis.Microbiome,7(1),66.
24. Hung, LC,Kung, PT,Lung, CH(2020).Assessment of the risk of oral cancer incidence in A high-risk population and establishment of A predictive model for oral cancer incidence using A population-based cohort in taiwan.Int J Environ Res Publ Health,17(2),665.
25. Iocca, O,Farcomeni, A,Di Rocco, A(2018).Locally advanced squamous cell carcinoma of the head and neck: a systematic review and Bayesian network meta-analysis of the currently available treatment options.Oral Oncol,80,40-51.
26. Isenring, EA,Bauer, JD,Capra, S(2007).Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice.J Am Diet Assoc.,107(3),404-412.
27. Isenring, EA,Capra, S,Bauer, JD(2004).Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area.Br J Cancer,91(3),447-452.
28. Javadzadeh Bolouri, A,Pakfetrat, A,Tonkaboni, A(2015).Preventing and therapeutic effect of propolis in radiotherapy induced mucositis of head and neck cancers: a triple-blind, randomized, placebo-controlled trial.Iran J Cancer Prev,8(5),e4019.
29. Ki, Y,Kim, W,Nam, J,Kim, D,Park, D,Kim, D(2009).C-reactive protein levels and radiation-induced mucositis in patients with head-and-neck cancer.Int J Radiat Oncol Biol Phys.,75(2),393-398.
30. Meyer, F,Bairati, I,Jobin, E(2007).Acute adverse effects of radiation therapy and local recurrence in relation to dietary and plasma beta carotene and alpha tocopherol in head and neck cancer patients.Nutr Cancer,59(1),29-35.
31. Mills, EE(1988).The modifying effect of beta-carotene on radiation and chemotherapy induced oral mucositis.Br J Cancer,57(4),416-417.
32. Ministry of Health and Welfare. Cause of death statistics [cited 12 Feb 2022] Available from: https://www.mohw.gov.tw/cp-5256-63399-2.html; 2020.
33. Mohammed, FF,Poon, I,Zhang, L(2012).Acute-phase response reactants as objective biomarkers of radiation-induced mucositis in head and neck cancer.Head Neck,34(7),985-993.
34. Moslemi, D,Nokhandani, AM,Otaghsaraei, MT,Moghadamnia, Y,Kazemi, S,Moghadamnia, AA(2016).Management of chemo/radiation-induced oral mucositis in patients with head and neck cancer: a review of the current literature.Radiother Oncol,120(1),13-20.
35. Moslemi, D,Nokhandani, AM,Otaghsaraei, MT,Moghadamnia, Y,Kazemi, S,Moghadamnia, AA(2016).Management of chemo/radiation-induced oral mucositis in patients with head and neck cancer: a review of the current literature.Radiother Oncol,120(1),13-20.
36. Motallebnejad, M,Zahedpasha, S,Moghadamnia, AA(2020).Protective effect of lycopene on oral mucositis and antioxidant capacity of blood plasma in the rat exposed to gamma radiation.Caspian J Intern Med.,11(4),419-425.
37. Muzumder, S,Srikantia, N,Udayashankar, AH,Kainthaje, PB,John Sebastian, MG(2019).Burden of acute toxicities in head-and-neck radiation therapy: a single-institutional experience.South Asian J Cancer,8(2),120-123.
38. Nagi, R,Patil, DJ,Rakesh, N,Jain, S,Sahu, S(2018).Natural agents in the management of oral mucositis in cancer patients-systematic review.J Oral Biol Craniofac Res,8(3),245-254.
39. Nonzee, NJ,Dandade, NA,Markossian, T,Agulnik, M,Argiris, A,Patel, JD(2008).Evaluating the supportive care costs of severe radiochemotherapy-induced mucositis and pharyngitis: results from a Northwestern University Costs of Cancer Program pilot study with head and neck and nonsmall cell lung cancer patients who received care at a county hospital, a Veterans Administration hospital, or a comprehensive cancer care center.Cancer,113(6),1446-1452.
40. Ormsby, SM(2021).Hot and cold theory: evidence in nutrition.Adv Exp Med Biol,1343,87-107.
41. Peterson, DE,Boers-Doets, CB,Bensadoun, RJ,Herrstedt, J,ESMO Guidelines Committee(2015).Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up.Ann Oncol,26(Suppl 5),v139-v151.
42. Powanda, MC,Moyer, ED(2021).A brief, highly selective history of acute phase proteins as indicators of infection, inflammation and injury.Inflammopharmacology,29(3),897-901.
43. Rothwell, JA,Knaze, V,Zamora-Ros, R(2017).Polyphenols: dietary assessment and role in the prevention of cancers.Curr Opin Clin Nutr Metab Care,20(6),512-521.
44. Rühle, A,Haehl, E,David, H(2020).The value of laboratory parameters for anemia, renal function, systemic inflammation and nutritional status as predictors for outcome in elderly patients with head-and-neck cancers.Cancers,12(6),1698.
45. Schwartz, M,Neiers, F,Feron, G,Canon, F(2021).The relationship between salivary redox, diet, and food flavor perception.Front Nutr,7,612735.
46. Shetty, SS,Maruthi, M,Dhara, V(2021).Oral mucositis: current knowledge and future directions.Dis Mon,101300.
47. Sonis, ST(2009).Mucositis: the impact, biology and therapeutic opportunities of oral mucositis.Oral Oncol,45(12),1015-1020.
48. Sproston, NR,Ashworth, JJ(2018).Role of C-reactive protein at sites of inflammation and infection.Front Immunol,9,754.
49. Sung, H,Ferlay, J,Siegel, RL(2021).Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA A Cancer J Clin,71(3),209-249.
50. Toaldo, IM,Cruz, FA,da Silva, EL,Bordignon-Luiz, MT(2016).Acute consumption of organic and conventional tropical grape juices (Vitis labrusca L.) increases antioxidants in plasma and erythrocytes, but not glucose and uric acid levels, in healthy individuals.Nutr Res,36(8),808-817.
51. Tsai, HC,Li, YC,Young, TH,Chen, MH(2016).Citrus polyphenol for oral wound healing in oral ulcers and periodontal diseases.J Formos Med Assoc.,115(2),100-107.
52. van den Berg, MG,Rasmussen-Conrad, EL,Wei, KH,Lintz-Luidens, H,Kaanders, JH,Merkx, MA(2010).Comparison of the effect of individual dietary counseling and of standard nutritional care on weight loss in patients with head and neck cancer undergoing radiotherapy.Br J Nutr.,104(6),872-877.
53. Wang, C,Wang, P,Ouyang, H(2018).Efficacy of traditional Chinese medicine in treatment and prophylaxis of radiation-induced oral mucositis in patients receiving radiotherapy: a randomized controlled trial.Integr Cancer Ther,17(2),444-450.
54. Winter, C,Keimel, R,Gugatschka, M,Kolb, D,Leitinger, G,Roblegg, E(2021).Investigation of changes in saliva in radiotherapy-induced head neck cancer patients.Int J Environ Res Publ Health,18(4),1629.
55. World Health Organization=WHO(1979).WHO handbook for reporting results of cancer treatment.
56. Xie, A,Huang, H,Kong, F(2020).Relationship between food composition and its cold/hot properties: a statistical study.J Agric Food Res,2,100043.
57. Zhang, YJ,Gan, RY,Li, S(2015).Antioxidant phytochemicals for the prevention and treatment of chronic diseases.Molecules,20(12),21138-21156.
58. Zhu, F,Du, B,Xu, B(2018).Anti-inflammatory effects of phytochemicals from fruits, vegetables, and food legumes: a review.Crit Rev Food Sci Nutr,58(8),1260-1270.