Oral glutamine to alleviate radiation-induced oral mucositis: a pilot randomized trial

Abstract

Purpose: To evaluate the influence of oral glutamine on radiation-induced oral mucositis in the radiotherapy of head and neck cancer. Methods and Materials: From July 1997 through June 1998, 17 patients with head and neck cancer receiving primary or adjuvant irradiation were randomized to either glutamine suspension (16 g in 240 ml normal saline) ( n = 8) or placebo (normal saline) ( n = 9) arm. Patients were instructed to swish the test solutions (30 ml) four times per day. All patients received half-mouth irradiation at least. Patients were treated 1.8 Gy per fraction daily, 5 days a week. We evaluated the grading of oral mucositis daily fraction at each day of treatment until 45 Gy/25 fractions. World Health Organization (WHO) step analgesic medication and body weight change were compared between the two arms. Results: The duration of objective oral mucositis ≥ Grade 1 ( p = 0.0097), Grade 2 ( p = 0.0232), and Grade 3 ( p = 0.0168) was shorter in the glutamine arm. Mean maximum grade of objective oral mucositis was less severe in the glutamine arm (1.6 vs. 2.6) ( p = 0.0058). Glutamine did not reduce the duration and severity of subjective oral mucositis except for duration ≥ Grade 3 ( p = 0.0386). In the analysis of mean maximum WHO step of analgesic medication, there was no statistical difference ( p = 0.5374) between the two arms. Mean body weight change was also not significantly different ( p = 0.8070). Conclusions: Oral glutamine may significantly reduce the duration and severity of objective oral mucositis during radiotherapy. It may shorten the duration of ≥ Grade 3 subjective mucositis.