29 September 2020

---

Efficacy of melatonin in prevention of oral mucositis in patients on anticancer therapy

Lara Figini

---

Head and neck cancers are unfortunately common today and the treatment options are multidisciplinary approaches including surgery, chemotherapy, and radiotherapy. However, radiotherapy and chemotherapy are not specific and inhibit the rapidly dividing of cells without distinguishing between normal and tumor cells.
One of the most debilitating side effects of anticancer therapy is the development of oral mucositis, which affects 40% -80% of patients undergoing chemotherapy and almost all those undergo radiation therapy of the head and neck.
Radiation-induced oral mucositis occurs due to DNA damage and cell apoptosis. To date, there is no defined effective therapy for mucositis or the pain associated with it.
 However, numerous studies have been conducted which proposed preventive and therapeutic management. Many studies in the literature have reported the use of melatonin in the treatment of various human oral conditions due to its cytoprotective and anti-inflammatory properties.

Materials and methods
In a study published in the Oral Disease of April 2020, the authors assessed the effectiveness of melatonin in the prevention of radiation-induced oral mucositis.
This randomized controlled clinical trial was conducted in forty patients with head and neck cancer (HNC) who underwent radiation therapy at the Department of Clinical oncology, Alexandria University, Egypt. Patients were equally assigned to either the control group (which received conventional treatment) or the test group (which received 20 mg of melatonin along with conventional treatment). All patients were clinically assessed for severity and pain of oral mucositis three and six weeks after initiation of radiation therapy. In addition, samples were assessed about the total antioxidant capacity (CT) in the saliva of the patients at the start of radiation therapy and six weeks later.

Results
92.5% of patients experienced oral mucositis with greater severity in the control group (30%) than in the test group (5%). Mean pain scores were significantly reduced in the test group compared to the control group. Total antioxidant capacity (TAC) values ​​showed a significant difference between the test group and the control group with a significant reduction in the TAC in the control group.

Conclusions
From the data of this study, which must be confirmed in other similar studies, it can be concluded that the administration of melatonin associated with conventional anticancer treatment significantly reduces the development of oral mucositis.

Clinical implications
The dentist, in patients in radiotherapy and chemotherapy for head and neck cancer and who can develop oral mucositis with high probability, can rely on melatonin, associated with conventional therapies, as it is able to reduce pain from mucositis and is able to hinder the reduction of the CT scan resulting from radiation therapy.


For additional information: Efficacy of Melatonin in Prevention of Radiation-Induced Oral Mucositis: A Randomized Clinical Trial.