Original Article

Preventive Effect of Glycyrrhiza Glabra Extract on Oral Mucositis in Patients under Head and Neck Radiotherapy: A Randomized Clinical Trial

Abstract

Objectives: About two-thirds of cancer patients undergo radiotherapy. Oral mucositis represents a major complication of radiotherapy, causing morbidity and mortality and decreasing the quality of life of patients. This study aimed to assess the preventive effect of Glycyrrhiza aqueous extract on oral mucositis in cancer patients under head and neck radiotherapy.
Materials and Methods: In this double-blind clinical trial, 37 head and neck cancer patients were divided into intervention (n=19) group receiving Glycyrrhiza aqueous extract and control (n=18) group receiving placebo. Patients in the test group used Glycyrrhiza aqueous extract topically twice a day from the first day of starting radiotherapy until the end of the second week. Patients were examined in the first day of radiotherapy for any type of wound before treatment and those with oral ulcers before radiotherapy were excluded from the study. The grade of mucositis was determined using the classification by the World Health Organization. ANCOVA was performed to assess any difference between the two groups with regard to oral mucosal irritation and wound size after the intervention while controlling for the covariates such as sex and age.
Results: Significant differences were found in the maximum grade of mucositis and oral mucosal irritation between the intervention and control groups (P<0.001).
Conclusions: This study showed that aqueous extract of Glycyrrhiza can be effective for decreasing the severity of oral mucositis in head and neck cancer patients undergoing radiotherapy.

- Bressan V, Stevanin S, Bianchi M, Aleo G, Bagnasco A, Sasso L. The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: A systematic review. Cancer Treat Rev. 2016 Apr;45:105-19.

- Franceschi S, Talamini R, Barra S, Barón AE, Negri E, Bidoli E, et al. Smoking and drinking in relation to cancers of the oral cavity, pharynx, larynx, and esophagus in northern Italy. Cancer Res. 1990 Oct;50(20):6502-7.

- Torre LA, Bray F, Siegel RL, Ferlay J, Lortet‐Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015 Mar;65(2):87-108.

- Ferretti G, Ash R, Brown A, Parr M, Romond E, Lillich T. Control of oral mucositis and candidiasis in marrow transplantation: a prospective, double-blind trial of chlorhexidine digluconate oral rinse. Bone Marrow Transplant. 1988 Sep;3(5):483-93.

- Kubota K, Kobayashi W, Sakaki H, Nakagawa H, Kon T, Mimura M, et al. Professional oral health care reduces oral mucositis pain in patients treated by superselective intra-arterial chemotherapy concurrent with radiotherapy for oral cancer. Support Care Cancer. 2015 Nov;23(11):3323-9.

- Peterson D, D'ambrosio J. Diagnosis and management of acute and chronic oral complications of nonsurgical cancer therapies. Dent Clin North Am. 1992 Oct;36(4): 945-66.

- Franzén L, Funegård U, Ericson T, Henriksson R. Parotid gland function during and following radiotherapy of malignancies in the head and neck: A consecutive study of salivary flow and patient discomfort. Eur J Cancer. 1992 Feb;28(2-3):457-62.

- Köstler WJ, Hejna M, Wenzel C, Zielinski CC. Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment. CA Cancer J Clin. 2001 Sep-Oct;51(5):290-315.

- Kazemian A, Kamian S, Aghili M, Hashemi F, Haddad P. Benzydamine for prophylaxis of radiation‐induced oral mucositis in head and neck cancers: a double‐blind placebo‐controlled randomized clinical trial. Eur J Cancer Care (Engl). 2009 Mar;18(2):174-8.

- Kondo K, Shiba M, Nakamura R, Morota T, Shoyama Y. Constituent properties of licorices derived from Glycyrrhiza uralensis, G. glabra, or G. inflata identified by genetic information. ‎Biol. Pharm. Bull. 2011;82(1):122-8.

- Gupta VK, Fatima A, Faridi U, Negi AS, Shanker K, Kumar JK, et al. Antimicrobial potential of Glycyrrhiza glabra roots. J Ethnopharmacol. 2008 Mar;116(2):377-80.

- Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004 Nov;4(1):26.

- Avritscher EB, Cooksley CD, Elting LS, editors. Scope and epidemiology of cancer therapy-induced oral and gastrointestinal mucositis. Seminars in oncology nursing; Seminars in Oncology Nursing. WB Saunders, 2004 Feb;20(1):3-10.

- Kong M, Hwang D-S, Yoon SW, Kim J. The effect of clove-based herbal mouthwash on radiation-induced oral mucositis in patients with head and neck cancer: a single-blind randomized preliminary study. Onco Targets Ther. 2016 Jul;9:4533-8.

- Santos RC, Dias RS, Giordani AJ, Segreto RA, Segreto HR. Mucositis in head and neck cancer patients undergoing radiochemotherapy. Rev Esc Enferm USP. 2011 Dec;45(6):1338-44.

- Stubbe CE, Valero M. Complementary strategies for the management of radiation therapy side effects. J Adv Pract Oncol. 2013 Jul;4(4):219-31.

- Messier C, Epifano F, Genovese S, Grenier D. Licorice and its potential beneficial effects in common oro‐dental diseases. Oral Dis. 2012 Jan;18(1):32-9.

- Kim JK, Oh SM, Kwon HS, Oh YS, Lim SS, Shin HK. Anti-inflammatory effect of roasted licorice extracts on lipopolysaccharide-induced inflammatory responses in murine macrophages. Biochem Biophys Res Commun. 2006 Jul;345(3):1215-23.

- Račková L, Jančinová V, Petríková M, Drábiková K, Nosáľ R, Štefek M, et al. Mechanism of anti-inflammatory action of liquorice extract and glycyrrhizin. Nat Prod Res. 2007 Dec;21(14):1234-41.

- Akamatsu H, Komura J, Asada Y, Niwa Y. Mechanism of anti-inflammatory action of glycyrrhizin: effect on neutrophil functions including reactive oxygen species generation. Planta Med. 1991 Apr;57(2):119-21.

- Pompei R, Flore O, Marccialis MA, Pani A, Loddo B. Glycyrrhizic acid inhibits virus growth and inactivates virus particles. Nature. 1979 Oct;281(5733):689-90.

- Fiore C, Eisenhut M, Krausse R, Ragazzi E, Pellati D, Armanini D, et al. Antiviral effects of Glycyrrhiza species. Phytother Res. 2008 Feb;22(2):141-8.

- Wang X, Zhang H, Chen L, Shan L, Fan G, Gao X. Liquorice, a unique “guide drug” of traditional Chinese medicine: a review of its role in drug interactions. J Ethnopharmacol. 2013 Dec;150(3):781-90.

- Messier C, Grenier D. Effect of licorice compounds licochalcone A, glabridin and glycyrrhizic acid on growth and virulence properties of Candida albicans. Mycoses. 2011 Nov;54(6):e801-6.

- Mekseepralard C, Kamkaen N, Wilkinson JM. Antimicrobial and antioxidant activities of traditional Thai herbal remedies for aphthous ulcers. Phytother Res. 2010 Oct;24(10):1514-9.

- Pompei R, Laconi S, Ingianni A. Antiviral properties of glycyrrhizic acid and its semisynthetic derivatives. Mini Rev Med Chem. 2009 Jul;9(8):996-1001.

- Galal M, Nasry SA, Mostafa DM, Ammar NM. Therapeutic Efficacy of Herbal formulations for Recurrent Aphthous Ulcer. Correlation with Salivary Epidermal Growth Factor. Life Sci J. 2012;9(3):2398-406.

- Das SK, Das V, Gulati AK, Singh VP. Deglycyrrhizinated liquorice in aphthous ulcers. J Assoc Physicians India. 1989 Oct;37(10):647.

- Burgess J, Van Der Ven P, Martin M, Sherman J, Haley J. Review of over-the-counter treatments for aphthous ulceration and results from use of a dissolving oral patch containing glycyrrhiza complex herbal extract. J Contemp Dent Pract. 2008 Mar;9(3):88-98.

- Das D, Agarwal SK, Chandola HM. Protective effect of Yashtimadhu (Glycyrrhiza glabra) against side effects of radiation/chemotherapy in head and neck malignancies. Ayu. 2011 Apr;32(2):196-9.

Files
IssueVol 14, No 5 (2017) QRcode
SectionOriginal Article
Keywords
Mucositis Glycyrrhiza Radiotherapy Mouth Neoplasms

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Najafi S, Ebrahimpour Koujan S, Manifar S, Kharazifard MJ, Kidi S, Hajheidary S. Preventive Effect of Glycyrrhiza Glabra Extract on Oral Mucositis in Patients under Head and Neck Radiotherapy: A Randomized Clinical Trial. Front Dent. 2017;14(5):267-274.

Most read articles by the same author(s)