| Radiotherapy is the major therapeutic modality in the management of the patients with head and neck cancer, which may increase the organ preservation rate.Although radiotherapy may improve the outcome of head and neck cancer treatment, radiotherapy has been shown to increase the incidence of oral and pharyngeal mucositis, which may restrict this treatment of head and neck cancer. Radiotherapy is one of the commonly treatments for those patients,but it also brings some adverse reactions,the common one is radiotherapy-induced oral mucositis, the incidence is up to 85%～100%in head and neck cancer patients who treated by radiotherapy.Radiation-induced injury to the oral and pharyngeal mucosa triggers a cascade of problems, and maybe make it difficult to complete the planned course of radiotherapy.Interruption of radiotherapy results in wound healing, it also allows the tumour cells to recover, but with consequent negative impact on the therapeutic effect of radiotherapy. Severe oral or pharyngeal mucositis is very painful, limiting oral intake and resulting in prolonged malnutrition, which decreases the quality of life for these patients and, in rare instances, results in death.Currently,symptomatic treatment is usually used, as there is no effective radiation-protective method or therapeutic therapy for Radiotherapy-induced mucositis. there is no agent or method that is uniformly effective in preventing or treating the oral mucositis that results from radiotherapy. Most of the published studies had relatively small sample sizes and used inconsistent measures to evaluate the extent and severity of oral mucositis. Therefore, definitive conclusions regarding the effectiveness of any of the agents tested in the prevention and treatment of Radiotherapy-induced oral mucositis cannot be drawn.Today, Radiotherapy-induced oral mucositis remains the most common complication among patients with head and neck cancer. Although a number of strategies and products are being investigated and new directions are promising, holding ice in the mouth have not studied.By The principle of low-temperature in oral, at the beginning of radiotherapy, Patients in treatment group hold the ice in the mouth after radiotherapy daily up to finish radiotherapy. Oral mucositis was scored according to the Radiation Therapy Oncology Group (RTOG) criteria for acute morbidity of mucosal membranes.The spss for Windows ver. 13.0 software was used for data analysis. The paired t-test with the 95% confidence interval was used to compare the grades of mucositis who hold the ice or no before and after 30Gy.Objective To evaluate the efficacy of holding the ice in the mouth as prophylaxis against radiochemotherapy-induced mucositis after radiotherapy in head and neck, through clinical scoring of oral and oropharyngeal mucositis. Method 68 patients, with radiotherapy in head and neck were enrolled into this randomized clinical trial, The cases were divided into treatment group (n=33:24 men,9women) and control group( n=35:24 men,11 women).with a median age of 60.2±10.438years (range 19~81years), were recruited to the present study. All patients were randomized to receive conventional radiotherapy (2-Gy fractions, 5 days weekly, to a total of 50-74 Gy,the middle is 62Gy depending on the tumor localization and TNM classification. All patients received the planned radiation dose. None of the patients had to interrupt RT because of acute mucositis. All of the patients accepted conventional oral care after rediotherapy daily. Besides, from the beginning of radiotherapy, Patients in treatment group hold the ice in the mouth after radiotherapy daily up to finish radiotherapy. Holding the ice in the mouth means:Keep the ice which volume is 2cm×2cm×2cm, colded by saline in the mouth daily, for twice each day and 30-minute for each, by 30-minute interval. An objective mucositis assessment tool was used everyday to document the change of Oral mucosa. Mucositis were diagnosed and evaluated according to the RTOG Toxicity Criteria.Results There was significant difference between two groups when total doses is 30 Gy (P<0.05) and total doses of finished radiotherapy (P<0.05). The incidence of oral mucositis in the treatment group is lower than that in the control group, acute toxicities (mucositis and dysphagia) were less severe in the treatment group. By less than 30Gy,69% of the patients in the control group experienced mucositis compared with only 42% in the treated group. By the end of radiotherapy, 91.4% of the patients in the control group experienced mucositis compared with 78.8% in the treated group. The patients with severe mucositis (grade 3~4 adverse) in the treatment group was less than that in the control group when finished radiotherapy. Tow severe patients were cured. And all of the patients have no adverse reactions. In the treatment group, the time of the first appearance in different level oral mucositis postponed for about one week. Conclusion Acute mucositis is a serious complication of radiotherapy.Mucositis of the oral cavity and pharynx is a major dose-limiting factor for head and neck radiotherapy in Cancer patients.The treatment of Radiotherapy- induced oral mucositis remains a challenge despite several pharmacologic interventions. Interruption of radiotherapy because of mucositis prolongs the overall treatment time, which in turn can have a negative impact on local control and may decrease survival rates . Therefore, the interruption of radiotherapy directly correlates with the outcome of radiotherapy. In the present study, we show that topical treatment of the oral mucosa with holding the ice is effective in patients with radiotherapy-induced mucositis. Holding the ice in the mouth after radiotherapy were effective to prevent and treat acute radioactive oral mucositis resulted from head and neck radiotherapy in Cancer patients. Furthermore, holding the ice in mouth reduced the severity of oral mucositis,a side effect of radiotherapy with long-lasting consequences. And did not affect the clinical outcome.Therefore, it is highly assumable that holding the ice in the mouth is potentially useful for prevention of oral mucositis and improvement of quality of life without reducing the tumor response.
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