Orhan Sezen

Zinc sulfate in the prevention of radiation-induced oropharyngeal mucositis: a prospective, placebo-controlled, randomized study.

PURPOSE To determine the effect of oral zinc sulphate supplementation on radiation-induced oropharyngeal mucositis in patients with head-and-neck cancer. MATERIALS AND METHODS Thirty patients with head-and-neck cancer were randomly assigned to receive either zinc sulfate or placebo. Primary tumors were localized in the larynx in 14 patients, in the nasopharynx in 4, in the oral cavity in 4, in a salivary gland in 1, in the maxillary sinus in 1, in neck nodes (lymphoma presenting primarily) in 3 and in neck metastases from an unknown primary in 3. In the placebo group, 3 patients were excluded; 1 patient died during treatment, 1 left the study, and 1 did not come to the 6 week control visit. The patients were treated with telecobalt radiotherapy at conventional fractionation (2 Gy/fraction, five fractions weekly, for 20-35 fractions within 4-7 weeks). The median radiation dose was 6400 cGy (4000-7000 cGy). Oral mucositis was assessed by two independent physicians, experts in radiation oncology, using the Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring criteria. RESULTS In the zinc sulfate group, Grade 3-4 mucositis was not detected in any patient; Grade 0 mucositis was detected in 2, and Grade 1 in 8, and Grade 2 in 5 patients. In the placebo group, Grade 2 mucositis was detected in 4 and Grade 3 in 8 patients. We observed that the degree of mucositis in the patients in the zinc sulfate group was significantly lower than that in the placebo group (p < 0.05). Confluent mucositis developed earlier in the placebo group than in the zinc sulfate group after the onset of treatment (p < 0.05) and started to improve sooner in the zinc sulfate group than in the placebo group (p < 0.05). CONCLUSIONS Zinc sulfate is beneficial in decreasing the severity of radiation-induced mucositis and oral discomfort. These results should be confirmed by additional evaluation in randomized studies with a larger number of patients.

Protective role of intramuscularly administered vitamin E on the levels of lipid peroxidation and the activities of antioxidant enzymes in the lens of rats made cataractous with gamma-irradiation.

Purpose To determine the antioxidant role of vitamin E (VE) (10 mg/kg/day) against radiation-induced cataract in lens after total-cranium irradiation of rats with a single dose of 5 Gy. Methods Sprague-Dawley rats were divided into three groups. Group 1 did not receive VE or irradiation but received both 0.1 ml physiologic saline intraperitoneally and sham irradiation (control group). Group 2 received to total cranium 5 Gy of gamma irradiation as a single dose (RT group) plus 0.1 ml physiologic saline intraperitoneally. Group 3 received irradiation to total cranium plus 10 mg/kg/day VE (RT+VE group). The rats were irradiated using a cobalt-60 teletherapy unit. Chylacks cataract classification (1) was used in this study. At the end of 10 days, the rats were killed and their eyes were enucleated to measure the antioxidant enzymes (the activity of superoxide dismutase [SOD], glutathione peroxidase [GSH-Px]) and lipid peroxidation level (malondialdehyde [MDA]). Results While grade 1 cataract development was detectable in seven rats in the RT group, it was detectable only in two rats in the RT+VE group, whereas none of the rats in the control group exhibited any biomicroscopic change in their lenses. MDA level and GSH-Px activity in the rat lens in the RT group was significantly higher than in the control group. SOD activity in the RT group was lower than in the control group. The activity of SOD and GSH-Px enzymes was higher in the RT+VE group, but MDA level was lower in the RT+VE group when compared with the RT group. Conclusions Vitamin E has a protective effect on radiation-induced cataract by decreasing oxidative stress.

Effects of Oral Ginkgo biloba Supplementation on Cataract Formation and Oxidative Stress Occurring in Lenses of Rats Exposed to Total Cranium Radiotherapy

PurposeTo determine the antioxidant role of Ginkgo biloba (GB) in preventing radiation-induced cataracts in the lens after total-cranium irradiation of rats with a single radiation dose of 5 Gy.MethodsSprague-Dawley rats were randomly divided into three groups. Group 1 received neither GB nor irradiation (control group). Group 2 was exposed to total-cranium irradiation of 5 Gy in a single dose [radiation therapy (RT) Group], and group 3 received total cranium irradiation from a cobalt-60 teletherapy unit, plus 40 mg/kg per day GB (RT+GB group). At the end of the tenth day, the rats were killed and their eyes were enucleated to measure the antioxidant enzymes, the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and the lipid peroxidation level [malondialdehyde (MDA)].ResultsIrradiation significantly increased both the MDA level and the activity of GSH-Px, and significantly decreased the activity of SOD in the rat lenses. GB supplementation significantly increased the activities of SOD and GSH-Px enzymes and significantly decreased the MDA level. Total cranium irradiation of 5 Gy in a single dose promoted cataract formation, and GB supplementation protected the lenses from radiation-induced cataracts.ConclusionsWe suggest that Ginkgo biloba is an antioxidant that protects the rat lens from radiation-induced cataracts.

The effects of oral zinc sulphate during radiotherapy on anti‐oxidant enzyme activities in patients with head and neck cancer: A prospective, randomised, placebo‐controlled study

The purpose was to determine the effects of oral zinc sulphate along with radiotherapy on anti‐oxidant enzyme activities in patients with head and neck cancer. Thirty patients with head and neck cancer were randomly assigned to receive either zinc sulphate capsules (including 50 mg zinc) (n = 15) or placebo (n = 15) three times a day, starting on the day of the first radiotherapy fraction and continuing throughout the scheduled radiotherapy course including weekends and 6 weeks after radiotherapy. The patients were treated with telecobalt radiation at conventional fractionation of 2 Gy/fraction and five fractions/week in 20–35 fractions for a period of 4–7 weeks. Blood samples for biochemical parameters were collected after an overnight fast (12 h) before radiotherapy, the first day and 6 weeks after radiotherapy. In the placebo group, three patients were excluded. No difference was detected in any final measurement activities of erythrocyte anti‐oxidant enzyme such as copper‐zinc superoxide dismutase (Cu‐Zn SOD), catalase (CAT) and glutathione peroxidase (GSH‐Px) in the direct comparison between the zinc sulphate and the placebo group, except erythrocyte SOD activities measured the first day after radiotherapy (p < 0.03). In therespective measurement analysis of the groups in themselves, in the zinc sulphate group, while the statistical analysis for the activities of erythrocyte CAT and GSH‐Px were significantly different (χ2 = 12.4, p < 0.05; χ2 = 8.9, p < 0.05, respectively) before radiotherapy, the first day and 6 weeks after radiotherapy, the activities of SOD did not differ (χ2 = 4.2, p > 0.05). In these three measurements, there was no statistical significance in the activities of enzymes in erythrocyte Cu‐Zn SOD, CAT and GSH‐Px in the placebo group. Before radiotherapy, plasma zinc levels were normal in 16 patients (59.2%) and were lower in 11 patients (40.8%) compared with laboratory levels. It would be worthwhile studying the effect of oral zinc sulphate supplements to improve the anti‐oxidant enzyme activity in radiation‐treated cancer patients, in the hope of reducing radiation‐induced toxicity.

Zinc sulfate in the prevention of total-body irradiation-induced early hematopoietic toxicity: a controlled study in a rat model.

Exposure to ionizing total-body radiation suppresses hematopoiesis, resulting in decreased production of blood cells. Many researchers have demonstrated the critical role of zinc (Zn) in diverse physiological processes, such as growth and development, maintenance and priming of the immune system, and tissue repair. The aim of the present study was to determine the effects of zinc sulfate (40 mg/kg and 80 mg/kg) on early hematopoietic toxicity, caused by total-body irradiation (TBI) of rats with a single dose of 8 Gy. Both in the Zn 40 and in the Zn 80 groups, there were significantly increased white blood cell (WBC) count, when compared with control group. The WBC count was higher in the control group than in the TBI group. This result was statistically significant (p<0.05). Both the TBI+Zn 40 and the TBI+Zn 80 groups had a significantly protected WBC count against TBI. No difference was detected in any final measurement of thrombocyte count and hemoglobin level with direct comparison among all groups, with the exception that the hemoglobin level in the Zn 80 group compared to the control group. Whereas hemoglobin level in the control group was at a median figure of 13.98 g/dL (13.30–14.80), it was at a median figure of 14.25 g/dL (14.10–15.50) in the Zn 80 group. It would be worth while studying the effect of oral zinc sulfate supplements in radiation-treated cancer patients, in the hope of reducing radiation-induced toxicity.