Prophylactic use of episil oral liquid to prevent oral mucositis during head and neck concurrent chemoradiotherapy: a prospective single-arm study

Abstract

Abstract Episil oral liquid (episil) has been reported to relieve pain caused by oral mucositis (OM) in cancer patients undergoing chemotherapy and/or radiotherapy. However, its prophylactic use during head and neck concurrent chemoradiotherapy (HN-CCRT) has not yet been evaluated. Based on the known mechanisms of OM progression, we hypothesized that prophylactic use of episil would be more effective than therapeutic use. This study aimed to evaluate the effect of prophylactic episil use on OM during HN-CCRT. This was a prospective, single arm observation study including 22 patients with head and neck cancer who underwent HN-CCRT between 2019 and 2020. Patients received episil prophylactically from the start of treatment. OM pain intensity was assessed using an 11-point numerical rating scale (NRS), and OM severity was graded using the WHO scale. Based on prior studies, the pain score threshold and expected value were set at 5.68 and 3.90, respectively. The highest mean NRS pain score during treatment was 2.73. Grade 3 OM occurred in 13.6% of patients. No patients required treatment interruption or modification due to OM, and all completed prophylactic episil use throughout HN-CCRT. Prophylactic use of episil may be associated with a favorable profile in reducing oral pain and preventing severe OM during HN-CCRT. These findings suggest the potential benefit of the strong, long-lasting bioadhesive barrier formed by episil in potentially preventing the exacerbation of OM due to mucosal infection and trauma.