Honey Useful, Cost Effective Treatment for Radiation Mucositis

Role of Honey in the Management of Radiation Mucositis
Biswa Mohan Biswal Mbbs (Utkal), MD (AIIMS), DNB (India) ; Assoc. Prof. Clinical Oncology & Head Department of Nuclear Medicine, Radiotherapy Oncology, School of Medical Sciences, USM Health Campus, Kubang Kerian, Kelantan, Malaysia

[Editor’s Note: This is the fourth in a series of abstracts from the 1st International Conference on the Medicinal Uses of Honey (From Hive to Therapy) held by Universiti Sains Malaysia in August of 2006. The abstracts have been published by the Malaysian Journal of Medical Sciences (Vol.14 No.1, January 2007).]

Radiation therapy is an important modality of management for head and neck cancers. While irradiating the tumors inside head and neck anatomy, a significant extent of the oral and pharyngeal mucosa get therapeutic doses leading to mucositis. Mucositis is a condition characterized by damage to the epithelium of the oropharyngeal cavity and gastrointestinal tract from radiation or chemotherapy.

One of the reasons that epithelial cells are more susceptible to cytotoxic effects of radiation and chemotherapy is because of their relatively high rate of turn over of cells compared to other organs. Radiotherapy or chemotherapy further deplete stem cells of the basal epithelium resulting in a reduction of epithelial cells, release cytokines which increase local vascularity and cause inflammation.

Mucositis can lead to secondary infection, ulceration, and pain leading to malnutrition. Severe mucositis can result in hospitalization and delay in scheduling treatment, compromising therapeutic efficacy. In many instances, patients used to discontinue effective radiotherapy treatment.

Though radiation induced mucositis is a very common side effect of radiotherapy, there is no established guidelines of management. Treatments like antibiotic lozenges, topical sucralfate, aspirin mucilage, local laser treatment, GM-CSF, keratin growth factors have been applied with varying response rate in research set up.

Honey results primarily from the transformation and concentration of nectars from flowers by two processes: interaction with the upper digestive tract secretion of the honeybee and concentration by the water loss (>80%) in beehives. It is a golden yellow viscus fluid containing sugar and many useful compounds. Earlier basic laboratory and animal studies has shown to be epithelial regenerative, anti-bacterial and nutritional properties. Earlier literature evidences reported usefulness of honey in the management of burn and post surgical wound.

In a randomized comparative study conducted at University Science Malaysia for the first time showed a significant reduction of severe (RTOG grade III-IV) radiation induced mocositis among head and neck cancer patient’s undergone fractionated radiotherapy.

In addition to prevention of severe mucositis, we observed positive gain in the body weight. Currently we are conducting a multicenter double blind randomized trial on the application of pure natural honey in the management of mucositis induced by concurrent chemoradiotherapy in nasopharyngeal cancers.

Honey being a natural agent available worldwide may found to be a useful and cost effective treatment in radiation mucositis.