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Doxepin for radiation therapy-induced mucositis pain in the treatment of oral cancers

Ritujith Jayakrishnan, Kenneth Chang, Gamze Ugurluer, Robert C. Miller, Terence T. Sio
  • Ritujith Jayakrishnan
    Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
  • Kenneth Chang
    Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
  • Gamze Ugurluer
    Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA; Department of Radiation Oncology, Acibadem Adana Hospital, Acibadem University, Adana, Turkey
  • Robert C. Miller
    Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
  • Terence T. Sio
    Department of Radiation Oncology, Mayo Clinic, Rochester, MN; Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, United States | Sio.Terenc@mayo.edu

Abstract

Radiotherapy (RT), an integral part of the oncologic treatment for patients with head and neck cancer, can cause adverse side effects such as oral mucositis (OM). Pain from OM can impact a patient’s quality of life and interrupt RT treatment schedules, which decreases the probability for achieving cancer cure. Conventionally, RT-induced OM pain is treated with analgesics and/or mouthwash rinses. Doxepin, a traditional tricyclic antidepressant with analgesic and anesthetic properties when applied topically to the mucosa, has been shown to lower OM pain in multiple single-arm trials (Epstein et al.) and more recently, in a placebo-controlled crossover study (Leenstra and Miller et al.). Currently, a placebo-controlled study (Sio and Miller et al.) using doxepin for esophagitis pain caused by RT to the thorax is underway. Doxepin will also be further compared with magic mouthwash and a placebo solution in a three-arm trial (Miller and Sio et al.) with head and neck cancer patients with OM pain caused by RT. Doxepin may represent a new standard for treating RT-induced OM pain in the future.

Keywords

Oral mucositis; radiation therapy; doxepin; head and neck cancer; symptom control.

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Submitted: 2015-09-19 06:10:28
Published: 2015-12-09 12:37:19
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Copyright (c) 2015 Ritujith Jayakrishnan, Kenneth Chang, Gamze Ugurluer, Robert C. Miller, Terence T. Sio

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