Treatment of chemotherapy-induced oral mucositis by silymarin

Abstract EN

Background : oral mucositis is a common and severe complication of head and neck radiation therapy.

Silymarin is a polyphenolic flavonoid extracted from the milk thistle exhibits a strong antioxidant activity, and anti-inflammatory effects.

The efficacy for the treatment was assessed in comparison with indomethacin.

Patients and Methods: A prospective, randomized, double blind; placebo controlled study was conducted in 65 of chemotherapy-induced oral mucositis patients; plasma IL-1β, leptin, and Trolox equivalent antioxidant capacity (TEAC) were assessed for 3 orally treated groups; Silymarin 140mg, or Indomethacin 25mg, or placebo, 3 times daily for 14 days, radiation technique and dose were similar.

The oral mucositis was assessed weekly according to OMAS and WHO scale, pain related to oral mucositis was scored subjectively by visual analog scale.

Results : Patients' characteristics showed no significant differences between tested groups.

Statistical significance showed in ; lower OMAS value at the time of using Silymarin, and lower mean time to healing of oral mucositis in Silymarin treated group compared to Indomethacin treated and placebo groups.

Ulcer healing and pain relief were seen in 100 % of Silymarin treated group but only 40 % of Indomethacin treated group compared to placebo after 5 days of treatment.

Serum IL-1β, leptin were reduced significantly, and TEAC showed significant elevation in Silymarin treated group compared to baseline and other tested drugs.

Conclusion : Silymarin could interrupt or block the mucositis process at multiple targets that protect the mucosa and promote healing of chemotherapy-induced mucositis by reducing the incidence, blocking the oxidative stress and anti-inflammatory actions.