The effect of systemic enzyme therapy (Phlogenzym) in the treatment of
radiomucositis in patients with laryngeal cancer
Pluzhnikov M. S., Ryabova M.A., Karpiscenko S.A. The effect of
systemic enzyme therapy (Phlogenzym)
in the treatment of radiomucositis in patients with laryngeal
cancer. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae
1999, Vol. 5, No.1-2/99, pp. 73-75. 17 KR
Healthy tissue surrounding oncologic lesion is
regularly intervened in the course of radiotherapy, too. Three
degrees of skin reaction are distinguished :
erythema caused by the total doses of 30 – 35 Gy,
dry dermatitis (hyperemia, edema, epidermal separation, sudoriferous
and salivary gland functional impairment; skin is dry, pigmented)
caused by total doses of 40 Gy,
wet dermatitis, caused by the doses of 50 Gy and more.
Mucosa seems to be more radio-sensitive than skin. As the basal
layer gets damaged, cicatrization develops under white fibrinous
deposit. The soreness makes swallowing very difficult. Xerostomia is
detected as a consequence of progressive radiomucositis with
impairment of salivary gland cells.
As the patients lose appetite, they mostly insist on discontinuation
of radiotherapy. In order to prevent radiomucositis, a
non-irritating diet is recommended as well as absence of alcohol and
smoking. Postradiation disease is treated by antibiotics,
analgesics, alkaline throat wash, vitamins etc.
Clinical effect of Phlogenzym on radiation-induced epitheliitis was
studied at the Clinic of Otorhinolaryngology I.P.Pavlova in 15
patients suffering from laryngeal cancer. 9 patients underwent
endoscopic resection of larynx, 2 patients underwent extirpation of
larynx, 3 were treated by radiation only, and one patient was
subject to pharyngotomy and resection of palate tonsil and tongue
root. 15 patients suffering from laryngeal cancer and treated by
radiation without administration of Phlogenzym served as a control
group.
Xerostomia, swallowing difficulties, hyperemia, fibrinous deposits,
and crusts on mucosa were recorded in the control group. In spite of
the fact, that conventional palliative therapy was administered
(antibiotics, NSAID, anesthetics), it was necessary to discontinue
the treatment in 4 patients who refused to eat. Radiation
side-effects persisted for 3 weeks up to 3 months, resulting in food
intake reduction and necessary medication.
In the group of 15 patients receiving 2x3 tablets of Phlogenzym for
10 days, no case of radiomucositis of II degree was recorded, as
well as the occurrence of fibrinous deposits and crusts.
The course of radiotherapy was not discontinued in any patient. Mean
weight loss in the enzyme-treated patients was 5 %, while in the
control group it was 10 %. Blood leukocyte count was 5 x 109 / l,
while in the control group it was 3 x 109 / l. The symptoms of
epitheliitis disappeared within one week after treatment.
Administration of enzyme therapy alleviated the consequences of
radiation-induced epitheliitis and Phlogenzym was well tolerated
without any side effects.