title: Management of acute skin toxicity with Hypericum perforatum and neem oil during platinum-based concurrent chemo-radiation in head and neck cancer patients.
abstract: Acute skin toxicity is a frequent finding during combined radiotherapy and chemotherapy in head and neck cancer patients. Its timely and appropriate management is crucial for both oncological results and patient's global quality of life. We herein report clinical data on the use of Hypericum perforatum and neem oil in the treatment of acute skin toxicity during concurrent chemo-radiation for head and neck cancer. A consecutive series of 50 head and neck cancer patients undergoing concomitant radio-chemotherapy with weekly cisplatin was analyzed. Treatment with Hypericum perforatum and neem oil was started in case of G2 acute skin toxicity according to the RTOG/EORTC scoring scale and continued during the whole treatment course and thereafter until complete recovery. The maximum detected acute skin toxicity included Grade 2 events in 62% of cases and G3 in 32% during treatment and G2 and G3 scores in 52 and 8%, respectively, at the end of chemo-radiation. Grade 2 toxicity was mainly observed during weeks 4-5, while G3 during weeks 5-6. Median times spent with G2 or G3 toxicity were 23.5 and 14 days. Patients with G3 toxicity were reconverted to a G2 profile in 80% of cases, while those with a G2 score had a decrease to G1 in 58% of cases. Time between maximum acute skin toxicity and complete skin recovery was 30 days. Mean worst pain score evaluated with the Numerical Rating Scale-11 was 6.9 during treatment and 4.5 at the end of chemo-radiotherapy. Hypericum perforatum and neem oil proved to be a safe and effective option in the management of acute skin toxicity in head and neck cancer patients submitted to chemo-radiation with weekly cisplatin. Further studies with a control group and patient-reported outcomes are needed to confirm this hypothesis.
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy. pierfrancesco.franco@unito.it.
authors.forename: Pierfrancesco
authors.identifier: http://orcid.org/0000-0003-2276-0687
authors.initials: P
authors.lastname: Franco
authors.affiliation: Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Rampino
authors.affiliation: 2nd Medical Oncology Division, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Oliviero
authors.initials: O
authors.lastname: Ostellino
authors.affiliation: 1st Medical Oncology Division, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Schena
authors.affiliation: 1st ENT Division, Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Pecorari
authors.affiliation: Maxillofacial Surgery Division, Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Garzino Demo
authors.affiliation: Maxillofacial Surgery Division, Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Fasolis
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Arcadipane
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Martini
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cavallin
authors.affiliation: Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Airoldi
authors.affiliation: Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003875:Drug Eruptions / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005989:Glycerides / Q000627:therapeutic use*; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D020902:Hypericum; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy / Q000379:methods; D011855:Radiodermatitis / Q000188:drug therapy* / Q000209:etiology; D013729:Terpenes / Q000627:therapeutic use*
chemical_list: D005989:Glycerides; D013729:Terpenes; C002443:neem oil; D002945:Cisplatin
keywords: Concomitant chemo-radiotherapy; Head and neck cancer; Hypericum perforatum; Neem oil; Skin toxicity