Number of days from radiotherapy start to enrollment†
14 (± 6)
14 (± 7)
14 (± 6)
0.721
Tumor site‡
0.400
Oral cavity
20 (35.7)
7 (26.9)
13 (43.3)
Larynx
19 (33.9)
9 (34.6)
10 (33.3)
Pharynx
12 (21.4)
7 (26.9)
5 (16.7)
Larynx, pharynx
4 (7.1)
3 (11.5)
1 (3.3)
Nasal cavity
1 (1.8)
0 (0.0)
1 (3.3)
T stage‡
> 0.900
0
2 (3.6)
1 (3.8)
1 (3.3)
1
1 (1.8)
1 (3.8)
0 (0.0)
2
13 (23.2)
6 (23.1)
7 (23.3)
3
17 (30.4)
8 (30.8)
9 (30.0)
4
8 (14.3)
3 (11.5)
5 (16.7)
4a
10 (17.9)
4 (15.4)
6 (20.0)
4b
4 (7.1)
2 (7.7)
2 (6.7)
X
1 (1.8)
1 (3.8)
0 (0.0)
N category‡
0.200
0
18 (32.1)
12 (46.2)
6 (20.0)
1
5 (8.9)
3 (11.5)
2 (6.7)
2
10 (17.9)
4 (15.4)
6 (20.0)
2b
11 (19.6)
2 (7.7)
9 (30.0)
2c
3 (5.4)
2 (7.7)
1 (3.3)
3
8 (14.3)
3 (11.5)
5 (16.7)
3b
1 (1.8)
0 (0.0)
1 (3.3)
M category‡
0.700
0
53 (94.6)
24 (92.3)
29 (96.7)
1
2 (3.6)
1 (3.8)
1 (3.3)
X
1 (1.8)
1 (3.8)
0 (0.0)
Data are presented as † mean (± standard deviation); * median (interquartile range, IQR), or as an ‡ absolute number (percentage of the total number of respondents in the subject group)
Declarations
Author contributions
ZG, JR, and NG: Investigation, Writing—review & editing. AŠ: Conceptualization, Resources, Methodology, Supervision. MM: Conceptualization, Methodology, Supervision, Writing—original draft. ATA: Conceptualization, Writing—original draft. UG: Conceptualization, Data curation, Software, Formal analysis, Supervision, Visualization, Methodology, Writing—original draft. All authors approved the final version of the manuscript.
Conflicts of interest
Aziz Šukalo, Meliha Mehić, Amna Tanović Avdić, and Una Glamočlija disclose the following relationships—employees of Bosnalijek d.d., a pharmaceutical company producing lysozyme-based products.
Ethical approval
The study was registered with the Agency for Medicinal Products and Medical Devices of Bosnia and Herzegovina under the protocol number LCS-OM-01. The clinical study was approved by the Agency for Medicinal Products and Medical Devices of Bosnia and Herzegovina, number 08-07.5-6730-1/20 on July 20, 2020.
Consent to participate
Informed consent to participate in the study was obtained from all participants.
Consent to publication
Not applicable.
Availability of data and materials
The datasets generated for this study are available from the corresponding author upon reasonable request.
Funding
The authors declare that this study was supported by Bosnalijek d.d. (a company that is a producer of lysozyme-based products). Bosnalijek d.d. had a role in the design of the study; in the collection, analyses, and interpretation of data; in the writing of the manuscript, and in the decision to publish the results. The data and results of this study are not affected by the interest of the Bosnalijek d.d.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Pulito C, Cristaudo A, Porta CL, Zapperi S, Blandino G, Morrone A, et al. Oral mucositis: the hidden side of cancer therapy.J Exp Clin Cancer Res. 2020;39:210. [DOI] [PubMed] [PMC]
Shetty SS, Maruthi M, Dhara V, Arruda JAAd, Abreu LG, Mesquita RA, et al. Oral mucositis: Current knowledge and future directions.Dis Mon. 2022;68:101300. [DOI] [PubMed]
Abusamak M, Abu-Samak A, Cai W, Al-Waeli H, Al-Hamed FS, Al-Tamimi M, et al. Chronotherapy in head and neck cancer: A systematic review and meta-analysis.Int J Cancer. 2024;[Epub ahead of print]. [DOI] [PubMed]
Sieracki RL, Voelz LM, Johannik TM, Kopaczewski DM, Hubert K. Development and implementation of an oral care protocol for patients with cancer.Clin J Oncol Nurs. 2009;13:718–22. [DOI] [PubMed]
Yoshida K, Watanabe S, Hoshino N, Pak K, Hidaka N, Konno N, et al. Hospital pharmacist interventions for the management of oral mucositis in patients with head and neck cancer receiving chemoradiotherapy: a multicenter, prospective cohort study.Support Care Cancer. 2023;31:316. [DOI] [PubMed]
WHO handbook for reporting results of cancer treatment [Internet].World Health Organization; [cited 2024 Apr 12]. Available from: https://iris.who.int/handle/10665/37200
Blanchard A, Yarom N, Levi L, Cheng KKF, Bossi P, Zadik Y, et al.; Atask force of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Clinicians’ experience with topical benzydamine and morphine for the management of oral mucositis: adverse effects and barriers.Support Care Cancer. 2022;30:10255–62. [DOI] [PubMed]
Wang X, Zeng L, Feng X, Zhao N, Feng N, Du X. Did you choose appropriate mouthwash for managing chemoradiotherapy-induced oral mucositis? The therapeutic effect compared by a Bayesian network meta-analysis.Front Oral Health. 2023;3:977830. [DOI] [PubMed] [PMC]
Shen B, Zhou Y, Wu D, Liu J. Efficacy of photobiomodulation therapy in the management of oral mucositis in patients with head and neck cancer: A systematic review and meta-analysis of randomized controlled trials.Head Neck. 2024;46:936–50. [DOI] [PubMed]
Rupel K, Cornacchia A, Poiani M, Mohamed S, Bellis ED, Ballerini M, et al. Preventive versus curative photobiomodulation for oral mucositis in patients with multiple myeloma undergoing hematopoietic stem cell transplantation: which approach is more effective?Support Care Cancer. 2024;32:208. [DOI] [PubMed]
Parra-Rojas S, Spanemberg JC, Díaz-Robayna NDM, Peralta-Mamani M, Cayón RTV. Assessing the Cost-Effectiveness of Photobiomodulation for Oral Mucositis Prevention and Treatment: A Systematic Review.Biomedicines. 2024;12:2366. [DOI] [PubMed] [PMC]
Chan J, Filippi F, Filippi C. Clinical guidance for maintaining oral hygiene in patients undergoing chemotherapy or radiation therapy: a scoping review.Swiss Dent J. 2023;133:368–79. [DOI] [PubMed]
Eminagić D, Lokvančić A, Hasanbegović B, Mekić-Abazović A, Avdičević A, Marijanović I, et al. Efficacy and safety of local lysozyme treatment in patients with oral mucositis after chemotherapy and radiotherapy.Acta Pharm. 2019;69:695–704. [DOI] [PubMed]
Rasic A, Kapo B, Avdicevic A, Mekic-Abazovic A, Jankovic SM, Lokvancic A. Efficacy and Safety of Lysozyme, Cetylpyridinium and Lidocaine Fixed Combination for Treatment of Chemotherapy- and Radiotherapy-Induced Oral Mucositis: a Pilot Study.Mater Sociomed. 2019;31:166–71. [DOI] [PubMed] [PMC]
Ragland SA, Criss AK. From bacterial killing to immune modulation: Recent insights into the functions of lysozyme.PLoS Pathog. 2017;13:e1006512. [DOI] [PubMed] [PMC]
Bergamo A, Sava G. Lysozyme: A Natural Product with Multiple and Useful Antiviral Properties.Molecules. 2024;29:652. [DOI] [PubMed] [PMC]
Carrillo W, Spindola H, Ramos M, Recio I, Carvalho JE. Anti-Inflammatory and Anti-Nociceptive Activities of Native and Modified Hen Egg White Lysozyme.J Med Food. 2016;19:978–82. [DOI] [PubMed]
Ogundele MO. A novel anti-inflammatory activity of lysozyme: modulation of serum complement activation.Mediators Inflamm. 1998;7:363–5. [DOI] [PubMed] [PMC]
Bianchi C. Is Fleming’s lysozyme an analgesic agent? An experimental reappraisal of clinical data.Eur J Pharmacol. 1981;71:211–21. [DOI] [PubMed]
Zhao M, Huang M, Li Z. Exploring the therapeutic potential of recombinant human lysozyme: a review on wound management system with antibacterial.Front Bioeng Biotechnol. 2023;11:1292149. [DOI] [PubMed] [PMC]
Wickham H. ggplot2: Elegant Graphics for Data Analysis. Cham: Springer; 2016.
Olsen MF, Bjerre E, Hansen MD, Hilden J, Landler NE, Tendal B, et al. Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain.BMC Med. 2017;15:35. [DOI] [PubMed] [PMC]
Zhang X, Lei Y, Xiao Y, Cao X, Tian X, Zhu Y, et al. Hen Egg Lysozyme Alleviates Static Mechanical Pain Via NRF1-Parkin-TACAN Signaling Axis in Sensory Neurons.Neuroscience. 2022;502:52–67. [DOI] [PubMed]
Hukić M, Seljmo D, Ramovic A, Ibrišimović MA, Dogan S, Hukic J, et al. The Effect of Lysozyme on Reducing Biofilms by Staphylococcus aureus, Pseudomonas aeruginosa, and Gardnerella vaginalis: An In Vitro Examination.Microb Drug Resist. 2018;24:353–8. [DOI] [PubMed]
Bergamo A, Sava G. Pharmacological Modulation of Host Immunity with Hen Egg White Lysozyme (HEWL)—A Review.Molecules. 2023;28:5027. [DOI] [PubMed] [PMC]
Lin CTS, Raman R. Comparison of the efficacy between oral rinse, oral gargle, and oral spray.J Prim Care Community Health. 2012;3:80–2. [DOI] [PubMed]