Fifty-four patients with cancer of the oral cavity or oropharynx who were scheduled to undergo radiation therapy were randomly assigned, in double-blind fashion, to rinse their mouth with a solution containing either 400 mg of vitamin E or placebo before each irradiation session and again 8 to 12 hours later. The solution was dissolved in the saliva, rinsed all over the oral cavity for five minutes, and then swallowed. The treatment was continued throughout the course of radiation therapy (five to seven weeks during). Episodes of mucositis occurred during 21.5% of patient-weeks in the vitamin E group, compared with 33.5% of patient-weeks in the placebo group (36% reduction; p = 0.038). Pain grades 2 or 3 (on a scale of 0-4, with higher scores indicating more severe pain) were experienced by 10.7% of patients in the vitamin E group, and by 53.8% of patients in the placebo group (p = 0.0001). No episodes of grade 4 pain occurred in either group. Vitamin E treatment had no effect on survival.

Comment: Mucositis is an important side effect of radiation therapy to the head and neck area; it can also occur with certain chemotherapy regimens. Mucositis can cause severe pain, making it difficult to eat, and sometimes requires temporary interruption of therapy. The results of the present study indicate that administration of vitamin E (as a rinse and swallow) can decrease the incidence and severity of radiation-induced mucositis in patients with cancer of the oropharynx or oral cavity. Although some doctors have expressed concern that supplementation with antioxidants might block the anti-cancer effects of radiation or chemotherapy, there is little or no evidence that this actually occurs in cancer patients.

Ferreira PR, et al. Protective effect of alpha-tocopherol in head and neck cancer radiation-induced mucositis: a double-blind randomized trial. Head Neck 2004;26:313-321.