Title : Stainless steel ice oral cryotherapy for oral mucositis in nasopharyngeal cancer: A case report
Abstract:
Introduction: Oral mucositis is a common and debilitating complication in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy, with incidence exceeding 80%. It is characterized by painful oral ulcerations, dysphagia, xerostomia, and taste disturbances leading to reduced oral intake, malnutrition, and impaired quality of life. Despite advances in radiotherapy techniques, effective management of Radiation-Induced Oral Mucositis (RIOM) remains largely supportive. Therefore, simple, safe and easily implementable non- pharmacological interventions are needed to alleviate symptoms and support nutritional intake during cancer treatment. Oral cryotherapy using stainless steel ice represents a potential supportive strategy to reduce oral discomfort and improve nutritional intake patients with nasopharyngeal cancer.
Case Report: A 63-year-old male with locally advanced nasopharyngeal carcinoma had completed neoadjuvant TPF chemotherapy (docetaxel, cisplatin, and 5-fluorouracil) and was undergoing intensity-modulated radiation therapy at a total dose of 70/60/54 Gy in 33 fractions. During treatment, patient developed RIOM presenting with significant oral pain resulting in reduced oral intake, progressive weight loss, and clinically moderate malnutrition. As part of supportive care integrated with comprehensive medical nutrition therapy, oral cryotherapy using stainless steel ice was implemented to alleviate mucositis-related pain, while enteral nutrition via nasogastric tube was used to ensure adequate nutritional intake. Over the observation period, the patient demonstrated improved oral intake tolerance, weight gain, and improvement in quality of life, as assessed using the University of Washington Quality of Life questionnaire.
Discussion: Oral cryotherapy using stainless steel ice may alleviate mucositis-related pain through localized vasoconstriction, thereby reducing inflammatory mediator delivery to the oral mucosa and limiting tissue injury. The cooling effect also provides transient analgesia, improving oral comfort and swallowing tolerance. Unlike pharmacological interventions, oral cryotherapy is simple, low-cost, non-invasive, and associated with minimal risk, making it a feasible adjunctive strategy in routine clinical practice.
Conclusion: Oral cryotherapy using stainless steel ice is a simple and safe supportive intervention that may reduce RIOM related pain and improve oral intake in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy. When combined with medical nutrition therapy, it may contribute to improved nutritional status and quality of life.
Keywords: Oral Mucositis, Oral Cryotherapy, Nasopharyngeal Carcinoma, Nutritional Intake, Quality of Life.
