الفهرس 
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Abstract
Head and neck cancer (HNC) is the seventh most common cancer globally. It often requires a multimodality approach involving surgery, chemotherapy, and radiation. Radiation therapy (RT) causes double-stranded DNA breaks, which can lead to a cascade of cellular and extracellular changes. This damage leads to proportionally more deleterious effects on fast-dividing tissues, such as malignant cancers; however, it also causes quantifiable damage to healthy tissues within and adjacent to the radiation treatment field. This high cellular turnover of mucosal cells, a trait shared with cancers of the head and neck, makes them especially susceptible to the effects of RT.
Oral mucositis is a common condition encountered by oncologists, and it can be severe enough to require hospitalization or unplanned breaks in radiotherapy RT. Almost all patients with head and neck cancer who receive chemotherapy and cumulative radiation doses of >30Gy to the oral mucosal fields will develop mucositis. The incidence of radiation-induced oral mucositis is 80% in head and neck cancer irradiated patients and reaches up to 100% in patients with altered fractionation head and neck cancer
Oral mucositis can lead to several issues such as intense pain, incapacitating conditions, difficulty in eating leading to nutritional
problems, and a higher likelihood of oral infections due to the presence of sores in the oral mucosa. This condition significantly impacts the patient’s quality of life and treatment choices. Various methods have been attempted to prevent and treat severe mucositis, including oral hygiene, the use of topical anesthetics and antimicrobial agents, and oral rinsing. However, there is no established standard treatment.
Glutamine is the most abundant amino acid in the body and serves as a primary fuel for rapidly proliferating cells such as enterocytes, fibroblasts, lymphocytes, and macrophages. Therefore, it is classified as a conditionally essential amino acid and has antioxidant properties. During severe stress, the body may not produce enough glutamine, leading to decreased plasma levels and negative effects on mucosal immunity. Patients with advanced cancer undergoing cytotoxic therapy may develop glutamine deficiency.
The aim of the present study was to evaluate the effect of oral glutamine suspension in radiation induced oral mucositis.
Forty subjects with radiation induced oral mucositis were included in this study. They were randomly grouped into two groups; the test group included twenty subjects that received glutamine oral suspension, and the control group included twenty subjects received maltodextrin oral suspension. Both groups used the swish and swallow technique to take their respective suspensions throughout their radiotherapy treatment.
The results of the present study showed that test group gave the best results regarding the WHO scale, OMAS scale pain-VAS, incidence of opioid use, BMI change, and TGF-β1 over the control group.
from present results we concluded that, glutamine oral suspension gave the best results in management of radiation induced oral mucositis. Salivary TGF-β1 levels can provide a noninvasive method for evaluating the local impact of radiation in patients receiving RT for head and neck tumors.