Hyaluronic acid for treatment of the radiation therapy side effects: a systematic review

The main limit of radiation therapy is the dose-dependent toxicity to healthy tissues. The 36% of patients exposed to radiotherapy for pelvic malignancies reporting gastrointestinal symptoms as incontinence, pain, mucus discharge, and bleeding (radiation proctopathy). In the cervix cancer, healthy tissues exposed to radiations easily develop inflammation of vaginal mucosa, bleeding and pain and to improve these symptoms, some medical devices were developed. One of the most interesting for its features is undoubtedly the hyaluronic acid. Considering the histological similarity between the vaginal and the rectal mucosa, the application of hyaluronic acid for the radiation proctopathy represents an interesting opportunity.

We performed a literature search of MEDLINE, EMBASE, PubMed, and Research Gate for studies published up to March 2018. The following combination of medical subject headings, terms and free text words were used: 'hyaluronic acid', 'hyaluronate', 'topical application' and 'radiation proctitis'.

After the screening of titles and abstracts, and using the established criteria, 7 studies were selected for inclusion in the systematic review.

The clinical use of hyaluronic acid for topical administration in patients with inflammatory conditions at the level of the vaginal and anal mucosa, following radio and chemo-therapies, resulted an innovative approach to help patients in managing the AEs. Hyaluronic acid confirmed its totally safety profile and resulted effective in the inflammation decrease, improving the tissue health and the symptoms related. For all these reasons, we can easily promote the clinical application of hyaluronic acid on inflamed tissues though a substantial work is necessary to investigate more deeply the hyaluronic acid role on this context.