– Cisplatin 80 mg/m2 IV every 3 weeks
– Intensity-modulated radiation therapy (IMRT)
– Daily amifostine prior to radiation
  (discontinued after 3 weeks due to hiccups).

	Despite medical advice, the patient refused placement of a PEG tube before radiation therapy and chemotherapy were started.
	Prior to initiation of therapy, the patient underwent a dental examination, cleaning, and fluoride treatments.
	After 4 weeks of therapy, the patient complained of dysphagia, and a documented weight loss of 25 pounds required placement of the PEG tube.
	Patient was diagnosed with grade 2-3 mucositis and fungal infection.

Clinical Plan                                                                             
 

	The treatment plan included administration of GELCLAIR (bioadherent oral gel) 4 times daily and an oral antifungal agent.
	Patient refused narcotic pain medications.

Outcomes                                                                                

1 week after initiation of GELCLAIR
 

	Due to continued weight loss, radiation was withheld for 5 days.
	Subsequently, the patient completed his course of radiation while continuing GELCLAIR and antifungal medication.
	Patient reported a reduction in pain following the use of GELCLAIR and required no narcotic pain medications.
	Nutritional supplementation resulted in weight gain.
	Patient continued using GELCLAIR for 2 weeks post-radiation and then prophylactically before and after chemotherapy.