The intervention group received an oral supplement of 2000 mg nicotinamide orally 2-3 hours before chemotherapy. Additionally, they underwent carbogen gas inhalation (95% O2 and 5% CO2) starting 10 minutes before chemotherapy and continuing until the completion of the chemotherapy procedure. Inhalation was administered through a modified non-rebreathing mask at a flow rate of 10 liters/minute to minimize room air inhalation during carbogen administration. Conversely, the control group only underwent chemotherapy without any supplementary interventions.