Preventive Intervention Possibilities in Radiotherapy- and Chemotherapy-induced Oral Mucositis: Results of Meta-analyses

• Published in: Journal of Dental Research Vol. 85; no. 8; pp. 690 - 700
• Main Authors: Stokman, M.A., Spijkervet, F.K.L., Boezen, H.M., Schouten, J.P., Roodenburg, J.L.N., de Vries, E.G.E.
• Format: Book Review Journal Article
• Language: English
• Published: United States SAGE Publications 01.08.2006; SAGE PUBLICATIONS, INC
• Subjects: Amifostine - therapeutic use; Anti-Bacterial Agents - therapeutic use; Antineoplastic Agents - adverse effects; Colony-Stimulating Factors - therapeutic use; Cranial Irradiation - adverse effects; Cryotherapy; Drug Combinations; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - radiotherapy; Humans; Mouth Mucosa - drug effects; Mouth Mucosa - radiation effects; Mucositis - etiology; Mucositis - prevention & control; Radiation-Protective Agents - therapeutic use; Stomatitis - etiology; Stomatitis - prevention & control; meta-analysis; mucositis; scoring; prevention
• ISSN: 0022-0345; 1544-0591
• DOI: 10.1177/154405910608500802

The aim of these meta-analyses was to evaluate the effectiveness of interventions for the prevention of oral mucositis in cancer patients treated with head and neck radiotherapy and/or chemotherapy, with a focus on randomized clinical trials. A literature search was performed for reports of randomized controlled clinical studies, published between 1966 and 2004, the aim of which was the prevention of mucositis in cancer patients undergoing head and neck radiation, chemotherapy, or chemoradiation. The control group consisted of a placebo, no intervention, or another intervention group. Mucositis was scored by either the WHO, the National Cancer Institute-Common Toxicity Criteria (NCI-CTC) score, or the absence or presence of ulcerations, or the presence or absence of grades 3 and 4 mucositis. The meta-analyses included 45 studies fulfilling the inclusion criteria, in which 8 different interventions were evaluated: i.e., local application of chlorhexidine; iseganan; PTA (polymyxin E, tobramycine, and amphotericin B); granulocyte macrophage-colony-stimulating factor/granulocyte colony-stimulating factor (GM-CSF/G-CSF); oral cooling; sucralfate and glutamine; and systemic administration of amifostine and GM-CSF/G-CSF. Four interventions showed a significant preventive effect on the development or severity of oral mucositis: PTA with an odds ratio (OR) = 0.61 (95% confidence interval [CI], 0.39–0.96); GM-CSF, OR = 0.53 (CI: 0.33–0.87); oral cooling, OR = 0.3 (CI: 0.16–0.56); and amifostine, OR = 0.37 (CI: 0.15–0.89). To date, no single intervention completely prevents oral mucositis, so combined preventive therapy strategies seem to be required to ensure more successful outcomes.