Prophylaxis of oral mucositis in irradiated head-and-neck cancer patients: a proposed classification scheme of interventions and meta-analysis of randomized controlled trials.
OBJECTIVE
To identify, classify, and evaluate agents used in the prophylaxis of oral mucositis in irradiated head and neck cancer patients.


METHODS
Data sources included multiple databases and manual citation review of relevant literature. Based on the eligibility criteria, 59 studies were independently reviewed by two reviewers. Forty-two studies were included in the classification scheme, of which 15 met the criteria for inclusion in the meta-analysis. Data were extracted by duplicate independent review, with disagreement resolved by consensus.


RESULTS
Overall, the interventions reduced the odds of developing severe oral mucositis, when assessed by clinicians, by 36% (OR: 0.64; 95% CI: 0.46, 0.88). Subgroup analysis suggested that only the narrow-spectrum antibacterial lozenges were effective (OR: 0.45; 95% CI: 0.23, 0.86); however, the power of the aggregated data in the other classes may have been insufficient to detect differences. When the outcome was assessed by patients, no significant difference was seen in the outcome between the treatment and the control groups (OR: 0.79; 95% CI: 0.56-1.12).


CONCLUSIONS
Overall, interventions chosen on a sound biologic basis to prevent severe oral mucositis are effective. In particular, when oral mucositis is assessed by clinicians, narrow-spectrum antibiotic lozenges appear to be beneficial. Methodologic limitations were evident in many of the studies. Further research using validated measurement tools in larger, methodologically sound trials is warranted.
Sutherland
S E
SE
Department of Dentistry, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada. susan.sutherland@swchsc.on.ca
Browman
G P
GP
D016001:Confidence Intervals; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D009061:Mouth Mucosa / Q000528:radiation effects; D016017:Odds Ratio; D011832:Radiation Injuries / Q000150:complications / Q000517:prevention & control*; D011837:Radiation-Protective Agents / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013280:Stomatitis / Q000517:prevention & control*
D011837:Radiation-Protective Agents