EFFICACY OF ORAL AND TOPICAL ANTIOXIDANTS IN THE PREVENTION AND MANAGEMENT OF ORAL MUCOSITIS IN PATIENTS WITH HEAD AND NECK CANCER. A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

<h3>Objectives</h3> The objective of this study was to evaluate the effectiveness of antioxidants in the prevention and management of oral mucositis in adults undergoing radiotherapy with or without chemotherapy with diagnosed head and neck cancer (HNC) compared with placebo intervention. <h3>Study Design</h3> The Cochrane Library, MEDLINE via PubMed, Web of Science, and EMBASE libraries were searched. Randomized controlled trials (RCTs) comparing oral or topical antioxidants with placebo in clinically diagnosed adult patients with HNC undergoing radiotherapy with or without chemotherapy were included. Primary outcome was to assess the efficacy of the antioxidant to prevent and decrease the prevalence and severity of oral/oropharyngeal mucositis. Risk of bias was analyzed based on Cochrane's handbook. <h3>Results</h3> The initial search strategy yielded 202 unduplicated references up to February 5, 2020. Fourteen RCTs were included, with 647 adult patients diagnosed with HNC. Meta-analysis showed a significant improvement in mucositis severity score for all antioxidants except melatonin; however, further studies are needed because only 2 studies were available for propolis/honey and zinc, and only 1 study reported outcomes for curcumin, silymarin, and vitamin E. Patients receiving vitamin E had 60% less chance of developing severe mucositis Radiation Therapy Oncology Group (RTOG) 2 or higher in 1 study than those receiving placebo (<i>P</i> = .040). No statistically significant differences were found in incidence of severe mucositis or the number of patients requiring analgesics for melatonin, propolis/honey, aloe vera, or vitamin E in 1 trial. Owing to unclear or high risk of bias, the small total sample size of participants in each meta-analysis (<400), plus the small number of studies pooled, the quality of the evidence was low. <h3>Conclusions</h3> Though oral and topical antioxidants provided a significant improvement in mucositis severity scores, evidence was of low quality owing to the small number of studies and unclear or high risk of bias; additional studies are needed to confirm these results.