Efficacy of Oral Cryotherapy in the Prevention of Oral Mucositis Associated with Cancer Chemotherapy: Systematic Review with Meta-Analysis and Trial Sequential Analysis.

Ali Hatem Manfi Al-Rudayni,Divya Gopinath,Rohit Kunnath Menon,Mari Kannan Maharajan,Sajesh Kalkandi Veettil

doi:10.3390/curroncol28040250

Ali Hatem Manfi Al-Rudayni, Divya Gopinath + Show 3 more

Open Access

https://doi.org/10.3390/curroncol28040250

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Abstract

Background: This review aimed to evaluate the efficacy of oral cryotherapy in the prevention of chemotherapy-induced oral mucositis using meta-analysis and trial sequential analysis, as well as to assess the quality of the results by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Methods: A comprehensive search of three databases including Medline, Embase and Central was performed to identify randomized controlled trials that used oral cryotherapy for the prevention of chemotherapy-induced oral mucositis. The primary outcome was the incidence of oral mucositis for trials employing oral cryotherapy as the intervention for the prevention of oral mucositis. The meta-analysis was performed using the random-effects model and random errors of the meta-analyses were detected by trial sequential analysis. Results: A total of 14 RCTs with 1577 participants were included in the present meta-analysis. Patients treated with oral cryotherapy were associated with a significantly lower risk of developing oral mucositis of any grade (risk ratio (RR), 0.67 (95% CI: 0.56–0.81, p < 0.05)). Findings from the subgroup analyses showed that oral cryotherapy significantly reduced the risk of oral mucositis in patients undergoing bone marrow transplantation (RR 0.69, CI: 0.54–0.89, p < 0.05) as well as chemotherapy (RR 0.66, CI: 0.58–0.75, p < 0.05). Findings from the trial sequential analysis suggested that the evidence on oral cryotherapy as a preventive intervention for oral mucositis in patients with solid malignancies receiving conventional chemotherapy was conclusive. Conclusion: Oral cryotherapy is effective in preventing oral mucositis in patients undergoing chemotherapy for the management of solid malignancies. The use of oral cryotherapy in preventing oral mucositis in bone marrow transplantation settings showed promising efficacy, but the evidence is not conclusive and requires more high-quality randomized controlled trials.

Highlights

Oral mucositis (OM) is a common complication of cancer treatment, and the incidence may vary according to the antineoplastic treatment modality
In cancer patients receiving conventional chemotherapy doses, the incidence of OM varies between 20% and 40%, whereas the incidence of OM in patients undergoing bone marrow transplantation (BMT) can be as high as 80% due to the high doses required to achieve myeloablation [1,2]
OC significantly reduced the risk of severe OM with an risk ratio (RR) 0.47

Summary

Introduction

Oral mucositis (OM) is a common complication of cancer treatment, and the incidence may vary according to the antineoplastic treatment modality. OM can significantly affect nutritional status, oral hygiene and quality of life [6] For those patients receiving chemotherapy prior to BMT, OM has been found to be the single most debilitating complication [7]. Findings from the subgroup analyses showed that oral cryotherapy significantly reduced the risk of oral mucositis in patients undergoing bone marrow transplantation (RR 0.69, CI: 0.54–0.89, p < 0.05) as well as chemotherapy (RR 0.66, CI: 0.58–0.75, p < 0.05). Findings from the trial sequential analysis suggested that the evidence on oral cryotherapy as a preventive intervention for oral mucositis in patients with solid malignancies receiving conventional chemotherapy was conclusive. The use of oral cryotherapy in preventing oral mucositis in bone marrow transplantation settings showed promising efficacy, but the evidence is not conclusive and requires more high-quality randomized controlled trials

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