Abstract
Objectives: The role of oral glutamine for the management of oral mucositis (OM) has not yet been confirmed. The objective of the present study is to further investigate whether oral glutamine is effective in preventing and treating OM among patients with head and neck cancer (HNC) receiving radiotherapy alone or concurrent with chemotherapy.Methods: A systematic search was performed in PubMed, EMBASE, EBSCO, and Cochrane Central Register of Controlled Trials (CENTRAL) to capture all potential citations from the inception to June 2019. Then data extraction and assessment of risk of bias were carried out after selecting the eligible citations. RevMan 5.3 software was used to perform all statistical analyses.Results: Six randomized controlled trials (RCTs) including 441 patients were included in the final analysis. The meta-analysis showed that oral glutamine couldn't significantly decrease the incidence of OM (risk ratio [RR] = 0.98, 95% confidence interval [CI] = 0.94−1.02) and alleviate the development of moderate or severe grade of OM (Moderate-to-severe OM: RR = 0.81, 95% CI = 0.59−1.12; Severe OM: RR = 0.45, 95% CI = 0.13−1.52). But oral glutamine may have the potential to reduce the opioid use (RR = 0.84, 95% CI = 0.71−0.99). The role of oral glutamine in delaying the onset of OM remains uncertain due to conflicting results between quantitative (mean difference [MD] = 4.11 days, 95% CI = 3.49−4.73) and qualitative results.Conclusions: Oral glutamine may have no clinical benefits to prevent or reduce the incidence and severity of radiation-induced OM in patients with HNC receiving radiotherapy alone or concurrent with chemotherapy. It is also uncertain whether oral glutamine can delay the onset of OM. But it may have the potential to relieve the degree of oral pain. Nevertheless, we must cautiously interpret the results because the observed effect size for delay in mucositis start or reduction in opioid use is marginal. Moreover, further RCTs with more rigorous methodology and large-scale are required to enhance the quality of evidence.
Highlights
Issued data showed that head and neck cancer (HNC) was ranked at eighth among all cancers and the new cases were more than 710 thousand in 2018 [1]
All studies reported that the baseline information between the glutamine group and the control group was not statistically significant
The results showed that the incidence of moderate and severe Oral mucositis (OM), and the incidence of severe OM were both not statistically significant between the two groups
Summary
Issued data showed that head and neck cancer (HNC) was ranked at eighth among all cancers and the new cases were more than 710 thousand in 2018 [1]. Radiotherapy (RT) is one of the three cornerstones in the treatment of HNC [2]. Oral mucositis (OM) is viewed as the most prevalent and troubling side effect in HNC patients receiving RT, which results from the direct toxic damage of RT with or without chemotherapy (CT) on oral mucosa [4]. 80% of HNC patients will experience OM during RT, which is much higher than that in most cancers such as esophageal cancer (57.8%) and colorectal cancer (63%) [5, 6]. When cumulative doses of RT are larger than 30 Gy in the field of oral mucosal and patients receive CT simultaneously, nearly 100% of the HNC patients may develop OM [7]
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