Prophylaxis With Oral Zinc Sulfate Against Radiation Induced Oral Mucositis in Patients With Head and Neck Cancers: A Systematic Review and Meta-Analysis of Four Randomized Controlled Trials.

Ting Shuai,Hui Chen,Xiu-E Li,Bing Shi,Xiao-Ling Liu,Wei-Qing Chen,Xu Tian,Li-Juan Yi

doi:10.3389/fonc.2019.00165

Abstract

Background: Oral mucositis is an inevitable and distressing adverse event patients, who were treated with irradiation for head and neck cancer, face. Although several studies have investigated the potential of oral zinc sulfate in preventing radiation-induced oral mucositis in patients with head and neck cancers, conclusive results have not yet been found.Objective: The aim of the present study is to determine whether oral zinc sulfate is effective in preventing radiation-induced oral mucositis, in patients with head and neck cancers.Methods: We electronically searched all potential citations in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and EBSCO from their inception to December 2018. After the search and checked literatures, extracted data and appraised risk of bias, RevMan software version 5.3 was used to perform meta-analysis.Results: Four randomized controlled trials (RCTs) involving 162 patients were included. A meta-analysis showed that zinc sulfate did not decrease the incidence (RR [relative risk], 0.97; 95% CI [confidence interval], 0.74–1.28), and did not relieve the moderate and severe grade of radiation induced oral mucositis (moderate and severe oral mucositis: RR, 0.84; 95% CI, 0.14–4.87; severe oral mucositis: RR, 0.43; 95% CI, 0.00–38.98). A qualitative analysis suggested that zinc sulfate was associated with the onset of oral mucositis.Conclusions: Based on limited evidence, zinc sulfate may not have the benefit of prophylaxis against radiation-induced oral mucositis, in patients with head and neck cancers. However, further RCTs with larger sample sizes and more rigorous methodologies are needed to enhance the evidence of these results.

Highlights

Issued data revealed that head and neck cancer ranks eighth of all cancers, in incidence, and it has been estimated that about 710, 000 new cases were reported in 2018 [1]
The meta-analysis suggested that there were no significant differences in the incidence of oral mucositis between the zinc sulfate and control groups
After performing a meta-analysis, the pooled results revealed that zinc sulfate had no impact on decreasing the severity of oral mucositis (Moderate and severe oral mucositis: RR, 0.84; 95% CI, 0.14–4.87; P = 0.85, I2 = 89%, Figure 4A; Severe oral mucositis: RR, 0.43; 95% CI, 0.00–38.98; P = 0.71, I2 = 79%, Figure 4B)

Summary

Introduction

Issued data revealed that head and neck cancer ranks eighth of all cancers, in incidence, and it has been estimated that about 710, 000 new cases were reported in 2018 [1]. Radiotherapy, with or without chemotherapy, has always been considered as the medical regime that prevalently treats radical head and neck cancers [2, 3], this regime may result in some distressing adverse side-effects [4]. Of all of these adverse effects, oral mucositis (OM) seems to be the most common and troubling side effect, which results from the cytotoxic effects of radiation therapy on mucosa [5, 6]. Several studies have investigated the potential of oral zinc sulfate in preventing radiation-induced oral mucositis in patients with head and neck cancers, conclusive results have not yet been found

Methods

Results

Conclusion