Topical Treatment of Oral Mucositis in Cancer Patients: A Systematic Review of Randomized Clinical Trials

Abstract

Background and Purpose: Evidence-based protocols of topical therapy for oral mucositis (OM) induced by chemoradiotherapy (CRT) are continuously established and updated. Thus, the present systematic review aims to evaluate the scientific literature in terms of effectiveness of topical treatment of OM in cancer patients undergoing CRT. Materials and Methods: This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist. Randomized clinical trials were identified through electronic database searches on CINAHL, Cochrane Library, LILACS, Livivo, PubMed, SCOPUS, and Web of Science. Grey literature was also assessed on Google Scholar, Open Grey, and ProQuest. The risk of bias in the included studies was assessed by the Cochrane Collaboration Risk of Bias Tool. Results: Twenty-three randomized clinical trials (n=1169 patients) met the inclusion criteria. Twenty-three different topical agents were examined and categorized into five groups: analgesics (30.4%), natural agents (21.7%), other topical agents (21.7%), antimicrobial agents (17.4%), and growth factors (8.8%). Of the included studies, 50% presented a resolution of OM within 14 days. Topical natural agents yielded good results with average resolution time of 3–7 days. The included studies generally demonstrated that patients treated with mouthwashes presented superior benefits compared to the control, depending on OM severity. Conclusion: Topical agents effectively reduced the severity of OM lesions and pain intensity in patients receiving chemoradiotherapy, although the effects varied by agent type. However, the heterogeneity in the results of these topical intervention studies underscores the need for standardized clinical trial methodologies. Clinical Relevance: Topical agents were effective in patients with severe OM lesions receiving chemoradiotherapy and are a good alternative of home care in relation to pain control, reduction of inflammation and consequent improvement in quality of life.

Addressing the Chemotherapy Induced Oral Mucositis

“…Chemotherapeutic Agents Causing Mucositis (24) Alkylating agents: Busulfan, Cyclophosphamide, thiotepa, procarbazine Anthracyclines: Doxorubicin, epirubicin, daunorubicin Antimetabolites: 5-FU, methotrexate, hydroxyurea Antitumor agents: Actinomycin D, bleomycin, mitomycin Texans: Paclitaxel Vinca alkaloids: Vincristine, vinblastine Chemotherapy induced Oral mucositis (OM) is known to have a significant impact on Quality of Life (19) . The occurrence of OM is accompanied by difficulty in chewing, swallowing, eating, and drinking.…”

The chromatographic constitution of andiroba oil and his healing effects, compared to the LLLT outcomes, in oral mucositis induced in golden Syrian hamsters: a new treatment option

“…Thus, the execution of a preventive and curative treatment to reduce OM incidence seems to be necessary. The regular medical interventions are palliative conducts related to releasing the OM symptomatology [3], such as the use of cryotherapy [4], topical anesthetics, antifungals, antiseptics, antivirals, antibiotics, anti-inflammatory drugs inhibitors of COX-2 and/or prostaglandin E2, protective agents of the mucosa, vitamins E and A [5], use of low-level laser therapy [6][7][8][9], and phytotherapy [10][11][12]. www.oncotarget.com…”