Review: various interventions prevent or reduce oral mucositis in patients with cancer receiving chemotherapy or radiotherapy.

Are prophylactic interventions effective for oral mucositis in patients with cancer receiving chemotherapy or radiotherapy?METHODSData sources: Medline, EMBASE/Excerpta Medica, Cochrane Oral Health Group Trials register, Cochrane Central Register of Controlled Trials, and 4 other databases (most recent search April 2004), and bibliographies of relevant studies.Study selection and assessment: randomised controlled trials (RCTs) that compared prophylactic drugs with other treatments, placebo, or no treatment in patients with cancer receiving chemotherapy or radiotherapy. Studies with a primary outcome of survival or cure or mucositis as a toxicity outcome were excluded. 71 RCTs (n = 5217, age range 1-70 y) met the selection criteria. Quality assessment was based on allocation concealment, blinded outcome assessment, and handling of withdrawals.Outcomes: presence of mucositis and mucositis severity scores (0 = absent, 1 = mild, 2 = moderate, 3 = severe).MAIN RESULTSMeta-analyses showed that amifostine, ice chips, antibiotics, and hydrolytic enzymes reduce the incidence or severity of mucositis (table). Single RCTs (n<100) also showed benefit for calcium phosphate, benzydamine, povidone, oral care, honey, and zinc sulphate compared with placebo or no treatment (table). Folinic acid performed significantly worse than placebo.CONCLUSIONVarious interventions prevent or reduce the incidence and severity of oral mucositis in patients with cancer receiving chemotherapy or radiotherapy.