A network meta-analysis in comparing prophylactic treatments of radiotherapy-induced oral mucositis for patients with head and neck cancers receiving radiotherapy. (December 2017)

• Record Type: Journal Article
• Authors: Peng, Hao; Chen, Bin-Bin; Chen, Lei; Chen, Yu-Pei; Liu, Xu; Tang, Ling-Long; Mao, Yan-Ping; Li, Wen-Fei; Zhang, Yuan; Lin, Ai-Hua; Sun, Ying; Ma, Jun
• Is Part Of: Oral oncology. Volume 75(2017)
• Page Start: 89
• Page End: 94
• Publication Date: 2017-12
• Subjects: Head and neck cancers -- Radiotherapy -- Supportive care -- Oral mucositis -- Network meta-analysis; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2017.11.001
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: This is the first network meta-analysis of oral mucositis in head and neck cancers. Low-level laser additional could significantly reduce grade 3–4 oral mucositis. Standard oral care achieved the worst effect on reducing severe oral mucositis. Abstract: Objectives: The objective of this network meta-analysis is to optimize the prophylactic treatment for radiotherapy-induced oral mucositis in patients with head and neck cancer (HNSCC) receiving postoperative or definitive radiotherapy with or without chemotherapy. Materials and methods: We searched electronic databases to identify all eligible randomized clinical trials on oral mucositis. The endpoint was grade 0–2 oral mucositis. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were extracted. Network meta-analysis was performed using the frequentist approach to conduct multiple treatment comparisons. Results: In total, 57 trials with 5261 patients were eligible for this study. Both direct and network meta-analysis revealed that low-level laser additional to standard oral care (SOC) was better than most of the other treatments and achieved the highest effect on grade 0–2 oral mucositis, with a surface under the cumulative ranking curve (SUCRA) of 95.8%; however, SOC with or without placebo had worse effect than most of the other treatments and was ranked worst (SUCRA = 0.4%). Moreover, sensitivity analysis performed after we had combined the SOC and placebo groups (non-medication treatment, NMT) yielded similar results, with SUCRA of 91.3% and 3.5% for low-level laser and NMT, respectively. Conclusions: Low-level laser additional to SOC may be a more effective prophylactic treatment for reducing severe radiotherapy-induced oral mucositis; SOC alone is insufficient for patients with HNSCC receiving postoperative or definitive radiotherapy with or without chemotherapy.