Efficacy of Oral Cryotherapy in the Prevention of Oral Mucositis Associated with Cancer Chemotherapy: Systematic Review with Meta-Analysis and Trial Sequential Analysis

Abstract

Background: This review aimed to evaluate the efficacy of oral cryotherapy in the prevention of chemotherapy-induced oral mucositis using meta-analysis and trial sequential analysis, as well as to assess the quality of the results by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Methods: A comprehensive search of three databases including Medline, Embase and Central was performed to identify randomized controlled trials that used oral cryotherapy for the prevention of chemotherapy-induced oral mucositis. The primary outcome was the incidence of oral mucositis for trials employing oral cryotherapy as the intervention for the prevention of oral mucositis. The meta-analysis was performed using the random-effects model and random errors of the meta-analyses were detected by trial sequential analysis. Results: A total of 14 RCTs with 1577 participants were included in the present meta-analysis. Patients treated with oral cryotherapy were associated with a significantly lower risk of developing oral mucositis of any grade (risk ratio (RR), 0.67 (95% CI: 0.56–0.81, p < 0.05)). Findings from the subgroup analyses showed that oral cryotherapy significantly reduced the risk of oral mucositis in patients undergoing bone marrow transplantation (RR 0.69, CI: 0.54–0.89, p < 0.05) as well as chemotherapy (RR 0.66, CI: 0.58–0.75, p < 0.05). Findings from the trial sequential analysis suggested that the evidence on oral cryotherapy as a preventive intervention for oral mucositis in patients with solid malignancies receiving conventional chemotherapy was conclusive. Conclusion: Oral cryotherapy is effective in preventing oral mucositis in patients undergoing chemotherapy for the management of solid malignancies. The use of oral cryotherapy in preventing oral mucositis in bone marrow transplantation settings showed promising efficacy, but the evidence is not conclusive and requires more high-quality randomized controlled trials.

Cryotherapy for oral mucositis in cancer: review of systematic reviews and meta-analysis

“…Five meta-analyses were found not to met the inclusion criteria and were excluded. Ultimately, 10 SRMAs were found to match the criteria and were included 14 33–41. Among the meta-analyses, 25 RCTs17–19 42–62 were included in the umbrella review.…”

“…According to the results of methodological quality evaluation of the meta-analyses, the most important problem in the studies is not reporting the funding source,33–40 and not involving the effect of ROB in interpreting the results and discussion 33–40. In summary, two SRMAs were rated to have high methodological quality,14 41 one was rated low,33 and the rest were rated to have a critically low methodological quality,34–40 according to the AMSTAR overall judgement.…”

Oral changes in patients undergoing hematopoietic stem cell transplantation and their risk factors: a cohort study

“…Oral mucositis is characterized initially as an erythema in the oral mucosa that can progress to atrophy, ulceration, and the formation of pseudomembranes [21]. The development of oral mucositis is associated with the formation of diffuse ulcers, with imprecise and generally non-delimited limits, often not surrounded by an erythematous halo [10,22]. These characteristics were used to differentiate oral mucositis from changes not associated with it in the present research.…”

Suvremeni pristup liječenju oralnog mukozitisa

“…In conclusion, the efficacy of cryotherapy in OM may be limited to chemotherapeutic agents, and there is no evidence that OC would be effective in preventing radiotherapy-induced OM 29 .…”