Glutamine for prevention and alleviation of radiation‐induced oral mucositis in patients with head and neck squamous cell cancer: Systematic review and meta‐analysis of controlled trials

Abstract

We conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs) that investigated glutamine efficacy in preventing and alleviating radiation‐induced oral mucositis (OM) among patients with head and neck (H&N) cancer. We screened five databases from inception till February 4, 2021 and followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. We included 11 RCTs, comprising 922 patients (458 and 464 patients were assigned to glutamine and control group, respectively). The incidence and onset of radiation‐induced OM of any grade did not substantially differ between both groups. However, glutamine substantially reduced the severity of radiation‐induced OM, as reflected by the reduced incidence of severe OM and reduced mean maximal OM grade score. Additionally, glutamine significantly decreased the rates of analgesic opioid use, nasogastric tube feeding, and therapy interruptions. Oral glutamine supplementation demonstrated various therapeutic benefits in preventing and ameliorating radiation‐induced OM among patients with H&N cancer.

Predictive Risk Factors Associated with Severe Radiation-Induced Mucositis in Nasopharyngeal or Oropharyngeal Cancer Patients: A Retrospective Study

“…In fact, the controlling Nutritional Status (CONUT) score, a screening tool for evaluating malnutrition, takes into account serum albumin, total cholesterol, and total lymphocyte levels [ 25 ]. As such, the relationship between lymphocyte count and nutrition may explain the therapeutic benefits of oral glutamine supplementation in preventing and ameliorating radiation-induced oral mucositis among patients with head and neck cancer, as described previously [ 26 ].…”

Manejo odontológico de las manifestaciones orales inducidas por radioterapia de cabeza y cuello

“…La glutamina es un nutriente utilizado para aumentar la proliferación celular, por ende, su deficiencia podría afectar negativamente la función de los tejidos del huésped 26 . Un metaanálisis señaló que, si bien la glutamina no logró una diferencia significativa en la incidencia de mucositis oral en comparación con el grupo control, redujo sustancialmente la gravedad de la RIOM 27 . Davy & Heathcote 20 evaluaron la eficacia de tres intervenciones de bajo costo para mitigar la RIOM y concluyeron que la glutamina oral era la única recomendada para dicho fin.…”

Amino acids and cancer: potential for therapies?

“…A systematic review and meta-analysis performed with head and neck squamous cell cancer found that Gln supplementation confers benefits in avoiding and improving radiation-mediated mucositis [32 ▪ ].…”