Supportive Cryotherapy: A Review From Head to Toe

Abstract

Context Conventional chemotherapy leads to multiple adverse mucocutaneous complications including oral mucositis, alopecia, ocular toxicity, and onycholysis. Limited pharmacologic interventions are available for preventing these clinical problems. Objectives This study aimed to critically review the role of cryotherapy (regional hypothermia) for alleviating these adverse symptoms. Methods A narrative review was performed, with an emphasis on randomized controlled trials. A comprehensive search using PubMed, Ovid, Embase, and MEDLINE® was completed. References of all cited articles also were reviewed. Data from the review were comprised of articles published between 1970 to May 2013. Results Available evidence suggests that regional hypothermia decreases the burden of chemotherapy-related oral mucositis, alopecia, ocular toxicity, and onycholysis. The major limitations of studies include the absence of blinded control groups and variable clinical endpoints. Conclusion Regional hypothermia decreases the burden of these four chemotherapy-induced complications and is well tolerated. More research is needed to determine what subgroups of cancer patients are most likely to respond to different types of regional hypothermia, the ideal duration of cooling needed, and to further improve the ease of use of the cooling devices.

Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy

“…New research shows a growing interest towards cryotherapy or regional hypothermia for alleviating chemotherapyinduced toxicities such as oral mucositis, ocular toxicity, onycholysis and peripheral neuropathy [11]. Of these debilitating side effects, chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity of several neurotoxic chemotherapeutic agents, manifesting as severe pain and tingling sensation in the finger and toe tips [30].…”

Potential Benefits of Oral Cryotherapy for Chemotherapy-Induced Mucositis

“…The first of these trials (Mahood et al, 1991) found that the use of oral cryotherapy during infusion of bolus 5-fluorouracil reduced the incidence of mucositis by about 50%. Several confirmatory analyses followed, and similar results were produced (Kadakia et al, 2014).…”

“…Oral cryotherapy is a technique that has been studied extensively since the 1990s, with the intention of preventing or reducing the severity of mucositis during chemotherapy infusion (Peterson et al, 2013). The cooling of the oral mucous membranes with ice chips causes hypothermic vasoconstriction of blood vessels in the buccal membrane, which limits the exposure of cytotoxins to the mucosa (Kadakia, Rozell, Butala, & Loprinzi, 2014). For best results, the patient should begin to hold ice in his or her mouth at least 5-15 minutes prior to the start of the infusion.…”

Oral Mucositis: Melatonin Gel an Effective New Treatment

“…However, it is only effective for short bolus chemotherapeutic infusions [38], may not be tolerated by some subjects, and thus cannot play a significant role in radiation-induced oral mucositis treatments [25]. …”