Efficacy of preventive intervention of cryotherapy on radiation-induced oral mucositis in head and neck cancer: a meta-analysis

doi:10.3969/j.issn.1674-8115.2022.05.012

Abstract

Abstract: Objective

·To systematically review the efficacy of cryotherapy in head and neck cancer patients with radiation-induced oral stomatitis.

Methods

·PubMed, EMbase, Cochrane Library, Web of Science, CNKI, WanFang, VIP and CBM databases were searched to collect randomized controlled trials (RCTs) of cryotherapy in head and neck cancer patients with ration-induced stomatitis from inception to January 31th, 2022. Literature screening, data extraction, and quality evaluation were performed independently by two researchers. Meta-analysis was then performed by using RevMan 5.4 and Stata 16.0 software.

Results

·A total of 36 RCTs were included. The results of meta-analysis showed that compared to control group, cryotherapy group had a lower total incidence of radiation-induced stomatitis [adds ratio (OR)=0.30, 95% confidence interval (CI) 0.23?0.39, P=0.000] and a lower incidence of severe radiation-induced stomatitis (OR=0.17, 95%CI 0.14?0.21, P=0.000).

Conclusion

·Cryotherapy may contribute to reducing the incidence of radiation-induced stomatitis and the incidence of severe radiation-induced stomatitis.

Key words: cryotherapy, head and neck neoplasms, radiation-induced oral stomatitis, meta-analysis, randomized controlled trial

CLC Number:

R739.8

CHEN Weihong, HOU Lili, YANG Ling, MAO Yan, ZHANG Jinfeng. Efficacy of preventive intervention of cryotherapy on radiation-induced oral mucositis in head and neck cancer: a meta-analysis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(5): 635-645.

Figures/Tables 7

TrendMD

References 61

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Study	Number of cases		Disease	Intervention		Assessment scale
Study	Exp	Con	Disease	Exp	Con	Assessment scale
GONG^［9］，2010	33	35	Head and neck cancer	RN+holding NS ice in the mouth	RN	RTOG
LI^［10］，2017	50	50	Nasopharyngeal cancer	RN+holding NS ice in the mouth	RN	WHO
XU^［11］，2021	80	80	Nasopharyngeal cancer	RN+holding NS ice in the mouth	RN	RTOG
CHEN^［12］，2012	48	42	Nasopharyngeal and oral cancer	RN+holding NS ice in the mouth+spraying rhEGF	RN+spraying rhEGF	WHO
ZHANG^［13］，2013	60	60	Nasopharyngeal cancer	RN+holding NS ice in the mouth+spraying rhEGF	RN+spraying rhEGF	WHO
GONG^［14］，2011	40	40	Nasopharyngeal cancer	RN+ice compress	RN	RTOG
JI^［15］，2008	31	31	Head and neck cancer	RN+ice compress	RN	RTOG
QU^［16］，2019	44	44	Nasopharyngeal cancer	RN+ice compress+strengthening nursing	RN	WHO
YAN^［17］，2011	66	66	Nasopharyngeal cancer	RN+ice compress+spraying JUS	RN	WHO
CAI^［18］，2021	55	55	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	RTOG
LI^［19］，2010	22	18	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	WHO
MIN^［20］，2014	10	10	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	NCI-CTC
GU^［21］，2020	45	44	Nasopharyngeal cancer	RN+holding green tea ice in the mouth	RN	RTOG
XU^［22］，2019	39	41	Nasopharyngeal cancer	RN+holding green tea ice in the mouth	RN	RTOG
HUANG^［23］，2011	40	40	Nasopharyngeal cancer	RN+holding Kuding tea ice in the mouth	RN	WHO
ZHANG^［24］，2017	25	25	Head and neck cancer	RN+holding Kuding tea ice in the mouth	RN	WHO
ZHANG^［25］，2015	30	30	Nasopharyngeal cancer	RN+holding SB ice in the mouth	RN	WHO
YU^［26］，2011	30	30	Head and neck cancer	RN+holding SB ice in the mouth+aerosol inhalation with deproteinised calf blood extract	RN	WHO
ZHAO^［27］，2015	25	25	Oral cancer	RN+holding milk ice in the mouth	RN	RTOG
WAN^［28］，2011	99	99	Nasopharyngeal cancer	RN+holding milk ice in the mouth+drinking the herbal tea	RN	WHO
HUANG^［29］，2018	50	50	Nasopharyngeal cancer	RN+holding Glycyrrhiza and Wumei ice in the mouth	RN	WHO
JIN^［30］，2019	50	50	Nasopharyngeal cancer	RN+holding Chuanbeipipagao and Yunnanbaiyao ice in the mouth	RN	WHO
LIU^［31］，2010	30	30	Nasopharyngeal cancer	RN+holding Glycyrrhiza ice in the mouth	RN	WHO
LU^［32］，2015	52	48	Nasopharyngeal cancer	RN+holding Biyafen ice in the mouth	RN+mouth-washing with Titai solution	RTOG
TANG^［33］，2018	20	20	Nasopharyngeal cancer	RN+holding carrot ice in the mouth	RN+drinking vitamin solution	RTOG
WANG^［34］，2016	40	40	Nasopharyngeal cancer	RN+holding Smecta ice in the mouth	RN+mouth-washing with warm Smecta solution	RTOG
LIU^［35］，2014	30	30	Oral and maxillofacial cancer	RN+holding ice cream in the mouth	RN	WHO
LU^［36］，2017	20	20	Head and neck cancer	RN+holding the frozen device in the mouth+mouth-washing with vitamin-B12 solution	RN	RTOG
GU^［37］，2016	47	47	Nasopharyngeal cancer	RN+holding sterile distilled water ice in the mouth+mouth-washing with icy saline solution	RN	WHO
HE^［38］，2018	50	50	Nasopharyngeal cancer	RN+mouth-washing with icy aloe solution	RN	WHO
QIN^［39］，2020	40	40	Nasopharyngeal cancer	RN+mouth-washing with icy mixed solution （which contains tea polyphenols， normal saline， lidocaine and dexamethasone）	RN+mouth-washing with NS solution	RTOG
QIN^［40］，2021	60	60	Nasopharyngeal cancer	RN+mouth-washing with icy mixed solution （which contains tea polyphenols， normal saline， lidocaine and dexamethasone）	RN+mouth-washing with sodium bicarbonate solution	RTOG
YANG^［41］，2019	36	36	Nasopharyngeal cancer	RN+mouth-washing with icy water+taking artificial cow-bezoar pills	RN	WHO
XIE^［42］，2019	30	30	Head and neck cancer	RN+mouth-washing with icy solution which contains G-CSF	RN	RTOG
PANG^［43］，2013	25	25	Head and neck cancer	RN+mouth-washing with icy mixed solution which contains thymus protein	RN+mouth-washing with Duobeier solution	WHO
BAI^［44］，2019	33	35	Head and neck cancer	RN+cryogenic aerosol inhalation（4‒8 ℃）	RN+normal aerosol inhalation（18‒24 ℃）	RTOG

Study	Number of cases		Disease	Intervention		Assessment scale
Study	Exp	Con	Disease	Exp	Con	Assessment scale
GONG^［9］，2010	33	35	Head and neck cancer	RN+holding NS ice in the mouth	RN	RTOG
LI^［10］，2017	50	50	Nasopharyngeal cancer	RN+holding NS ice in the mouth	RN	WHO
XU^［11］，2021	80	80	Nasopharyngeal cancer	RN+holding NS ice in the mouth	RN	RTOG
CHEN^［12］，2012	48	42	Nasopharyngeal and oral cancer	RN+holding NS ice in the mouth+spraying rhEGF	RN+spraying rhEGF	WHO
ZHANG^［13］，2013	60	60	Nasopharyngeal cancer	RN+holding NS ice in the mouth+spraying rhEGF	RN+spraying rhEGF	WHO
GONG^［14］，2011	40	40	Nasopharyngeal cancer	RN+ice compress	RN	RTOG
JI^［15］，2008	31	31	Head and neck cancer	RN+ice compress	RN	RTOG
QU^［16］，2019	44	44	Nasopharyngeal cancer	RN+ice compress+strengthening nursing	RN	WHO
YAN^［17］，2011	66	66	Nasopharyngeal cancer	RN+ice compress+spraying JUS	RN	WHO
CAI^［18］，2021	55	55	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	RTOG
LI^［19］，2010	22	18	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	WHO
MIN^［20］，2014	10	10	Nasopharyngeal cancer	RN+holding Kangfuxin ice in the mouth	RN	NCI-CTC
GU^［21］，2020	45	44	Nasopharyngeal cancer	RN+holding green tea ice in the mouth	RN	RTOG
XU^［22］，2019	39	41	Nasopharyngeal cancer	RN+holding green tea ice in the mouth	RN	RTOG
HUANG^［23］，2011	40	40	Nasopharyngeal cancer	RN+holding Kuding tea ice in the mouth	RN	WHO
ZHANG^［24］，2017	25	25	Head and neck cancer	RN+holding Kuding tea ice in the mouth	RN	WHO
ZHANG^［25］，2015	30	30	Nasopharyngeal cancer	RN+holding SB ice in the mouth	RN	WHO
YU^［26］，2011	30	30	Head and neck cancer	RN+holding SB ice in the mouth+aerosol inhalation with deproteinised calf blood extract	RN	WHO
ZHAO^［27］，2015	25	25	Oral cancer	RN+holding milk ice in the mouth	RN	RTOG
WAN^［28］，2011	99	99	Nasopharyngeal cancer	RN+holding milk ice in the mouth+drinking the herbal tea	RN	WHO
HUANG^［29］，2018	50	50	Nasopharyngeal cancer	RN+holding Glycyrrhiza and Wumei ice in the mouth	RN	WHO
JIN^［30］，2019	50	50	Nasopharyngeal cancer	RN+holding Chuanbeipipagao and Yunnanbaiyao ice in the mouth	RN	WHO
LIU^［31］，2010	30	30	Nasopharyngeal cancer	RN+holding Glycyrrhiza ice in the mouth	RN	WHO
LU^［32］，2015	52	48	Nasopharyngeal cancer	RN+holding Biyafen ice in the mouth	RN+mouth-washing with Titai solution	RTOG
TANG^［33］，2018	20	20	Nasopharyngeal cancer	RN+holding carrot ice in the mouth	RN+drinking vitamin solution	RTOG
WANG^［34］，2016	40	40	Nasopharyngeal cancer	RN+holding Smecta ice in the mouth	RN+mouth-washing with warm Smecta solution	RTOG
LIU^［35］，2014	30	30	Oral and maxillofacial cancer	RN+holding ice cream in the mouth	RN	WHO
LU^［36］，2017	20	20	Head and neck cancer	RN+holding the frozen device in the mouth+mouth-washing with vitamin-B12 solution	RN	RTOG
GU^［37］，2016	47	47	Nasopharyngeal cancer	RN+holding sterile distilled water ice in the mouth+mouth-washing with icy saline solution	RN	WHO
HE^［38］，2018	50	50	Nasopharyngeal cancer	RN+mouth-washing with icy aloe solution	RN	WHO
QIN^［39］，2020	40	40	Nasopharyngeal cancer	RN+mouth-washing with icy mixed solution （which contains tea polyphenols， normal saline， lidocaine and dexamethasone）	RN+mouth-washing with NS solution	RTOG
QIN^［40］，2021	60	60	Nasopharyngeal cancer	RN+mouth-washing with icy mixed solution （which contains tea polyphenols， normal saline， lidocaine and dexamethasone）	RN+mouth-washing with sodium bicarbonate solution	RTOG
YANG^［41］，2019	36	36	Nasopharyngeal cancer	RN+mouth-washing with icy water+taking artificial cow-bezoar pills	RN	WHO
XIE^［42］，2019	30	30	Head and neck cancer	RN+mouth-washing with icy solution which contains G-CSF	RN	RTOG
PANG^［43］，2013	25	25	Head and neck cancer	RN+mouth-washing with icy mixed solution which contains thymus protein	RN+mouth-washing with Duobeier solution	WHO
BAI^［44］，2019	33	35	Head and neck cancer	RN+cryogenic aerosol inhalation（4‒8 ℃）	RN+normal aerosol inhalation（18‒24 ℃）	RTOG

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