Prevention of Radiation Induced Oral Mucositis in Head and Neck Cancer Patients: A Systematic Review

Learning Objective 1: The learner will be able to understand the effect of mouthrinse on preventing and treating radiation induced oral mucositis among head-and-neck cancer patients. Learning Objective 2: The learner will be able to describe the evidence limitations of current mouthrinse studies. Purpose: This systematic review aims to examine the effectiveness of mouthrinse on preventing and treating radiation induced oral mucositis among head and neck cancer patients. Methods: We systematically searched literature from five English (MEDLINE, PubMed, Cochrane Library, CINAHL, and ProQuest) and two Chinese (CEPS and Taiwan NDL Thesis and Dissertations) databases from 2001 to 2011. The search terms used were ‘head and neck cancer’, ‘mouthwash or mouthrinse’, ‘radiotherapy or irradiated’, and ‘oral mucositis’. A total of 493 articles were identified. Four RCTs and three CCTs met the inclusion criteria and analyzed by the current review. Research quality of reviewed studies was assessed by the Johns Hopkins Evidence-based Practice Quality Rating Scale. Results: Research quality of included studies ranged from high to medium. Presence of different types and times of outcome measures impeded the quantitative integration of research evidence. Comparing to plain water, Chlorhexidine and PTA did not provide a better solution across studies. The effect of Benzydamine was not consistent across studies. Providone-iodine presented conflicted results between two studies. For those patients who received high dosage radiotherapy, none of any mouthrinse provided any preventive or therapeutic effect on oral mucositis. Conclusion: Results of this systematic review revealed insufficient evidence to support the decision making on selection of effective mouthrinse for preventing or treating radiation induced oral mucocitis. Future studies are encouraged to include both measures of incidence and severity of oral mucocitis to ease the accumulation of research evidence