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Efficacy of bioadhesives in the management of oral mucositis in patients undergoing radio-chemotherapy for treatment of head and neck cancer—a systematic review and meta-analysis

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Abstract

Background

Management of head and neck cancers requires a multidisciplinary approach where surgery followed by radio and chemotherapy is the mainstay of treatment. The above-mentioned treatment can cause mucositis, a severely debilitating side effect. This can have a significant impact on quality of life. A recent advancing mode of drug delivery is the bioadhesive system. This interacts with mucosa by adhering to it and thereby improving the efficacy of the therapeutic agent delivered.

Aim and objective

The purpose of this systematic review is to evaluate the effectiveness of bioadhesives in reducing oral mucositis and relieving pain associated with mucositis in head and neck cancer patients receiving radio-chemotherapy.

Materials and method

Studies assessing the effectiveness of bioadhesives for the treatment of radiation-induced oral mucositis were retrieved from specialized databases (PubMed/MEDLINE, Scopus, ProQuest, Google Scholar, LILACS, OpenGrey) as well as institutional repositories. Data on incidence, pain reduction, resolution, and improvement of oral mucositis using bioadhesive were compiled. A Cochrane tool was used for randomized controlled trials and a JBI tool for non-randomized controlled trials and observational studies to assess the quality of included studies. Based on the eligible study data, a meta-analysis was conducted with STATA version 16, 2019 software, and 95% confidence intervals and p values greater than 0.05.

Results

A total of 15 studies were included which assessed the effectiveness of bioadhesives in managing mucositis and its associated pain. Studies included in the review described either reduction, resolution, or incidence of oral mucositis respectively. A total of three meta-analyses were conducted to assess the incidence of oral mucositis and the pain associated with it, as well as the reduction in incidence. Bioadhesives showed statistically significant differences in the incidence of severe mucositis (p = 0.04). A meta-analysis comparing bioadhesives efficacy in reducing mucositis and pain associated with it found no statistically significant differences (p = 0.36).

Conclusion

Bioadhesives are emerging as a novel drug delivery method for treating radio-chemotherapy-induced oral mucositis because of their rapid absorption and easy application. Regardless of its benefits, clinical trials comparing it with conventional treatment methods are necessary to assess its efficacy in treating oral mucositis.

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This was a self-funded systematic review and meta-analysis and did not receive any specific grants/funding from any funding agency in any of the sectors.

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  1. Department of Oral Medicine & Radiology KAHER’s KLE Vishwanath Katti Institute of Dental Sciences, Constituent Unit of KLE Academy of Higher Education & Research, Nehru Nagar, Belagavi, Karnataka, 590010, India

    T Jayapriya, Vaishali Keluskar, Vasanti Lagali-Jirge & M Sridhar

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Contributions

Dr. Jayapriya T: conceptualization and protocol development, methodology, data collection and extraction, bias assessment, meta-analysis, and manuscript writing. Dr. Vaishali Keluskar: conceptualization, methodology, data collection and extraction, bias assessment, manuscript—review, and editing. Dr. Vasanti Lagali-Jirge: supervision, validation, visualization, bias assessment, manuscript—review, and editing. Dr. Sridhar M: data curation, supervision, writing review, and editing.

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Correspondence to M Sridhar.

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Registration and protocol: Protocol for this systematic review was prepared before the start of the review and was registered in the International Prospective Register of Systematic Reviews (PROSPERO) maintained by the Centre of Reviews and Dissemination, University of York, York, UK (Ref No. CRD42022340445), which can be accessed through (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340445). The current systematic review was written in concordance with the preferred reporting items for the systematic review and meta-analysis (PRISMA) 2020 statement.

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Jayapriya, T., Keluskar, V., Lagali-Jirge, V. et al. Efficacy of bioadhesives in the management of oral mucositis in patients undergoing radio-chemotherapy for treatment of head and neck cancer—a systematic review and meta-analysis. Support Care Cancer 31, 470 (2023). https://doi.org/10.1007/s00520-023-07920-2

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