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Systematic review of oral cryotherapy for the management of oral mucositis in cancer patients and clinical practice guidelines

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Abstract

Purpose

To update the 2013 Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) clinical practice guidelines on oral cryotherapy for the management of oral mucositis (OM) caused by cancer therapies.

Methods

A systematic review was conducted by the Mucositis Study Group of MASCC/ISOO. The evidence for each intervention for specific cancer treatment modalities was assigned a level of evidence (LoE). The findings were added to the database used to develop the 2013 MASCC/ISOO clinical practice guidelines. Based on the LoE, the guidelines were set as: recommendation, suggestion, or no guideline possible.

Results

A total of 114 papers were identified: 44 from PubMed and 70 from Web of Science. After abstract triage and merging with the 2013 database, 36 papers were reviewed. The LoE for prevention of OM with oral cryotherapy in patients undergoing autologous hematopoietic stem cell transplant using high-dose melphalan conditioning protocols was upgraded, and the guideline changed to recommendation. Additionally, the recommendation for prevention of OM with oral cryotherapy in patients receiving bolus 5-fluorouracil for the treatment of solid tumors was confirmed. No guidelines were possible for other clinical settings.

Conclusions

The evidence supports recommendations for the use of oral cryotherapy for the prevention of OM for either (i) patients undergoing autologous hematopoietic stem cell transplant with high-dose melphalan conditioning protocols or (ii) patients receiving bolus 5-fluorouracil chemotherapy.

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Acknowledgments

The authors would like to thank the following medical librarians for their valuable contribution to this project:

Lorraine Porcello, MSLIS, MSIM—Bibby Dental Library, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA and Daniel A. Castillo, MLIS—Edward G. Miner Library, University of Rochester Medical Center, Rochester, NY, USA.

Author information

Authors and Affiliations

  1. Oral Medicine, Post-Graduation Program, Oncology Department, School of Medical Science, University of Campinas, Cidade, Universitária Zeferino Vaz - Barão Geraldo, Campinas, São Paulo, 13083-970, Brazil

    M Elvira P Correa

  2. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore

    Karis Kin Fong Cheng

  3. Pharmacy Department, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia

    Karen Chiang

  4. Electronic Medical Records, Department, Melbourne Health, Parkville, Victoria, Australia

    Karen Chiang

  5. Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India

    Abhishek Kandwal

  6. Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA

    Charles L Loprinzi

  7. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    Takehiko Mori

  8. Department of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands

    Carin Potting

  9. Dental Oncology Program, Health Sciences North, North East Cancer Center, Sudbury, Ontario, Canada

    Tanya Rouleau

  10. Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA

    Juan J Toro

  11. Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, USA

    Vinisha Ranna

  12. Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

    Anusha Vaddi

  13. Division of Oral and Maxillofacial Diagnostic Sciences, UConn School of Dental Medicine, UConn Health, Farmington, CT, USA

    Anusha Vaddi, Douglas E Peterson & Rajesh V Lalla

  14. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health - Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy

    Paolo Bossi

  15. Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

    Sharon Elad

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  1. M Elvira P Correa
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Correspondence to M Elvira P Correa.

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Conflict of interest

Per the MASCC Guidelines Policy, employees of commercial entities were not eligible to serve on this MASCC Guidelines Panel. All authors completed a Conflict of Interest disclosure form and conflicts are disclosed in the guideline’s publications.

The authors disclose no conflict of interest (MEPC, KC, AK, TM, CP, TR, JJT, VR, AV, DEP). PB has served an advisory role for Galera Therapeutics, AstraZeneca, Helsinn, and Kyowa Kyrin and received grants from Merck, Kyowa Kyrin, and Roche.

CLL reports personal fees from PledPharma, Disarm Therapeutics, Asahi Kasei, Metys Pharmaceuticals, and OnQuality, outside the submitted work.

RVL reports personal fees from Colgate Oral Pharmaceuticals, grants and personal fees from Galera Therapeutics, personal fees from Ingalfarma, other from Logic Biosciences, personal fees from Monopar Therapeutics, personal fees from Mundipharma, grants from Novartis, grants from Oragenics, grants and personal fees from Sucampo Pharma, personal fees from Alira Health, outside the submitted work.

SE reports no conflict in regard to mucositis and consulting to Falk Pharma outside the submitted work.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO)

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Correa, M.E.P., Cheng, K.K.F., Chiang, K. et al. Systematic review of oral cryotherapy for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 28, 2449–2456 (2020). https://doi.org/10.1007/s00520-019-05217-x

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