Worthington Helen V, Clarkson Jan E, Bryan Gemma, Furness Susan, Glenny Anne-Marie, Littlewood Anne, McCabe Martin G, Meyer Stefan, Khalid Tasneem
Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Coupland III Building, Oxford Road, Manchester, UK, M13 9PL.
Cochrane Database Syst Rev. 2011 Apr 13;2011(4):CD000978. doi: 10.1002/14651858.CD000978.pub5.
Treatment of cancer is increasingly more effective but is associated with short and long term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them. One of these side effects is oral mucositis (mouth ulcers).
To evaluate the effectiveness of prophylactic agents for oral mucositis in patients with cancer receiving treatment, compared with other potentially active interventions, placebo or no treatment.
Electronic searches of Cochrane Oral Health Group and PaPaS Trials Registers (to 16 February 2011), CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to 16 February 2011), EMBASE via OVID (1980 to 16 February 2011), CINAHL via EBSCO (1980 to 16 February 2011), CANCERLIT via PubMed (1950 to 16 February 2011), OpenSIGLE (1980 to 2005) and LILACS via the Virtual Health Library (1980 to 16 February 2011) were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information.
Randomised controlled trials of interventions to prevent oral mucositis in patients receiving treatment for cancer.
Information regarding methods, participants, interventions, outcome measures, results and risk of bias were independently extracted, in duplicate, by two review authors. Authors were contacted for further details where these were unclear. The Cochrane Collaboration statistical guidelines were followed and risk ratios calculated using random-effects models.
A total of 131 studies with 10,514 randomised participants are now included. Overall only 8% of these studies were assessed as being at low risk of bias. Ten interventions, where there was more than one trial in the meta-analysis, showed some statistically significant evidence of a benefit (albeit sometimes weak) for either preventing or reducing the severity of mucositis, compared to either a placebo or no treatment. These ten interventions were: aloe vera, amifostine, cryotherapy, granulocyte-colony stimulating factor (G-CSF), intravenous glutamine, honey, keratinocyte growth factor, laser, polymixin/tobramycin/amphotericin (PTA) antibiotic pastille/paste and sucralfate.
AUTHORS' CONCLUSIONS: Ten interventions were found to have some benefit with regard to preventing or reducing the severity of mucositis associated with cancer treatment. The strength of the evidence was variable and implications for practice include consideration that benefits may be specific for certain cancer types and treatment. There is a need for further well designed, and conducted trials with sufficient numbers of participants to perform subgroup analyses by type of disease and chemotherapeutic agent.
癌症治疗越来越有效，但会带来短期和长期的副作用。尽管使用了多种药物来预防，但口腔副作用仍是疾病的主要来源之一。其中一种副作用是口腔黏膜炎（口腔溃疡）。
评估预防性药物对接受治疗的癌症患者口腔黏膜炎的有效性，并与其他可能有效的干预措施、安慰剂或不治疗进行比较。
对Cochrane口腔健康小组和PaPaS试验注册库（截至2011年2月16日）、CENTRAL（Cochrane图书馆2011年第1期）、通过OVID检索的MEDLINE（1950年至2011年2月16日）、通过OVID检索的EMBASE（1980年至2011年2月16日）、通过EBSCO检索的CINAHL（1980年至2011年2月16日）、通过PubMed检索的CANCERLIT（1950年至2011年2月16日）、OpenSIGLE（1980年至2005年）以及通过虚拟健康图书馆检索的LILACS（1980年至2011年2月16日）进行了电子检索。对相关文章的参考文献列表进行了检索，并联系了符合条件试验的作者以识别试验并获取更多信息。
对接受癌症治疗的患者预防口腔黏膜炎的干预措施的随机对照试验。
两名综述作者独立、重复地提取了有关方法、参与者、干预措施、结局指标、结果和偏倚风险的信息。在信息不明确时联系作者获取更多细节。遵循Cochrane协作组的统计指南，并使用随机效应模型计算风险比。
现在纳入了131项研究，共10514名随机参与者。总体而言，这些研究中只有8%被评估为偏倚风险较低。在荟萃分析中有多项试验的十种干预措施显示，与安慰剂或不治疗相比，在预防或减轻黏膜炎严重程度方面有一些具有统计学意义的益处（尽管有时较弱）。这十种干预措施是：芦荟、氨磷汀、冷冻疗法、粒细胞集落刺激因子（G-CSF）、静脉注射谷氨酰胺、蜂蜜、角质形成细胞生长因子、激光、多黏菌素/妥布霉素/两性霉素（PTA）抗生素含片/糊剂和硫糖铝。
发现十种干预措施在预防或减轻与癌症治疗相关的黏膜炎严重程度方面有一定益处。证据的强度各不相同，对实践的启示包括考虑这些益处可能特定于某些癌症类型和治疗方法。需要进一步设计良好且实施的试验，有足够数量的参与者，以便按疾病类型和化疗药物进行亚组分析。
