Granulocyte macrophage-colony stimulating factors therapy and laser therapy in radiotherapy-induced oral mucositis in adults with head and neck cancer

Abstract

Oral mucositis is an inflammation of the mucosa ranging from redness to severe ulcers of the mouth mucosa. It is a burdensome side effect of radiotherapy that is administered to treat head and neck cancer in adult patients. For this reason, strategies to prevent and treat oral mucositis are necessary, especially through the utilization of an approved, effective intervention. Despite extensive research that has studied the effectiveness of various interventions the results of these studies appear scattered and lack consistency, casting doubt on the efficacy of such interventions. This warrants further investigation since oral mucositis is a serious side effect in patients with head and neck cancer. The current available literature presents encouraging results for both Granulocyte Macrophage-Colony Stimulating Factors therapy and Laser therapy. Thus these two interventions were chosen for an evaluation of their clinical role in the management of oral mucositis through the principal outcomes comprising of onset, duration, severity, dysphagia, pain intensity and side complications. A PICO question was developed which consisted of comparison of the effectiveness of Granulocyte Macrophage-Colony Stimulating Factor therapy and Laser therapy as interventions in the management of prevention and treatment of radiotherapy-induced oral mucositis, in adults with head and neck cancer. Inclusion and exclusion criteria were primarily set up. The inclusion criteria consisted of articles from 2000 onwards; cancer in head and neck area; adult population, 18 years and over; patients at risk of, or diagnosed with oral mucositis due to radiotherapy with or without chemotherapy; Granulocyte Macrophage-Colony Stimulating Factor Therapy and Laser Therapy; the latter interventions used as preventive and/or curative measures or both; ethical consideration including approval from ethical board and/or consent form and corresponding exclusion criteria. This was followed by a thorough search strategy involving the introduction of several main keywords related to the PICO question in various databases. Fourteen studies were ultimately retrieved regarding these two interventions. Twelve studies were critically appraised utilizing the Critical Appraisal Skills Programme, with the two other studies appraised through Strengthening The Reporting of Observational Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analysis, according to their relevant methodology, approaches and methods. The results were interpreted according to the strength of evidence reflected in the studies, in an attempt to explore the clinical benefits of these two interventions on oral mucositis. Comparisons of these two interventions was quite challenging due to gaps in oral mucositis outcomes, insufficient data and relatively weak methodological quality, different countries of conduct, the variety of assessment tools utilised, constantly small sample sizes, and length and standards of administration of interventions. It is for these reasons, that the results should be treated cautiously. Laser therapy demonstrated consistently encouraging findings in relation to oral mucositis outcomes emerged as compared to weak findings and contraindications for Granulocyte Macrophage-Colony Stimulating Factor therapy. Whilst the results indicate that Laser therapy is effective in the management of radiotherapy-induced oral mucositis and its clinical outcomes, more investigation is required to identify the discrepancies in the available literature and monitor, and update suitable methodologies. Targeting the appropriate people by making the results of available evidence accessible and raising awareness of new findings is recommended. Consultation of clinical costs, timing and organizational support, convenience of application, equipment and training of laser therapy as well as determining policy guidelines and proposing standard protocols for oral mucositis management in the local hospitals is needed.