Zinc Supplementation for Mitigating Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy and Chemoradiotherapy - A Systematic Review.
Objective: Head and Neck Cancers (HNCs) pose a significant global health burden, with increasing incidence projected by 2030. Treatment typically involves radiotherapy (RT) and chemoradiotherapy (CMRT), often leading to debilitating oral mucositis (OM), which impairs quality of life and may treatment discontinuation. Currently, there are no established preventive and therapeutic measures for OM in HNC patients. This systematic review aims to consolidate available evidence on the efficacy of zinc supplementation in mitigating the onset, duration, and severity of OM during RT and CMRT in HNC patients.
Methods: We searched the Medline, Embase, and Web of Science databases for studies on HNC patients receiving RT or CMRT with zinc supplementation from January 2013 to July 2023. Search terms included various HNC, RT, chemoradiotherapy, and zinc supplementation permutations. Only interventional studies were included, with quality assessment conducted using the JBI risk of bias tools. Findings were synthesized narratively.
Results: Eight studies involving 651 HNC patients, comprising six randomized controlled trials (RCTs) and two non-randomized controlled trials, were included. Various radiotherapy techniques and concurrent chemotherapy were utilized across studies, with zinc administered in multiple forms including syrup, tablets, suspension, topical application, and mouthwashes. Overall, six studies reported a beneficial effect of zinc supplementation in reducing the incidence, onset, duration, and severity of OM, while two studies reported no significant impact.
Conclusions: Zinc supplementation shows promise in ameliorating OM in HNC patients undergoing RT and chemoradiotherapy, likely due to its antioxidative, anti-inflammatory, and wound healing properties. Further research is warranted to elucidate optimal dosage and regimen for zinc supplementation in this context.