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Meta-Analysis
. 2021 Jun 1;22(6):1671-1684.
doi: 10.31557/APJCP.2021.22.6.1671.

A Systematic Review and Meta-Analysis on the Efficacy of Curcumin/Turmeric for the Prevention and Amelioration of Radiotherapy/Radiochemotherapy Induced Oral Mucositis in Head and Neck Cancer Patients

Sreedevi Dharman  1 , Maragathavalli G  1 , Karpagavalli Shanmugasundaram  2 , Rajesh Kumar Sampath  3
Affiliations
Meta-Analysis

A Systematic Review and Meta-Analysis on the Efficacy of Curcumin/Turmeric for the Prevention and Amelioration of Radiotherapy/Radiochemotherapy Induced Oral Mucositis in Head and Neck Cancer Patients

Sreedevi Dharman et al. Asian Pac J Cancer Prev. .

Abstract

Background: Oral Mucositis(OM) is an acute debilitating dose limiting toxicity of Radiotherapy/Radiochemotherapy(RT/RCT) in management of Head and Neck Cancer (HNC). Curcumin/Turmeric may reduce OM in patients.

Aim: Efficacy of Curcumin/Turmeric for preventing and ameliorating the onset and severity of RT/RCT induced OM was analysed in this review.

Methods: A systematic literature search with meta-analysis were performed using Mesh terms in PubMed, Google scholar, Science Direct, Cochrane library and manual searching, articles published from 2010 to April 2021 were included. Clinical trials that studied the efficacy/effects of turmeric / curcumin in management of RT/RCT induced OM in HNC patients were included. Statistical Analysis were done to calculate the pooled Risk ratio at 95%confidence interval with significance at p.

Keywords: Oral Mucositis; Turmeric; curcumin; head and neck cancer; radiotherapy.

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Figures

Figure 1
Figure 1
PRISMA Search Flow Chart Showing the Sources and the Final Short Listed Articles Included in This Review
Figure 2
Figure 2
Risk of Bias and Applicability Concerns Summary: review authors judgements about each domain for each included study
Figure 3
Figure 3
Risk of Bias and Applicability Concerns Graph: review authors' judgements about each domain presented as percentages across included studies
Figure 4
Figure 4
Forest Plot Depicting the Meta-Analysis Results of Curcumin Effect on Overall Incidence of Oral Mucositis Compared with Control in the Prophylactic Phase. Results plotted in left hand side indicate effect in favor of Curcumin and the combined effect including variance is plotted as black diamond at the bottom of forest plot. Analysis was done per subgroup (Radiotherapy and Radiochemotherapy). Events: Patients who had onset of OM
Figure 5
Figure 5
Forest Plot Depicting the Incidence of Delay in Onset of Oral Mucositis (Grade1, week 1) among Curcumin and Control Group
Figure 6
Figure 6
Forest Plot Depicting the Meta-Analysis Results of Curcumin Effect on Incidence of Severe ((Grade>3) Equal or more to 3) Oral Mucositis Compared with Control in Prophylactic Phase. Results plotted in left hand side indicate effect in favor of Curcumin and the combined effect including variance is plotted as black diamond at the bottom of forest plot. Analysis was done per subgroup (Topical and Oral). Events: Patients who had OM severity with grade > 3 more or equal to 3 after treatment
Figure 7
Figure 7
Forest Plot Depicting the Mean Mucositis Grading (Grade 3) among Curcumin and Control group
Figure 8
Figure 8
Forest Plot Depicting Pain Scores of Curcumin and Control in Therapeutic Phase. A, Baseline pain scores; B, Second Follow up
Figure 9
Figure 9
Forest Plot Depicting the Mean Change of Weight loss between Curcumin and Control Group
Figure 10
Figure 10
Funnel Plot Depicting Various Studies within Triangular Graph for the Analysis of Publication Bias in the Meta-Analysis for the Comparison of Curcumin and Control Group. A, Overall incidence of OM (5 Studies); B, Delay in onset of OM (4 studies); C. Mean Mucositis Grade-Grade 3 (4 studies)
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References

    1. Adhvaryu M, Vakharia B, Reddy N. Curcumin Prevents Mucositis and Improves Patient Compliance in Head & Neck Cancer Patients Undergoing Radio-Chemotherapy. Ann Med Chem Res. 2018;4:1022.
    1. Ana GS, Normando AGC, de Toledo IP, et al. Topical treatment of oral mucositis in câncer patients: A systematic review of randomized clinical trials. Asian Pac J Cancer Prev. 2020;21:1851. - PMC - PubMed
    1. Anderson PM, Lalla RV. Glutamine for Amelioration of Radiation and Chemotherapy Associated Mucositis during Cancer Therapy. Nutrients. 2020;12:1675. - PMC - PubMed
    1. Arun P, Sagayaraj A, Mohiyuddin SA, et al. Role of turmeric extract in minimising mucositis in patients receiving radiotherapy for head and neck squamous cell cancer: a randomised, placebo-controlled trial. J Laryngol Otol. 2020;134:159–4. - PubMed
    1. Bensinger W, Schubert M, Ang KK, et al. NCCN task force report: prevention and management of mucositis in cancer care. J Nat Comprehensive Cancer Network. 2008;6:S–1. - PubMed

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