Thirty-three studies with 6,181 patients were included in the review.
Three studies (n=405) reported on the incidence of oral pain. Of these, two studies used mixed AF-RT and conventional RT while the other used conventional RT. Sixty-nine per cent of patients experienced oral pain. Twenty-three per cent of patients in these studies experienced grade 3 to 4 mucositis.
Four studies (n=660) reported dysphagia. The incidence of dysphagia was 56%. Three of these studies involved interventions to reduce mucositis. Two of these intervention studies reported significant reductions in dysphagia in the intervention group (polymixin, tobramycin and amphotericin, P=0.006; amifostine, P=0.001), while one (sucralfate) found no effect.
One study (n=30), using combined RT and chemotherapy, reported on opioid use. Opioids were administered to 53% of patients, and 33% of patients had grade 3 to 4 mucositis.
Ten studies (n not stated) reported a mean weight loss ranging from 3.0 to 6.7 kg (6 to 12% of body weight). Eight studies (n=880) reported the incidence of weight loss; 34% of patients lost weight in these studies. In the 3 studies (n=485) that reported losses of 10% or more of body weight, 17% of the patients lost at least 10% of their body weight.
One study (n not stated) reported quality of life, but without reference to the incidence or severity of mucositis.
Three studies (n=932) reported planned treatment interruptions for grade 3 to 4 mucositis. Two studies compared AF-RT with AF-RT plus chemotherapy, with interrupted treatment planned only for the groups receiving chemotherapy. The rates in one study (n not given) were 75% for AF-RT and 76% for AF-RT plus chemotherapy. In the other study (n not given), the rates were 16% for AF-RT and 38% for AF-RT plus chemotherapy. A third study (n=253) compared AF-RT with conventional RT, with interrupted treatment planned only for the group receiving AF-RT, and found rates of 49% for conventional RT and 65% for AF-RT.
Eighteen studies (n=3,852) reported unplanned interruptions or modifications to treatment. Eleven per cent (n=424) of patients had a deviation from their treatment plan. Five studies (n=1,267) reported unplanned interruptions or modifications to RT due to mucositis. In these studies, 11% of modifications resulted from mucositis (range: 8 to 27%).
Three studies (n=700) reported hospitalisation due to mucositis with an overall incidence of 16%. A higher proportion of those receiving AF-RT (32%) had mucositis than those receiving conventional RT (5%).
Five studies (n=819) reported feeding tube insertion, with a mean frequency of 19%.