Mucositis is one of the most common oral complications arising in cancer patients receiving chemotherapy and/or radiotherapy. The pain and distress of mucositis can be enough to cause disability during the course of treatment. Vitamin E has been found to have antioxidant and free radical scavenging properties which can reduce inflammation. To date, vitamin E supplementation in the form of tablets or pastes have been tried with different levels of success in several trials, however, there is no clear recommendation for its use. This study was done to obtain a more precise estimate of the efficacy of vitamin E on radiotherapy and chemotherapy-induced mucositis, in the hopes of providing an easily available, inexpensive but effective treatment for this condition.
A systematic search of Pubmed, Embase, Cochrane, Clinical trials databases and hand search were utilized to identify randomized controlled trials (RCTs) dated until December 2019, investigating the efficacy of oral or topical vitamin E in reducing oral mucositis in cancer patients receiving chemotherapy or radiotherapy. Using the random effects model, pooled Odds Ratio (OR) with 95% confidence intervals (CI) were calculated in measuring the incidence of improvement or resolution of oral mucositis.
Four RCTs were included (N=171). The pooled rate of mucositis resolution was significantly higher in the group treated with Vitamin E (84.7% vs 51.2%), with an odds ratio of 6.04 (95% CI 2.46-14.84, p < 0.0001). Heterogeneity between the studies was minimal (I2 0-20%). Vitamin E was well-tolerated and there were no severe adverse effects reported in the studies.
The results showed that vitamin E (topical or oral) was significantly associated with higher rates of improvement of oral mucositis among solid cancer patients who underwent chemotherapy or radiotherapy. Our results suggest that vitamin E can be considered a simple, non-toxic, yet effective therapy for oral mucositis. Subgroup analysis based on type and dose of vitamin E administration, type of anti-tumor treatment, and type of cancer can be done once with additional studies in the future.
The authors.
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All authors have declared no conflicts of interest.