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

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 <0.05. RESULTS: Nine studies with overall 582 patients with HNC undergoing RT/RCT were included qualitatively. From evidence, orally 1,500-2,000 mg/day of Curcumin/Turmeric, (80mg/day/0.1%mouthwash) of nanocurcumin, topically gel/mouthwash used with increase in frequency prior and the entire course of RT/RCT with long follow ups are beneficial with no serious adverse effects. Meta-analysis of 5 prophylactic trials favoured curcumin/turmeric in reducing the severity of OM (RR 0.48 at 95% CI=0.23,0.99,P=0.05), did not prevent the overall incidence of OM (RR 0.99 at 95%CI=0.95,1.03,P=0.67) but delayed the onset of OM (RR 0.38 at 95% CI=0.18,0.80, P=0.01) during RT/RCT compared to control. Mean mucositis grade (Grade 3) was reduced in curcumin/turmeric with a mean difference of (-0.85 at 95%CI=-1.02,0.67, P<0.00001) over control. Pooling of 2 therapeutic trials favoured Curcumin/Turmeric with significant reduction of pain score at a mean difference of -2.17 at 95%CI =-2.77, -1.58,P<0.00001 over chlorhexidine. CONCLUSION: Curcumin/Turmeric are safe, efficacious, well tolerated in preventing the delay in onset and severity of OM, therapeutically ameliorated pain in patients with cancer therapy induced OM. We recommend novel curcumin formulations, high quality randomised controlled trials to further improve its therapeutic effects.