Current perspectives of nanotherapies in the prevention and treatment of radiotherapy/chemotherapy-induced oral mucositis in head and neck cancer-A narrative review

Aim: Therapy for head and neck cancer (HNC) causes oral mucositis (OM) which significantly affects the patient's quality of life. Currently, there are no effective therapy or prevention of OM. This review focuses on a nanomedicine-based approach to prevent and treat chemotherapy (CT)- or radiotherapy (RT)-induced OM in HNC. Materials and Methods: Systematic article searches on nanoparticles in CT/RT-induced OM published in English language until December 2022 were conducted in PubMed using MeSH terms, Google Scholar, Cochrane Library, and Web of Science. Search keywords used were: (Nanoparticles) [all fields, MeSH Terms])) OR (Nanocapsules) [all fields, MeSH Terms])) OR (Metal Nanoparticles) [all fields, MeSH Terms])) OR (Lipid Nanoparticles) [all fields, MeSH Terms])) AND (Treatment)) [all fields, MeSH Terms])) OR (Prevention)) [all fields] AND (chemotherapy [all fields, MeSH Terms])) OR (Radiotherapy [all fields, MeSH Terms])) AND (oral mucositis [all fields, MeSH Terms])) AND (Head and Neck Tumor)) [all fields, MeSH Terms])). Results: Overall, this review included nine studies after full-text review of articles, among them six were in vivo animal studies and three were clinical trials. Gold nanoparticles (Au NPs) and quarcetin nanoemulsion prevented OM by inhibiting the inflammatory and oxidative stress markers. Among polymeric nanoparticles, poly DL-lactide-co-glycolide (PLGA) dexamethasone NPs were efficient at -10-fold lower dose of free dexamethasone. Chitosan-coated PLGA NPs with rebamipide loading had superior oral retention, and benzydamine hydrochloride-PLGA-NPs-hydrogel demonstrated mucoadhesive and in vitro drug release features, allowing for more rapid and effective treatment of mucositis. Ketoprofen-loaded Eudragit electrospun nanofibers had better efficacy due to local buccal delivery and suppression of the inflammation associated with mucositis. Oral curcumin-loaded nanomicelle is effective due to the enhanced absorption of curcumin aiding in the prevention and treatment of OM. Curcumin nanomouthwash was equally efficient and safe when compared with benzydamine and delayed the onset of OM. Conclusion: This narrative review summarized various nanomedicine in OM as an efficient strategy that aided in local buccal delivery, mucoadhesion, and sustained release with reduced doses that can be used as conventional supportive therapy for HNC patients with OM receiving CT/RT.