Vitamin E in the management of oral mucositis: Systematic review with meta-analysis of randomized clinical trials

Published on Friday, 28 August 2026

Abstract

This review aims to evaluate the efficacy of vitamin E in the treatment of oral mucositis (OM). This review was conducted in accordance with Reporting Items for Systematic Reviews and Meta-analyses and registered in the International Prospective Register of Systematic Reviews (PROSPERO). The search was conducted in seven databases and in the Brazilian repository of Theses and Dissertations of CAPES, consulted as a complementary source identifying clinical trials that evaluated the use of vitamin E alone in cancer patients for the treatment of OM.

The risk of bias was assessed using the Joanna Briggs Institute tool. The data were extracted and systematized in a meta-analysis using a fixed-effect model in RStudio software.

Fourteen articles were included, which evaluated 715 patients, with 330 patients in the intervention group and 385 in the control group.

Among the included studies, 64.3% (n = 9) showed a significant reduction in the incidence of severe OM with the use of vitamin E (p < 0.05). The risk of bias assessment indicated low methodological risk, with 65% (n = 9) classified as low overall risk.

The meta-analysis showed a lower incidence of severe mucositis (grades 3-4) in the vitamin E group compared to controls (RR: 0.37; 95% CI: 0.25-0.57), with a consistent effect in pediatric (RR: 0.14; 95% CI: 0.05-0.35) and non-pediatric (RR: 0.57; 95% CI: 0.35-0.92) populations.

The results suggest a potential benefit of vitamin E in the management of OM induced by antineoplastic therapies, especially in reducing the incidence of more severe forms of this condition.

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About this publication.

- The Di Bella Method (A Fixed Part - Alpha tocopheryl acetate/Vitamin E, approximately 20 grams per day orally);

- Cancer and Vitamin E (analogues and/or derivatives) and cancer - In vitro, review and in vivo publications;

- Solution of retinoids in vitamin E in the Di Bella Method biological multitherapy;

- The Di Bella Method (A Fixed Part - All-Trans Retinoic Acid, Analogues and/or Derivatives - Approximately 60mg per day orally: 40mg per day Beta-Carotene/β-Carotene, 10mg per day ATRA and 10mg per day Axerophthol palmitate);

- All-Trans-Retinoic Acid (ATRA - analogues and/or derivatives) - In vitro, review and in vivo publications;

- The Di Bella Method (A Fixed Part - Cyclophosphamide 50mg tablets and/or Hydroxyurea 500mg tablets, one or two per day);

- The Di Bella Method (A Variable Part - Selenium methonine, 40 μg capsules, twice a day);

The Di Bella's Method: Use of Vitamin E - together with others chemical compounds: the dosage and administration schedule must be individualised for each patient - in several Oncological Pathologies:

- A retrospective observational clinical study of triple negative breast cancer cases treated with Di Bella Method: A preliminary data;

- The Synergism of Somatostatin, Melatonin, Vitamins Prolactin and Estrogen Inhibitors Increased Survival, Objective Response and Performance Status In 297 Cases of Breast Cancer;

- Complete objective response, stable for 5 years, with the Di Bella Method, of multiple-metastatic carcinoma of the breast;

- Evaluation of the safety and efficacy of the first-line treatment with somatostatin combined with melatonin, retinoids, vitamin D3, and low doses of cyclophosphamide in 20 cases of breast cancer: a preliminary report;

- The Di Bella Method (DBM) improved survival, objective response and performance status in a retrospective observational clinical study on 122 cases of breast cancer;

- Complete objective response to biological therapy of plurifocal breast carcinoma;

- A retrospective observational study on cases of anaplastic brain tumors treated with the Di Bella Method: A rationale and effectiveness;

- Recurrent Glioblastoma Multiforme (grade IV – WHO 2007): a case of complete objective response achieved by means of the concomitant administration of Somatostatin and Octreotide – Retinoids – Vitamin E – Vitamin D3 – Vitamin C – Melatonin – D2 R agonists (Di Bella Method – DBM) associated with Temozolomide;

- The Di Bella Method DBM improved survival objective response and performance status in a retrospective observational clinical study on 23 tumours of the head and neck;

- Chronic Lymphocytic Leukemia: Long-Lasting Remission with Combination of Cyclophosphamide, Somatostatin, Bromocriptine, Retinoids, Melatonin, and ACTH;

- Somatostatin, retinoids, melatonin, vitamin D, bromocriptine, and cyclophosphamide in advanced non-small-cell lung cancer patients with low performance status;

- Somatostatin, retinoids, melatonin, vitamin D, bromocriptine, and cyclophosphamide in chemotherapy-pretreated patients with advanced lung adenocarcinoma and low performance status;