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      MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy

      review-article
      , DDS, PhD 1 , , , PhD 2 , , DMD, MDSc 3 , , PhD 4 , , DMD, MSD 5 , , MD 2 , , PhD, RN 6 , , DDS, MS, PhD 7 , , DDS, MSc, DrDent 8 , , DMD, PhD 1 , , DDS, PhD 9 , , DMD, DMSc 10 , , DMD, MSc 11 , The Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO).
      Cancer
      Wiley
      mucositis, stomatitis, oral, gastrointestinal, guidelines, Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO)

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          Abstract

          BACKGROUND

          Mucositis is a highly significant, and sometimes dose‐limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for mucositis.

          METHODS

          A literature search was conducted to identify eligible published articles, based on predefined inclusion/exclusion criteria. Each article was independently reviewed by 2 reviewers. Studies were rated according to the presence of major and minor flaws as per previously published criteria. The body of evidence for each intervention, in each treatment setting, was assigned a level of evidence, based on previously published criteria. Guidelines were developed based on the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline possible.

          RESULTS

          The literature search identified 8279 papers, 1032 of which were retrieved for detailed evaluation based on titles and abstracts. Of these, 570 qualified for final inclusion in the systematic reviews. Sixteen new guidelines were developed for or against the use of various interventions in specific treatment settings. In total, the MASCC/ISOO Mucositis Guidelines now include 32 guidelines: 22 for oral mucositis and 10 for gastrointestinal mucositis. This article describes these updated guidelines.

          CONCLUSIONS

          The updated MASCC/ISOO Clinical Practice Guidelines for mucositis will help clinicians provide evidence‐based management of mucositis secondary to cancer therapy. Cancer 2014;120:1453–1461 . © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

          Abstract

          Mucositis is a highly significant, and sometimes dose‐limiting, toxicity of cancer therapy. This article presents evidence‐based clinical practice guidelines for the management of mucositis.

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          Most cited references27

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          Updated clinical practice guidelines for the prevention and treatment of mucositis.

          Considerable progress in research and clinical application has been made since the original guidelines for managing mucositis in cancer patients were published in 2004, and the first active drug for the prevention and treatment of this condition has been approved by the United States Food and Drug Administration and other regulatory agencies in Europe and Australia. These changes necessitate an updated review of the literature and guidelines. Panel members reviewed the biomedical literature on mucositis published in English between January 2002 and May 2005 and reached a consensus based on the criteria of the American Society of Clinical Oncology. Changes in the guidelines included recommendations for the use of palifermin for oral mucositis associated with stem cell transplantation, amifostine for radiation proctitis, and cryotherapy for mucositis associated with high-dose melphalan. Recommendations against specific practices were introduced: Systemic glutamine was not recommended for the prevention of gastrointestinal mucositis, and sucralfate and antimicrobial lozenges were not recommended for radiation-induced oral mucositis. Furthermore, new guidelines suggested that granulocyte-macrophage-colony stimulating factor mouthwashes not be used for oral mucositis prevention in the transplantation population. Advances in mucositis treatment and research have been complemented by an increased rate of publication on mucosal injury in cancer. However, additional and sustained efforts will be required to gain a fuller understanding of the pathobiology, impact on overall patient status, optimal therapeutic strategies, and improved educational programs for health professionals, patients, and caregivers. These efforts are likely to have significant clinical and economic impact on the treatment of cancer patients. Cancer 2007;109:820-31. (c) 2007 American Cancer Society.
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            • Article: not found

            The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis.

            Mucositis is a common but poorly studied problem among patients with solid tumors. The authors examined the clinical and economic outcomes of oral and gastrointestinal (GI) mucositis among patients receiving myelosuppressive chemotherapy. A retrospective, random sample of 599 patients who developed chemotherapy-induced myelosuppression was followed for development of oral or GI mucositis and for development of subsequent episodes of bleeding or infection. Multilevel regression models of the risk of bleeding and infection were fit with chemotherapy cycles nested within patients. Mucositis developed during 37% of 1236 cycles of chemotherapy. Episodes of bleeding were significantly more common during cycles with GI mucositis than during cycles without GI mucositis (13% vs. 8%; P = 0.04). Episodes of infection were significantly more common during cycles with mucositis (especially GI mucositis) than during cycles without mucositis (73% vs. 36%; P < 0.0001). The mean durations of hospitalization were 4 days, 6 days, and 12 days during cycles with no mucositis, oral mucositis, and GI mucositis, respectively. After accounting for the depth and duration of myelosuppression and for other predictive factors, GI mucositis was associated with both bleeding (odds ratio [OR], 2.0; P = 0.01) and infection (OR, 2.24; P < 0.0001), whereas oral mucositis was associated with infection only (OR, 2.4; P < 0.0001). Mucositis was clinically and economically significant among patients with solid tumors who were receiving myelosuppressive chemotherapy. New preventive and therapeutic agents are needed. Copyright 2003 American Cancer Society.DOI 10.1002/cncr.11671
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              • Article: not found

              Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma.

              The current study was conducted to characterize the risks and clinical consequences of oral mucositis (OM) in patients with head and neck carcinoma (HNC) who are receiving radiation therapy. Data regarding 450 HNC patients who had received radiation therapy were collected via chart review from 154 U.S. medical and radiation oncologists. Information obtained included patient characteristics, treatments received, highest recorded grade of OM during radiation therapy (none, mild, moderate, or severe), and outcomes potentially associated with mucosal injury. The mean age (+/- standard deviation [SD]) of the study subjects was 61.3 years (12.3 yrs); the majority of patients (80%) were men. Primary tumor locations included the oropharynx (26.4%), larynx (26.4%), oral cavity including the lip (24.4%), hypopharynx (13.6%), and nasopharynx (9.1%). The majority of tumors were new and were classified as AJCC Stages III or IV. The majority of patients (83%) received standard radiation therapy; the mean (+/- SD) cumulative dose was 6285 centigrays (cGy) (+/- 1158 cGy). Approximately 33% of the patients received concomitant chemotherapy. The majority of patients (83%) developed OM; 29% developed severe OM. Patients with severe OM were more likely to have nasopharyngeal or oropharyngeal tumors (adjusted odds ratio [OR] of 10.1 [95% confidence interval (95% CI), 2.1-49.9] and 6.9 [95% CI, 2.4-19.7], respectively), and to have received cumulative radiation doses > 5000 cGy (OR of 10.4; 95% CI, 2.9-37.1) and concomitant chemotherapy (OR of 3.3; 95% CI, 1.4-8.0). Patients with OM had more unplanned breaks in radiation therapy (OR of 3.8; 95% CI, 1.7-8.5) and hospital admissions (OR of 3.5; 95% CI, 1.3-9.5). HNC patients with nasopharyngeal or oropharyngeal tumors, and those who receive cumulative radiation doses > 5000 cGy or concomitant chemotherapy, are more likely to develop OM. Patients with OM are at a higher risk of unplanned breaks in radiation therapy and hospitalization.
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                Author and article information

                Journal
                Cancer
                Cancer
                10.1002/(ISSN)1097-0142
                CNCR
                Cancer
                Wiley
                0008-543X
                1097-0142
                25 February 2014
                06 May 2014
                : 120
                : 10 ( doiID: 10.1002/cncr.v120.10 )
                : 1453-1461
                Affiliations
                [ 1 ]University of Connecticut Farmington Connecticut
                [ 2 ]University of Adelaide Adelaide South AustraliaAustralia
                [ 3 ]Winthrop University Hospital Mineola New York
                [ 4 ]The University of Texas MD Anderson Cancer Center Houston Texas
                [ 5 ]City of Hope Medical Center Duarte California
                [ 6 ]Virginia Commonwealth University Richmond Virginia
                [ 7 ]University of Tennessee Health Science Center Memphis Tennessee
                [ 8 ]University of Athens AthensGreece
                [ 9 ]Academic Medical Center‐Amsterdam Amsterdamthe Netherlands
                [ 10 ]Brigham and Women's Hospital Boston Massachusetts
                [ 11 ]University of Rochester Rochester New York
                Author notes
                [*] [* ] Corresponding author: Rajesh V. Lalla, DDS, PhD, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030‐1605; Fax: (860)679‐4760; Lalla@ 123456uchc.edu
                Article
                CNCR28592
                10.1002/cncr.28592
                4164022
                24615748
                6e6ac1db-5791-441f-8bc5-796e827db19a
                © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 12 September 2013
                : 21 November 2013
                : 20 December 2013
                Page count
                Pages: 9
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                cncr28592
                15 May 2014
                Converter:WILEY_ML3GV2_TO_NLM version:4.0.5 mode:remove_FC converted:21.05.2014

                Oncology & Radiotherapy
                mucositis,stomatitis,oral,gastrointestinal,guidelines,multinational association of supportive care in cancer and international society of oral oncology (mascc/isoo)

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