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

Abstract

BACKGROUNDMucositis 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.METHODSA 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.RESULTSThe 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.CONCLUSIONSThe 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.

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“…Therefore, it significantly affects the patients' quality of life. When OM becomes severe, it might lead to a reduction in CTx dose or an interruption in RT treatment, which has a negative impact on the patients' prognosis [37,38].…”

“…The panel made a recommendation for pharmacological agents that are mainly used for palliative care and pain relief. These agents include patient-controlled analgesia with morphine, transdermal fentanyl, and local anesthetics (morphine or doxepin mouthwash) [38].…”

“…They made a recommendation for the use of LLLT for the prevention of OM in patients receiving high-dose CTx in cases of hematopoietic stem cell transplantation (HSCT). In addition, the panel suggested the use of LLLT for the prevention of OM in head and neck cancer patients undergoing RT without concomitant CTx [38,39]. Additionally, the European Society for Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN) made also the same suggestion to use LLLT in patients receiving high-dose CTx or chemoradiotherapy before HSCT in order to reduce the incidence of OM and its associated pain [37,40].…”

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“…However, the present study identified reproducible radioprotective effects of pravastatin on acute radiation-induced injury in the intestine and the lung. Late intestinal complications are common following radiotherapy for abdominal and pelvic malignancies and these can substantially reduce the patient's quality of life (2). The mechanism underlying late radiation damage involves chronic inflammation, leading to fibrogenesis and angiopathy (22,23).…”

“…Radiation-induced gastrointestinal disorders are the most common adverse events associated with the treatment of malignancies affecting the abdomen and pelvis (1). These disorders often reduce the patient's quality of life during treatment and sometimes limit the dose of radiotherapy that can be used to treat abdominal and pelvic tumors (2). Amifostine has been recommended for preventing severe radiation-induced toxicities and is the only radioprotectant that has been approved by the US Food and Drug Administration (3).…”