粒-巨噬细胞集落刺激因子治疗血液肿瘤化疗所致口腔黏膜炎的疗效观察

[目的]研究粒-巨噬细胞集落刺激因子(GM-CSF)悬液对治疗血液肿瘤化疗所致口腔黏膜炎(OM)的疗效。[方法]选取136例血液肿瘤化疗后出现口腔黏膜炎病人,随机将136例病人分为观察组和对照组,对照组用替硝唑漱口液漱口,观察组予以GM-CSF混悬液涂布溃疡处,比较两组不同部位和程度OM的愈合情况。[结果]观察组与对照组OM愈合时间比较差异有统计学意义(P<0.01);唇部OM愈合最早,硬腭部OM愈合最晚。[结论]对血液肿瘤化疗所致的OM,应用GM-CSF混悬液涂布溃疡处明显优于常规替硝唑漱口液治疗。     

粒-巨噬细胞集落刺激因子治疗血液肿瘤化疗所致口腔黏膜炎的疗效观察

[目的]研究粒-巨噬细胞集落刺激因子（GM—CSF）悬液对治疗血液肿瘤化疗所致口腔黏膜炎（OM）的疗效。[方法]选取136例血液肿瘤化疗后出现口腔黏膜炎病人,随机将136例病人分为观察组和对照组,对照组用替硝唑漱口液漱口,观察组予以GM—CSF混悬液涂布溃疡处,比较两组不同部位和程度0M的愈合情况。[结果]观察组与对照组OM愈合时间比较差异有统计学意义（P〈0．01）;唇部0M愈合最早,硬腭部OM愈合最晚。[结论]对血液肿瘤化疗所致的OM,应用GM—CSF混悬液涂布溃疡处明显优于常规替硝唑漱口液治疗。     

G - CSF预防泵注5- Fu所致口腔溃疡的效果观察

目的 观察重组人粒细胞集落刺激因子(G- CSF)预防性处理泵5-注氟尿嘧啶(5-Fu)化疗导致的口腔溃疡的疗效.方法 应用G-CSF对泵注5-Fu的化疗患者实施口腔溃疡的预防性处理.结果 实验组口腔黏膜反应程度明显较对照组轻,且无不良反应.结论 G-CSF含漱能有效预防泵注5-Fu化疗引起的口腔溃疡.     

G-CSF预防泵注5-Fu所致口腔溃疡的效果观察

目的观察重组人粒细胞集落刺激因子（G-CSF）预防性处理泵5-注氟尿嘧啶（5-Fu）化疗导致的口腔溃疡的疗效。方法应用G-CSF对泵注5-Fu的化疗患者实施口腔溃疡的预防性处理。结果实验组口腔黏膜反应程度明显较对照组轻,且无不良反应。结论 G-CSF含漱能有效预防泵注5-Fu化疗引起的口腔溃疡。     

Oral glutamine for the prevention of oral mucositis associated with high-dose paclitaxel and melphalan for autologous bone marrow transplantation

OBJECTIVE: To determine the effect of glutamine suspension on mucositis associated with the administration of high-dose preparative regimens for bone marrow transplantation. METHODS: We performed a retrospective analysis of 21 consecutive patients receiving high-dose paclitaxel and melphalan as the preparative regimen for autologous peripheral blood stem-cell transplantation for metastatic breast cancer between January 1997 and December 1997. Glutamine suspension was given as swish-and-swallow administration every four hours around the clock starting day-7, for a total dose of 24 g/d. RESULTS: The group given oral glutamine suspension demonstrated significantly fewer days of mucositis and a lower maximum grade of mucositis. The treatment group also had fewer days of parenteral morphine for pain relief. The group that did not receive glutamine required an average of 5.22 days of patient-controlled analgesia (PCA) morphine; the glutamine group did not require PCA morphine. The total days of narcotic pain relief were decreased in the glutamine group; however, this did not reach statistical significance. Qualitatively, the patients in the glutamine group had less oral ulceration and bleeding, and were able to tolerate liquids sooner than those in the nonglutamine group. Patients tolerated the glutamine suspension well. CONCLUSIONS: This study showed that around-the-clock administration of oral glutamine may decrease both the severity and duration of mucositis associated with high-dose bone marrow transplant preparative regimens. The decrease in severity and duration of mucositis translated into reduced parenteral narcotic use. A prospective, randomized, controlled trial is needed to determine future applications of glutamine in the support of patients undergoing high-dose chemotherapy.     

Oral status during radiotherapy and chemotherapy: a descriptive study of patient experiences and the occurrence of oral complications

The aim of the present study was to describe patients' experiences of their oral status and their relation to oral complications during radiotherapy and chemotherapy. The sample consisted of 41 consecutive patients admitted for radiotherapy with >40 Gy including the oral cavity for tumours within the head and neck area, or for chemotherapy of haematological malignancies. At the start of radiotherapy or the second/third cycle of chemotherapy, patients rated their experiences of oral symptoms on a 100-mm visual analogue scale with endpoints "no oral discomfort" and "worst imaginable oral discomfort". Mucositis was assessed and unstimulated whole saliva was collected. Patients were examined regularly at every 10 Gy increase of radiotherapy or once a week during chemotherapy, and after completion of the radiotherapy or the chemotherapy cycle. In addition, patients given radiotherapy rated their experiences of oral symptoms 1 month after treatment. Patients receiving radiotherapy experienced a significant increase in oral symptoms over time. One month after treatment several oral symptoms were still present. The severity of mucositis increased over time. The unstimulated salivary secretion rate showed a rapid decrease after the start of radiotherapy, followed by a slow recovery. Patients who received chemotherapy reported fewer oral symptoms, with a peak 1-2 weeks after the start of treatment, and their mucositis score showed a parallel pattern of development. Their unstimulated salivary secretion rate did not change over time. There was good agreement between patient experiences and observations recorded by dental staff.     

Efficacy of treatment to relieve mucositis-induced discomfort

 To determine the efficacy of a mouthwash in relieving mucositis-induced discomfort in patients receiving chemotherapy, 31 (16 male, 15 female) with a mean age of 45 (range 16–80) were given an in-house three-drug (lidocaine, diphenhydramine and sodium bicarbonate in normal saline) mouthwash when they developed mucositis of any severity. The complications were assessed on the CALGB (Cancer and Leukemia Group B) scale. The response to the mouthwash was reported on a self-assessment scale. Patients' response data were analyzed with reference to: (1) relief throughout the duration of mucositis and (2) relief during the worst stage (for each episode) of mucositis. Five patients with fungal, viral or bacterial oral infection were excluded from study. Overall, 4 patients had grade I, 16 patients had grade II, 10 patients had grade III and 1 patient had grade IV mucositis. The average duration of mucositis was 7.9 days (range 3–23 days), and the mean duration of the worst stage of mucositis was 4.81 days (range 2–13 days). The mean mucositis severity score was 1.9 (range 1–4), and the average self-assessment (response) score was 0.81 (range 0–2). The mean mucositis score during the worst stage of mucositis was 2.25 (range 1–4), and the average self-assessment (response) score during the worst stage of mucositis was 0.91 (range 0–2.7). These results suggests that this three-drug mouthwash provides effective symptomatic relief in patients with chemotherapy-induced mucositis. Published online: 5 October 1999     

头颈部肿瘤放疗中口腔黏膜反应的治疗

目的探讨2种漱口液治疗肿瘤患者在放射治疗过程中急性上口腔黏膜炎的疗效。方法将87例头颈部肿瘤患者按随机数字表法分为2组,自制漱口液组（n=43例）和口泰漱口液组（n=44例）。2组在放疗过程中分别采用自制漱口液和口泰漱口液含漱,每次10mL,4～5次.d-1,自放射治疗开始后1周内使用,连续使用7周。根据RTOG/EORTC急性放射性黏膜炎分级标准对2组患者的疗效及口腔黏膜损伤情况进行比较。结果自制漱口液组有效率高于口泰漱口液组、Ⅲ级急性放射性黏膜炎发生率低于口泰漱口液组（均P〈0.05）。结论头颈部肿瘤患者在放疗过程中口腔黏膜反应是不可避免的,自制漱口液配制简单、价格便宜、疗效确定,在头颈部肿瘤患者放射治疗过程中可作为预防和治疗用药。     

Prophylaxis with povidone-iodine against induction of oral mucositis by radiochemotherapy

Oral mucositis is a frequent complication of radiochemotherapy. The origin of radiation-induced mucosal lesions is iatrogenic in nature, although further development of mucositis is essentially influenced by infection. It can be assumed that disinfection measures should decrease the severity of mucositis induced by radiochemotherapy. Therefore, in a prospective randomised study the efficacy of prophylactic oral rinsing with a disinfection agent was investigated. A randomised, prospective comparative trial was conducted with 40 patients undergoing radiochemotherapy of the head and neck region because of malignant disease. The treatment scheme consisted of irradiation to the tumour region and adjacent lymph nodes, with a total dose of 71.3 Gy, and simultaneous chemotherapy with carboplatin (60 mg/m²) on days 1–5 and 29–34. In all patients mucositis prophylaxis with nystatin, rutosides, panthenol and immunoglobulin was undertaken. In addition, 20 patients rinsed the oral cavity 4 times daily with povidone-iodine solution, while the group for comparison rinsed with sterile water. Clinical examination of the oral mucosa was performed weekly. Onset, grading and duration of mucositis were used as the main variables. Clinically manifest oral mucositis was observed in 14 patients in the iodine group (mean grading: 1.0) and in all 20 patients in the control group (mean grading: 3.0). The total duration (mean) of clinically observed mucositis was 2.75 weeks in treatment patients and 9.25 weeks in control patients. Median AUC (area under curve for grade vs duration) was 2.5 in the iodine rinsing patients and 15.75 in control patients. All differences found between the two groups were statistically significant. Increased iodine incorporation was not observed. A pathologic rise in thyroid hormone levels was not found in the iodine group. The results obtained indicate that incidence, severity and duration of radiochemotherapy-induced mucositis can be significantly reduced by oral rinsing with povidone-iodine in addition to the standard prophylaxis scheme. It can be concluded that rinsing with povidone-iodine is an easy, cheap and safe prophylactic method and can be recommended as a supportive treatment during antineoplastic treatment of the head and neck region.     

局部冷疗对造血干细胞移植预处理中口腔黏膜炎愈合时间的影响

目的:探讨局部冷疗对造血干细胞移植预处理中口腔黏膜炎愈合时间的影响.方法:将28例以BUCY+ ATG为基本预处理方案的造血干细胞移植患者随机分为试验组和对照组各14例,对照组为常规护理组,化疗药物输注期间和进食前后使用甲硝唑漱口液常规漱口,试验组除常规护理外,化疗药物输注期间全程间断含冰(含冰时间为2h).结果:与对照组相比,试验组可以有效地缩短患者口腔黏膜炎愈合时间.结论:预处理中局部冷疗可延缓口腔黏膜炎的发生,并有效地缩短患者口腔黏膜炎愈合时间.     

Administration of Ratanhia-based herbal oral care products for the prophylaxis of oral mucositis in cancer chemotherapy patients: a clinical trial

Oral complications are a common side effect of cancer chemotherapy, as antineoplastic agents affect both the immune system and the oral mucosa. This study demonstrates preventive and therapeutic effects of dental treatment and regular use of Weleda Ratanhia-Mundwasser((R)) (herbal mouthwash) and Weleda Pflanzen-Zahngel((R)) (herbal toothgel) on oral mucositis during chemotherapy. Thirty-two female patients with breast cancer starting on chemotherapy were evaluated in this study. Plaque index, gingival index, degree of mucositis and 10 single symptoms were monitored once weekly for four consecutive weeks. After four weeks, plaque and gingival indexes were slightly decreased compared to baseline values. The degree of mucositis was increased by one grade in 15.6 % of the patients and over 70 % remained without symptoms. On the whole, single symptoms decreased from day 7 since beginning of chemotherapy to day 28. Mucositis symptoms were moderate in severity, and the results indicate a positive influence of using Weleda Ratanhia-Mundwasser and Weleda Pflanzen-Zahngel. Further studies might be promising.     

Impact of oral mucositis on short-term clinical outcomes in paediatric and adolescent patients undergoing chemotherapy

Purpose

The purpose of this study is to determine the burden of the peak severity of oral mucositis and severity over time on selected clinical outcomes in paediatric and adolescent patients receiving chemotherapy.

Patients and methods

A multicentre study enrolled 140 patients between the ages of 6 and 18 years, who had been treated with chemotherapy and completed the self-report Mouth and Throat Soreness-related questions of the Oral Mucositis Daily Questionnaire for 14 days. Clinical data were collected from patients' medical records during the first 14 days after starting chemotherapy.

Results

Forty-one percent developed oral mucositis. Multiple linear regression analysis revealed that oral mucositis was significantly associated with an increased loss of baseline body weight, after controlling for nausea/vomiting (β?=?0.34, p?=?0.002). Multiple logistic regression analysis showed that severe mucositis was significantly associated with a higher probability of fluid replacement, after controlling for nausea/vomiting (adjusted OR?=?12.8; 95 % CI?=?2.7–61.0; p?=?0.001). In addition, severe mucositis was significantly associated with a higher probability of fever, after controlling for neutropoenia (adjusted OR?=?5.4; 95 % CI?=?1.8–15.4; p?=?0.002). No difference was observed for oral or systemic infections among the subgroups. About 5 % of the patients with oral mucositis had delays in chemotherapy (≤7 days). None of the patients had dose modification or unplanned hospitalization due to oral mucositis. The associations of peak severity and overall oral mucositis with adverse clinical outcomes in paediatric and adolescent patients were equivalent.

Conclusion

Oral mucositis is associated with negative effects on clinical outcomes.     

Prevention of 5-fluorouracil-related stomatitis by oral cryotherapy: a randomized controlled study.

Stomatitis is a common adverse effect of intravenously infused 5-fluorouracil (5FU). Although there are encouraging studies about the preventive role of oral cryotherapy in stomatitis induced by intravenous administration of 5FU, this simple and cost-effective method is not part of clinical practice. This prospective randomized study investigates whether oral cryotherapy alleviates 5FU-induced stomatitis. Thirty six patients, included in the cryotherapy group, were instructed to hold ice cubes in their oral cavity, shortly before, during and shortly after the infusion of 5FU. Both mean physician and patient-graded stomatitis of our cryotherapy group were compared with those of a control group (40 patients) and were found significantly reduced for all three chemotherapy cycles. The percentage of patients who were free from oral toxicity was significantly higher in the cryotherapy group in all three chemotherapy cycles, as judged both by patients and physicians. The results of this study encourage the use of cryotherapy in patients receiving 5FU in alleviating stomatitis by using a side-effect-free, easy to perform and inexpensive measure, which does not interfere with the efficacy of antineoplastic agents.     

Filgrastim (r-metHuG-CSF) and its potential use in the reduction of radiation-induced oropharyngeal mucositis: an interim look at a randomized, double-blind, placebo-controlled trial

We wished to determine if filgrastim administration to chemotherapy/radiation therapy-naive patients receiving external-beam irradiation for head-and-neck malignancies would reduce the incidence and severity of oral/oropharyngeal mucositis. Patients were randomized to receive subcutaneous injections of either filgrastim or placebo beginning on day 1 of radiation and continuing daily throughout treatment. Study medication was titrated to keep the neutrophil count between 10 x 10(9) and 30 x 10(9)/l. The left and right buccal mucosa, hard palate, and posterior pharyngeal wall were scored weekly, by a blinded evaluator using two different scales, and the most severe score per week was used in data analysis. Fourteen of a planned 54 patients were randomized (8 filgrastim, 6 placebo), and were evaluable for a planned interim analysis. No statistically significant between-group differences were seen in mean worst scores across time using repeated measures analysis of variance (Hickey, p = 0.231; WHO, p= 0.288). At almost all timepoints, however, the worst mean scores were lower in patients treated with filgrastim compared with those in patients treated with placebo, and the number of severe (i.e., grade 3) mucositis scores was significantly lower in the filgrastim-treated group. Filgrastim may decrease the severity of radiation-induced oral/oropharyngeal mucositis.     

Chemotherapy: the effect of oral cryotherapy on the development of mucositis

Aims and objective. The aim of this study is to investigate the effect of oral cryotherapy on the development of chemotherapy‐induced mucositis in patients administered combined chemotherapy. Background. Mucositis has been of interest to scientists for more than 20 years. Unfortunately, this has not resulted in the development of standard procedures for prevention and management. To cope with this side‐effect and to prevent opportunistic infections that may emerge during treatment, attempts are taken to provide preventative and comfort measures. In this context, cryotherapy (oral cooling) has become popular as a cheap and readily applicable method in preventing the developing due the rapid infusion of chemotherapy agents, or decreasing its severity. Design and method. Study involved 60 patients, 30 of whom were in the study group and 30 in the control group. Ice cubes at a size that can be moved easily in the mouth and whose corners have been smoothed in order that they will not cause irritation in the mouth has been used in oral cryotherapy in the study group. Oral chemotherapy was initiated five minutes before chemotherapy and maintained during venous infusions of etoposide (Vepesid®), platinol (Cisplatin®), mitomycin (Mitomycin‐C®) and vinblastin (Velbe®) depending on the chemotherapy course. Results. According to Patient‐Judged Mucositis Grading, the rate of mucositis is 36.7% in study group and 90.0% in control group, the difference between two groups being statistically significant (P < 0.05). According to Physician‐Judged Mucositis Grading, the rate of mucositis is 10.0% in the study group and 50.0% in the control group, the difference between two groups being statistically significant (P < 0.05). Oral pH values decreased in 90% of the subjects in study group, i.e. mucositis risk was reduced whereas oral pH values remained unchanged or decreased in 86.7% of the subjects in the control group, namely mucositis risk increased. The difference between study and control groups in terms of the change in pH values after chemotherapy was found to be statistically significant (P < 0.05). Conclusion. Our findings have demonstrated that oral cryotherapy makes an important contribution to the protection of oral health by reducing the mucositis score according to patient‐ and physician‐judged mucositis score and by increasing oral pH values. Relevance to clinical practice. Aggressive cancer therapy places patients at greater risk for oral complications and treatment‐related consequences. Unfortunately, prevention and/or treatment of such oral sequelae have often become overlooked as priorities of the treatment team. Effective approaches for the prevention or treatment of oral mucositis have not been standardized, and vary considerably among institutions. Prophylactic measures begin with an increased emphasis on improved oral status. Oral cryotherapy, the therapeutic administration of cold, is a prophylactic measure for oral inflammation. The relevance for clinical practice will be to understand the content of mucositis; comprehensive care should focus on the prevention of this complication in the clinical practice.     

An oral care protocol intervention to prevent chemotherapy-induced oral mucositis in paediatric cancer patients: a pilot study.

The likelihood of paediatric cancer patients experiencing oral mucositis has increased significantly as high-dose and multiple chemotherapy agents are used in the treatment of childhood cancer in recent years. The resulting oral ulcerative lesions can cause significant pain, dysphagia, alteration in nutritional status and increased risk for localized infections that could disseminate systemically. The purpose of this pilot study was to determine the clinical benefits of an oral care protocol intervention on the prevention and reduction of the severity of oral mucositis in paediatric patients receiving chemotherapy. Fourteen children were enrolled in the study; there were seven children in the control and seven in the experimental group. In the experimental group, children received a preventive oral care protocol consisting of tooth brushing, normal saline rinse and 0.2% chlorhexidine mouth rinse. Children in the control group received usual care according to the study's clinical setting. Data were collected at baseline, then twice a week for 3 weeks. The incidence of ulcerative lesions, severity of oral mucositis and the related pain intensity were used as the main outcome variables. The experimental group exhibited fewer and less painful oral mucositis lesions. The results of this study support the preventive use of oral care protocols in paediatric patients undergoing chemotherapy for cancer treatment.     

思密达与碘甘油混合液治疗化疗性口腔黏膜炎的效果观察

目的探讨思密达与碘甘油混合液局部涂抹治疗化疗性口腔黏膜炎的效果。方法将肿瘤化疗后发生口腔黏膜炎的患者130例,按照随机数字表分为两组,观察组63例,对照组67例。对照组采用生理盐水400ml＋庆大霉素64万u＋维生素B12 500mg复合液漱口,每天4次,每次含漱1min;观察组在对照组的基础上,采用思密达3g粉剂倒入碘甘油瓶内（10m1）混合后搅拌均匀,涂抹于患处,每天4次。两组患者连续干预5d后比较其疗效。结果两组患者口腔黏膜炎治疗效果比较,差异有统计学意义,观察组治疗效果明显优于对照组（P〈0．001）。结论思密达与碘甘油混合液治疗化疗性口腔黏膜炎效果显著,建议其将作为治疗成年肿瘤患者化疗性口腔黏膜炎的一线治疗手段。     

Systematic review of basic oral care for the management of oral mucositis in cancer patients

Purpose

The purpose of this project was to evaluate research in basic oral care interventions to update evidence-based practice guidelines for preventing and treating oral mucositis (OM) in cancer patients undergoing radio- or chemotherapy.

Methods

A systematic review of available literature was conducted by the Basic Oral Care Section of the Mucositis Study Group of MASCC/ISOO. Seven interventions—oral care protocols, dental care, normal saline, sodium bicarbonate, mixed medication mouthwash, chlorhexidine, and calcium phosphate—were evaluated using the Hadorn (J Clin Epidemiol 49:749–754, 1996) criteria to determine level of evidence, followed by a guideline determination of one of the following: recommendation, suggestion, or no guideline possible, using Somerfield’s (Classic Pap Cur Comments 4:881–886, 2000) schema.

Results

Fifty-two published papers were examined by treatment population (radiotherapy, chemotherapy, and hematopoietic stem cell transplant) and by whether the intervention aimed to prevent or treat OM. The resulting practice suggestions included using oral care protocols for preventing OM across all treatment modalities and age groups and not using chlorhexidine mouthwash for preventing OM in adults with head and neck cancer undergoing radiotherapy. Considering inadequate and/or conflicting evidence, no guidelines for prevention or treatment of OM were possible for the interventions of dental care, normal saline, sodium bicarbonate, mixed medication mouthwash, chlorhexidine in patients receiving chemotherapy or hematopoietic stem cell transplant, or calcium phosphate.

Conclusions

The evidence for basic oral care interventions supports the use of oral care protocols in patient populations receiving radiation and/or chemotherapy and does not support chlorhexidine for prevention of mucositis in head and neck cancer patients receiving radiotherapy. Additional well-designed research is needed for other interventions to improve the amount and quality of evidence guiding future clinical care.