Mucositis

Clinical Practice Guidelines for the Prevention and Treatment of Cancer Therapy-Induced Oral and Gastrointestinal Mucositis

PEP Weight of Evidence Category: Recommended for Practice

Rubenstein et al., 2004¹

Multinational Association of Supportive Care in Cancer, 2005⁶

(Oral mucositis only)

Foundation of care

Oral care protocols that include patient education. As part of protocol, soft toothbrush should be changed frequently.

1) Hematopoietic stem cell transplantation

a. Patient-controlled analgesic morphine for oral mucositis pain

b. Do not use pentoxifylline for prevention.

c. Low-level laser therapy for centers capable of supporting technology and training

d. Keratinocyte growth factor-1 (palifermin) IV

e. High-dose melphalan: cryotherapy

f. Granulocyte macrophage–colony-stimulating factor mouthwashes not be used for prevention of mucositis

2) Radiation therapy

a. Use of midline radiation blocks and 3D radiation tx.

b. Head and neck: benzydamine for prevention in cases treated with moderate-dose XRT

c. Chlorhexidine should not be used for prevention.

d. Sucralfate should not be used for prevention.

e. Antimicrobial lozenges should not be used for prevention.

3) Standard-dose chemotherapy

a. Chlorhexidine should not be used for treatment of mucositis.

b. 5-FU bolus: 30-minute oral cryotherapy

c. Edatrexate bolus: 20- to 30-minute oral cryotherapy

d. Acyclovir and analogs should not be used routinely.

Many clinical trials fail to meet current standards because of methodologic deficiencies. New trials show positive results for several agents, including human keratinocyte growth factor 2 (KGF-2, repifermin), AES-14 or L-glutamine, and Iseganan. Studies using Gelclair demonstrate effectiveness for pain management. There are a variety of agents with insufficient evidence, including antimicrobial agents and growth factor agents.

The authors conclude that mucositis research needs to develop a scoring system or classification to determine the mucotoxic potential of newer treatments to allow for comparisons of newer treatments.