Vitaliana De Sanctis1, Paolo Bossi2, Giuseppe Sanguineti3, Fabio Trippa4, Daris Ferrari5, Almalina Bacigalupo6, Carla Ida Ripamonti7, Michela Buglione8, Stefano Pergolizzi9, Johannes A Langendjik10, Barbara Murphy11, Judith Raber-Durlacher12, Elvio G Russi13, Rajesh V Lalla14. 1. Department of Radiotherapy, University "La Sapienza", Rome, Italy. Electronic address: vitaliana.desanctis@uniroma1.it. 2. Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. Electronic address: paolo.bossi@istitutotumori.mi.it. 3. Department of Radiotherapy, National Cancer Institute Regina Elena, Rome, Italy. Electronic address: Gsangui1@gmail.com. 4. Radiation Oncology Department, A. O. S. Maria, Terni, Italy. Electronic address: fabiotrippa@gmail.com. 5. Medical Oncology Department, AO. S. Paolo, Milano, Italy. Electronic address: daris.ferrari@ao-sanpaolo.it. 6. IRCCS San Martino-IST, Largo R Benzi 10, 16132 Genoa, Italy. Electronic address: almalina.bacigalup@hsanmartino.it. 7. Supportive Care in Cancer Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. Electronic address: carla.ripamonti@istitutotumori.mi.it. 8. Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: michela.buglione@unibs.it. 9. Radiation Oncology Department, Unit of University of Messina, Italy. Electronic address: Stefano.pergolizzi@unime.it. 10. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: j.a.langendijk@umcg.nl. 11. Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, TN, USA. Electronic address: barbara.murphy@vanderbilt.edu. 12. Department of Oral and Maxillofacial Surgery, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Dental Interaction, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands. Electronic address: j.e.raberdurlacher@amc.uva.nl. 13. Radiation Oncology Department, AO. S. Croce e Carle, Cuneo, Italy. Electronic address: elviorussi@gmail.com. 14. Section of Oral Medicine, MC1605, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1605, USA. Electronic address: lalla@uchc.edu.
Abstract
BACKGROUND: Oral mucositis (OM) due to radiotherapy and systemic therapies in head and neck cancer treatment represents a major problem causing a wide spectrum of clinical signs and symptoms. This adverse event may reduce quality of life, resulting from debilitating oral pain, bleeding, dysphagia, infections, impairment of food intake, high rate of hospitalization and may interfere with the delivery of programmed treatment plans, ultimately jeopardizing patient outcome. Globally, there is a lack of evidence on effective measures for the prevention and treatment of OM, and only scant uniform conclusions and recommendations can be derived from the existing literature and guidelines. A multidisciplinary team of Italian head and neck cancer experts met in Milan 17-18 February 2013 with the aim of reaching consensus on prophylaxis and management of mucositis. The results of the literature review and the statements that achieved consensus are reported and discussed in this paper. MATERIAL AND METHODS: The Delphi Appropriateness Method was used as a structured communication method for achieving consensus. Subsequently, external expert reviewers evaluated the conclusions carefully according to their area of expertise. RESULTS: This paper presents 13 clusters of statements on prophylaxis and treatment of mucositis that achieved consensus. CONCLUSIONS: OM represents a very stressful situation for head and neck cancer patients submitted to chemo-radiation or exclusive radiation treatment. A multidisciplinary approach is mandatory, but there is still no gold-standard protocol that is prominently better than others.
BACKGROUND:Oral mucositis (OM) due to radiotherapy and systemic therapies in head and neck cancer treatment represents a major problem causing a wide spectrum of clinical signs and symptoms. This adverse event may reduce quality of life, resulting from debilitating oral pain, bleeding, dysphagia, infections, impairment of food intake, high rate of hospitalization and may interfere with the delivery of programmed treatment plans, ultimately jeopardizing patient outcome. Globally, there is a lack of evidence on effective measures for the prevention and treatment of OM, and only scant uniform conclusions and recommendations can be derived from the existing literature and guidelines. A multidisciplinary team of Italian head and neck cancer experts met in Milan 17-18 February 2013 with the aim of reaching consensus on prophylaxis and management of mucositis. The results of the literature review and the statements that achieved consensus are reported and discussed in this paper. MATERIAL AND METHODS: The Delphi Appropriateness Method was used as a structured communication method for achieving consensus. Subsequently, external expert reviewers evaluated the conclusions carefully according to their area of expertise. RESULTS: This paper presents 13 clusters of statements on prophylaxis and treatment of mucositis that achieved consensus. CONCLUSIONS: OM represents a very stressful situation for head and neck cancerpatients submitted to chemo-radiation or exclusive radiation treatment. A multidisciplinary approach is mandatory, but there is still no gold-standard protocol that is prominently better than others.
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