Anura Ariyawardana1,2, Karis Kin Fong Cheng3, Abhishek Kandwal4, Vanessa Tilly5, Abdul Rahman Al-Azri6, Dimitra Galiti7, Karen Chiang8, Anusha Vaddi9, Vinisha Ranna10, Ourania Nicolatou-Galitis7, Rajesh V Lalla11, Paolo Bossi12, Sharon Elad9. 1. College of Medicine and Dentistry, James Cook University, Cairns, Australia. anura.ariyawardana@jcu.edu.au. 2. Metro South Oral Health, Brisbane, Australia. anura.ariyawardana@jcu.edu.au. 3. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 4. Department of Dental Surgery, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayn University, Dehradun, Uttarakhand, India. 5. Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 6. Dental and OMFS Department, Oral Pathology and Medicine, Al-Nahdha Hospital, Ministry of Health, Muscat, Oman. 7. Dental School, National and Kapodistrian University of Athens, Athens, Greece. 8. Pharmacy Department, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia. 9. Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA. 10. Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, USA. 11. Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, USA. 12. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy.
Abstract
PURPOSE: The aim of this systematic review was to update the clinical practice guidelines for the use of anti-inflammatory agents in the prevention and/or treatment of oral mucositis. METHODS: A systematic review was conducted by the Multinational Association of Supportive Care in Cancer/ International Society of Oral Oncology (MASCC/ISOO) subcommittee on mucositis guideline update. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the clinical practice guidelines published in 2014. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guidelines. RESULTS: A total of 11 new papers across five interventions were examined. The recommendation for the use of benzydamine mouthwash for the prevention of radiotherapy-induced mucositis remained unchanged. New suggestion for the use of the same for prevention of mucositis associated with chemoradiotherapy was made. No guideline was possible for any other anti-inflammatory agents due to inadequate and/or conflicting evidence. CONCLUSIONS: Of the anti-inflammatory agents studied for oral mucositis, the evidence supports the use of benzydamine mouthwash in the specific populations listed above. Additional well-designed research is needed on other (class of agents) interventions and in other cancer treatment settings.
PURPOSE: The aim of this systematic review was to update the clinical practice guidelines for the use of anti-inflammatory agents in the prevention and/or treatment of oral mucositis. METHODS: A systematic review was conducted by the Multinational Association of Supportive Care in Cancer/ International Society of Oral Oncology (MASCC/ISOO) subcommittee on mucositis guideline update. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the clinical practice guidelines published in 2014. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guidelines. RESULTS: A total of 11 new papers across five interventions were examined. The recommendation for the use of benzydamine mouthwash for the prevention of radiotherapy-induced mucositis remained unchanged. New suggestion for the use of the same for prevention of mucositis associated with chemoradiotherapy was made. No guideline was possible for any other anti-inflammatory agents due to inadequate and/or conflicting evidence. CONCLUSIONS: Of the anti-inflammatory agents studied for oral mucositis, the evidence supports the use of benzydamine mouthwash in the specific populations listed above. Additional well-designed research is needed on other (class of agents) interventions and in other cancer treatment settings.
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