Peterson Douglas E, Keefe Dorothy M, Hutchins Ronald D, Schubert Mark M
Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, 06030-1605, USA.
Support Care Cancer. 2006 Jun;14(6):499-504. doi: 10.1007/s00520-006-0057-2. Epub 2006 Apr 26.
The field of terminology and assessment of oral and gastrointestinal mucosal injury caused by high-dose cancer therapies in cancer patients has undergone important evolution in recent years. The advances are important for several clinical and research reasons. These reasons include improved patient management and design and conduct of clinical trials based on molecularly targeted therapies. For several decades leading up to the 1980s, terminology was characterized by varying use of "mucositis" and "stomatitis" to describe oral mucosal inflammatory changes and ulceration caused by cancer treatments. In addition, oral mucositis was viewed principally as an epithelial event and one that likely did not intersect with causative mechanisms associated with gastrointestinal mucositis. The term "stomatitis" was directed to oral toxicities and seemed to isolate these conditions from parallel events occurring throughout the alimentary tract and potentially other tissues as well. These perspectives and varying use of these terms resulted in several dilemmas, including (1) difficulty in accurately reporting incidence and severity of oral mucositis and, (2) an under-appreciation of potential significance of alimentary tract mucosal toxicity relative to overall course of therapy, patient quality of life, and in some cases, survivorship. These and related components of the model relative to mucositis have undergone strategic shifts over the past 15 years. A 1989 National Institutes of Health Consensus Development Conference targeted oral mucositis research as one of the key areas for investigation relative to causation, clinical impact, and potential links with other complications in cancer patients. Research in this area over the past 15 years has evolved such that oral and gastrointestinal mucositis are now appropriately framed as a continuum of pathobiologic changes over time, with clinical impact that may well contribute to overall symptom clustering in selected patient cohorts.
This paper will review history, current status, and new research directions associated with terminology and assessment of mucosal injury in cancer patients in the context described above.
近年来，癌症患者因高剂量癌症治疗导致的口腔和胃肠道黏膜损伤的术语及评估领域经历了重要演变。这些进展因多种临床和研究原因而至关重要。这些原因包括改善患者管理以及基于分子靶向疗法的临床试验的设计与开展。在20世纪80年代之前的几十年里，术语的特点是对“黏膜炎”和“口腔炎”的使用各异，用于描述癌症治疗引起的口腔黏膜炎症变化和溃疡。此外，口腔黏膜炎主要被视为一种上皮事件，且可能与胃肠道黏膜炎的致病机制并无交集。“口腔炎”一词针对口腔毒性，似乎将这些情况与整个消化道以及可能其他组织中发生的类似事件区分开来。这些观点以及这些术语的不同用法导致了几个难题，包括：（1）难以准确报告口腔黏膜炎的发病率和严重程度；（2）相对于治疗的总体过程、患者生活质量以及在某些情况下的生存率，对消化道黏膜毒性的潜在重要性认识不足。在过去15年中，该模型中与黏膜炎相关的这些及其他组成部分经历了战略转变。1989年美国国立卫生研究院共识发展会议将口腔黏膜炎研究作为癌症患者病因、临床影响以及与其他并发症潜在联系等关键研究领域之一。过去15年该领域的研究不断发展，如今口腔和胃肠道黏膜炎被恰当地视为随时间推移的一系列病理生物学变化的连续统一体，其临床影响很可能导致特定患者群体出现总体症状群集。
本文将在上述背景下综述与癌症患者黏膜损伤术语及评估相关的历史、现状和新的研究方向。
