von Bültzingslöwen Inger, Brennan Michael T, Spijkervet Fred K L, Logan Richard, Stringer Andrea, Raber-Durlacher Judith E, Keefe Dorothy
Department of Oral Medicine, Sahlgrenska Academy, Göteborg University, P.O. Box 450, 405 30, Göteborg, Sweden.
Support Care Cancer. 2006 Jun;14(6):519-27. doi: 10.1007/s00520-006-0052-7. Epub 2006 Apr 21.
Growth factors and cytokines may be useful in preventing chemotherapy (CT)- and radiotherapy (RT)-induced oral and gastrointestinal mucositis. Two systematic reviews of the medical literature on growth factors and cytokines for the amelioration of CT- and RT-induced mucositis throughout the alimentary tract were performed by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology. The aim of these evidence-based scientific reviews was to critically evaluate the literature and create evidence-based guidelines for the use of growth factors and cytokines in the prevention or treatment of CT- and RT-induced mucositis.
The two reviews covered articles on clinical trials from January 1966 through May 2002 and preclinical studies from June 2002 through May 2005, respectively. The systematic review process was based on a well-established method for evaluating scientific literature.
The number of articles in the first review was 29. In the second review, 23 articles were evaluated, 14 preclinical and 9 clinical studies. It was concluded from the first review that there was no sufficient evidence to provide any recommendations for clinical practice guidelines regarding growth factors and cytokines. From the second review, a guideline could be presented recommending the use of recombinant human keratinocyte growth factor-1 (palifermin) to prevent oral mucositis in patients receiving high-dose CT and total body irradiation followed by stem cell transplantation for haematological malignancies. A guideline could also be provided suggesting that granulocyte macrophage colony-stimulating factor mouthwash not be used for the prevention of oral mucositis in the transplant setting with high-dose CT and autologous or allogeneic stem cell transplantation.
These systematic reviews have provided clarity and shown exciting new results. Further studies will provide new options for this debilitating side-effect of cancer therapy.
生长因子和细胞因子可能有助于预防化疗（CT）和放疗（RT）引起的口腔和胃肠道黏膜炎。癌症支持治疗多国协会/国际口腔肿瘤学会黏膜炎研究小组对关于生长因子和细胞因子改善全消化道CT和RT引起的黏膜炎的医学文献进行了两项系统评价。这些循证科学评价的目的是严格评估文献，并制定关于使用生长因子和细胞因子预防或治疗CT和RT引起的黏膜炎的循证指南。
两项评价分别涵盖了1966年1月至2002年5月的临床试验文章和2002年6月至2005年5月的临床前研究文章。系统评价过程基于一种成熟的科学文献评估方法。
第一次评价中的文章数量为29篇。在第二次评价中，评估了23篇文章，其中14篇临床前研究和9篇临床研究。第一次评价得出的结论是，没有足够的证据为关于生长因子和细胞因子的临床实践指南提供任何建议。从第二次评价中，可以提出一项指南，推荐使用重组人角质形成细胞生长因子-1（帕利夫明）预防接受大剂量CT和全身照射后进行造血系统恶性肿瘤干细胞移植患者的口腔黏膜炎。还可以提供一项指南，建议在大剂量CT以及自体或异基因干细胞移植的移植环境中，不使用粒细胞巨噬细胞集落刺激因子漱口水预防口腔黏膜炎。
这些系统评价提供了清晰的信息，并显示出令人兴奋的新结果。进一步的研究将为癌症治疗这种使人衰弱的副作用提供新的选择。
