口腔黏膜炎的诊断与管理
Diagnosis and management of oral mucositis.
作者信息
Silverman Sol
机构信息
Universityof California San Francisco School of Dentistry, 513 Parnassus Avenue, San Francisco, CA 94143, USA.
出版信息
J Support Oncol. 2007 Feb;5(2 Suppl 1):13-21.
Oral mucositis is a common complication in cancer patients receiving chemotherapy and/or radiation therapy. Nearly all patients undergoing myeloablative therapy for stem-cell or bone marrow transplantation experience oral mucositis. Those receiving radiation therapy for head and neck cancer are at especially high risk. However,this toxicity also occurs with standard-dose chemotherapy and can be seen in association with treatment of many other tumor types. Oral mucositis significantly complicates cancer treatment by contributing to pain, dysphagia, weight loss, depression, higher risk of infection, decreased quality of life, and increased healthcare costs. This review summarizes the impact of oral mucositis in patients with cancer, including its pathogenesis, diagnosis, financial implications, and management. Current treatment guidelines are presented, and novel targeted therapies are discussed. Newer agents, such as palifermin (recombinant human keratinocyte growth factor-1), have been shown in clinical trials to reduce the incidence and severity of oral mucositis,and Saforis (an oral glutamine suspension) may also promote recovery from mucosal damage following chemotherapy or radiation therapy. Continued advances in understanding the pathobiology of oral mucositis should lead to the development of additional agents for its effective prevention and treatment in patients undergoing cancer therapy.
口腔黏膜炎是接受化疗和/或放疗的癌症患者常见的并发症。几乎所有接受干细胞或骨髓移植清髓治疗的患者都会发生口腔黏膜炎。接受头颈部癌症放疗的患者风险尤其高。然而,这种毒性在标准剂量化疗时也会出现,并且在许多其他肿瘤类型的治疗中也可见。口腔黏膜炎通过导致疼痛、吞咽困难、体重减轻、抑郁、感染风险增加、生活质量下降以及医疗费用增加,使癌症治疗显著复杂化。本综述总结了口腔黏膜炎对癌症患者的影响,包括其发病机制、诊断、经济影响和管理。介绍了当前的治疗指南,并讨论了新型靶向治疗方法。新型药物,如帕利夫明(重组人角质形成细胞生长因子-1),在临床试验中已显示可降低口腔黏膜炎的发生率和严重程度,而萨福里斯(一种口服谷氨酰胺混悬液)也可能促进化疗或放疗后黏膜损伤的恢复。在理解口腔黏膜炎病理生物学方面的持续进展应会促使开发更多药物,用于有效预防和治疗接受癌症治疗的患者的口腔黏膜炎。