Ruiz-Esquide Gonzalo, Nervi Bruno, Vargas Alex, Maíz Alberto
Departamento de Nutrición, Diabetes y Metabolismo, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Med Chil. 2011 Mar;139(3):373-81. Epub 2011 Aug 25.
One of the most common and troublesome complications of modern intensive anticancer treatments is oral mucositis. The purpose of this review is to summarize current evidence and clinical guidelines regarding its prevention and therapy. The use of keratinocyte growth factor-1, supplementary glutamine and other recently developed treatment modalities are discussed. The injury of the oral mucosa caused by antineoplastic agents promotes the local expression of multiple pro-inflammatory and pro-apoptotic molecules and eventually leads to the development of ulcers. Such lesions predispose patients to several infectious and nutritional complications. Also, they lead to modification of treatment schedules, potentially affecting overall prognosis. Local cryotherapy with ice chips and phototherapy with low energy laser may be useful as preventive measures. Mouthwashes with allopurinol and phototherapy with low energy laser can be used as treatment. In radiotherapy, special radiation administration techniques should be used to minimize mucosal injury. Pain control should always be optimized, with the use of patient controlled analgesia and topical use of morphine. Supplemental glutamine should not be used outside of research protocols. Lastly, thorough attention should be paid to general care and hygiene measures.
现代强化抗癌治疗中最常见且棘手的并发症之一是口腔黏膜炎。本综述的目的是总结关于其预防和治疗的当前证据及临床指南。文中讨论了角质形成细胞生长因子-1、补充谷氨酰胺及其他近期研发的治疗方式的应用。抗肿瘤药物导致的口腔黏膜损伤会促进多种促炎和促凋亡分子的局部表达，最终导致溃疡形成。此类损伤使患者易发生多种感染和营养并发症。此外，它们还会导致治疗方案的调整，可能影响总体预后。用碎冰进行局部冷冻疗法以及用低能量激光进行光疗可用作预防措施。用别嘌醇漱口以及用低能量激光进行光疗可用于治疗。在放射治疗中，应采用特殊的放射给药技术以尽量减少黏膜损伤。应始终优化疼痛控制，采用患者自控镇痛并局部使用吗啡。在研究方案之外不应使用补充谷氨酰胺。最后，应充分重视一般护理和卫生措施。
