Kadowaki Shigenori, Yamaguchi Kensei
Dept. of Gastroenterology, Saitama Cancer Center, Saitama, Japan.
Gan To Kagaku Ryoho. 2011 Nov;38(11):1761-6.
Chemotherapy-induced mucositis is a clinically important and sometimes dose-limiting toxicity of cancer treatment, including standard-dose chemotherapy, high-dose chemotherapy and chemoradiotherapy. Consequently, dose reductions or treatment delays resulting from mucositis may impair treatment effectiveness. Symptoms are oral mucositis, dysphagia, abdominal pain and diarrhea, depending on the affected site. Although the underlying pathobiology of oral mucositis has been considerably elucidated over the past decade, there are few interventions for the prevention or treatment validated by randomized trials. The most commonly accepted intervention is basic oral care. Diarrhea is most common in patients treated with irinotecan and in some cases, life-threatening. No definitive interventions for the prevention of diarrhea exist, but there is evidence that loperamide and octreotide are effective for chemotherapy-induced diarrhea. In future, there is a need for well designed trials, preferably including a placebo or no treatment control, validating more effective interventions for managing chemotherapy- induced mucositis.
化疗引起的粘膜炎是癌症治疗中一种具有临床重要性且有时会限制剂量的毒性反应,包括标准剂量化疗、大剂量化疗和放化疗。因此,由粘膜炎导致的剂量减少或治疗延迟可能会损害治疗效果。症状包括口腔粘膜炎、吞咽困难、腹痛和腹泻,具体取决于受影响的部位。尽管在过去十年中,口腔粘膜炎的潜在病理生物学已得到相当程度的阐明,但经随机试验验证的预防或治疗干预措施却很少。最普遍认可的干预措施是基本的口腔护理。腹泻在接受伊立替康治疗的患者中最为常见,在某些情况下会危及生命。目前尚无预防腹泻的确切干预措施,但有证据表明洛哌丁胺和奥曲肽对化疗引起的腹泻有效。未来,需要设计完善的试验,最好包括安慰剂或无治疗对照,以验证更有效的化疗引起的粘膜炎管理干预措施。