对西班牙马德里地区大学医院网络中接受放射治疗患者的口腔护理方案的批判性评估。
A critical assessment of oral care protocols for patients under radiation therapy in the regional University Hospital Network of Madrid (Spain).
作者信息
Lanzós Isabel, Herrera David, Lanzós Eduardo, Sanz Mariano
机构信息
ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain.
Oncological Radiotherapy Service Hospital 12 de Octubre, Madrid, Spain.
出版信息
J Clin Exp Dent. 2015 Dec 1;7(5):e613-21. doi: 10.4317/jced.52557. eCollection 2015 Dec.
BACKGROUND
This research was aimed to critically evaluate, under the light of the available scientific evidence, the oral care protocols recommended by different hospitals in head and neck cancer (HNC) patients under radiation therapy.
MATERIAL AND METHODS
A questionnaire requesting all the relevant information for the oral care of these patients was sent to the 9 University Hospitals in Madrid. The answers were categorized and analyzed. In addition, an electronic search was conducted to identify the most relevant papers (systematic reviews [SR] and randomized clinical trials [RCTs]) assessing oral care protocols for patients treated for HNC with radiation therapy.
RESULTS
Eight out of nine centers answered the questionnaire and the retrieved information was tabulated and compared. These recommendations were analyzed by a computerized search on MEDLINE and the Cochrane Oral Health Collaboration Database. The results of the analysis clearly shown a great heterogeneity, in terms of oral health care protocols, regarding the management of irradiated patients (for HNC) within the Hospitals of Madrid region. In addition, some of the recommendations lack solid scientific support.
CONCLUSIONS
The present survey revealed that the recommendations provided by the different hospitals were clearly different. The available evidence, supported by SR and RCTs, suggested the need of an oral assessment before cancer treatment, in order to prevent and treat dental pathologies and avoiding potential complications; during cancer treatment, it is relevant monitoring the patient in order to decrease the severity of the side effects, and to avoid any tooth extraction or surgery and special attention should be paid to mucositis, xerostomia and candidiasis; after cancer treatment, the following are relevant aspects: the risk of osteoradionecrosis, trismus, caries and the risks associated to dental implants.
KEY WORDS
Head and neck cancer, supportive care in cancer, radiotherapy complications, management and oral care on cancer treatment.
背景
本研究旨在根据现有科学证据，严格评估马德里不同医院针对接受放射治疗的头颈癌（HNC）患者推荐的口腔护理方案。
材料与方法
向马德里的9家大学医院发送了一份问卷，询问这些患者口腔护理的所有相关信息。对答案进行分类和分析。此外，进行了电子检索，以确定评估接受放射治疗的HNC患者口腔护理方案的最相关论文（系统评价[SR]和随机临床试验[RCT]）。
结果
9个中心中有8个回答了问卷，并将检索到的信息制成表格进行比较。通过在MEDLINE和Cochrane口腔健康协作数据库上的计算机检索对这些建议进行了分析。分析结果清楚地表明，在马德里地区医院内，对于接受放疗的（HNC）患者的口腔卫生护理方案存在很大差异。此外，一些建议缺乏坚实的科学依据。
结论
本次调查显示，不同医院提供的建议明显不同。SR和RCT支持的现有证据表明，在癌症治疗前需要进行口腔评估，以预防和治疗牙齿疾病并避免潜在并发症；在癌症治疗期间，对患者进行监测以减轻副作用的严重程度，并避免任何拔牙或手术，应特别关注口腔黏膜炎、口干症和念珠菌病；在癌症治疗后，以下是相关方面：放射性骨坏死、牙关紧闭、龋齿的风险以及与牙种植体相关的风险。
关键词
头颈癌、癌症支持治疗、放疗并发症、癌症治疗中的管理与口腔护理
Zotero 插件