Data ultima revisione del testo: 3 giugno 2011
Data creazione: giugno 2011
Redatto da: Emanuela Ferrarin
ESTRATTO dalla Review Cochrane:
Interventions for preventing oral mucositis for patients with
cancer receiving treatment
Citation: Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Littlewood A, McCabe MG, Meyer S,
Khalid T. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database
of Systematic Reviews 2011, Issue 4. Art. No.: CD000978. DOI: 10.1002/14651858.CD000978.pub5.
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Link al Full Text: http://www.thecochranelibrary.com/view/0/index.html
Se non possiedi o autorizzazioni o abbonamento: chiedi alla Biblioteca scientifica del CRO Aviano
([email protected]) o al CIFAV ([email protected])
Misure per prevenire la mucosite orale nei pazienti che ricevono cure oncologiche
TRADUZIONE ITALIANA del RIASSUNTO
Cochrane Systematic Review Issue 4, 2011
Le terapie per il cancro, compreso il trapianto di midollo, possono causare mucositi orali con
ulcere, anche severe, alla bocca. Come conseguenza di questa condizione dolorosa, i pazienti
spesso sperimentano difficoltà a nutrirsi, a bere e a deglutire. Possono anche insorgere infezioni
locali che prolungano la loro permanenza in ospedale. Attualmente vengono utilizzate diverse
strategie per prevenire questa condizione e la revisione degli studi rivela che alcune sarebbero
efficaci. In particolare, la crioterapia, cioè l’applicazione locale di cubetti di ghiaccio in specifici
momenti di somministrazione di alcune terapie e l’impiego del fattore di crescita dei cheratinociti
(Palifermin), hanno evidenziato un beneficio nella prevenzione della mucosite. Il sucralfato
risulterebbe invece efficace nel ridurre la severità della mucosite, mentre altre tipologie di
intervento: aloe vera, amifosfina, glutamina somministrata per endovena, fattore di crescita
granulocitario (G-CSF), miele, terapia laser e terapie antibiotiche orali contenenti
polimixina/tobramicina/amfotericina (PTA) rivelerebbero un’evidenza di beneficio più limitata.
Quanto riportato è stato valutato su pazienti con diverse patologie tumorali e sottoposti a diversi
regimi di terapia. Le evidenze di beneficio riscontrate potrebbero quindi essere circoscritte a
determinate patologie e a determinati trattamenti, che sono stati qui valutati.
ABSTRACT COMPLETO TRATTO DALLA COCHRANE LIBRARY
Abstract
Background
Treatment of cancer is increasingly more effective but is associated with short and long term side
effects. Oral side effects remain a major source of illness despite the use of a variety of agents to
prevent them. One of these side effects is oral mucositis (mouth ulcers).
Objectives
To evaluate the effectiveness of prophylactic agents for oral mucositis in patients with cancer
receiving treatment, compared with other potentially active interventions, placebo or no
treatment.
Search strategy
Electronic searches of Cochrane Oral Health Group and PaPaS Trials Registers (to 16 February
2011), CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to 16 February
2011), EMBASE via OVID (1980 to 16 February 2011), CINAHL via EBSCO (1980 to 16 February
2011), CANCERLIT via PubMed (1950 to 16 February 2011), OpenSIGLE (1980 to 2005) and LILACS
via the Virtual Health Library (1980 to 16 February 2011) were undertaken. Reference lists from
relevant articles were searched and the authors of eligible trials were contacted to identify trials
and obtain additional information.
Selection criteria
Randomised controlled trials of interventions to prevent oral mucositis in patients receiving
treatment for cancer.
Data collection and analysis
Information regarding methods, participants, interventions, outcome measures, results and risk of
bias were independently extracted, in duplicate, by two review authors. Authors were contacted
for further details where these were unclear. The Cochrane Collaboration statistical guidelines
were followed and risk ratios calculated using random-effects models.
Main results
A total of 131 studies with 10,514 randomised participants are now included. Overall only 8% of
these studies were assessed as being at low risk of bias. Ten interventions, where there was more
than one trial in the meta-analysis, showed some statistically significant evidence of a benefit
(albeit sometimes weak) for either preventing or reducing the severity of mucositis, compared to
either a placebo or no treatment. These ten interventions were: aloe vera, amifostine,
cryotherapy, granulocyte-colony stimulating factor (G-CSF), intravenous glutamine, honey,
keratinocyte growth factor, laser, polymixin/tobramycin/amphotericin (PTA) antibiotic
pastille/paste and sucralfate.
Authors' conclusions
Ten interventions were found to have some benefit with regard to preventing or reducing the
severity of mucositis associated with cancer treatment. The strength of the evidence was variable
and implications for practice include consideration that benefits may be specific for certain cancer
types and treatment. There is a need for further well designed, and conducted trials with sufficient
numbers of participants to perform subgroup analyses by type of disease and chemotherapeutic
agent.
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
CIFAV-Onlus Centro di Informazione sul Farmaco per l’Area Vasta Pordenonese.
Via F. Gallini,2 33081 Aviano (PN) Italy
www.cifav.it
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