The MASCC/ISOO Mucositis Guidelines: dissemination and clinical impact

Abstract

This editorial introduces the second set of articles related tothe update of the clinical practice guidelines for mucositis,developedbythe MucositisStudy Groupofthe MultinationalAssociation of Supportive Care in Cancer/International Soci-etyofOralOncology(MASCC/ISOO).ThefirstsetofarticleswaspublishedinaspecialsectionoftheJanuary2013issueofSupportive Care in Cancer. The January 2013 articles report-ed on the methods used, considerations driving the update ofthe mucositis guidelines, results related to gastrointestinalmucositis, as well as several classes of interventions for oralmucositis including oral cryotherapy, laser and other lighttherapy, cytokines and growth factors, and amifostine [1–8].In the current special section of this issue, we present theremaining articles related to this update that focus on: oralhygiene maintenance, use of several additional classes ofinterventions, as well as pathogenesis of mucositis and riskof oral mucositis in patients receiving targeted therapies.Basic oral care is widely acceptedas good clinical practiceinoncology(andother)patients.ThearticlebyMcGuireetal.examines the evidence on whether oral hygiene maintenancecan actually reduce oral mucositis severity. A suggestion wasdeveloped in favor of using oral care protocols for theprevention of oral mucositis in all age groups and across allcancer treatment modalities. However, no guideline was pos-sibleforspecificagentssuchassalineandsodiumbicarbonatemouthwashes, which are commonly used in clinical practicefor oral hygiene maintenance. Next, Nicolatou-Galitis et al.reviewthe use of anti-inflammatory agentsfor oralmucositis.Although itis wellacceptedthat inflammatory pathwaysplayaroleinthepathogenesisofmucositis,evidencerelatedtotheuse of anti-inflammatory agents is insufficient and/orconflicting. The only guideline possible in favor of an agentwasacontinuationofapreviousguidelinerelatedtotheuseofbenzydamine mouthwash for the prevention of oral mucositisin head and neck cancer patients receiving moderate-doseradiation therapy (up to 50 Gy), without concomitant chemo-therapy. Saunders et al. present an overview of the evidencerelated to a number of classes of agents including antimicro-bials, mucosal coating agents, anesthetics, and analgesics.Guidelines were developed in favor of some analgesic agentsfor relief of pain due to mucositis. In contrast, the evidencesupported recommendations against the use of topical antimi-crobial agents (for mucositis) and the mucosal coating agentsucralfate.Yarometal.examinetheuseofproductsofnaturalorigin for mucositis. The evidence supported a new sugges-tion in favor of systemic zinc in patients receiving head andneck radiation and a recommendation against intravenousglutamine in patients receiving hematopoietic stem cell trans-plant. Jensen et al. present results related to miscellaneousagents that did not fall into any of the previously discussedcategories. Two agents, pilocarpine and pentoxifylline, werefound to be ineffective while no guideline in favor of anymiscellaneous agent was possible.In addition to the sectionsexamining various interventionsfor mucositis, we alsohad two additional groups. Al-Dasooqiet al. reviewed the preclinical and clinical literature related tothepathogenesisofmucositis.Thecurrentstatusoftheknowl-edge on the pathogenesis of mucositis is presented in theirmanuscript. Finally, Elting et al. examine the risk of oral and