title: Prevention and treatment of oral mucositis in patients with head and neck cancer treated with (chemo) radiation: report of an Italian survey.
abstract: OBJECTIVE
  There is a limited number of therapies with a high level of recommendations for mucositis, while several strategies are currently employed with a limited evidence for efficacy. A national survey among Italian oncologists who treat head and neck cancer (HNC) was conducted in order to assess the most common preventive and therapeutic protocols (including nutritional support and pain control) for oral mucositis (OM) in patients undergoing chemoradiotherapy.
  
  
  METHODS
  From September to November 2012, a nationwide electronic survey with 21 focused items was proposed to chemotherapy and radiotherapy centers.
  
  
  RESULTS
  We collected 111 answers. Common Terminology Criteria for Adverse Events (CTCAE) scale is employed by 55% of the physicians in assessing mucosal toxicity. The most relevant predictive factors for OM development are considered smoke, alcohol use, planned radiotherapy, and concurrent use of radiosensitizing chemotherapy. Prophylactic gastrostomy is adopted in <10% of the patients. Preventive antibiotics or antimycotics are prescribed by 46% of the responders (mainly local or systemic antimycotic drugs). Alkalinizing mouthwashes or coating agents are frequently adopted (70% of the cases). Among therapeutic interventions, systemic fluconazole is administered by 80% of the physicians. Pain is mainly treated by weak followed by strong opioids.
  
  
  CONCLUSIONS
  A variety of preventive and therapeutic protocols for OM exists among the participating Italian centers, with some uniformity in respect to nutritional support, use of antimycotic and painkillers. There is an urgent need for well-conducted clinical trials aimed at assessing the best choices for OM prevention and treatment in HNC.
authors.affiliation: Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy, paolo.bossi@istitutotumori.mi.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bossi
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Santis
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Ruo Redda
authors.forename: Alessia
authors.initials: A
authors.lastname: Reali
authors.forename: Liliana
authors.initials: L
authors.lastname: Belgioia
authors.forename: Maria
authors.initials: M
authors.lastname: Cossu Rocca
authors.forename: Ester
authors.initials: E
authors.lastname: Orlandi
authors.forename: Mario
authors.initials: M
authors.lastname: Airoldi
authors.forename: Alamalina
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Marta
authors.initials: M
authors.lastname: Mazzer
authors.forename: Gabriella
authors.initials: G
authors.lastname: Saibene
authors.forename: Elvio
authors.initials: E
authors.lastname: Russi
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D009067:Mouthwashes / Q000008:administration & dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D013280:Stomatitis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D009067:Mouthwashes