title: Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus statements.
abstract: BACKGROUND
  Oral mucositis (OM) due to radiotherapy and systemic therapies in head and neck cancer treatment represents a major problem causing a wide spectrum of clinical signs and symptoms. This adverse event may reduce quality of life, resulting from debilitating oral pain, bleeding, dysphagia, infections, impairment of food intake, high rate of hospitalization and may interfere with the delivery of programmed treatment plans, ultimately jeopardizing patient outcome. Globally, there is a lack of evidence on effective measures for the prevention and treatment of OM, and only scant uniform conclusions and recommendations can be derived from the existing literature and guidelines. A multidisciplinary team of Italian head and neck cancer experts met in Milan 17-18 February 2013 with the aim of reaching consensus on prophylaxis and management of mucositis. The results of the literature review and the statements that achieved consensus are reported and discussed in this paper.
  
  
  METHODS
  The Delphi Appropriateness Method was used as a structured communication method for achieving consensus. Subsequently, external expert reviewers evaluated the conclusions carefully according to their area of expertise.
  
  
  RESULTS
  This paper presents 13 clusters of statements on prophylaxis and treatment of mucositis that achieved consensus.
  
  
  CONCLUSIONS
  OM represents a very stressful situation for head and neck cancer patients submitted to chemo-radiation or exclusive radiation treatment. A multidisciplinary approach is mandatory, but there is still no gold-standard protocol that is prominently better than others.
authors.affiliation: Department of Radiotherapy, University "La Sapienza", Rome, Italy. Electronic address: vitaliana.desanctis@uniroma1.it.
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Sanctis
authors.affiliation: Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. Electronic address: paolo.bossi@istitutotumori.mi.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bossi
authors.affiliation: Department of Radiotherapy, National Cancer Institute Regina Elena, Rome, Italy. Electronic address: Gsangui1@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
authors.affiliation: Radiation Oncology Department, A. O. S. Maria, Terni, Italy. Electronic address: fabiotrippa@gmail.com.
authors.forename: Fabio
authors.initials: F
authors.lastname: Trippa
authors.affiliation: Medical Oncology Department, AO. S. Paolo, Milano, Italy. Electronic address: daris.ferrari@ao-sanpaolo.it.
authors.forename: Daris
authors.initials: D
authors.lastname: Ferrari
authors.affiliation: IRCCS San Martino-IST, Largo R Benzi 10, 16132 Genoa, Italy. Electronic address: almalina.bacigalup@hsanmartino.it.
authors.forename: Almalina
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: Supportive Care in Cancer Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. Electronic address: carla.ripamonti@istitutotumori.mi.it.
authors.forename: Carla Ida
authors.initials: CI
authors.lastname: Ripamonti
authors.affiliation: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: michela.buglione@unibs.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.affiliation: Radiation Oncology Department, Unit of University of Messina, Italy. Electronic address: Stefano.pergolizzi@unime.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pergolizzi
authors.affiliation: Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: j.a.langendijk@umcg.nl.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendjik
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, TN, USA. Electronic address: barbara.murphy@vanderbilt.edu.
authors.forename: Barbara
authors.initials: B
authors.lastname: Murphy
authors.affiliation: Department of Oral and Maxillofacial Surgery, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Dental Interaction, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands. Electronic address: j.e.raberdurlacher@amc.uva.nl.
authors.forename: Judith
authors.initials: J
authors.lastname: Raber-Durlacher
authors.affiliation: Radiation Oncology Department, AO. S. Croce e Carle, Cuneo, Italy. Electronic address: elviorussi@gmail.com.
authors.forename: Elvio G
authors.initials: EG
authors.lastname: Russi
authors.affiliation: Section of Oral Medicine, MC1605, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1605, USA. Electronic address: lalla@uchc.edu.
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Lalla
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D007558:Italy; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D012307:Risk Factors; D013280:Stomatitis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*
keywords: Chemoradiation; Chemotherapy; Clinical management; Head and neck cancer; Mucositis; Oral mucositis; Radiation therapy; Radiotherapy; Supportive care