MASCC ISOO Clinical Practice Guidelines for the …

1 MASCC = isoo Clinical Practice Guidelines for the Managementof Mucositis Secondary to Cancer TherapyRajesh V. Lalla, DDS, PhD1; Joanne Bowen, PhD2; Andrei Barasch, DMD, MDSc3; Linda Elting, PhD4;Joel Epstein, DMD, MSD5; Dorothy M. Keefe, MD2; Deborah B. McGuire, PhD, RN6; Cesar Migliorati, DDS, MS, PhD7;Ourania Nicolatou-Galitis, DDS, MSc, DrDent8; Douglas E. Peterson, DMD, PhD1; Judith E. Raber-Durlacher, DDS, PhD9;Stephen T. Sonis, DMD, DMSc10; Sharon Elad, DMD, MSc11; and The Mucositis Guidelines Leadership Group of theMultinational Association of Supportive Care in Cancer and International Society of Oral Oncology ( MASCC = isoo ).

2 BACKGROUND:Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this system-atic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology( MASCC = isoo ) Clinical Practice Guidelines for :A literature search was conducted to identify eligible publishedarticles, based on predefined inclusion=exclusion criteria. Each article was independently reviewed by 2 reviewers. Studies were ratedaccording to the presence of major and minor flaws as per previously published criteria.

3 The body of evidence for each intervention,in each treatment setting, was assigned a level of evidence, based on previously published criteria. Guidelines were developed basedon the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline :The literature search identified 8279 papers, 1032 of which were retrieved for detailed evaluation based on titles and abstracts. Ofthese, 570 qualified for final inclusion in the systematic reviews. Sixteen new Guidelines were developed for or against the use of vari-ous interventions in specific treatment settings.

4 In total, the MASCC = isoo Mucositis Guidelines now include 32 Guidelines : 22 for oralmucositis and 10 for gastrointestinal mucositis. This article describes these updated :The updatedMASCC= isoo Clinical Practice Guidelines for mucositis will help clinicians provide evidence-based management of mucositis second-ary to cancer ;120:1453 The by Wiley Periodicals, Inc. on behalf of Ameri-can Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivsLicens e, which permits use and distribution in any medium, provided the original work is properly cited, the use is non- commercialand no modifications or adaptations are :mucositis, stomatitis, oral, gastrointestinal, Guidelines , Multinational Association of Supportive Care in Cancer and Inter-national Society of Oral Oncology ( MASCC = isoo ).

5 Corresponding author:Rajesh V. Lalla, DDS, PhD, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030-1605; Fax: of Connecticut, Farmington, Connecticut;2 University of Adelaide, Adelaide, South Australia, Australia;3 Winthrop University Hospital, Mineola, NewYork;4 The University of Texas MD Anderson Cancer Center, Houston, Texas;5 City of Hope Medical Center, Duarte, California;6 Virginia Commonwealth University,Richmond, Virginia;7 University of Tennessee Health Science Center, Memphis, Tennessee.

6 8 University of Athens, Athens, Greece;9 Academic Medical Center-Am-sterdam, Amsterdam, the Netherlands;10 Brigham and Women s Hospital, Boston, Massachusetts;11 University of Rochester, Rochester, New YorkAdditional supporting information may be found in the online version of this members of the Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Societyof Oral On-cology ( MASCC = isoo ) are: Noor Al-Dasooqi, PhD; Michael Brennan, DDS, MHS; Rachel Gibson, PhD; Janet Fulton, PhD, RN; Ian Hewson, BDS; Siri B.

7 Jensen, DDS,PhD; Richard Logan, BDS, MDS, PhD; Kerstin Ohrn, PhD, RDH; Triantafyllia Sarri, DDS, MSc; Deborah Saunders, DDS; Inger von B ultzingsl owen, DDS, PhD; andNoam Yarom, contributors to the Guidelines update included Justin Allemano, Abdul Rahman Al-Azri, Heliton Spindola Antunes, Anura Ariyawardana, Emma Bateman,Nicole Blijlevens, Christine B. Boers-Doets, Paolo Bossi, Carlton G. Brown, Yu-Chia Chang, Karis K. Cheng, Catherine Cooksley, Elvira P. Correa, Kristopher Dennis,Mario Di Palma, Scott Drucker, June Eilers, Carmen Escalante, Cherry L.

8 Estilo, Hele Everaus, Margot Fijlstra, Monica Fliedner, Annette Freidank, Erich Gerber, FaithGibson, Jes us Garcia Gomez, Josiah Halm, Guido Hita, Ronald D. Hutchins, Brian Hodgson, Allan Hovan, Virginia Jarvis, Emily E. King, Vassilios E. Kouloulias, MarieC. Latortue, Judith Lees, Nilza Nelly Fontana Lopes, Charles Loprinzi, Marisol Michelet, Takehiko Mori, Raj G. Nair, Pasquale Niscola, Loree K. Oberle-Edwards, An-thony Osaguona, Pratibha Parelkar, Jumin Park, Ira Parker, Bo G. Pettersson, Carin Potting, Nikhil G.

9 Rao, Dorothea Riesenbeck, Tanya Rouleau, MarkM. Schubert,Sol Silverman Jr, Yoshihiko Soga, Fred Spijkervet, Monique Stokman, Andrea M. Stringer, Wim Tissing, Walter van der Velden, Marianne D. van deWetering, Madhuri Vithala, Dianna S. Weikel, Roger Yazbeck, Eric Yeoh, and Yehuda : The Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology ( MASCC = isoo ) Mucositis Guidelines are devel-oped to facilitate the evidence-based management of mucositis. However, clinicians should also use their own judgment in making treatment decisions for indi-vidual patients.

10 The guideline authors and the MASCC = isoo do not guarantee or take responsibility for Clinical outcomes in individual Guidelines refer to the use of the listed agents for the specific indication listed (ie, the prevention or treatment of mucositis or related symptoms). Theseguidelines do not apply to the use of the listed agents for other indications. For example, although it is suggested that chlorhexidine mouthwash not be usedto prevent oral mucositis in patients receiving head and neck radiation therapy, clinicians may choose to use this agent for other indications in thisor ,Received:September 12, 2013;Revised:November 21, 2013.