Alleviation of Gastrointestinal Mucosal Toxicity Related to Chemotherapy and Radiation Therapy: The NCCTG Experience.

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Purpose. Cancer patients undergoing chemotherapy and radiation therapy may experience substantial mucosal toxicity. The North Central Cancer Treatment Group (NCCTG) has developed a series of Phase III clinical trials to study agents to alleviate mucosal injury. This manuscript will review this experience. Results. An NCCTG trial demonstrated that oral cryotherapy for 30 minutes is able to decrease 5-FU stomatitis by approximately 50%. This result was replicated in an independent trial. Other NCCTG trials evaluating means of reducing 5-FU-induced stomatitis have demonstrated lack of efficacy for allopurinol mouthwashes, chamomile mouthwashes, a sucralfate slurry, and oral glutamine. Trials evaluating means of alleviating radiation-induced oral mucositis have demonstrated that a chlorhexidine mouthwash is detrimental while oral non-absorbable antibiotic lozenges may provide some marginal benefit, but not enough to recommend it for standard clinical practice. A single trial evaluating radiation-induced esophagitis failed to demonstrate any benefit for a sucralfate slurry. Three trials have been developed to evaluate means for alleviating radiation-induced proctitis. The first trial demonstrated that olsalazine was detrimental in this situation. A second trial, evaluating sucralfate, closed in June 1997. A third trial, designed to evaluate glutamine, is being readied to initiate patient entry. Conclusions. The NCCTG, through a program of randomized, placebo-controlled, clinical trials, has been able to evaluate whether purported treatment options are beneficial for the alleviation of mucosal injury from cancer treatment.





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Hematology | Medical Sciences | Medicine and Health Sciences | Oncology


Department of Medicine, Hematology-Medical Oncology Division

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