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MASCC/ISOO clinical practice guidelines for the management of mucositis: sub-analysis of current interventions for the management of oral mucositis in pediatric cancer patients

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Abstract

Objective

The aim of this sub-analysis was to highlight the MASCC/ISOO clinical practice guidelines for the management of oral mucositis (OM) in pediatric patients and to present unique considerations in this patient population.

Methods

This sub-analysis of the pediatric patient population is based on the systematic review conducted by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISSO) published in 2019/2020. Studies were scored and assigned a level of evidence based on previously published criteria. Data regarding adverse effects and compliance was collected from the original publications.

Results

A total of 45 papers were included and assessed in this sub-analysis, including 21 randomized controlled trials (RCTs). Chewing gum was demonstrated to be not effective in preventing OM in pediatric cancer patients in 2 RCTs. The efficacy of all other interventions could not be determined based on the available literature.

Conclusion

There is limited or conflicting evidence about interventions for the management of OM in pediatric cancer patients, except for chewing gum which was ineffective for prevention. Therefore, currently, data from adult studies may need to be extrapolated for the management of pediatric patients. Honey and photobiomodulation therapy in this patient population had encouraging potential. Implementation of a basic oral care protocol is advised amid lack of high level of evidence studies.

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Acknowledgments

The authors would like to thank the members of the Mucositis Study Group of MASC/ISOO who contributed to the guidelines development. The authors thank Rachel Lubart, PhD, and Lilach Gavish, PhD, for advising on laser physics.

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Author notes

  1. Wanessa Miranda-Silva and Wagner Gomes-Silva contributed equally to this work.

Authors and Affiliations

  1. Instituto de Ensino e Pesquisa, Hospital Sírio Libanês, 69 Prof. Daher Cutait, Sao Paulo, SP, 01308-060, Brazil

    Wanessa Miranda-Silva

  2. Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, Fundação Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil

    Wagner Gomes-Silva

  3. Medical School, Universidade Nove de Julho, Sao Paulo, Brazil

    Wagner Gomes-Silva

  4. Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Yehuda Zadik

  5. Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel

    Yehuda Zadik

  6. Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel

    Noam Yarom

  7. School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

    Noam Yarom

  8. Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia

    Abdul Rahman Al-Azri

  9. Dental and OMFS Department, Oral Pathology and Medicine, Al-Nahdha Hospital, Ministry of Health, Muscat, Oman

    Abdul Rahman Al-Azri

  10. Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore

    Catherine H. L. Hong

  11. College of Medicine and Dentistry, James Cook University, Cairns, Australia

    Anura Ariyawardana

  12. Metro South Oral Health, Brisbane, Australia

    Anura Ariyawardana

  13. Department of Dental Oncology, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada

    Deborah P. Saunders

  14. Oral Medicine, Post-Graduation Program, Oncology Department, School of Medicine Science, University of Campinas, Campinas, São Paulo, Brazil

    M. Elvira Correa

  15. Department of Oral Biology and Biomedical Engineering, School of Dental Medicine, Engineering and Applied Science, University at Buffalo, Buffalo, NY, USA

    Praveen R. Arany

  16. Adelaide Medical School, The University of Adelaide, Adelaide, Australia

    Joanne Bowen

  17. Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Karis Kin Fong Cheng

  18. Department of Pediatric Oncology, Univesity of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Wim J. E. Tissing

  19. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health – Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy

    Paolo Bossi

  20. Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

    Sharon Elad

Authors
  1. Wanessa Miranda-Silva
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  2. Wagner Gomes-Silva
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  3. Yehuda Zadik
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  4. Noam Yarom
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  8. Deborah P. Saunders
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  9. M. Elvira Correa
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  14. Paolo Bossi
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  15. Sharon Elad
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Consortia

On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society for Oral Oncology (MASCC/ISOO)

Corresponding author

Correspondence to Wanessa Miranda-Silva.

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Conflict of interest

PRA has received grants and personal fees from PhotomedTech, personal fees from Kerber Applied Research, personal fees from Seaborough, personal fees from Shepherd University, non-financial support from National Institute of Aging, NIH, personal fees from Curalaser, personal fees and non-financial support from Vielight, personal fees from Zoovv, non-financial support from Thor Photomedicine, non-financial support from Weber Medical, non-financial support from K laser (Summa), non-financial support from Biolase, non-financial support from Irradia, non-financial support from Quasar Biotech, and non-financial support from Light scalpel, outside the submitted work; In addition, PRA has a patent light-based dental systems issued.

PB has served an advisory role for Merck Serono, Sanofi, Merck Sharp & Dohme, Sun Pharma, Angelini, Astra Zeneca, Bristol-Myers-Squibb, Helsinn, and GSK and received grants from Merck, Kyowa Hakko Kirin, and Roche. WMS, WGS, YZ, NY, ARAA, CHLH, AA, DPS, MEC, JB, KKFC, WJET, and SE declare that they have no conflict of interest.

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Miranda-Silva, W., Gomes-Silva, W., Zadik, Y. et al. MASCC/ISOO clinical practice guidelines for the management of mucositis: sub-analysis of current interventions for the management of oral mucositis in pediatric cancer patients. Support Care Cancer 29, 3539–3562 (2021). https://doi.org/10.1007/s00520-020-05803-4

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