Recommended guidelines for the treatment of cancer treatment-induced diarrhea

被引:402
作者
Benson, AB
Ajani, JA
Catalano, RB
Engelking, C
Kornblau, SM
Martenson, JA
McCallum, R
Mitchell, EP
O'Dorisio, TM
Vokes, EE
Wadler, S
机构
[1] Northwestern Univ, Robert H Lurie Comprehens Canc Ctr, Feinberg Sch Med, Chicago, IL 60611 USA
[2] Univ Chicago, Med Ctr, Chicago, IL 60637 USA
[3] Univ Texas, MD Anderson Canc Ctr, Houston, TX 77030 USA
[4] Coalit Natl Canc Cooperat Grp Inc, Philadelphia, PA USA
[5] Thomas Jefferson Univ, Philadelphia, PA 19107 USA
[6] Westchester Med Ctr, Airlin Canc Inst, Valhalla, NY USA
[7] Cornell Univ, Weill Med Coll, New York, NY USA
[8] Mayo Clin, Rochester, MN USA
[9] Univ Kansas, Med Ctr, Kansas City, KS 66103 USA
[10] Univ Iowa Hosp & Clin, Iowa City, IA 52242 USA
关键词
D O I
10.1200/jco.2004.04.132
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose To update and expand on previously published clinical practice guidelines for the treatment of cancer treatment-induced diarrhea. Methods An expert multidisciplinary panel was convened to review the recent literature and discuss recommendations for updating the practice guidelines previously published by this group in the Journal of Clinical Oncology in 1998. MEDLINE searches were performed and the relevant literature published since 1998 was reviewed by all panel members. The treatment recommendations and algorithm were revised by panel consensus. Results A recent review of early toxic deaths occurring in two National Cancer Institute-sponsored cooperative group trials of irinotecan plus high-dose fluorouracil and leucovorin for advanced colorectal cancer has led to the recognition of a life-threatening gastrointestinal syndrome and highlighted the need for vigilant monitoring and aggressive therapy for this serious complication. Loperamide remains the standard therapy for uncomplicated cases. However, the revised guidelines reflect the need for recognition of the early warning signs of complicated cases of diarrhea and the need for early and aggressive management, including the addition of antibiotics. Management of radiation-induced diarrhea is similar but may not require hospitalization, and chronic low- to intermediate-grade symptoms can be managed with continued loperamide. Conclusion With vigilant monitoring and aggressive therapy for cancer treatment-induced diarrhea, particularly in patients with early warning signs of severe complications, morbidity and mortality may be reduced. (C) 2004 by American Society of Clinical Oncology.
引用
收藏
页码:2918 / 2926
页数:9
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