Prevention and management of chemotherapy-induced diarrhea in patients with colorectal cancer: a consensus statement by the Canadian Working Group on Chemotherapy-Induced Diarrhea.
Prevention and management of chemotherapy-induced diarrhea in patients with colorectal cancer: a consensus statement by the Canadian Working Group on Chemotherapy-Induced Diarrhea.
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DOI：
10.3747/co.2007.96
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发表时间：
2007-02-01
期刊：
影响因子：
--
通讯作者：
Wong, R
中科院分区：
文献类型：
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作者：
Maroun, J A;Anthony, L B;Wong, R
化疗引起的腹泻 (cid) 是癌症治疗的常见副作用，可导致显着的发病率和死亡率。腹泻常常严重到需要减少化疗剂量、延迟化疗或停止化疗。据报道，伊立替康和推注 5-氟尿嘧啶治疗结直肠癌的临床试验中，腹泻相关死亡率高达 3.5%。 cid 的发生频率及其对患者管理的影响在临床实践中经常被低估。2001 年成立了一个由医学肿瘤学家和肿瘤药剂师组成的加拿大工作组，以审查管理 cid 的最佳方法并确定和实施新的研究领域。以下建议是该小组工作的结果。cid 的急性医疗治疗包括洛哌丁胺或地芬诺酯作为一线药物。建议皮下注射奥曲肽治疗顽固性 2 级腹泻，对于大剂量洛哌丁胺无法缓解的 1 级腹泻，可考虑使用奥曲肽皮下注射。 3、4级cid患者建议住院治疗；住院治疗包括补液、抗生素治疗和奥曲肽。对于在之前的化疗周期中出现过 3 级或 4 级腹泻的患者，通常建议减少化疗剂量。如果不需要减少剂量，可以考虑肌内注射长效缓释奥曲肽进行预防。上述建议基于专家意见，需要前瞻性临床试验验证。
Chemotherapy-induced diarrhea (cid) is a common side effect of cancer treatment and can cause significant morbidity and mortality. Diarrhea is frequently severe enough to require a dose reduction of, a delay in, or a discontinuation of chemotherapy. Diarrhea-associated mortality has been reported to be as high as 3.5% in clinical trials of irinotecan and bolus 5-fluorouracil in colorectal cancer. The frequency of cid and its impact on patient management are frequently under-recognized in clinical practice.A Canadian working group, consisting of medical oncologists and an oncology pharmacist, was formed in 2001 to review the optimal approach to managing cid and to identify and implement new areas of research. The recommendations that follow are the result of the group's work.Acute medical management of cid includes loperamide or diphenoxylate as first-line agents. Subcutaneous octreotide is recommended for intractable grade 2 diarrhea and may be considered for grade 1 cid that does not resolve with high-dose loperamide. Hospitalization is recommended for patients with grades 3 and 4 cid; in-hospital care includes rehydration, antibiotic therapy, and octreotide.A chemotherapy dose reduction is generally advised for patients who have experienced grade 3 or 4 diarrhea in a previous chemotherapy cycle. If a dose reduction is not desired, prophylaxis with intramuscular long-acting release octreotide may be considered.The foregoing recommendations are based on expert opinion and require validation in prospective clinical trials.