Recommended guidelines for the treatment of cancer treatment-induced diarrhea
Recommended guidelines for the treatment of cancer treatment-induced diarrhea
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DOI：
10.1200/jco.2004.04.132
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发表时间：
2004-07-15
影响因子：
45.3
通讯作者：
Wadler, S
中科院分区：
文献类型：
--
作者：
Benson, AB;Ajani, JA;Wadler, S
PurposeTo更新和扩大以前发表的临床实践指南治疗癌症治疗引起的diarrheum.MethodsAn专家多学科小组召开了审查最近的文献和讨论的建议，更新实践指南以前发表的这组在杂志上的临床肿瘤学在1998年。进行了MEDLINE检索，并由所有小组成员审查了自1998年以来发表的相关文献。治疗的建议和算法进行了修订，由小组consensus.ResultsA最近审查的早期毒性死亡发生在两个国家癌症研究所主办的合作组试验的伊立替康加高剂量氟尿嘧啶和甲酰四氢叶酸治疗晚期结直肠癌导致了危及生命的胃肠道综合征的认识，并强调需要警惕的监测和积极的治疗这种严重的并发症。洛哌丁胺仍然是无并发症病例的标准治疗。然而，修订后的指南反映了需要认识到腹泻复杂病例的早期预警信号，以及需要早期和积极的管理，包括增加抗生素。放射性腹泻的管理是相似的，但可能不需要住院治疗，慢性低至中级症状可以管理与持续loperamine.ConclusionWith警惕的监测和积极的治疗癌症治疗引起的腹泻，特别是在患者的早期预警信号严重并发症，发病率和死亡率可能会降低。(C)2004年，美国临床肿瘤学会。
PurposeTo update and expand on previously published clinical practice guidelines for the treatment of cancer treatment-induced diarrhea.MethodsAn 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.ResultsA 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.ConclusionWith 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.