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Therapeutische Beeinflussung der radiogenen oralen Mukositis

Therapeutic management of radiation-induced oral mucositis

Zusammenfassung

Hintergrund

Die akute Reaktion der Mundschleimhaut ist eine regelmäßige Nebenwirkung der klinischen Strahlentherapie von Kopf-Hals-Tumoren, die in vielen Fällen eine Unterbrechung der Behandlung erzwingt. In den Behandlungspausen besteht gerade bei den im Kopf-Hals-Bereich häufigen Plattenepithelkarzinomen die Gefahr der verstärkten Proliferation von Tumorstammzellen, die in der Folge die Tumorheilungsaussichten drastisch verringern kann. Zudem führen überschießende Akutreaktionen in vielen Fällen zu einer Verstärkung von späten Strahlenfolgen („consequential damage”). Die Verminderung der Schleimhautreaktion mit dem Ziel der Vermeidung von Bestrahlungspausen und der Verminderung von Spätschäden kann den therapeutischen Erfolg der Radiotherapie entscheidend verbessern.

Patienten und Methode

Verschiedene Ansätze zur Beeinflussung der strahleninduzierten Mukositis auf symptomatischer oder strahlen- und epithelbiologischer Grundlage wurden zusammengefaßt und systematisch dargestellt.

Ergebnisse

Es existiert eine Vielzahl prophylaktischer und therapeutischer Ansätze zur Verminderung akuter radiogener Reaktionen der Mundschleimhaut. Häufig ist die Wirksamkeit jedoch nur für Chemotherapie oder im Zusammenhang mit einer immunsuppressiven Therapie nachgewiesen, so daß oft eher ein systemischer als ein lokaler Effekt angenommen werden muß.

Schlußfolgerungen

Als allgemeine Mukositisprophylaxe können neben einer Zahnsanierung regelmäßige mundhygienische Maßnahmen nach den Mahlzeiten sowie antiseptische Spülungen herangezogen werden. Die Bedeutung einer engmaschigen persönlichen Betreuung der Patienten ist zu betonen. Das Anlegen eines perkutanen endoskopischen Gastrostoma muß am Zustand des Patienten sowie an der Ausdehnung und Lage des Bestrahlungsfeldes und damit der zu erwartenden Beeinträchtigung der Nahrungsaufnahme orientiert werden. Als therapeutische Maßnahmen bei manifesten Schleimhautreaktionen kommen eine lokale bzw. systemische Schmerzbehandlung sowie die lokale Applikation von Antimykotika und Antibiotika in Betracht.

Abstract

Background

Acute reactions of oral mucosa are a frequent side effect of radiotherapy, which often necessitates interruption of the treatment. Marked proliferation of tumor stem cells during treatment interruptions may occur in squamous cell carcinomata, which represent the majority of tumors in the head and neck area. Hence a fatal consequence of treatment breaks may be a significant decrease in tumor cure rates. Furthermore, marked acute responses frequently result in increased late sequelae (“consequential damage”). Therefore, amelioration of the mucosal response aiming at avoiding treatment breaks and at reduction of late reactions could definitely increase the therapeutic success of radiation treatment.

Patients and Method

Various possibilities for the therapeutic management of radiation-induced oral mucositis with a symptomatic or radio- and epithelial biological background are summarized and presented systematically.

Results

A variety of prophylactic and therapeutic methods have been proposed for the management of acute radiation reactions of the oral mucosa. Frequently, their efficacy has been established for chemotherapy or in combination with other immunosuppressive treatments. Hence, systemical rather than local effects have to be considered.

Conclusions

In general, prophylaxis of oral mucositis is mainly based on dental restoration or edentation, in combination with frequent oral hygienic measures after the meals and with antiseptic mouthwashes. Intensive personal care is recommended. The necessity of a percutaneous endoscopic gastrostoma is dependent on the status of the patient and on size and localization of the treatment area, i. e. the impairment of food uptake which is to be expected. therapeutic intervention is restricted to local or systemic treatment of pain and local application of antimycotics and antibiotics.

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Literatur

  1. 1.

    Abdelaal, A. S., D. S. Barker, M. M. Fergusson: Treatment for irradiation-induced mucositis. Lancet 1 (1989), 97.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Allison, R. R., V. Vongtama, J. Vaughan, K. H. Shin: Symptomatic acute mucositis can be minimized or prophylaxed by the combination of sucralfate and fluconazole. Cancer Invest. 13 (1995), 16–22.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Attal, M., F. Huguet, H. Rubie, J.-P. Charlet, D. Schlaifer, A. Huynh, G. Laurent, J. Pris: Prevention of regimen-related toxicities after bone marrow transplantation by pentoxifylline: a prospective, randomized trial. Blood 82 (1993), 732–736.

    PubMed  CAS  Google Scholar 

  4. 4.

    Baumann, M.: Impact of endogenous and exogenous factors on radiation sequelae. In: Dunst, J., R. Sauer (eds.): Late sequelae in oncology. Springer, Berlin 1995, p. 3–12.

    Google Scholar 

  5. 5.

    Bianco, J. A., J. Nemunaitis, D. F. Andrews, M. Lilly, A. Shields, J. W. Singer: Combined therapy with pentoxifylline (PTX), ciprofloxacin (CI-PRO) and prednisone (PD) reduces regimen related toxicity (RRT) and accelerates engraftment in patients undergoing bone marrow transplantation (BMT). Blood 38 (1991), 267–271.

    Google Scholar 

  6. 6.

    Bjelkengren, G., K. F. Aronsen, N. E. Augustsson, S. Borgström, C. Lindström, G. Nylander: The radioprotective effect of locally administered glypressin on the rectal mucosa. A study in the rat. ESTRO, 6th Annual Meeting 1987, Book of Abstracts p. 287.

  7. 7.

    Björnberg, A., L. Hellgren, S. Oisson: Treatment of radiation dermatitis with fluocinolone acetonide. Acta Radiol. Ther. Phys. Biol. 3 (1965), 129–134.

    Google Scholar 

  8. 8.

    Borowski, B., E. Benhamou, J. L. Pico, A. Laplanche, J. P. Margainaud. M. Hayat: Prevention of oral mucositis in patients treated with high-dose chemotherapy and bone marrow transplantation: a randomised controlled trial comparing two protocols of dental care. Europ. J. Cancer 30-B (1994), 93–97.

    Google Scholar 

  9. 9.

    Bruce, W. R., W. R. Barklay: The suppression by cortisone on the acute local radiation reaction in the rabbit ear. Radiat. Res. 13 (1960), 168.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Carl, W., L. S. Emrich: Management of oral mucositis during local radiation and systemic chemotherapy: a study of 98 patients. J. prosthet. Dent. 66 (1991), 361–369.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Cascinu, S., A. Fedeli, S. L. Fedeli, G. Catalano: Oral cooling (cryotherapy), an effective treatment for the prevention of 5-fluorouracil-induced stomatitis. Europ. J. Cancer 30-B (1994), 234–236.

    Google Scholar 

  12. 12.

    Ciais, G., M. Namer, M. Schneider, F. Demard, N. Pourreau-Schneider, P. M. Martin, M. Soudry, J. C. Franquin, H. Zattara: Soft-laser therapy for prevention and treatment of mucositis induced cancer chemotherapy. Bull. Cancer 79 (1992), 183–191.

    PubMed  CAS  Google Scholar 

  13. 13.

    Dietz, A., J. Nollert, H. Maier, V. Rudat, M. Flentje: Zur Problematik der radiogen- bzw. chemotherapieinduzierten Mukositis der Mundschleimhaut am Beispiel der akzelerierten Radiochemotherapie mit Carboplatin bei Patienten mit inoperablen Plattenepithelkarzinomen des Kopf-/Halsbereichs. HNO 43 (1995), 403–413.

    PubMed  CAS  Google Scholar 

  14. 14.

    Dörr, W., A. Jacubek, J. Kummermehr, T. Herrmann, I. Dölling-Jochem, U. Eckelt: Effects of stimulated repopulation on oral mucositis during conventional radiotherapy. Radiother. Oncol. 37 (1995), 100–107.

    PubMed  Article  Google Scholar 

  15. 15.

    Dörr, W., J. Kummermehr: Increased radiation tolerance of mouse tongue epithelium after local conditioning. Int. J. Radiat. Biol. 61 (1992), 369–379.

    PubMed  Article  Google Scholar 

  16. 16.

    Epstein, J. B., P. Stevenson-Moore: Benzydamine hydrochloride in prevention and management of pain in oral mucositis associated with radiation therapy. Oral Surg. oral Med. oral Path. 62 (1986), 145–148.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Epstein, J. B., P. Stevenson-Moore, S. Jackson, J. H. Mohamed, J. J. Spinelli: Prevention of oral mucositis in radiation therapy: a controlled study with benzydamine hydrochloride rinse. Int. J. Radiat. Oncol. Biol. Phys. 16 (1989), 1571–1575.

    PubMed  CAS  Google Scholar 

  18. 18.

    Epstein, J. B., F. L. W. Wong: The efficacy of sucralfate suspension in the prevention of oral mucositis due to radiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 28 (1994), 693–698.

    PubMed  CAS  Google Scholar 

  19. 19.

    Estler, C.-J.: Lehrbuch der allgemeinen und systematischen Pharmakologie und Toxikologie. Schattauer, Stuttgart-New York 1986.

  20. 20.

    Ferretti, G. A., T. P. Raybould, A. T. Brown, J. S. Macdonald, M. Green-wood, Y. Maruyama, J. Geil, T. T. Lillich, R. C. Ash: Chlorhexidine prophylaxis for chemotherapy- and radiotherapy-induced stomatitis: a randomized double-blind trial. Oral Surg. oral Med. oral Path. 69 (1990), 331–338.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Fletcher, G. H.: Basic clinical parameters. In: Fletcher, G. H. (ed.): Text-book of radiotherapy, 3rd ed. Lea and Febiger, Philadelphia 1980, p. 180–224.

    Google Scholar 

  22. 22.

    Foote, R. L., C. L. Loprinzi, A. R. Frank, J. R. O’Fallon, S. Gulavita, H. H. Tewfik, M. A. Ryan, J. M. Earle, P. Novotny: Randomized trial of a chlorhexidine mouthwash for alleviation of radiation-induced mucositis. J. clin. Oncol. 12 (1994), 2630–2633.

    PubMed  CAS  Google Scholar 

  23. 23.

    Franzén, L., R. Henriksson, B. Littbrand, B. Zackrisson: Effects of sucralfate on mucositis during and following radiotherapy of malignancies in the head and neck region. Acta Oncol. 34 (1995), 219–223.

    PubMed  Article  Google Scholar 

  24. 24.

    Guttenberger, R., Y. Feng, N. Hunter, K. K. Ang, R. Price: Effects of TGF-α on radiation response in lip and jejunal mucosa in mice. In: Chapman, J. D., W. C. Dewey, G. F. Whitmore (eds.). Radiation research: a twentieth-century perspective, Vol. I: Congress abstracts. Academic Press Inc. San Diego-New York-Boston 1991, p. 151.

    Google Scholar 

  25. 25.

    Hamilton, E., C. S. Potten: Influence of hair plucking on the turnover of the epidermal basal layer. Cell Tiss. Kinet. 5 (1972), 505–517.

    CAS  Google Scholar 

  26. 26.

    Hennings, H., K. Elgjo: Epidermal regeneration after cellophane tape stripping of hairless mouse skin. Cell Tiss. Kinet. 3 (1970), 243–252.

    CAS  Google Scholar 

  27. 27.

    Herrmann, T., A. Jacubek, K. R. Trott: The importance of the timing of a gap in radiotherapy of squamous cell carcinomas of the head and neck. Strahlenther. Onkol. 170 (1994), 545–549.

    PubMed  CAS  Google Scholar 

  28. 28.

    Hopewell, J. W., M. E. C. Robbins, G. J. M. J. Van den Aardweg, G. M. Morris, G. A. Ross, E. Whitehouse, D. F. Horrobin, C. A. Scott: The modulation of radiation-induced damage to pig skin by essential fatty acids. Brit. J. Cancer 68 (1993), 1–7.

    PubMed  CAS  Google Scholar 

  29. 29.

    Hopewell, J. W., G. J. M. J. Van den Aardweg, G. M. Morris, M. Rezvani, M. E. C. Robbins, G. Ross, E. M. Whitehouse, C. A. Scott, D. F. Horrobin: Amelioration of both early and late radiation-induced damage to pig skin by essential fatty acids. Int. J. Radiat. Oncol. Biol. Phys. 30 (1994) 1119–1125.

    PubMed  CAS  Google Scholar 

  30. 30.

    Houghton, L. E., J. B. Walter, D. E. A. Jones: The inhibition of acute X-ray damage by cortisone. Brit. med. J. (1954), 1313.

  31. 31.

    Janjan, N. A., D. E. Weissman, A. Pahule: Improved pain management with daily nursing intervention during radiation therapy for head and neck carcinoma. Int. J. Radiat. Oncol. Biol. Phys. 23 (1992), 647–752.

    PubMed  CAS  Google Scholar 

  32. 32.

    Kaanders, J. H. A. M., L. A. M. Pop, H. L. Muytjens, I. Bruaset, W. A. J. Van Daal Topical administration of antimicrobial agents to prevent irradiation mucositis of the oral cavity and oropharynx: a pilot study. Radiat. Oncol. Invest. 2 (1996), 283–290.

    Article  Google Scholar 

  33. 33.

    Kalz, F., A. Scott: Inhibition of grenz ray erythema by one single topical hormone application. J. Invest. Derm. 26 (1956), 165–172.

    PubMed  CAS  Google Scholar 

  34. 34.

    Kim, J. H., F. C. H. Chu, V. Lakshmi, R. Houde: Benzydamine HCl, a new agent for the treatment of radiation mucositis of the oropharynx. Amer. J. clin. Oncol. 9 (1986), 132–134.

    CAS  Article  Google Scholar 

  35. 35.

    Konturek, S. J., J. W. Konturek, T. Brzozowski, B. L. Slomiany, A. Slomiany: Effects of sucralfate on growth factor availability. In: Hollander, T., G. N. J. Tygtat (eds.): Sucralfate. From basic science to bedside. Plenum Med. Book Co., New York-London 1995, p. 175–189.

    Google Scholar 

  36. 36.

    Kuhrer, I., R. Kuzmits, W. Linkesch, H. Ludwig: Topical PGE2 enhances healing of chemotherapy-associated mucosal lesions. Lancet 1 (1986), 623.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Kuwayama, H.: Sucralfate and cell proliferation. In: Hollander, T., G. N. J. Tygtat (eds.): Sucralfate. From basic science to the bedside. Plenum Med. Book Co., New York-London 1995, p. 141–149.

    Google Scholar 

  38. 38.

    Labar, B., M. Mrsic, Z. Pavletic, V. Bogdanic, D. Nemet, I. Aurer, I. Radmann, N. Filipovic-Grcic, D. Sertic, S. Kalenic, P. Presecki: Prostaglandin E2 for prophylaxis of oral mucositis following BMT. Bone Marrow Transpl. 11 (1993), 379–382.

    CAS  Google Scholar 

  39. 39.

    Lisciana, R., P. Scorza-Barcellona, B. Silvestrini: Research on the topical activity of Benzydamine. Europ. J. Pharmacol. 3 (1968), 157–162.

    Article  Google Scholar 

  40. 40.

    Maciejewski, B., H. R. Withers, J. M. G. Taylor, A. Hliniak: Dose fractionation and regeneration in radiotherapy for cancer of the oral cavity and oropharynx. Part 2: Normal tissue responses: acute and late effects. Int. J. Radiat. Oncol. Biol. Phys. 18 (1990), 101–111.

    PubMed  CAS  Google Scholar 

  41. 41.

    Maciejewski, B., A. Zajusz, B. Pilecki, K. Swiatnicka, W. Dörr, J. Kummermehr, K.-R. Trott: Acute mucositis in the stimulated oral mucosa of patients during radiotherapy for head and neck cancer. Radiother. Oncol. 22 (1991), 7–11.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Mahood, D. J., A. M. Dose, C. L. Loprinzi, M. H. Veeder, L. M. Athmann, T. M. Therneau, J. M. Sorensen, D. K. Gainey, J. A. Mailiard, N. L. Gusa, G. K. Finck, C. Johnson, R. M. Goldberg: Inhibition of fluorouracil-induced stomatitis by oral cryotherapy. J. clin. Oncol. 9 (1991), 449–452.

    PubMed  CAS  Google Scholar 

  43. 43.

    Mealey, B. L., S. E. Semba, W. W. Hallmon: The head and neck radiotherapy patient. Part 2: Management of oral complications. Compend. Contin. Educ. Dent. 15 (1994), 442–452.

    CAS  Google Scholar 

  44. 44.

    Morales, P. L.: The effect of ACTH and cortisone on the erythema reaction to low kilovoltage radiation. Amer. J. Roentgenol. 70 (1953), 1015.

    PubMed  CAS  Google Scholar 

  45. 45.

    Mose, S., I. A. Adamietz, F. Saran, C. Thilmann, R. Heyd, H. D. Böttcher: Wirksamkeit der prophylaktischen Anwendung von Immunglobulin bei der radiogenen Mukositis. Strahlenther. Onkol. 171 (1995), 415–416.

    PubMed  CAS  Google Scholar 

  46. 46.

    Mose, S., I. A. Adamietz, C. Thilmann, F. Saran, R. Heyd, R. Knecht, H. D. Böttcher: Immunglobulin zur Prophylaxe der radiogen induzierten Mukositis. HNO 43 (1995), 421–426.

    PubMed  CAS  Google Scholar 

  47. 47.

    Nicopoulos, N., A. Mantidis, E. Stathopoulos, S. Papaodysseas, J. Kouvaris, H. Varveris, C. Papavasiliou: Prophylactic administration of indomethacin for irradiation esophagitis. Radiother. Oncol. 3 (1985), 23–25.

    Article  Google Scholar 

  48. 48.

    Ohlsén, L., H. Evers, K. Segerström, E. Hagelqvist, S. Graffman: Local anaesthetics modifying the dermal response of radiation. Acta Oncol. 26 (1987), 467–476.

    PubMed  Article  Google Scholar 

  49. 49.

    Osaki, T., E. Ueta, K. Yoneda, J. Hirota, T. Yamamoto: Prophylaxis of oral mucositis associated with chemoradiotherapy for oral carcinoma by azelastine hydrochloride (azelastine) with other antioxidants. Head Neck 16 (1994), 331–339.

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Overgaard, J., M. Hjelm-Hansen, L. Vendelbo Johansen, A. P. Andersen: Comparison of conventional and split-course radiotherapy as primary treatment in carcinoma of the larynx. Acta Oncol. 27 (1988), 147–152.

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    Pfeiffer, P., E. L. Madsen, O. Hansen, O. May: Effect of prophylactic sucralfate suspension on stomatitis induced by cancer chemotherapy. Acta Oncol. 29 (1990), 171–173.

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Pillsbury, H. C., W. P. Webster, J. G. Rosenman: Prostaglandin inhibitor and radiotherapy in advanced head and neck cancers. Arch. Otolaryng. Head Neck Surg. 112 (1986), 552–553.

    PubMed  Google Scholar 

  53. 53.

    Porteder, H., E. Rausch, G. Kment, G. Watzek, M. Matejka, H. Sinzinger: Local prostaglandin E2 in patients with oral malignancies undergoing chemo- and radiotherapy. J. cranio-maxillofac. Surg. 16 (1988), 371–374.

    Article  CAS  Google Scholar 

  54. 54.

    Potten, C. S., C. A. Chadwick: Small intestinal growth regulatory factors extracted by simple diffusion from intact irradiated intestine and tested in vivo. Growth Factors 10 (1994), 63–75.

    PubMed  Article  CAS  Google Scholar 

  55. 55.

    Potten, C. S., G. Owen, D. Hewitt, C. A. Chadwick, H. Hendry, B. I. Lord, L. B. Woolford: Stimulation and inhibition of proliferation in the small intestinal crypts of the mouse after in vivo administration of growth factors. Gut 36 (1995), 864–873.

    PubMed  Article  CAS  Google Scholar 

  56. 56.

    Prada, A., F. Chiesa: Effects of benzydamine on the oral mucositis during antineoplastic radiotherapy and/or intra-arterial chemotherapy. Int. J. Tiss. React. 9 (1987), 115–119.

    CAS  Google Scholar 

  57. 57.

    Puorreau-Schneider, N., M. Soudry, J. C. Franquin, H. Zattara, P. M. Martin, G. Ciais, M. Namer, M. Schneider, P. Chauvel, F. Demard: Soft laser therapy for iatrogenic mucositis in cancer patients receiving high-dose fluorouracil: a preliminary report. J. nat. Cancer Inst. 84 (1992), 358–359.

    Article  Google Scholar 

  58. 58.

    Rachmilewitz, D.: Stimulation of mucosal prostaglandins by sucralfate. In: Hollander, T., G. N. J. Tygtat (eds.): Sucralfate. From basic science to the bedside. Plenum Med. Book Co., New York-London 1995, p. 127–132.

    Google Scholar 

  59. 59.

    Rocke, L. K., C. L. Loprinzi, J. K. Lee, S. J. Kunselman, R. K. Iverson, G. Finck, D. Lifsey, K. C. Glaw, B. A. Stevens, A. K. Hatfield, N. L. Vaught, J. Bartel, N. Pierson: A randomized clinical trial of two different durations of oral cryotherapy for prevention of 5-fluorouracil-related stomatitis. Cancer 72 (1993), 2234–2238.

    PubMed  Article  CAS  Google Scholar 

  60. 60.

    Rugg, T., M. I. Saunders, S. Dische: Smoking and mucosal reactions to radiotherapy. Brit. J. Radiol. 63 (1990), 554–556.

    PubMed  CAS  Article  Google Scholar 

  61. 61.

    Rutkauskas, J. S., J. W. Davis: Effects of chlorhexidine during immunosuppressive chemotherapy. Oral Surg. oral Med. oral Path. 76 (1993), 441–448.

    PubMed  Article  CAS  Google Scholar 

  62. 62.

    Samaranayake, L. P., A. G. Robertson, T. W. MacFarlane, I. P. Hunter, G. MacFarlane, D. S. Soutar, M. M. Ferguson: The effect of chlorhexidine and benzydamine mouthwashes on mucositis induced by therapeutic irradiation. Clin. Radiol. 39 (1988), 291–294.

    PubMed  Article  CAS  Google Scholar 

  63. 63.

    Schedler, M., H. Feidt, M. Niewaldt: Läßt sich die radiogene Mukositis mit Immunglobulin behandeln? Zbl. Hals-Ohren-Heilk. Kopf-Hals-Chir. 139 (1990), 3–4.

    Google Scholar 

  64. 64.

    Scherlacher, A., F. Beaufort-Spontin: Strahlentherapie von Kopf-Hals-Malignomen: Entzündungsprophylaxe der Schleimhaut durch Sucralfatbehandlung. HNO 38 (1990), 24–28.

    PubMed  CAS  Google Scholar 

  65. 65.

    Shenep, J., D. K. Kalwinsky, P. R. Hutson, S. L. George, R. K. Dodge, K. R. Blankenship, D. Thornton: Efficacy of oral sucralfate suspension in prevention and treatment of chemotherapy-induced mucositis. J. Pediat. 113 (1988), 768–793.

    Article  Google Scholar 

  66. 66.

    Sonis, S. T., C. Lindqvist, A. Van Vugt, A. A. Stewart, K. Stam, G.-Y. Qu, K. K. Iwata, J. D. Haley: Prevention of chemotherapy-induced ulcerative mucositis by transforming growth factor β3. Cancer Res. 54 (1994), 1135–1138.

    PubMed  CAS  Google Scholar 

  67. 67.

    Steeb, C. B., J. F. Trahair, L. C. Read: Administration of insulin-like growth factor-I (IGF-I) peptides for three days stimulates proliferation of the small intestinal epithelium in rats. Gut 37 (1995), 630–638.

    PubMed  Article  CAS  Google Scholar 

  68. 68.

    Stockschläder, M., P. Kalhs, S. Peters, W. Zeller, W. Krüger, H. Kabisch, K. Lechner, A. Zander: Intravenous pentoxifylline failed to prevent transplant-related toxicities in allogeneic bone marrow transplant recipients. Bone Marrow Transplant. 12 (1993), 357–362.

    PubMed  Google Scholar 

  69. 69.

    Strieter, R. M., P. A. Remick, R. N. Ward, R. N. Spengler, J. P. Lynch, J. Larrick, S. L. Kunkel: Cellular and molecular regulation of tumor necrosis factor-alpha production by pentoxifylline. Biochem. biophys. Res. Comm. 155 (1988), 1230.

    PubMed  Article  CAS  Google Scholar 

  70. 70.

    Sur, R. K., R. Kochhar, D. P. Singh: Oral sucralfate in acute radiation oesophagitis. Acta Oncol. 33 (1994), 61–63.

    PubMed  Article  CAS  Google Scholar 

  71. 71.

    Sweet, R. D.: Acute accidential superficial X-ray burns. Brit. J. Dermat. 74 (1962), 392–398.

    Article  CAS  Google Scholar 

  72. 72.

    Tochner, Z., M. Barnes, J. B. Mitchell, K. Orr, E. Glatstein: Protection by indomethacin against acute radiation esophagitis. Digestion 47 (1990), 81–87.

    PubMed  Article  CAS  Google Scholar 

  73. 73.

    Trott, K.-R., J. Kummermehr: What is known about tumour proliferation rates to choose between accelerated fractionation or hyperfractionation. Radiother. Oncol. 3 (1985), 1–9.

    PubMed  Article  CAS  Google Scholar 

  74. 74.

    Van der Jagt, R. H. C., G. Pari, S. A. McDiarmid, D. M. Boisvert, L. B. Huebsch: Effect of pentoxifylline on regimen related toxicity in patients undergoing allogeneic or autologous bone marrow transplantation. Bone Marrow Transplant. 13 (1994), 203–207.

    PubMed  Google Scholar 

  75. 75.

    Van der Schueren, E., W. Van den Bogaert, L. Vanuytsel, E. Van Limbergen: Radiotherapy by multiple fractions per day (MFD) in head and neck cancer: acute reactions of skin and mucosa. Int. J. Radiat. Oncol. Biol. Phys. 19 (1990), 301–311.

    PubMed  Google Scholar 

  76. 76.

    Verdi, C. J.: Cancer therapy and oral mucositis. An appraisal of drug prophylaxis. Drug Safety 9 (1993), 185–195.

    PubMed  Article  CAS  Google Scholar 

  77. 77.

    Vinzenz, K., U. Stauder: Die Therapie der radiogenen Mukositis mit Enzymen. In: Vinzenz, K., H. W. Waclawiczek (eds.): Chirurgische Therapie von Kopf-Hals-Karzinomen. Springer, Wien 1992, p. 299–314.

    Google Scholar 

  78. 78.

    Wang, R., A. Boyle: A convenient method for guarding against localized mucositis during radiation therapy. J. Prosth. 3 (1994), 198–201.

    Article  CAS  Google Scholar 

  79. 79.

    Weinberg, J. B., S. N. Mason, T. S. Wortham: Inhibition of tumor necrosis factor-a (TNF-α) and interleukin (IL-1β) messenger-RNA (or RNA) expression in HL-60 leukemia cells by pentoxifylline and dexamethasone: dissociation of acivicin-induced TNF-α and IL-1β-mRNA expression from acivicin-induced monocytoid differentiation. Blood 79 (1992), 3337–3343.

    PubMed  CAS  Google Scholar 

  80. 80.

    Weisdorf, D. J., B. Bostrom, D. Raether, M. Mattingly, P. Walker, B. Pihlstrom, P. Ferrieri, R. Haake, A. Goldman, W. Woods: Oropharyngeal mucositis complicating bone marrow transplantation: prognostic factors and the effect of chlorhexidine mouth rinse. Bone Marrow Transplant 4 (1989), 89–95.

    PubMed  CAS  Google Scholar 

  81. 81.

    Zaghloul, M. S., M. J. Dorie, R. F. Kallman: Interleukin 1β protects against the acute reaction of the mouse lip inflicted by irradiation and irradiation combined with cyclophosphamide (CY). Radiation research Society, 40th Annual Meeting, Book of Abstracts 1992, p. 18.

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Correspondence to W. Dörr.

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Dörr, W., Dölling-Jochem, I., Baumann, M. et al. Therapeutische Beeinflussung der radiogenen oralen Mukositis. Strahlenther. Onkol. 173, 183–192 (1997). https://doi.org/10.1007/BF03039287

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