Recomendações baseadas em evidências para prevenção e Tratamento tópico da mucosite oral

Abstract

Cancer has been presenting high incidence passing through the years. Its treatment consists in inhibiting excessive proliferation of neoplasic cells, can include surgery, chemotherapy, radiotherapy or the association of those interventions. The oral mucositis is a mucosal inflammation, and stands out as the acute collateral effect of higher frequency and debilitating prevalence deriving from radio and chemotherapy, being able to lead to the treatment’s interruption. The aggravation means a determining impact in patient life quality. In spite of severity and epidemiological importance and of the huge measures arsenal aiming to prevention and treatment, do not exist evidences of these agents effectiveness. The purpose of this study is establish recommendations based on scientific evidences for prevention and topic treatment of oral mucositis with effectiveness. It is an integrative review and has as theoretical frame of reference the practice based on evidences. The search of studies was done, electronically, through “Biblioteca Virtual em Saúde” (BVS) – Virtual Library in Health - , in which had been researched the basis LILACS, SCIELO and Cochrane. The access to MEDLINE was through PubMed. Were considered the following inclusion criteria for sample composition: published articles in the period from 1 January 2010 to 25 July 2012, in three languages (Portuguese, English or Spanish), whose adopted methodology was able to obtain significant evidences, such as controlled randomized individual study and non controlled randomized study, available on line, in its totality and without onus for the researcher. Another criteria of inclusion considered was the fact of primary study sample constitutes itself from submitted people to topical intervention for prevention or treatment of oral mucositis deriving from chemotherapy, radiotherapy, or both. As exclusion criteria were considered studies in patients with oral mucositis not deriving from chemotherapy, radiotherapy or both, in vitro studies, experiments done in animals and the impossibility of article acquisition in its totality. The obtained studies were analyzed for two independent evaluators. Data were extracted for collect instrument fulfilling and subsidized the classification of studies levels of evidence and relevance. The sample consisted from ten studies produced in seven countries, being three in Brazil. All the studies were published in English language and 11 interventions were identified, where laser, with three different specifications, was object of three studies and, in one of these, was analyzed with two distinguished specifications. Major of studies evaluate interventions in order to preventing mucositis, being: visible light, laser, prolaprezinc, cryotherapy, allopurinol. For treatment were found triclosan and phenylbutyrate to 5%. For simultaneously treatment and prevention, honey and laser. Among the interventions, the visible light, honey, triclosan, laser (660 nm/ 15mW/ 3.8 J/cm²/ 4 mm²), cryotherapy, gallium laser (660 nm, 40 mW, 4 J/cm²), presented results that permit consider those effectives. However, the significance levels of interventions and studies methodological rigor, do not accredit them to the protocolary recommendations array for prevention or treatment of oral mucositis. More consistent primary studies, well designed and anchored in methodological rigor, are necessary.