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Mucositis Irritation and inflammation of the mucous membranes particularly afflicting the oral and anal mucosa, but potentially involving the gastrointestinal tract, may accompany cytotoxic chemotherapy. Mucositis is due to damage to the proliferating cells at the base of the mucosal squamous epithelia or in the intestinal crypts. Topical therapies, including anesthetics and barrier-creating preparations, may provide symptomatic relief in mild cases. Palifermin or keratinocyte growth factor, a member of the fibroblast growth factor family, is effective in preventing severe mucositis in the setting of high-dose chemotherapy with stem cell transplantation for hematologic malignancies. It may also prevent mucositis from radiation. . | Chapter 081. Principles of Cancer Treatment Part 23 Mucositis Irritation and inflammation of the mucous membranes particularly afflicting the oral and anal mucosa but potentially involving the gastrointestinal tract may accompany cytotoxic chemotherapy. Mucositis is due to damage to the proliferating cells at the base of the mucosal squamous epithelia or in the intestinal crypts. Topical therapies including anesthetics and barrier-creating preparations may provide symptomatic relief in mild cases. Palifermin or keratinocyte growth factor a member of the fibroblast growth factor family is effective in preventing severe mucositis in the setting of high-dose chemotherapy with stem cell transplantation for hematologic malignancies. It may also prevent mucositis from radiation. Alopecia Chemotherapeutic agents vary widely in causing alopecia with anthracyclines alkylating agents and topoisomerase inhibitors reliably causing near-total alopecia when given at therapeutic doses. Antimetabolites are more variably associated with alopecia. Psychological support and the use of cosmetic resources are to be encouraged and chemo caps that reduce scalp temperature to decrease the degree of alopecia should be discouraged particularly during treatment with curative intent of neoplasms such as leukemia or lymphoma or in adjuvant breast cancer therapy. The richly vascularized scalp can certainly harbor micrometastatic or disseminated disease. Gonadal Dysfunction and Pregnancy Cessation of ovulation and azoospermia reliably result from alkylating agent- and topoisomerase poison-containing regimens. The duration of these effects varies with age and sex. Males treated for Hodgkin s disease with mechlorethamine- and procarbazine-containing regimens are effectively sterile whereas fertility usually returns after regimens that include cisplatin vinblastine or etoposide and after bleomycin for testicular cancer. Sperm banking before treatment may be considered to support patients likely to
