Bacterial Decolonization With Mupirocin Ointment for Acute Radiation Oral Mucositis Prevention
Notice bibliographique
Résumé
Importance: Acute radiation oral mucositis (AROM) is a major dose-limiting toxic effect in patients with nasopharyngeal cancer undergoing radiotherapy. Reduction of severe (grade ≥3) AROM by bacterial decolonization (BD) could improve treatment tolerance and quality of life. Objective: To evaluate the efficacy of BD with mupirocin nasal ointment in alleviating severe AROM compared with standard of care (SoC) by reducing Staphylococcus aureus colonization in nasal and oral mucosal during radiotherapy for nasopharyngeal cancer. Design, Setting, and Participants: This was a single-center, open-label, phase 3 randomized clinical trial in China that enrolled patients with nasopharyngeal carcinoma (NPC) undergoing definitive chemoradiotherapy between July 2023 and February 2024. Data were analyzed from June 2024 to September 2024. Interventions: The BD group received mupirocin nasal ointment twice daily for 3 days before radiotherapy for 5 consecutive days followed by a 1-week break, which was repeated throughout radiotherapy. Patients in the SoC group received routine nasal and oral care. Main Outcomes and Measures: The primary outcome was the incidence of severe (grade ≥3) AROM. Oral mucositis assessments were performed by independent evaluators who were blinded to group assignments. Secondary end points included quality of life assessed using the Quality-of-Life Questionnaire-Head and Neck 43 [QLQ-H&N43]), and the colonization levels of S aureus in nasal and oral mucosa. Results: A total of 176 patients (mean [SD] age, 52.1 [10.1] years; 42 female [23.9%] individuals) were randomly assigned to the BD intervention group (n = 88) or the SoC control group (n = 88). In the BD group, severe AROM occurred in 20 of 88 patients (22.7%) compared with 42 (47.7%) in the SoC group (relative risk, 0.48; 95% CI, 0.31-0.74; P < .001). Multivariable logistic analysis confirmed the effect of BD (odds ratio, 0.27, 95% CI, 0.13-0.54; P < .001) on severe AROM risk reduction. The QLQ-H&N43 assessment showed BD significantly reduced symptom severity compared to SoC during radiotherapy, with lower median (IQR) pain scores (25.0 [25.0-50.0] vs 50.0 [25.0-50.0]) and fewer swallowing difficulties (8.3 [8.3-33.3] vs 33.3 [8.3-33.3]). Colonization rates of S aureus at the end of radiotherapy were lower in the BD than in the SoC group: nasal, 9.4% (8 of 85) vs 22.9 % (19 of 83) and oral, 5.9% (5 of 85) vs 20.5% (17 of 83). Conclusions and Relevance: This phase 3 randomized clinical trial demonstrated that BD with mupirocin nasal ointment effectively reduced severe AROM, improved quality of life by alleviating oral pain and swallowing difficulties, and significantly reduced both nasal and oral S aureus colonization during radiotherapy. This approach offers a cost-effective strategy for AROM management, and although further studies are required to validate the findings, these results highlight the potential of microbial management to reduce radiation-related complications in patients with nasopharyngeal carcinoma. Trial Registration: ClinicalTrials.gov Identifier: NCT05893810.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».