ORAL COMPLICATIONS OF CANCER CHEMOTHERAPY Previously published in this series: FJ. Cleton and J.W.I.M. Simons, eds., Genetic Origins of Tumor Cells ISBN 90-247-2272-1 J. Aisner and P. Chang, eds., Cancer Treatment Research ISBN 90-247-2358-2 B.W. Ongerboer de Visser, D.A. Bosch and W.M.H. van Woerkom-Eykenboom, eds., Neuro Oncology: Clinical and Experimental Aspects ISBN 90-247-2421-X K. Hellmann, P. Hilgard and S. Eccles, eds., Metastasis: Clinical and Experimental Aspects ISBN 90-247-2424-4 H.F. Seigler, ed., Clinical Management of Melanoma ISBN 90-247-2584-4 P. Correa and W. Haenszel, eds., Epidemiology of Cancer of the Digestive Tract ISBN 90-247-2601-8 L.A. Liotta and I.R. Hart, eds., Tumor Invasion and Metastasis ISBN 90-247-2611-5 J. B<inoczy, ed., Oral Leukoplakia ISBN 90-247-2655-7 C. Tijssen, M. Halprin and L. Endtz, eds., Familial Brain Tumours ISBN 90-247-2691-3 E.M. Muggia, C.W. Young and S.K. Carter, eds., Anthracycline Antibiotics in Cancer ISBN 90-247-2711-1 B.W. Hancock, ed., Assessment of Tumour Response ISBN 90-247-2712-X ORAL COMPLICATIONS OF CANCER CHEMOTHERAPY edited by DOUGLAS E. PETERSON Baltimore College of Dental Surgery Department of Oral Diagnosis and the University of Maryland School of Medicine Baltimore, MD, USA STEPHEN T. SONIS Division of Dentistry Brigham and Women's Hospital and the Harvard School of Dental Medicine Boston, MA, USA MARTlNUS NIJHOFF PUBLISHERS The Hague/Boston/London Copyright 1983 © by Martinus NijhofI Publishers, The Hague Softeover reprint of the hardcover 15t edition 1983 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without written permission of the publisher, Martinus Nijhoff Publishers, P.o. Box 566, 2501 CN The Hague, The Netherlands. Distributors: for the United States and Canada for all other Countries Kluwer Boston, Inc. Kluwer Academic Publishers Group 190 Old Derby Street Distribution Center Hingham, MA 02043 P.O. Box 322 3300 AH Dordrecht The Netherlands Library of Congress Cataloging in Publication Data Main entry under title: Oral complications of cancer chemotherapy. (Developments in oncology; 12) Includes bibliographical references and index. 1. Mouth-Diseases. 2. Cancer-Chemotherapy-Complications and sequelae. 3. Antineoplastic agents--Side effects. I. Peterson, Douglas E. II. Sonis, Stephen T. III. Series. [DNLM: 1. Antineoplastic agents--Adverse effects. 2. Mouth diseases--Etiology. Wi DE998N v. 12 I QZ 267 063] RC815.067 1983 617'.522 82-22326 ISBN-13: 978-1-4613-3914-4 c-ISBN-13: 978-1-4613-3912-0 DOl: 10.107/978-1-4613-3912-0 CONTENTS Contributing Authors vii Foreword by Peter H. Wiemik, M.D. and Emil Frei, M.D. xi Preface Xlll 1. Epidemiology, Frequency, Distribution, Mechanisms, and Histopathology STEPHEN T. SONIS, D.M.D., D.M.SC. 2. Pharmacology of Chemotherapeutic Agents 13 NICHOLAS R. BACHUR, M.D., PH.D. 3. Principles of Infection Management and Prevention 23 JOSEPH AISNER, M.D., STEPHEN C. scmMPFF, M.D. 4. Oral Microbial Changes and Infections during Cancer Chemotherapy 41 SAMUEL DREIZEN, D.D.S., M.D., LEE R. BROWN, PH.D. 5. Bacterial Infections: Periodontal and Dental Disease 79 DOUGLAS E. PETERSON, D.M.D., PH.D. 6. Oral Complications of Bone-Marrow Transplantation 93 MARK M. SCHUBERT, D.D.S., M.S.D., KEITH M. SULLIVAN, M.D., KENNETH T. IZUTSU, PH.D., AND EDMOND 1. TRUELOVE, D.D.S., M.S.D. 7. Dental Management of Patients Receiving Chemotherapy 113 PETER B. LOCKHART, D.D.S. 8. Guidelines for Oral Hygiene, Denrure Care, and Nutrition in Patients with Oral Complications 151 USA T. WILUAMS, B.S., R.D.H., AND JOYCE L. O'DWYER, R.N., B.S.N. v vi Contents 9. Establishment of a Comprehensive Oral Oncology Program: Services, Facilities, and Management 169 c. DANIEL OVERHOLSER, JR., D.D.S., M.S.D. Index 179 CONTRIBUTING AUTHORS Joseph Aisner, MD. Head, Division of Medical Oncology Deputy Director for Clinical Affairs University of Maryland Cancer Center University of Maryland Hospital Associate Professor of Medicine University of Maryland School of Medicine Baltimore, MD 21201 Nicholas R. Bachur, M.D., PhD. Chief, Laboratory of Clinical Biochemistry Baltimore Cancer Research Program Division of Cancer Treatment National Cancer Institute National Institutes of Health Baltimore, MD 21201 Lee R. Brown, Ph.D. Professor of Pathology (Microbiology) University of Texas Dental Branch Professor University of Texas Dental Science Institute Houston, TX 77025 vii viii Contributing Authors Samuel Dreizen, D.D.S., M.D. Professor and Chairman Department of Dental Oncology University of Texas Dental Branch Professor University of Texas Dental Science Institute Houston, TX 77025 Kenneth T. Izutsu, Ph.D. Research Associate Professor Department of Oral Medicine Department of Oral Biology University of Washington School of Dentistry Seatde, WA 98195 Peter B. Lockhart, D.D.S. Program Director General Practice Residency Program Brigham and Women's Hospital Associate Physician Sidney Farber Cancer Institute Assistant Professor Department of Oral Medicine and Oral Pathology Harvard School of Dental Medicine Boston, MA 02115 Joyce L. O'Dwyer R.N., B.S.N. Patient Education Coordinator University of Maryland Cancer Center University of Maryland Hospital Baltimore, MD 21201 C. Daniel Overholser, D.D.S., M.S. Associate Professor and Chairman Department of Oral Diagnosis Baltimore College of Dental Surgery Dental School Assistant Professor Oncology University of Maryland School of Medicine University of Maryland at Baltimore Baltimore, MD 21201 Douglas E. Peterson, D.M.D., Ph.D. Associate Professor Department of Oral Diagnosis Baltimore College of Dental Surgery Dental School ix Assistant Professor Oncology University of Maryland School of Medicine University of Maryland at Baltimore Baltimore, MD 21201 Stephen C. Schimpff, M.D. Director University of Maryland Cancer Center University of Maryland Hospital Professor of Medicine University of Maryland School of Medicine Baltimore, MD 212()1 Mark M. Schubert, D.D.S., M.S.D. Lecturer Department of Oral Medicine University of Washington School of Dentistry Seattle, WA 98195 Director, Oral Medicine Support Services Fred Hutchinson Cancer Research Center Seattle, W A 98124 Stephen T. Sonis, D.M.D., D.M.Sc. Chief, Division of Dentistry Brigham and Women's Hospital Associate Physician Sidney Farber Cancer Institute Associate Professor Department of Oral Medicine and Oral Pathology Harvard School of Dental Medicine Boston, MA 02115 Keith M. Sullivan, M.D. Assistant Professor of Medicine University of Washington School of Medicine Seattle, W A 98195 Assistant Member Fred Hutchinson Cancer Research Center Seattle, WA 98124 Edmond L. Truelove, D.D.S., M.S.D. Associate Professor and Chairman Department of Oral Medicine University of Washington School of Dentistry Seattle, WA 98195 x Contributing Authors Lisa T. Williams, B.S., R.D.H. Dental Hygienist University of Maryland Cancer Center University of Maryland Hospital Instructor Department of Oral Diagnosis Baltimore College of Dental Surgery Dental School University of Maryland at Baltimore Baltimore, MD 21201