Oral mucositis

Abstract

Mucositis and xerostomia are the most common oral complications of the non-surgical therapy of cancer. Mucositis, a common sequel of radio- (DXR), chemo-(CXR) and radiochemo-therapy in patients with cancer, or patients requiring haemopoietic stem cell transplants (HSCT), has a direct and significant impact on the quality of life and cost of care, and also affects survival--because of the risk of infection. Apart from dose reduction, preventive and treatment options for mucositis are scarce, although multiple agents have been tested. Evidence suggests that cryotherapy, topical benzydamine and amifostine might provide some benefit in specific situations. The recombinant human keratinocyte growth factor Palifermin (Kepivance) was recently approved as a mucositis intervention in patients receiving conditioning regimens before HSCT for the treatment of haematological malignancies. A number of mechanistically based interventions are in various stages of development. Unfortunately, many other approaches have not been rigorously tested. This paper reviews the clinical features, prevalence, diagnosis, complications, pathogenesis, prophylaxis and management of mucositis.

Individualized pharmacological treatment of oral mucositis pain in patients with head and neck cancer receiving radiotherapy

“…A peak of OM severity is seen in the fifth week of RT [10]. The healing process starts two to three weeks after completed RT [8], but OM may remain severe five to seven weeks after the RT period [6].…”

“…In patients undergoing RT for head and neck cancer, oral mucositis (OM) is the most common acute adverse effect [3]. More aggressive tumor treatment methods in recent years, above all increased use of concomitant chemotherapy, have lead to increased severity of OM [4][5][6] and increased mean incidence of OM (80%) [4].…”

“…In the average temporal pattern, OM starts with erythema one week after RT start, coinciding with accumulated radiation dose of 10 Gray (Gy) [6][7][8][9]. Confluent erythema and ulcers are seen during the third week, coinciding with accumulated dose of 30 Gy [6,8,9]. Ulceration proceeds during the rest of the RT period.…”

“…Several pro-inflammatory and cytotoxic factors are involved [6][7][8]. In the average temporal pattern, OM starts with erythema one week after RT start, coinciding with accumulated radiation dose of 10 Gray (Gy) [6][7][8][9].…”

Role of the route of leukotrienes in an experimental model of oral mucositis induced by 5-fluorouracil

“…Oral mucositis (OM) is an important, dose-limiting side effect observed in patients undergoing radiotherapy (RT) and chemotherapy (CT) 1,2 . Proinflammatory cytokines are released in response to reactive oxygen species produced by CT-damaged cells; the pathogenesis of OM, however, is yet to be fully elucidated 3 .…”