Chemotherapy- and Radiotherapy-Induced Oral Mucositis: Review of Preventive Strategies and Treatment

Abstract

Oral mucositis is a frequently encountered and potentially severe complication associated with administration of chemotherapy and radiotherapy. Although many pharmacologic interventions have been used for the prevention and treatment of oral mucositis, there is not one universally accepted strategy for its management. Most preventive and treatment strategies are based on limited, often anecdotal, clinical data. Basic oral hygiene and comprehensive patient education are important components of care for any patient with cancer at risk for development of oral mucositis. Nonpharmacologic approaches for the prevention of oral mucositis include oral cryotherapy for patients receiving chemotherapy with bolus 5-fluorouracil, and low-level laser therapy for patients undergoing hematopoietic stem cell transplantation. Chlorhexidine, amifostine, hematologic growth factors, pentoxifylline, glutamine, and several other agents have all been investigated for prevention of oral mucositis. Results have been conflicting, inconclusive, or of limited benefit. Treatment of established mucositis remains a challenge and focuses on a palliative management approach. Topical anesthetics, mixtures (also called cocktails), and mucosal coating agents have been used despite the lack of experimental evidence supporting their efficacy. Investigational agents are targeting the specific mechanisms of mucosal injury; among the most promising of these is recombinant human keratinocyte growth factor.

Peculiaridades da radioterapia em idosos

“…Pharmacological and non-pharmacological measures should be aggressively instituted, even if only prophylactically, as well as the frequent monitoring of their application (28) . The use of topical agents (anesthetics, local protectors) and oral medications (analgesics, antiemetics), superinfection (oral moniliasis) treatment and the use of radioprotectors (amifostine), LASER and of the IMRT technique must occur in parallel with simple measures, such as guidance for appropriate dental hygiene, removal of irritating factors (alcohol, smoking, prostheses) and specialized dental and nutritional follow-up.…”

“…The use of topical agents (anesthetics, local protectors) and oral medications (analgesics, antiemetics), superinfection (oral moniliasis) treatment and the use of radioprotectors (amifostine), LASER and of the IMRT technique must occur in parallel with simple measures, such as guidance for appropriate dental hygiene, removal of irritating factors (alcohol, smoking, prostheses) and specialized dental and nutritional follow-up. However, one should bear in mind that in spite of the of the high number of available interventional options, the results of scientific studies on many such agents are many times conflicting or even non-existent, a fact that imposes a judicious use of those agents (28,29) .…”

Kemoterapi̇ye Bağli Mukozi̇t

“…Ancak bunlardan çoğunun yararı sınırlıdır. 16 Çeşitli kılavuzlarda hematopoetik kök hücre transplantasyonu öncesi yüksek dozlarda melfalan veya 5-fluorourasil uygulamasında oral kriyoterapi ve palifermin öneril-mektedir. Özellikle bolus tarzda 5 fluorourasil kullanan hastalarda mukozit önemli bir sorundur ve çeşitli çalışmalarda oral buz uygulamasının vazokonstrük-siyonu uyararak kısa etki süresi boyunca bu ilacın oral yan etkilerinden koruma sağladığı gösterilmiştir.…”

Glutamine: Beneficial to prevent oral mucositis in Mexican children with acute lymphoblastic leukemia?

“…The prevalence of OM is variable and has been reported in 18% to 52% of patients who received standard-doses of chemotherapy [5] and younger patients seem to have an increased risk of chemotherapy-induced OM [6] .…”