Chemotherapy in Pediatric Oncology Patients and the Occurrence of Oral Mucositis

Abstract

BackgroundIt is known that chemotherapeutic agents are not equally stomatotoxic and oral cavity lesions are the most frequent complications encountered in antineoplastic chemotherapy.AimsThe objective of this study was to evaluate the occurrence of severe oral mucositis during a chemotherapy treatment and to identify its relationship with the chemotherapeutic class used.Materials and methodsThis is a longitudinal, prospective, and observational study that used an intensive direct observation technique for assessing the oral clinical conditions and the chemotherapy treatment administered to 105 patients (both children and adolescents).ResultsSevere oral mucositis occurred in all the 10 weeks of evaluation (ranging from 16.2 to 31.4%) and the association between the type of chemotherapy and the occurrence of severe oral mucositis is recorded only in the 6th week, with the chance to develop severe oral mucositis being 3.07 (3.85–2.29) times higher in patients underwent chemotherapy with antimetabolites than in those who have not used chemotherapy (p = 0.012).ConclusionIt was concluded that the chemotherapeutic agents most related to severe oral mucositis and to the interruption in chemotherapy are those of the class of antimetabolites, especially the methotrexate and the Ara C.How to cite this articleRibeiro ILA, de Andrade Lima Neto E, et al. Chemotherapy in Pediatric Oncology Patients and the Occurrence of Oral Mucositis. Int J Clin Pediatr Dent 2019;12(4):261–267.

Risk factors associated with the development of oral mucositis in pediatric oncology patients: Systematic review and meta‐analysis

“…Some specific protocols and each chemotherapeutic agent reported in these protocols for the treatment of some neoplasms are described in Table 3, such as COG AHOD0031 and COG AHOD0831 for the treatment of Hodgkin lymphoma (HL) (Allen et al., 2017), leukemias (BFM‐95) (Figliolia et al., 2008), Burkitt's lymphoma, ALL and Ewing's sarcoma (COPADM, VIDE and multidrug conditioning regimen) (Gandemer et al., 2007), which were also considered to be factors. Other agents, such as daunorubicin, doxorubicin, vincristine, and etoposide (Damascena et al., 2020), busulfan (Fadda et al., 2006), MTX, and cytarabine (Ara‐C) (Ribeiro et al., 2019), were also presented as potential risk factors.…”

The Efficacy of Heat-Clearing (Qingre) and Detoxifying (Jiedu) Traditional Chinese Medicine Gargle for Chemotherapy-Induced Oral Mucositis: A Systematic Review and Meta-Analysis

“…Studies have shown that the younger a patient is, the higher the chances that chemotherapy will cause adverse effects on oral health are ( Cheng et al, 2011 ). The type, dosage, and frequency of chemotherapy drugs may have an impact on the occurrence and severity of OM, especially 5-fluorouracil, cyclophosphamide, cisplatin, and methotrexate; these chemotherapy drugs are involved in the emergence of changes in the oral mucosa ( Ribeiro et al, 2019 ). The result of the combined analysis of CIOM grade showed that, although the included studies were the same, slight differences in heterogeneity between the two studies were found.…”

Occurrence and Severity of Oral Mucositis in Brazilian Pediatric Cancer Patients

“…However, the chemotherapeutic drugs of choice in the treatment of pediatric cancer are not equally stomatotoxic. MTX and 5-fluorouracil, both antimetabolites, are the drugs most reported to cause alterations in the oral mucosa [8,18]. Patients whose therapeutic regimens do not include MTX tend to have a lower occurrence of SOM [7].…”

“…Four classes of chemotherapeutic drugs were considered, according to the classification of the National Health Surveillance Agency, namely: alkylating agents, antimetabolites, natural products and miscellaneous. The present study focused on the class of antimetabolites, particularly methotrexate (MTX), since previous studies have shown that patients under chemotherapy regimen with antimetabolites are more likely to develop SOM [7,8]. MTX is one of the most widely used chemotherapeutic drugs, despite presenting stomatotoxicity and being frequently related to the occurrence of SOM [18].…”

“…Different scales have been proposed to diagnose OM and to assess its severity in children; for instance, the modified Oral Assessment Guide (OAG) [7,8]. The modified OAG serves not only to screen for disruptions in the integrity of the oral mucosa, but it also allows for early identification of oral conditions, rendering therapeutic interventions timely and more clinically effective.…”