Oral Mucositis Induced By Anticancer Therapies

Abstract

Oral mucositis induced by conventional cytotoxic cancer therapies is a common and significant clinical problem in oncology. Mucositis symptoms, which include severe pain, may lead to dose reductions and unplanned interruptions of chemotherapy and/or radiotherapy, and often affect patients' quality of life. In addition, ulcerative mucositis represents a risk factor for local or systemic infectious complications that may be life-threatening in immunosuppressed patients. The development of biologically based targeted cancer therapies, which aim to block the growth, spread, and survival of tumors by interfering with specific molecular targets, may have reduced mucosal injury, but did not eliminate it. This article will review the epidemiology, pathobiology, and management of oral mucositis associated with conventional cytotoxic therapies for malignant diseases and will briefly summarize emerging information on oral mucosal injury associated with targeted therapies. Considerations for future research aimed at the development of more efficient and effective supportive care approaches will be presented, with emphasis on the contribution of dental researchers and clinicians in these efforts.

Chemotherapy: oral side effects and dental interventions. A review of the literature

“…Pathogens such as Porfyromonas gingivalis, as well as fungi and viruses, seem to be responsible for ulceration and mucositis. [23] Genes that determine the availability of active drug metabolites are related to the risk of development of mucositis. For example, the polymorphism associated with the expression of tumor necrosis factor alpha (TNF-a) has been implicated in OM.…”

“…At the final healing stage, keratinocytes, stimulated by extracellular matrix, migrate and proliferate to reconstruct epithelial layers. [23] The hematopoiesis resolves, the inflammation resolves, and the stromal fibroblasts are remodeled. [25] Mucositis is at its peak at 7-10 days after chemotherapy.…”

Adipose mesenchymal stromal cells minimize and repair radiation-induced oral mucositis

“…However, with moderately to severely ill patients, the duration may increase with risk of secondary bacterial or yeast infection [115]. …”

“…Maintaining good oral care is the main preventive measure for RIOM in order to minimize the risk for candidiasis or secondary bacterial infection, especially in hyperfractionated radiotherapy, combined chemo-radiation regimens, or radiotherapy combined with a targeted agent due to increased mucositis severity [115].…”

“…[115] OM = oral mucositis, μg = microgram, kg = kilogram, nm = nanometer, mW = milliwatt, J = Joule, cm = centimeter, Gy = Gray, HSCT = hematopoietic stem cell transplantation, TBI = total body irradiation, HNC = Head and Neck cancer.…”