Radiation induced oral mucositis

Satheesh Kumar Ps, Anita Balan, Arun Sankar, Tinky Bose, Satheesh Kumar Ps, Anita Balan, Arun Sankar, Tinky Bose

Abstract

PATIENTS RECEIVING RADIOTHERAPY OR CHEMOTHERAPY WILL RECEIVE SOME DEGREE OF ORAL MUCOSITIS THE INCIDENCE OF ORAL MUCOSITIS WAS ESPECIALLY HIGH IN PATIENTS: (i) With primary tumors in the oral cavity, oropharynx, or nasopharynx; (ii) who also received concomitant chemotherapy; (iii) who received a total dose over 5,000 cGy; and (iv) who were treated with altered fractionation radiation schedules. Radiation-induced oral mucositis affects the quality of life of the patients and the family concerned. The present day management of oral mucositis is mostly palliative and or supportive care. The newer guidelines are suggesting Palifermin, which is the first active mucositis drug as well as Amifostine, for radiation protection and cryotherapy. The current management should focus more on palliative measures, such as pain management, nutritional support, and maintenance, of good oral hygiene.

Keywords: Mucositis; Oral cancer; Radiation.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Oral mucositis in a patient who have undergone radiotherapy

References

    1. Plevovia P. Prevention and treatment of chemotherapy and radiotherapy induced oral mucositis: A review. Oral Oncol. 1999;35:453–70.
    1. Berger AM, Kilroy TJ. Oral complications. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: Principles and practice of oncology. 5th ed. Philadelphia: J B Lippincott; 1997. pp. 2714–25.
    1. Lalla RV, Peterson DE. Oral mucositis. Dent Clin North Am. 2005;49:167–84.
    1. Treister N, Sonis S. Mucositis: Biology and management. Curr Opin Otolaryngol Head Neck Surg. 2007;15:123–9.
    1. Vera-Llonch M, Oster G, Ford CM, Lu J, Sonis S. Oral mucositis and outcomes of allogenic hematopoietic stem-cell transplantation in patients with hematologic malignancies. Support Care Cancer. 2007;15:491–6.
    1. Vera-Llonch M, Oster G, Hagiwara M, Sonis S. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer. 2006;106:329–36.
    1. Logan RM, Gibson RJ, Sonis ST, Keefe DM. Nuclear factor-κappa B (NF-kappaB) and cyclooxygenase-2 (COX-2) expression in the oral mucosa following cancer chemotherapy. Oral Oncol. 2007;43:395–401.
    1. Gibson RJ, Bowen JM, Cummins AG, Logan R, Healey T, Keefe DM. Ultrastructural changes occur early within the oral mucosa following cancer chemotherapy [abstract A-373] Support Care Cancer. 2004;12:389.
    1. Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, et al. Perspectives on cancer therapy-induced mucosal injury: Pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 2004;100:1995–2025.
    1. Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, et al. Perspectives on cancer therapy-induced mucosal injury: Pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 2004;100:1995–2025.
    1. Sonis ST, Peterson RL, Edwards LJ, Lucey CA, Wang L, Mason L, et al. Defining mechanisms of action of interleukin-11 on the progression of radiation-induced oral mucositis in hamsters. Oral Oncol. 2000;36:373–81.
    1. Dorr W, Emmendorfer H, Haide E. Proliferation equivalent of ‘accelerated repopulation’ in mouse oral mucosa. Int J Radiat Biol. 1994;66:157–67.
    1. Epstein JB, Gorsky M, Guglietta A, Le N, Sonis ST. The correlation between epidermal growth factor levels in saliva and the severity of oral mucositis during oropharyngeal radiation therapy. Cancer. 2000;89:2258–65.
    1. Dodd MJ, Miaskowski C, Greenspan D, MacPhail L, Shih AS, Shiba G, et al. Radiation-induced mucositis: A randomized clinical trial of micronized sucralfate versus salt and soda mouthwashes. Cancer Invest. 2003;21:21–33.
    1. Nottage M, McLachlan SA, Brittain MA, Oza A, Hedley D, Feld R, et al. Sucralfate mouthwash for prevention and treatment of 5-fluorouracil-induced mucositis: A randomized, placebo-controlled trial. Support Care Cancer. 2003;11:41–7.
    1. Barclay L. Morphine mouthwash relieves pain of oral mucositis. Cancer. 2002;95:2230–6.
    1. Spijkevet FK, van Saene JJ, Panders AK, Vermy A, Mehta DM, Filder V. Effect of selective elimination of the oral flora on mucositis in irradiated head and neck cancer patients. J Surg Oncol. 1991;46:167–73.
    1. Matthews RH, Ercal N. Prevention of mucositis in irradiated head and neck cancer patients. J Exp Ther Oncol. 1996;1:135–8.
    1. Borowski B, Benhamou E, Pico JL, Laplanche A, Margainaud JP, Hayat M. Prevention of oral mucositis in patients treated with high-dose chemotherapy and bone marrow transplantation: A randomized controlled trial comparing two protocols of dental care. Eur J Cancer B Oral Oncol. 1994;308:93–7.
    1. Yoneda S, Imai S, Hanada N, Yamazaki T, Senpuku H, Ota Y, et al. Effects of oral care on development of oral mucositis and microorganisms in patients with esophageal cancer. Jpn J Infect Dis. 2007;60:23–8.
    1. McGuire DB, Correa ME, Johnson J, Wienandts P. The role of basic oral care and good clinical practice principles in the management of oral mucositis. Support Care Cancer. 2006;14:541–7.
    1. Barker G, Loffus L, Cuddy P, Barker B. The effects of of sucralfate suspension and diphenhydramine syrup plus kaolin-pectin on radiotherapy-induced mucositis. Oral Surg Oral Med Oral Pathol. 1991;71:288–93.
    1. Spielberger R, Stiff P, Bensinger W, Gentile T, Weisdorf D, Kewalramani T, et al. Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med. 2004;351:2590–8.
    1. von Bultzingslowen I, Brennan MT, Spijkervet FK, Logan R, Stringer A, Raber-Durlacher JE, et al. Growth factors and cytokines in the prevention and treatment of oral and gastrointestinal mucositis. Support Care Cancer. 2006;14:519–27.
    1. Lalla RV. Velafermin (CuraGen) Curr Opin Investig Drugs. 2005;6:1179–85.
    1. Rosen LS, Abdi E, Davis ID, Gutheil J, Schnell FM, Zalcberg J, et al. Palifermin reduces the incidence of oral mucositis in patients with metastatic colorectal cancer treated with fluorouracil-based chemotherapy. J Clin Oncol. 2006;24:5194–200.
    1. Epstein JB, Silverman S, Jr, Paggiarino DA, Crockett S, Schubert MM, Senzer NN, et al. Benzydamine HCl for prophylaxis of radiation-induced oral mucositis: Results from a multicenter, randomized, double-blind, placebo-controlled clinical trial. Cancer. 2001;92:875–85.
    1. Lalla RV, Schubert MM, Bensadoun RJ, Keefe D. Anti-inflammatory agents in the management of alimentary mucositis. Support Care Cancer. 2006;14:558–65.
    1. Coeffier M, Marion R, Leplingard A, Lerebours E, Ducrotté P, Déchelotte P. Glutamine decreases interleukin-8 and interleukin-6 but not nitric oxide and prostaglandins e production by human gut in vitro. Cytokine. 2002;18:92–7.
    1. Evans ME, Jones DP, Ziegler TR. Glutamine prevents cytokine-induced apoptosis in human colonic epithelial cells. J Nutr. 2003;133:3065–71.
    1. Bellon G, Monboisse JC, Randoux A, Borel JP. Effects of preformed proline and proline amino acid precursors (including glutamine) on collagen synthesis in human fibroblast cultures. Biochim Biophys Acta. 1987;930:39–47.
    1. Peterson DE, Jones JB, Petit RG., 2nd A Randomized, placebo-controlled trial of Saforis for prevention and treatment of oral mucositis in breast cancer patients receiving anthracycline-based chemotherapy. Cancer. 2007;109:322–31.
    1. Pytlik R, Benes P, Patorkova M, Chocensk´ E, Gregora E, Proch´zka B, et al. Standardized parenteral alanyl-glutamine dipeptide supplementation is not beneficial in autologous transplant patients: A randomized, doubleblind, placebo controlled study. Bone Marrow Transplant. 2002;30:953–61.
    1. Mantovani G, Maccio A, Madeddu C, Mura L, Massa E, Gramignano G, et al. Reactive oxygen species, antioxidant mechanisms and serum cytokine levels in cancer patients, Impact of an antioxidant treatment. J Environ Pathol Toxicol Oncol. 2003;22:17–28.
    1. Bensadoun RJ, Schubert MM, Lalla RV, Keefe D. Amifostine in the management of radiation induced and chemo-induced mucositis. Support Care Cancer. 2006;14:566–72.
    1. Barasch A, Peterson DE, Tanzer JM, D Ambrosio JA, Nuki K, Schubert MM, et al. Helium-neon laser effects on conditioning induced oral mucositis in bone marrow transplantation patients. Cancer. 1995;76:2550–6.
    1. Mills EE. The modifying effect of beta-carotene on radiation and radiotherapy and chemotherapy induced oral mucositis. Br J Cancer. 1988;57:416–7.
    1. Bianco JA, Appelbaum FR, Nemunaitis J, Almgren J, Andrews F, Kettner P, et al. Phase I-II trial of pentoxifyline for the prevention of transplant-related toxicities following bone marrow transplantation. Blood. 1991;78:1205–11.
    1. Clift RA, Bianco JA, Appelbaum FR, Buckner CD, Singer JW, Bakke L, et al. A randomized controlled trial of pentoxifylline for the prevention of regimen-related toxicities in patients undergoing allogeneic marrow transplantation. Blood. 1993;82:2025–30.
    1. Mose S, Adametz IA, Saran F, Thilmann C, Hayd R, Knecht R, et al. Can Prophylactic application of immunoglobulin decrease radiotherapy-induced oral mucositis. Am J Clin Oncol. 1997;20:407–11.
    1. Hermann F, Schuiz G, Weser M, Kolbe K, Nicolay U, Noack M, et al. Effect of granulocyte-macrophage colony stimulating factor on neutropenia and related morbidity induced by myelotoxic chemotherapy. Am J Med. 1990;88:619–24.
    1. Gluckman E, Lotsberg J, Devergie A, Zhao XM, Melo R, Gomez-Morales M, et al. Oral acyclovir prophylactic treatment of herpes simplex infection after bone marrow transplantation. J Antimicrob Chemother. 1983;12:161–7.
    1. Kaanders JH, Fleming TJ, Ang KK, Maor MH, Peters LJ. Devices valuable in head and neck radiotherapy. Int J Radiat Oncol Biol Phys. 1992;23:639–45.
    1. Dahiya MC, Redding SW, Dahiya RS, Eng TY, Kirkpatrick WR, Coco BJ, et al. Oropharyngeal candidiasis caused by non-albicans yeast in patients receiving external beam radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2003;57:79–83.
    1. Bensadoun RJ, Franquin JC, Ciais G, Darcourt V, Schubert MM, Viot M, et al. Low-energy He/Ne laser in the prevention of radiation-induced mucositis: A multicenter phase III randomized study in patient's with head and neck cancer. Support Care Cancer. 1999;7:244–52.
    1. Migliorati CA, Oberle-Edwards L, Schubert M. The role of alternative and natural agents, cryotherapy, and/or laser for management of alimentary mucositis. Support Care Cancer. 2006;14:533–40.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe