Cancer treatment-induced oral mucositis: a critical review

Abstract

Head and neck cancer represents one of the main oncological problems. Its treatment, radiotherapy and chemotherapy leads to mucositis, and other side effects. The authors reviewed high-quality evidence published over the last 25 years on the treatment of cancer treatment-induced oral mucositis. A Medline search for double blind randomized controlled clinical trials between 1985 and 2010 was carried out. The keywords were oral mucositis, radiotherapy, chemotherapy, and head and neck. The different therapeutic approaches found for cancer treatment-induced oral mucositis included: intensive oral hygiene care; use of topical antiseptics and antimicrobial agents; use of anti-inflammatory agents; cytokines and growth factors; locally applied non-pharmacological methods; antioxidants; immune modulators; and homoeopathic agents. To date, no intervention has been able to prevent and treat oral mucositis on its own. It is necessary to combine interventions that act on the different phases of mucositis. It is still unclear which strategies reduce oral mucositis, as there is not enough evidence that describes a treatment with a proven efficiency and is superior to the other treatments for this condition.

Head and neck cancer, principally squamous cell carcinoma, is one of the main oncological problems owing to its high mortality rate and the after-effects of the treatment. It makes up 4–5% of all cancers, is more common in men than in women (4:1), and is more common in those aged over 40 years .

Malnourished patients, or those who drink and/or smoke, are at greater risk. This is because the upper aerodigestive tract epithelium of consumers is changed predisposing them to develop many cancers. Recent studies demonstrate that although the principal risk factors for head and neck cancer remain tobacco and alcohol use, human papillomavirus (HPV) is aetiologically associated with 20–25% of upper aerodigestive tract cancer, mostly in the oropharynx . The most common high risk-HPV associated with it is HPV-16 .

Radiotherapy, whether on its own or in combination with other treatments, is an important option in the treatment of many of the lesions found in this part of the body. Radiation (and chemotherapy) affects malignant cells and is also absorbed by the buccal and peribuccal tissue, especially in rapidly dividing cells .

Gastrointestinal tract cells have the highest rate of cell proliferation and turnover in the human body. Even though anti-neoplastic treatment has become more effective, it continues to be associated with numerous short and long-term side effects .

Oral mucositis is one of the most common side effects of radiotherapy and/or chemotherapy. It is a debilitating condition that appears as a result of the cytotoxic effects of the chemotherapy drugs used and radiation to the oral mucosa .

This review aims to update knowledge about the concept, epidemiology, aetiopathogenesis, clinical manifestation, diagnosis and prognosis of oral mucositis induced by radiation or chemotherapeutic agents. It also aims to evaluate the effectiveness of interventions that have been used in the last 25 years to prevent and treat it in patients with head and neck malignances.

Material and methods

The authors performed two searches on the Medline database. In the first search they looked for metanalysis and systematic reviews related to concept, epidemiology, aetiopathogenesis, clinical manifestations, diagnosis and prognosis of oral mucositis induced by radiotherapy with or without chemotherapy, using the following keywords: induced oral mucositis cancer treatment.

In the second search, double-blind randomized controlled clinical trials in humans, from January 1985 to May 2011 were sought, using the following keywords: induced oral mucositis; stomatitis; head and neck cancer; radiotherapy; chemotherapy. 74 articles were found; of which only 62 complied with the objectives and criteria of the literature search. Inclusion criteria were: patients of both sexes; aged between 18 and 70 years; diagnosed with head and neck cancer undergoing radiotherapy and/or chemotherapy. The aims of the included studies were focused on the prevention and treatment of induced oral mucositis or stomatitis.

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Jan 26, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Cancer treatment-induced oral mucositis: a critical review
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