Results from cytotoxic injury to the epithelial lining of the oral mucosa, oropharyngeal and gastrointestinal tracts.
Side effect of radiation therapy for head and neck cancers.
Severity varies from erythema and edema with mild soreness to full thickness ulcerations with pain, impaired swallowing, increased risk of infections and life threatening disease.
Manifests as erosions or ulcerations of the non-keratinized oral mucosa, and its course depends on the form of cancer therapy.
Affects an estimated 14-81% of patients undergoing some forms of chemotherapy.
Among patients undergoing a hematopoetic stem cell transplantation, and affects an estimated 83%, but is often more severe and develops faster then chemotherapy associated oral mucositis.
Among patients receiving radiation therapy to the head and neck, oral mucositus occurs in 59-100% of patients, and signs of it develop within two weeks of treatment initiation, and worsens during the course of treatment.
In about 6% of cases radiotherapy associated oral mucositis becomes chronic and can continue for years.
It begins within days of initiating chemotherapy treatment, and lasts for up to two weeks depending on the dose, intensity of therapy, and stomatoxicity of the chemotherapy drugs.
One of the most difficult conditions for patients decreasing daily functioning, impairing quality of life because of difficulty eating, drinking, swallowing or speaking.
Often requires the use of analgesics and alternate forms of nutrition to allow for adequate hydration and caloric intake.
Common toxicity of chemotherapy and radiation treatments.
Incidence about 30-40% of patients treated with chemotherapy.
Often requires dose reductions in chemotherapy, delays in treatment, possible discontinuation of chemotherapy that may decreases response rates and increase mortality.
Most severe and debilitating mucositis associated with radiation for head and neck cancers and myeloablative treatments for transplants.
Common toxicity of radiation for head and neck cancers, occurring in virtually all patients (Elting).
The use of intensity modulated radiation does not reduce risk (Elting).
Infants are at higher risk for the development of chemotherapy induced mucositis.
The incidence of oral candidiasis does not vary with the degree of mucositis (Elting).
Associated with increased risk for infections, and in the presence of granulocytopenia strong association with sepsis.
Oral mucositis after hematopoietic stem cell transplant more likely to occur in patients with BMI>25, in those receiving preparative total body irradiation and in patients carrying the MTHFR 677TT genotype.
A serious complication in chemoradiation treated patients with 75% of patients who undergo stem-cell transplantation and 77% of patients, so treated, for head and neck cancer.
Oral cryotherapy given for 30 minutes around bolus 5-FU can decrease mucositis by about 50%.
Chlorhexidine associated with net harm when used to protect for radiation induced mucositis.
Daily oral care with a mucolytic rinse, such as a bicarbonate solution, followed by a normal saline rinse throughout the day can reduce the severity of mucositis (Kurtin SE).
Chemotherapy mucositis occurs due to direct toxic effects on oral mucosal by drugs.
Everolimus oral mucositis seems to be induced local inflammation from the targeted therapy.
In a randomized controlled study involving the use of doxepin mouthwash, diphenhydramine-lidocaine-antacid mouthwash and placebo the first two treatments met statistical significant improvement in pain but not but did not reach a predetermined threshold for a minimal clinical important difference.