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Chemotherapy- and radiotherapy-induced mucositis

Background

Overview

Definition
Chemotherapy- and radiation-induced mucositis refers to erythematous and ulcerative lesions of the oral mucosa in patients with cancer being treated with chemotherapy or radiation.
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Pathophysiology
Chemotherapy- and radiation-induced mucositis is caused by direct toxicities (cell death and reduction in cell turnover) and indirect toxicity (myelosuppression).
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Disease course
Tissue injury, upregulation of inflammation and proinflammatory cytokines, and ulceration results in chemotherapy- and radiation-induced mucositis, which causes clinical manifestations of severe pain, bleeding, and weight loss impacting nutritional intake, oral hygiene, and QoL; gastrointestinal mucositis can manifest as diarrhea. Mucositis complicated by infection during severe immunosuppression can lead to systemic sepsis.
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Prognosis and risk of recurrence
Chemotherapy- and radiation-induced mucositis independently is not associated with increased mortality.
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Guidelines

Key sources

The following summarized guidelines for the management of chemotherapy- and radiotherapy-induced mucositis are prepared by our editorial team based on guidelines from the American Society of Pain and Neuroscience (ASPN 2021), the European Society of Medical Oncology (ESMO 2020), the Multinational Association of Supportive Care in Cancer (MASCC/ISOO 2020), and the Infectious Diseases Society of America (IDSA 2011).
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Medical management

Management of oral mucositis, morphine: as per ISOO/MASCC 2020 guidelines, consider offering topical morphine 0.2% mouthwash the treatment of oral mucositis-associated pain in patients with head and neck cancer receiving concomitant radiotherapy and chemotherapy.
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  • Management of oral mucositis (ketamine)

  • Management of oral mucositis (pilocarpine)

  • Management of oral mucositis (sucralfate)

  • Management of oral mucositis (antibiotics)

  • Management of oral mucositis (hyperbaric oxygen therapy)

  • Management of oral mucositis (counseling)

  • Management of enteritis (octreotide)

  • Management of enteritis (sucralfate)

  • Management of proctitis (sucralfate enemas)

  • Management of proctitis (hyperbaric oxygen therapy)

Preventative measures

Prevention of oral mucositis, general principles: as per ISOO/MASCC 2020 guidelines, consider implementing multiagent combination oral care protocols for the prevention of oral mucositis during chemotherapy, head and neck radiotherapy, and HSCT.
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More topics in this section

  • Prevention of oral mucositis (oral cryotherapy)

  • Prevention of oral mucositis (intraoral photobiomodulation therapy)

  • Prevention of oral mucositis (mouthwashes)

  • Prevention of oral mucositis (recombinant keratinocyte growth factor 1)

  • Prevention of oral mucositis (oral glutamine)

  • Prevention of oral mucositis (honey)

  • Prevention of oral mucositis (chewing gum)

  • Prevention of oral mucositis (therapies with no evidence for benefit)

  • Prevention of esophagitis (amifostine)

  • Prevention of enteritis (probiotics)

  • Prevention of enteritis (sulfasalazine)

  • Prevention of enteritis (5-aminosalicylic acid)

  • Prevention of proctitis (amifostine)

  • Prevention of proctitis (misoprostol suppositories)