Oral mucositis: the hidden side of cancer therapy
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(2020) 39:210
REVIEW
Open Access
Oral mucositis: the hidden side of cancer therapy Claudio Pulito1, Antonio Cristaudo2, Caterina La Porta3,4, Stefano Zapperi5,6, Giovanni Blandino1, Aldo Morrone7 and Sabrina Strano8*
Abstract Inflammation response of epithelial mucosa to chemo- radiotherapy cytotoxic effects leads to mucositis, a painful side effect of antineoplastic treatments. About 40% of the patients treated with chemotherapy develop mucositis; this percentage rises to about 90% for head and neck cancer patients (HNC) treated with both chemo- and radiotherapy. 19% of the latter will be hospitalized and will experience a delay in antineoplastic treatment for highgrade mucositis management, resulting in a reduction of the quality of life, a worse prognosis and an increase in patient management costs. Currently, several interventions and prevention guidelines are available, but their effectiveness is uncertain. This review comprehensively describes mucositis, debating the impact of standard chemo-radiotherapy and targeted therapy on mucositis development and pointing out the limits and the benefits of current mucositis treatment strategies and assessment guidelines. Moreover, the review critically examines the feasibility of the existing biomarkers to predict patient risk of developing oral mucositis and their role in early diagnosis. Despite the expression levels of some proteins involved in the inflammation response, such as TNF-α or IL-1β, partially correlate with mucositis process, their presence does not exclude others mucositis-independent inflammation events. This strongly suggests the need to discover biomarkers that specifically feature mucositis process development. Non-coding RNAs might hold this potential. Keywords: Oral mucositis, HNC, Biomarker, Cytokine, Non-coding RNA, Quality of life
Background The advent of chemotherapy (CT) in 1940 led to a dramatic increase in mucositis adverse events, generically identified as stomatitis. The lack of efficacious therapies and of prevention guidelines for stomatitis consistently decreased patient quality of life and prognosis. Only sixty years later the complex mechanisms underlying mucositis pathogenesis were discovered and in 2007 the term mucositis was adopted to describe lesions associated to chemo- and/or radiotherapy (RT) cytotoxic effects.
* Correspondence: [email protected] 8 SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS, Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144 Rome, Italy Full list of author information is available at the end of the article
Mucositis affects all gastro-intestinal tract and oral cavity inducing patient pain, inability to eat, weight loss and local infection. Furthermore, patients affected by a high-grade mucositis have to reduce chemotherapy regimen with delayed cancer treatment and worse prognosis. About 30–40% of cancer patients treated with chemotherapy develops mucositis, this percentage rises to 60–85% for patients undergoing to an hema
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