Management of radiation therapy-induced mucositis in head and neck cancer patients. Part I: Clinical significance, patho
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REVIEW
Management of radiation therapy-induced mucositis in head and neck cancer patients. Part I: Clinical significance, pathophysiology and prevention Wei Cheong Ngeow • Wen Lin Chai • Rosnah Binti Zain
Received: 20 April 2008 / Accepted: 18 May 2008 / Published online: 11 July 2008 ©Springer-Verlag 2008
Abstract Oropharyngeal mucositis is the acute inflammatory and ulcerative reaction of the oral mucosa following radiation therapy to the head and neck region. It is such a common problem that nearly all head and neck cancer patients develop some degree of mucositis. This complication is usually transient in nature but it also represents an important clinical problem as it is a painful, debilitating, dose-dependent side effect for which there is no widely acceptable prophylaxis or effective treatment. As several authoritative groups have recently either undertaken systematic reviews or issued guidelines on the management of
mucositis, it is the aim of this review to provide instead an overview of all the possible remedies available, as well as highlighting to researchers the gaps that need to be filled. The first part of this review outlines the clinical significance and pathophysiology of radiation-induced mucositis, and looks into some of the preventive approaches available. Keywords Head and neck cancer • Radiation therapy • Mucositis • Management
Introduction
W.C. Ngeow (Y) Department of Oral & Maxillofacial Surgery Faculty of Dentistry, University of Malaya 50603 Kuala Lumpur, Malaysia e-mail: [email protected] W.L. Chai Department of General Dental Practice and Oral & Maxillofacial Imaging, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur, Malaysia R.B. Zain Department of Oral Pathology, Oral Medicine and Periodontology Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Radiation therapy (RT) is an important and indispensable mode of treatment for head and neck cancers, given to up to 75% of all head and neck cancer patients [1]. Besides ablating cancer, RT results in a number of biochemical changes, such as damage to membrane structures and cellular DNA, and alterations of the immune system, making it inefficient in resisting the attack of free radicals [2]. As the normal human oral mucosa has a rapid turnover rate, i.e. every 9–16 days, it means that the oral mucosa is very susceptible to the effects of RT [3]. Painful mouth sores described as mucositis/stomatitis is common during RT for head and neck cancer, with nearly all patients developing some degree of mucositis [4–7]. This happens because of the decreased cell renewal in the epithelium exposed to radiation [8]. Mucositis is made worse when concurrent chemotherapy (CT) is administered [4]. Most literature before the early 1980s used the term of stomatitis to describe the oral lesions after CT and RT. However, this was not specific as it included other
Oncol Rev (2008) 2:102–113
complications such as infection and pain in the oral cavity. The terminology of oral mucositis was later increasingly used. Thi
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