Vol 70, No 6 (2020)
Review paper
Published online: 2020-12-04

open access

Page views 1183
Article views/downloads 780
Get Citation

Connect on Social Media

Connect on Social Media

Oral mucositis (OM) – a common problem for oncologists and dentists

Magdalena Stawarz-Janeczek1, Katarzyna Szczeklik1, Jolanta Pytko-Polończyk1
Nowotwory. Journal of Oncology 2020;70(6):253-259.

Abstract

Oral mucositis (OM) caused by ionizing radiation is a significant therapeutic problem concerning almost all patients with head and neck cancers undergoing irradiation, however, an effective treatment method is still missing. Therapeutic ac­tions concentrate mostly on prophylaxis, including the maintenance of the correct hygiene of the oral cavity. In 2014 the International Society of Oral Oncology (ISOO) together with the (Multinational Association of Supportive Care in Cancer (MASCC) worked out the guidelines for the treatment of patients with z OM induced by radiotherapy and chemotherapy. In 2019 these guidelines were updated.

Research is ongoing to find medication which could be applicable for the prevention and treatment of OM. The problem is grave as it might complicate the progress of oncological treatment, deteriorate the patient’s quality of life or even affect the prognosis.

This paper describes the pathogenesis of oral mucositis, the current trends in treatment and discusses the role of a dentistry doctors in the care of the patient with symptoms of this condition. The article also refers to the role of a multidisciplinary team – the OM prophylaxis – as part of the preparation of an oncological patient for irradiation.

Article available in PDF format

View PDF Download PDF file

References

  1. http://onkologia.org.pl/nowotwory-zlosliwe-ogolem-2/.
  2. Krajowy Rejestr Nowotworów. http://onkologia.org.pl/nowotwory-narzadow-glowy-i-szyi/.
  3. Sonis ST. Pocket books for cancer supportive care. Oral mucositis. Springer Healthcare, Berlin 2012.
  4. Shankar A, Roy S, Bhandari M, et al. Current trends in management of oral mucositis in cancer treatment. Asian Pacific Journal of Cancer Prevention. 2017; 18(8): 2019–2026.
  5. Oronsky B, Goyal S, Kim M, et al. A Review of Clinical Radioprotection and Chemoprotection for Oral Mucositis. Translational Oncology. 2018; 11(3): 771–778.
  6. Maria O, Eliopoulos N, Muanza T. Radiation-Induced Oral Mucositis. Frontiers in Oncology. 2017; 7.
  7. Zapała J, Wyszyńska-Pawelec G. Wybrane zagadnienia z onkologii głowy i szyi. Wydawnictwo Uniwersytetu Jagiellońskiego, Kraków 2017: 350–355.
  8. Wysocki W, Małecki K. Zapalenia błony śluzowej związane z radioterapią i chemioterapią. Podsumowanie wytycznych MASCC/ISOO(2014r.). Medycyna praktyczna.pl. 2015. https://www.mp.pl/onkologia/wytyczne/111280.
  9. Szałek E. Zapalenie błony śluzowej jamy ustnej – istotny problem terapeutyczny w onkologii. Farmacja Współczesna. 2018; 11: 8–14.
  10. Dyszkiewicz M, Shaw H. Ocena stanu błony śluzowej jamy ustnej u pacjentów leczonych radio-i chemioterapią. Dent Med Probl. 2009; 46(1): 89–93.
  11. Moslemi D, Nokhandani A, Otaghsaraei M, et al. Management of chemo/radiation-induced oral mucositis in patients with head and neck cancer: A review of the current literature. Radiother Oncol. 2016; 120(1): 13–20.
  12. Sonis S. Mucositis: The impact, biology and therapeutic opportunities of oral mucositis. Oral Oncology. 2009; 45(12): 1015–1020.
  13. Bockel S, Vallard A, Lévy A, et al. Pharmacological modulation of radiation-induced oral mucosal complications. Cancer/Radiothérapie. 2018; 22(5): 429–437.
  14. Debraj HD, Singh V, Mohammad S, et al. Effect of Topical application of pure honey in chemo-radiation-induced mucositis and its clinical benefits in improving quality of life in patients of oral squamous cell carcinoma . International Journal of nursing studies. 2019; 89(2019): 80–87.
  15. Sroussi H, Epstein J, Bensadoun RJ, et al. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med. 2017; 6(12): 2918–2931.
  16. Lalla R, Bowen J, Barasch A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014; 120(10): 1453–1461.
  17. Mierzwa D, Hadzik J, et al. Pyrek Profilaktyka i leczenie zmian w jamie ustnej wywołanych chemioterapia i radioterapia onkologiczną przegląd piśmiennictwa. Bestom Dentonet.pl. 2014; Edentico 2(48): 14.8–14.13.
  18. Woźniak M, Czyż M. Mimetyki dysmutazy ponadtlenkowej- potencjalne zastosowania kliniczne. Postępy Hig Med. 2008; 62: 613–662.
  19. OncoLink Team.Mucositis (Mouth Sores) &Oral Care Tip Sheet 2018. www.oncolink.org.
  20. WHO handbook for reporting results of cancer treatment. World Health Organization 1979. http://www.who.int/iris/handle/10665/37200.
  21. Kornaś-Burek A, Lipska W, Darczuk D, et al. Mucositis-współczesne poglądy na rozpoznanie i leczenie Journal of stomatology. Journal of stomatology. 2014; 67(1): 114–127.
  22. Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, et al. [Exercise therapy in myocardial infarction according to the Republican Clinical Hospital in Kaunas]. Sveikatos Apsauga. 1962; 7(3)(5): 54–781.
  23. Gomes V, Gomes RN, Gomes M, et al. Effects of Matricaria Recutita (L.) in the Treatment of Oral Mucositis. The Scientific World Journal. 2018; 2018: 1–8.
  24. Yu YY, Deng JL, Jin XR, et al. Effects of 9 oral care solutions on the prevention of oral mucositis: a network meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020; 99(16): e19661.
  25. Münstedt K, Momm F, Hübner J. Honey in the management of side effects of radiotherapy- or radio/chemotherapy-induced oral mucositis. A systematic review. Complement Ther Clin Pract. 2019; 34: 145–152.
  26. Thomsen M, Vitetta L. Adjunctive Treatments for the Prevention of Chemotherapy- and Radiotherapy-Induced Mucositis. Integr Cancer Ther. 2018; 17(4): 1027–1047.
  27. Yang C, Gong G, Jin E, et al. Topical application of honey in the management of chemo/radiotherapy-induced oral mucositis: A systematic review and network meta-analysis. Int J Nurs Stud. 2019; 89: 80–87.
  28. Hong C, Gueiros L, Fulton J, et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines. Supportive Care in Cancer. 2019; 27(10): 3949–3967.
  29. Elad S. The MASCC/ISOO Mucositis Guidelines 2019 Update: introduction to the first set of articles. Support Care Cancer. 2019; 27(10): 3929–3931.
  30. Zadik Y, Arany PR, Fregnani ER, et al. Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2019; 27(10): 3969–3983.
  31. Yarom N, Hovan A, Bossi P, et al. Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO). Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines-part 1: vitamins, minerals, and nutritional supplements. Support Care Cancer. 2019; 27(10): 3997–4010.
  32. Ariyawardana A, Cheng K, Kandwal A, et al. Systematic review of anti-inflammatory agents for the management of oral mucositis in cancer patients and clinical practice guidelines. Supportive Care in Cancer. 2019; 27(10): 3985–3995.
  33. Le QT, Kim H, Schneider C, et al. Palifermin Reduces Severe Mucositis in Definitive Chemoradiotherapy of Locally Advanced Head and Neck Cancer: A Randomized, Placebo-Controlled Study. J Clin Oncol. 2011; 29(20): 2808–2814.
  34. Henke M, Alfonsi M, Foa P, et al. Palifermin Decreases Severe Oral Mucositis of Patients Undergoing Postoperative Radiochemotherapy for Head and Neck Cancer: A Randomized, Placebo-Controlled Trial. J Clin Oncol. 2011; 29(20): 2815–2820.
  35. Bockel S, Vallard A, Lévy A, et al. Pharmacological modulation of radiation-induced oral mucosal complications. Cancer/Radiothérapie. 2018; 22(5): 429–437.
  36. Barbor M. Novel therapy reduces duration of chemoradiotherapy-inducedmucositis in patients with head and neck cancer. The Asco Post, 2018 .
  37. Anderson C, Lee C, Saunders D, et al. Phase IIb, Randomized, Double-Blind Trial of GC4419 Versus Placebo to Reduce Severe Oral Mucositis Due to Concurrent Radiotherapy and Cisplatin For Head and Neck Cancer. J Clin Oncol. 2019; 37(34): 3256–3265.
  38. Hetnał M, Wysocki W. Popromienne zapalenie błony śluzowej jamy ustnej. Interna Szczeklika 2019. Medycyna Praktyczna, Kraków 2019.
  39. http://szpiczak.org/wp-content/uploads/aktualnosci/artykuly/2015/rekomendacje_dla_lekarzy_i_piel%C4%99gniarek_2015_poprawiony.pdf.
  40. Pytko-Polończyk J. Analiza stanu klinicznego i zmian mikroflory jamy ustnej w przebiegu radioterapii chorych na raka narządów głowy i szyi jako podstawa opracowania algorytmu stomatologicznego leczenia wspomagającego. Wydawnictwo Uniwersytetu Jagiellońskiego, Kraków 2009.
  41. http://www.90c.pl/3r/files/4115/4349/5555/Powiklania_popromienne_w_jamie_ustnej.pdf.
  42. Sourati A, Ameri A, Malekzadeh M. Acute Site Effects of Radiation Therapy. Springer International Publishing AG 2017: 53–78.
  43. Vera-Llonch M, Oster G, Hagiwara M, et al. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer. 2006; 106(2): 329–336.
  44. Sroussi HY, Epstein JB, Bensadoun RJ, et al. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med. 2017; 6(12): 2918–2931.
  45. Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, et al. Prevention and Treatment of Chemotherapy and Radiotherapy Induced Oral Mucositis. Medicina. 2019; 55(2): 25.
  46. Wang Li, Gu Z, Zhai R, et al. Efficacy of Oral Cryotherapy on Oral Mucositis Prevention in Patients with Hematological Malignancies Undergoing Hematopoietic Stem Cell Transplantation: A Meta-Analysis of Randomized Controlled Trials. PLOS ONE. 2015; 10(5): e0128763.
  47. Elting L, Keefe D, Sonis S, et al. Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy. Cancer. 2008; 113(10): 2704–2713.
  48. Narayan S, Lehmann J, Coleman M, et al. Prospective Evaluation to Establish a Dose Response for Clinical Oral Mucositis in Patients Undergoing Head-and-Neck Conformal Radiotherapy. Int J Radiat Biol Phys. 2008; 72(3): 756–762.e4.
  49. Shih A, Maiskowski C, Dodd MJ, et al. Mechanisms of radiation-induced oral mucositis and the consequences. Cancer Nurs. 2003; 26(3): 222–229.
  50. Kostler WJ, Hejna M, Wenzel C, et al. Oral Mucositis Complicating Chemotherapy and/or Radiotherapy: Options for Prevention and Treatment. CA Cancer J Clin. 2001; 51(5): 290–315.
  51. Tsan DL, Lin CY, Kang CJ, et al. The comparison between weekly and three-weekly cisplatin delivered concurrently with radiotherapy for patients with postoperative high-risk squamous cell carcinoma of the oral cavity. Radiat Oncol. 2012; 7(1): 215.
  52. Ren JH, Dai XF, Yan GL, et al. Acute oral mucositis in nasopharyngeal carcinoma patients treated with radiotherapy: Association with genetic polymorphism in DNA DSB repair genes. Int J Radiat Biol. 2014; 90(3): 256–261.
  53. Venkatesh G, Manjunath V, Mumbrekar K, et al. Polymorphisms in Radio-Responsive Genes and Its Association with Acute Toxicity among Head and Neck Cancer Patients. PLoS ONE. 2014; 9(3): e89079.
  54. Cox J, Stetz J, Pajak T. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31(5): 1341–1346.
  55. Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. Department of Health and Human Services 2017.
  56. Lalla R, Bowen J, Barasch A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014; 120(10): 1453–1461.
  57. Elad S. The MASCC/ISOO Mucositis Guidelines 2019 Update: introduction to the first set of articles. Support Care Cancer. 2019; 27(10): 3929–3931.
  58. Analiza stanu klinicznego i zmian mikroflory jamy ustnej w przebiegu radioterapii chorych na raka narządów głowy i szyi jako podstawa opracowania algorytmu stomatologicznego leczenia wspomagającego. Wydawnictwo Uniwerytetu Jagiellońskiego, Kraków 2009.