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Chemotherapy- and radiotherapy-induced mucositis

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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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 Multinational Association of Supportive Care in Cancer (MASCC/ISOO 2020; 2014), and the Infectious Diseases Society of America (IDSA 2011).
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Guidelines

1.Medical management

Management of oral mucositis, morphine, ISOO/MASCC: 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 (sucralfate)

  • Management of oral mucositis (antibiotics)

  • Management of enteritis (octreotide)

  • Management of enteritis (sucralfate)

  • Management of proctitis (sucralfate enemas)

  • Management of proctitis (hyperbaric oxygen therapy)

2.Preventative measures

Prevention of oral mucositis, general principles: 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)