Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Oral Mucositis


Introduction

  • ■

    Mucositis is defined as inflammation of the mucous membranes lining the alimentary tract, causing mucosal injury. Mucositis can occur in response to systemic chemotherapy or other etiologies (e.g., infection, radiation). Mucositis generally begins approximately 3 to 4 days following administration of chemotherapy. , Mucosal injury beyond the oropharynx is discussed in Chapter 6.

  • ■

    Initial stages of oral mucositis are generally mild, with notable soft tissue erythema and may be associated with burning or mucosal irritation. , Over the following 3 to 5 days, oral mucositis can progress into visible, painful, white desquamative patches advancing to shallow ulcerations due to epithelial sloughing and formation of large painful lesions; most frequently located on buccal tissue, floor of mouth, tongue and soft palate. The severity of oral mucositis ranges from mild to severe, depending on the chemotherapy regimen, and will generally continue for another 3 to 5 days before resolving. Patients receiving concurrent chemoradiotherapy regimens usually develop mucosal soreness by the end of the first week, with ulcerations appearing at the end of the second week. The mucosal ulcerations consolidate to form larger ulcers by the end of the third week and persist for approximately 2 to 4 weeks after completion of radiotherapy, with most ulcers spontaneously resolving without scarring. The more serious forms of oral mucositis are associated with dysphagia and reduced oral intake, and may provoke secondary infections or sepsis, especially in neutropenic patients. ,

Incidence of Oral Mucositis

  • ■

    Mucositis is one of the most common toxicities of chemotherapy, especially with combination radiation therapy to the mouth or oropharynx. However, the incidence of oral mucositis is generally underreported because toxicity scales are not consistent and oral mucositis is often only reported when considered severe. Table 5.1 describes the incidence of oral mucositis, Table 5.2 describes risk factors for the development of oral mucositis, and Table 5.3 describes the epidemiology of patients with oral mucositis. Notably, targeted therapies, discussed in detail in Part 2, are also complicit in the development of oral mucositis and may compound toxicity when chemotherapy is given in conjunction with radiotherapy.

    TABLE 5.1■
    Incidence of Oral Mucositis
    Clinically Significant Oral Mucositis in Solid Tumor Patients a Clinically Significant Oral Mucositis in Patients Receiving Chemoradiation and Radiation Therapy b
    WHO grade
    1: 40%
    2: 5%
    3, 4: 1%     		Mean incidence: 80%
    WHO, World Health Organization.

    a Prospective study of 298 patients. ,

    b Review of 33 studies involving 6000 patients. ,

    TABLE 5.2■
    Risk Factors Influencing the Frequency or Severity of Oral Mucositis , , , ,
    Patient related risk factors Age (young patients)
    Gender (female)
    Tumor type (hematological diseases)
    Oral health (poor oral hygiene, periodontal disease, dental caries)
    Smoking or alcohol use
    Nutritional status (malnutrition)
    Genetic susceptibility (may play a role)
    Kidney and liver function
    Chemotherapeutic agents Drugs that affect DNA synthesis
    High doses
    Route of administration
    Alkylating agents (cyclophosphamide, ifosfamide, bendamustine, melphalan)
    Anthracyclines (doxorubicin, daunorubicin)
    Antimetabolites (methotrexate, pralatrexate, 5-fluorouracil)
    Antitumor antibiotics (bleomycin, mitomycin)
    Purine analogues (cytarabine)
    Taxanes (paclitaxel, docetaxel)
    Topoisomerase inhibitors (irinotecan, topotecan, etoposide)
    Secretion into saliva (methotrexate, etoposide)
    Other risk factors Frequency of administration of chemotherapy
    Concomitant treatment with radiotherapy
    Radiation to head and neck
    Bone marrow transplantation

    TABLE 5.3■
    Epidemiology of Patients Developing Clinically Significant Oral Mucositis
    Treatment or Patient Characteristic Mucositis Risk
    Malignancies of the mouth, oropharynx, hypopharynx, larynx, nasopharynx, and salivary glands 70%
    Conditioning regimens of high dose melphalan or carmustine, etoposide, cytarabine, melphalan (BEAM) in multiple myeloma or non-Hodgkin's lymphoma 42%–46% (grades 3–4)
    Cyclophosphamide and etoposide 98% (grades 3–4)
    Doxorubicin, cyclophosphamide, paclitaxel, or docetaxel in breast cancer 20% (first cycle)
    70% (second cycle)
    Docetaxel and capecitabine in metastatic breast cancer 60% (grades 1–2)
    15% (grades 3–4)
    5-Fluorouacil (5-FU) based regimens in colorectal cancer 70% (all grades)
    15%–28% (grades 3–4)
    Pralatrexate 70% (all grades)
    21% (grades 3–4)
    Vinflunine for non–small-cell lung cancer 21% (all grades)

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts