Oral Mucositis

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. ^,

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.