ORAL MUCOSITIS INDUCED BY RADIATION/CHEMOTHERAPY; CHALLENGES IN THERAPEUTIC IMPLICATIONS AND FUTURE PROSPECTS
DOI:
https://doi.org/10.22159/ajpcr.2025v18i3.53766Keywords:
Mucosal inflammation, Cancer treatment toxicity, Keratinocyte growth factor, Low-level laser therapy, Treatment-related morbidity, Oral epithelial damageAbstract
Oral mucositis (OM) is a common and debilitating side effect of cancer treatments, primarily chemotherapy and radiotherapy. Inflammation of the oral mucosa leads to various severe outcomes, which affect the quality of life in patients. Sometimes, inhibition of treatment may be necessary, which may lead to insubstantial evasion of cancer therapy. The review article discusses current prevention and management techniques, such as oral hygiene protocols, cryotherapy, low-level laser therapy, and pharmacological interventions, including palifermin. It also comments on the risk factors that include the type of cancer, treatment protocols, and patient-related factors. It finally speaks about the clinical and economic impact of OM in the treatment of cancer and healthcare systems.
Downloads
References
Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AY, Arcelus JI, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2020 Feb 10;38(5):496-520. doi: 10.1200/JCO.19.01461, PMID 31381464
Kimura T, Takeda A, Tsurugai Y. In Reply to Li et al. Int J Radiat Oncol Biol Phys. 2021 Jun 1;110(2):616-7. doi: 10.1016/j.ijrobp.2020.12.054, PMID 33989585
Schiodt M, Otto S, Fedele S, Bedogni A, Nicolatou-Galitis O, Guggenberger R, et al. Workshop of European task force on medication-related osteonecrosis of the jaw-Current challenges. Oral Dis. 2019;25(7):1815-21. doi: 10.1111/odi.13160, PMID 31325201
Sonis ST. The pathobiology of mucositis. Nat Rev Cancer. 2004 Apr;4(4):277-84. doi: 10.1038/nrc1318, PMID 15057287
Klastersky JA. Supportive care in cancer: Quo vadis. Curr Opin Oncol. 2018 Jul 1;30(4):203-4. doi: 10.1097/CCO.0000000000000457, PMID 29794810
Lu X, Wang Z, Huang H, Wang H. Hedgehog signaling promotes multidrug resistance by regulation of ABC transporters in oral squamous cell carcinoma. J Oral Pathol Med. 2020 Oct;49(9):897-906. doi: 10.1111/jop.13050, PMID 32512620
Elad S, Cheng KK, Lalla RV, Yarom N, Hong C, Logan RM, et al. MASCC/ ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020 Oct 1;126(19):4423-31. doi: 10.1002/cncr.33100, PMID 32786044
Touchefeu Y, Montassier E, Nieman K, Gastinne T, Potel G, Bruley des Varannes S, et al. Systematic review: the role of the gut microbiota in chemotherapy- or radiation-induced gastrointestinal mucositis - current evidence and potential clinical applications. Aliment Pharmacol Ther. 2014 Sep;40(5):409-21. doi: 10.1111/apt.12878. PMID 25040088
Rémy B, Mion S, Plener L, Elias M, Chabrière E, Daudé D. Interference in bacterial quorum sensing: A biopharmaceutical perspective. Front Pharmacol. 2018 Mar 7;9:203. doi: 10.3389/fphar.2018.00203, PMID 29563876
De Sanctis V, Bossi P, Sanguineti G, Trippa F, Ferrari D, Bacigalupo A, et al. Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus statements. Crit Rev Oncol Hematol. 2016 Apr;100:147-66. doi: 10.1016/j.critrevonc.2016.01.010 PMID 26947812
de Farias Gabriel A, Silveira FM, Curra M, Schuch LF, Wagner VP, Martins MA, et al. Risk factors associated with the development of oral mucositis in pediatric oncology patients: Systematic review and meta-analysis. Oral Dis. 2022 May;28(4):1068-84. doi: 10.1111/odi.13863 PMID 33774891
Elsehrawy MG, Ibrahim NM, Eltahry SI, Elgazzar SE. Impact of educational guidelines on oral mucositis severity and quality of life in oncology patients receiving chemotherapy: A quasi-experimental study. Asian Pac J Cancer Prev. 2024 Jul 1;25(7):2427-38. doi: 10.31557/ APJCP.2024.25.7.2427, PMID 39068577, PMCID PMC11480610
Gupta T, Ghosh-Laskar S, Agarwal JP. Resource-sparing curative-intent hypofractionated-accelerated radiotherapy in head and neck cancer: More relevant than ever before in the COVID era. Oral Oncol. 2020 Dec 1;111:105045. doi: 10.1016/j.oraloncology.2020.105045, PMID 33091846
Wang HM, Jabbour SK, Lai YC. Oral mucositis in cancer patients: Mechanisms, prevention, and treatment. J Clin Oncol. 2021;39(6):663- 74. doi: 10.1200/JCO.2020.38.6
Eilers J, Epstein JB. Assessment and measurement of oral mucositis. Semin Oncol Nurs. 2004 Feb;20(1):22-9. doi: 10.1053/j. soncn.2003.10.005, PMID 15038514
Chen XJ, He MJ, Zhou G. All‐trans retinoic acid induces anti‐tumor effects via STAT3 signaling inhibition in oral squamous cell carcinoma and oral dysplasia. J Oral Pathol Med. 2019 Oct;48(9):832-9. doi: 10.1111/jop.12931, PMID 31323146
Tolaney SM, Wardley AM, Zambelli S, Hilton JF, Troso-Sandoval TA, Ricci F, et al. Abemaciclib plus trastuzumab with or without fulvestrant versus trastuzumab plus standard-of-care chemotherapy in women with hormone receptor-positive, HER2-positive advanced breast cancer (monarcHER): A randomised, open-label, phase 2 trial. Lancet Oncol. 2020 Jun 1;21(6):763-75. doi: 10.1016/S1470-2045(20)30112-1, PMID 32353342
Hong MH, Heo SG, Lee YG, Kim HS, Park KU, Kim HG, et al. Phase 2 study of afatinib among patients with recurrent and/or metastatic esophageal squamous cell carcinoma. Cancer. 2020 Oct 15;126(20):4521-31. doi: 10.1002/cncr.33123
Gourley C, Miller RE, Hollis RL, Ledermann JA. Role of poly (ADP-ribose) polymerase inhibitors beyond BReast CAncer Gene-mutated ovarian tumours: definition of homologous recombination deficiency? Curr Opin Oncol. 2020 Sep 1;32(5):442-50. doi: 10.1097/ CCO.0000000000000660, PMID 32796232
Brower JV, Blitzer GC, Vapiwala N, Harari PM. Declining medical student interest in radiation oncology: Wake-up call with a silver lining? Int J Radiat Oncol Biol Phys. 2021 Jun 1;110(2):274-7. doi: 10.1016/j. ijrobp.2021.02.035, PMID 33716119
Mantyh PW. Bone cancer pain: from mechanism to therapy. Curr Opin Support Palliat Care. 2014 Jun 1;8(2):83-90. doi: 10.1097/ SPC.0000000000000048, PMID 24792411
Sun HB, Park CM, Elo JA. Rapidly expanding mixed lesion of the maxilla in a 17-month-old boy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Mar 1;127(3):195-9. doi: 10.1016/j.oooo.2018.02.002, PMID 29571655
Tiwari L, Balasubramaniam R. Patterns of orofacial pain practice amongst oral medicine specialists in Australia. J Oral Pathol Med. 2020 Jul;49(6):590-4. doi: 10.1111/jop.13053, PMID 32516859
Spielberger R, Chow L, Lee H. Keratinocyte growth factor and its role in preventing chemotherapy-induced oral mucositis. Support Care Cancer. 2021;29(2):623-30. doi: 10.1007/s00520-020-05812-w
Sun HB, Park CM, Elo JA. Rapidly expanding mixed lesion of the maxilla in a 17-month-old boy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Mar 1;127(3):195-9. doi: 10.1016/j.oooo.2018.02.002, PMID 29571655
Elad S, Cheng KK, Lalla RV, Yarom N, Hong C, Logan RM, et al. MASCC/ ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020 Oct 1;126(19):4423-31. doi: 10.1002/cncr.33100, PMID 32786044
Elting LS, Shih YC, Shiraishi Y, Stiff PJ, Botteman MF. Patient factors associated with risk of developing oral mucositis during cancer treatment: A systematic review. Support Care Cancer. 2020;29(4):1963-73. doi: 10.1007/s00520-020-05612-4
Lalla RV, Saunders DP, Peterson DE. Chemotherapy or radiation-induced oral mucositis. Clinical approaches to oral mucosal disorders: Part II. Dent Clin North Am. 2014 Apr 28;58(2):341-9.
Hong MH, Heo SG, Lee YG, Kim HS, Park KU, Kim HG, et al. Phase 2 study of afatinib among patients with recurrent and/or metastatic esophageal squamous cell carcinoma. Cancer. 2020 Oct 15;126(20):4521-31. doi: 10.1002/cncr.33123
Brower JV, Blitzer GC, Vapiwala N, Harari PM. Declining medical student interest in radiation oncology: Wake-up call with a silver lining? Int J Radiat Oncol Biol Phys. 2021 Jun 1;110(2):274-7. doi: 10.1016/j. ijrobp.2021.02.035, PMID 33716119
Mantyh PW. Bone cancer pain: From mechanism to therapy. Curr Opin Support Palliat Care. 2014 Jun 1;8(2):83-90. doi: 10.1097/ SPC.0000000000000048, PMID 24792411
Sun HB, Park CM, Elo JA. Rapidly expanding mixed lesion of the maxilla in a 17-month-old boy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Mar 1;127(3):195-9. doi: 10.1016/j.oooo.2018.02.002, PMID 29571655
Xu Q, Wang C, Li B, Kim K, Li J, Mao M, et al. The impact of age on oral squamous cell carcinoma: A longitudinal cohort study of 2,782 patients. Oral Dis. 2019 Apr;25(3):730-41. doi: 10.1111/ odi.13015, PMID 30548550
Xie J, Zhang X, Song S. Role of the gut microbiota and its metabolites in chemotherapy-induced oral mucositis. Cancer Manag Res. 2020;12:1377-85. doi: 10.2147/CMAR.S242539
Wang G, Jia L. Herb medicine for relieving radiation induced oral mucositis: a systematic review and meta-analysis protocol. Medicine. 2019 Dec 1;98(50):e18337. doi: 10.1097/MD.0000000000018337, PMID 31852129
El-Feky GS, Zayed GM. PLGA nanoparticles loaded mucoadhesive and thermosensitive hydrogel as a potential platform for the treatment of oral mucositis. Int J Appl Pharm. 2019;11(1):106. doi: 10.22159/ ijap.2019v11i1.2946
Published
How to Cite
Issue
Section
Copyright (c) 2025 pradeep js

This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.