Chapter 43 • Mucositis, a major dose-limiting toxic effect of chemotherapy for solid tumors, develops in 5% to 40% of patients. • Mucositis develops in 70% to 100% of patients who receive high doses of chemotherapy with bone marrow rescue. • Mucositis is the most troublesome acute reaction for patients undergoing radiation therapy directed at the oral cavity. • Radiation therapy directed at the oral cavity frequently causes a host of other oral complications including xerostomia, dental caries, tissue necrosis, and taste alterations. • Oxidative stress caused by cytotoxic chemotherapy and radiation therapy leads to upregulation and subsequently amplification of multiple inflammatory pathways in a complex process. This subsequently leads to mucosal ulceration. • Secondary infections occur as a result of treatment-induced immunosuppression. • The importance of instituting oral hygiene protocols in patients receiving chemotherapy is well established. • Cryotherapy is the most conventional and easy to use preventative method, at least for 5-fluorouracil–based bolus therapy, and it appears to have implications for other chemotherapeutic regimens as well, such as edatrexate and high-dose melphalan therapy. • Keratinocyte growth factor has been approved by the Food and Drug Administration for use with high-dose chemotherapeutic regimens associated with high rates of mucositis and has shown promise in other settings as well. • Low-level laser therapy has shown promise, but its use is limited for now to centers that are able to support its use. • Pretreatment dental care, good oral hygiene, and sophisticated treatment planning is recommended for patients receiving radiation therapy. • Overall, evidence is lacking regarding the efficacy of various agents in promoting healing of the oral mucosa after mucositis is established. • Systemic analgesic therapy of mucositis pain with narcotic medications is well established and recommended. • Antibiotics and/or antifungal medications should be given to patients with evidence of infection. • In the palliative setting, various mouthwashes are widely used in clinical practice based on provider preference and experience. These mouthwashes most frequently contain combinations of diphenhydramine, viscous lidocaine, magnesium hydroxide/aluminum hydroxide, nystatin, and corticosteroids. The efficacy of these measures has not been adequately evaluated to date.
Oral Complications
Summary of Key Points
Incidence
Etiology of Complications
Prophylactic Measures
Treatment
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Oral Complications
