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Nutritional Management of Cancer Treatment Effects pp 85–106Cite as

Oral Mucositis

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Abstract

Oral mucositis refers to erythematous and ulcerative lesions of the oral mucosa observed in patients with cancer being treated with chemotherapy and/or with radiation therapy to fields involving the oral cavity. Oral mucositis, the breakdown of the mucosal lining of the oropharynx, occurs as a result of a toxic insult to the normal epithelium of the oral mucosa. Mucositis is also defined as inflammatory lesions of the oral and/or gastrointestinal tract caused by high-dose cancer therapies. The gastrointestinal tract mucositis refers to the expression of mucosal injury across the continuum of oral and gastrointestinal mucosa, from the mouth to the anus.

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References

  1. Lalla RV, Brennan MT, Schubert MM (2011) Oral complications of cancer therapy. In: Yagiela JA, Dowd FJ, Johnson BS et al (eds) Pharmacology and therapeutics for dentistry, 6th edn. St. Louis, Mosby Elsevier, pp 782–798

    Google Scholar 

  2. Beaven AW, Shea TC (2007) Recombinant human keratinocyte growth factor palifermin reduces oral mucositis and improves patient outcomes after stem cell transplant. Drugs Today (Barc) 43(7):461–473

    Article  CAS  Google Scholar 

  3. Keefe DM, Peterson DE, Schubert MM (2006) Developing evidence-based guidelines for management of alimentary mucositis: process and pitfalls. Support Care Cancer 14(6):492–498, Epub 2006 Apr 7

    Article  PubMed  Google Scholar 

  4. Keefe DM (2006) Mucositis management in patients with cancer. Support Cancer Ther 3(3):154–157

    Article  PubMed  Google Scholar 

  5. Sonis ST (1998) Mucositis as a biological process: a new hypothesis for the development of chemotherapy-induced stomatotoxicity. Oral Oncol 34(1):39–43 [PUBMED Abstract]

    Article  PubMed  CAS  Google Scholar 

  6. Sonis ST, Elting LS, Keefe D et al (2004) Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 100(9 Suppl):1995–2025 [PUBMED Abstract]

    Article  PubMed  Google Scholar 

  7. Peterson DE, Bensadoun RJ, Lalla RV, McGuire DB (2011) Supportive care treatment guidelines: value, limitations, and opportunities. Semin Oncol 38(3):367–373

    Article  PubMed  Google Scholar 

  8. Epstein JB, Klasser GD (2006) Emerging approaches for prophylaxis and management of oropharyngeal mucositis in cancer therapy. Expert Opin Emerg Drugs 11(2):353–373

    Article  PubMed  CAS  Google Scholar 

  9. Trotti A, Bellm LA, Epstein JB et al (2003) Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 66(3):253–262

    Article  PubMed  Google Scholar 

  10. Silverman S Jr (2007) Diagnosis and management of oral mucositis. J Support Oncol 5(2 Suppl 1):13–21

    PubMed  CAS  Google Scholar 

  11. Vera-Llonch M, Oster G, Ford CM, Lu J, Sonis S (2007) Oral mucositis and outcomes of allogeneic hematopoietic stem-cell transplantation in patients with hematologic malignancies. Support Care Cancer 15(5):491–496

    Article  PubMed  Google Scholar 

  12. Wardley AM, Jayson GC, Swindell R, Morgenstern GR, Chang J, Bloor R, Fraser CJ, Scarffe JH (2000) Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haemopoietic progenitor rescue. Br J Haematol 110(2):292–299

    Article  PubMed  CAS  Google Scholar 

  13. Elting LS, Cooksley CD, Chambers MS, Garden AS (2007) Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys 15:68(4):1110–1120. Epub 2007 Mar 29

    Google Scholar 

  14. Rubenstein EB, Peterson DE, Schubert M, Keefe D, McGuire D, Epstein J, Elting LS, Fox PC, Cooksley C, Sonis ST, Mucositis Study Section of the Multinational Association for Supportive Care in Cancer; International Society for Oral Oncology (2004) Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 100(9 Suppl):2026–2046

    Article  PubMed  Google Scholar 

  15. Wojtaszek C (2000) Management of chemotherapy-induced stomatitis. Clin J Oncol Nurs 4(6):263–270

    PubMed  CAS  Google Scholar 

  16. Vera-Llonch M, Oster G, Hagiwara M, Sonis S (2006) Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer 106(2):329–336

    Article  PubMed  Google Scholar 

  17. Sonis ST (2009) Mucositis: the impact, biology and therapeutic opportunities of oral mucositis. Oral Oncol 45(12):1015–1020, Epub 2009 Oct 13. Review

    Article  PubMed  CAS  Google Scholar 

  18. Dodd MJ, Dibble SL, Miaskowski C, MacPhail L, Greenspan D, Paul SM, Shiba G, Larson P (2000) Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90(1):39–47

    Article  PubMed  CAS  Google Scholar 

  19. Raber-Durlacher JE, Weijl NI, Abu Saris M, de Koning B, Zwinderman AH, Osanto S (2000) Oral mucositis in patients treated with chemotherapy for solid tumors: a retrospective analysis of 150 cases. Support Care Cancer 8(5):366–371

    Article  PubMed  CAS  Google Scholar 

  20. Brown CG, Wingard J (2004) Clinical consequences of oral mucositis. Semin Oncol Nurs 20(1):16–21, Review

    Article  PubMed  Google Scholar 

  21. Kwong KK (2004) Prevention and treatment of oropharyngeal mucositis following cancer therapy: are there new approaches? Cancer Nurs 27(3):183–205, Review

    Article  PubMed  Google Scholar 

  22. Harris DJ (2006) Cancer treatment-induced mucositis pain: strategies for assessment and management. Ther Clin Risk Manag 2(3):251–258

    Article  PubMed  Google Scholar 

  23. Epstein JB, Schubert MM (2003) Oropharyngeal mucositis in cancer therapy. Review of pathogenesis, diagnosis, and management. Oncology (Williston Park) 17(12):1767–1779; discussion 1779–1782, 1791–1792. Review

    Google Scholar 

  24. Palazzi M, Tomatis S, Orlandi E, Guzzo M, Sangalli C, Potepan P, Fantini S, Bergamini C, Gavazzi C, Licitra L, Scaramellini G, Cantu’ G, Olmi P (2008) Effects of treatment intensification on acute local toxicity during radiotherapy for head and neck cancer: prospective observational study validating CTCAE, version 3.0, scoring system. Int J Radiat Oncol Biol Phys 70(2):330–337, Epub 2007 Sep 19

    Article  PubMed  Google Scholar 

  25. Turhal NS, Erdal S, Karacay S (2000) Efficacy of treatment to relieve mucositis-induced discomfort. Support Care Cancer 8(1):55–58

    PubMed  CAS  Google Scholar 

  26. Takahashi H, Sato M, Tsukada K, Tsuchiya S, Tanda S (2011) A retrospective study of oral adverse events with colorectal cancer chemotherapy using bevacizumab. Gan To Kagaku Ryoho 38(6):959–962

    PubMed  Google Scholar 

  27. Barasch A, Gordon S, Geist RY, Geist JR (2003) Necrotizing stomatitis: report of 3 Pseudomonas aeruginosa-positive patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96(2):136–140

    Article  PubMed  Google Scholar 

  28. Ezzeldin HH, Diasio RB (2008) Predicting fluorouracil toxicity: can we finally do it? J Clin Oncol 26(13):2080–2082 [PUBMED Abstract]

    Article  PubMed  Google Scholar 

  29. Schwab M, Zanger UM, Marx C et al (2008) Role of genetic and nongenetic factors for fluorouracil treatment-related severe toxicity: a prospective clinical trial by the German 5-FU Toxicity Study Group. J Clin Oncol 26(13):2131–2138 [PUBMED Abstract]

    Article  PubMed  CAS  Google Scholar 

  30. Werbrouck J, De Ruyck K, Duprez F et al (2009) Acute normal tissue reactions in head-and-neck cancer patients treated with IMRT: influence of dose and association with genetic polymorphisms in DNA DSB repair genes. Int J Radiat Oncol Biol Phys 73(4):1187–1195 [PUBMED Abstract]

    Article  PubMed  CAS  Google Scholar 

  31. Hahn T, Zhelnova E, Sucheston L et al (2010) A deletion polymorphism in glutathione-S-transferase mu (GSTM1) and/or theta (GSTT1) is associated with an increased risk of toxicity after autologous blood and marrow transplantation. Biol Blood Marrow Transplant 16(6):801–808 [PUBMED Abstract]

    Article  PubMed  CAS  Google Scholar 

  32. Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, Migliorati CA, McGuire DB, Hutchins RD, Peterson DE (2007) Mucositis Study Section of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109(5):820–831

    Article  PubMed  CAS  Google Scholar 

  33. Yamagata K, Arai C, Sasaki H, Takeuchi Y, Onizawa K, Yanagawa T, Ishibashi N, Karube R, Shinozuka K, Hasegawa Y, Chiba S, Bukawa H (2011) The effect of oral management on the severity of oral mucositis during hematopoietic SCT. Bone Marrow Transplant. doi:10.1038/bmt.2011.171 [Epub ahead of print]

    Google Scholar 

  34. Schubert MM, Williams BE, Lloid ME et al (1992) Clinical assessment scale for the rating of oral mucosal changes associated with bone marrow transplantation. Development of an oral mucositis index. Cancer 69(10):2469–2477 [PUBMED Abstract]

    Article  PubMed  CAS  Google Scholar 

  35. McGuire DB, Peterson DE, Muller S et al (2002) The 20 item oral mucositis index: reliability and validity in bone marrow and stem cell transplant patients. Cancer Invest 20(7–8):893–903 [PUBMED Abstract]

    Article  PubMed  Google Scholar 

  36. Schubert MM (2000) Oro-pharyngeal mucositis. In: Atkinson K (ed) Clinical bone marrow and blood stem cell transplantation, 2nd edn. Cambridge University Press, Cambridge, pp 812–820

    Google Scholar 

  37. Alterio D, Jereczek-Fossa BA, Fiore MR, Piperno G, Ansarin M, Orecchia R (2007) Cancer treatment-induced oral mucositis. Anticancer Res 27(2):1105–1125

    PubMed  CAS  Google Scholar 

  38. Sonis ST, Eilers JP, Epstein JB et al (1999) Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis Study Group. Cancer 85:2103–2113

    CAS  Google Scholar 

  39. von Bültzingslöwen I, Brennan MT, Spijkervet FK, Logan R, Stringer A, Raber-Durlacher JE, Keefe D (2006) Growth factors and cytokines in the prevention and treatment of oral and gastrointestinal mucositis. Support Care Cancer 14(6):519–527, Epub 2006 Apr 21

    Article  Google Scholar 

  40. Worthington HV, Clarkson JE, Eden OB (2011) Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev 19(2):CD000978, Cochrane Database Syst Rev 2007;(4):CD000978

    Google Scholar 

  41. Vuyyuri SB, Hamstra DA, Khanna D, Hamilton CA, Markwart SM, Campbell KC, Sunkara P, Ross BD, Rehemtulla A (2008) Evaluation of D-methionine as a novel oral radiation protector for prevention of mucositis. Clin Cancer Res 14(7):2161–2170

    Article  PubMed  CAS  Google Scholar 

  42. Toback FG, Walsh-Reitz MM, Musch MW, Chang EB, Del Valle J, Ren H, Huang E, Martin TE (2003) Peptide fragments of AMP-18, a novel secreted gastric antrum mucosal protein, are mitogenic and motogenic. Am J Physiol Gastrointest Liver Physiol 285(2):G344–G353

    PubMed  CAS  Google Scholar 

  43. Chen P, Lingen M, Sonis ST, Walsh-Reitz MM, Toback FG (2011) Role of AMP-18 in oral mucositis. Oral Oncol 47(9):831–839, Epub 2011 Jul 6

    Article  PubMed  CAS  Google Scholar 

  44. Del Fante C, Perotti C, Bonferoni MC, Rossi S, Sandri G, Ferrari F, Scudeller L, Caramella CM (2011) Platelet lysate mucoadhesive formulation to treat oral mucositis in graft versus host disease patients: a new therapeutic approach. AAPS PharmSciTech 12(3):893–899, Epub 2011 Jul 6

    Article  PubMed  Google Scholar 

  45. Watkins B, Pouliot K, Fey E, Tuthill C, Sonis S (2010) Attenuation of radiation- and chemoradiation-induced mucositis using gamma-D-glutamyl-L-tryptophan (SCV-07). Oral Dis 16(7):655–660

    Article  PubMed  CAS  Google Scholar 

  46. Azzoli CG, Patel JD, Krug LM, Miller V, James L, Kris MG, Ginsberg M, Subzwari S, Tyson L, Dunne M, May J, Huntington M, Saunders M, Sirotnak FM (2011) Pralatrexate with vitamin supplementation in patients with previously treated, advanced Non-small cell lung cancer: safety and efficacy in a phase 1 trial. J Thorac Oncol 6(11):1915–1922

    Article  PubMed  Google Scholar 

  47. No authors listed (2008) Oral mucositis due to cancer treatments. Orodental hygiene and ice cubes. Prescrire Int 17(93):33–35

    Google Scholar 

  48. Karagözoğlu S, Filiz Ulusoy M (2005) Chemotherapy: the effect of oral cryotherapy on the development of mucositis. J Clin Nurs 14(6):754–765

    Article  PubMed  Google Scholar 

  49. McDonnell AM, Lenz KL (2007) Palifermin: role in the prevention of chemotherapy- and radiation-induced mucositis. Ann Pharmacother 41(1):86–94, Epub 2006 Dec 26

    PubMed  CAS  Google Scholar 

  50. Gori E, Arpinati M, Bonifazi F, Errico A, Mega A, Alberani F, Sabbi V, Costazza G, Leanza S, Borrelli C, Berni M, Feraut C, Polato E, Altieri MC, Pirola E, Loddo MC, Banfi M, Barzetti L, Calza S, Brignoli C, Bandini G, De Vivo A, Bosi A, Baccarani M (2007) Cryotherapy in the prevention of oral mucositis in patients receiving low-dose methotrexate following myeloablative allogeneic stem cell transplantation: a prospective randomized study of the Gruppo Italiano Trapianto di Midollo Osseo nurses group. Bone Marrow Transplant 39(6):347–352, Epub 2007 Feb 5

    Article  PubMed  CAS  Google Scholar 

  51. Simões A, Eduardo FP, Luiz AC, Campos L, Sá PH, Cristófaro M, Marques MM, Eduardo CP (2009) Laser phototherapy as topical prophylaxis against head and neck cancer radiotherapy-induced oral mucositis: comparison between low and high/low power lasers. Lasers Surg Med 41(4):264–270

    Article  PubMed  Google Scholar 

  52. Simões A, de Campos L, de Souza DN, de Matos JA, Freitas PM, Nicolau J (2010) Laser phototherapy as topical prophylaxis against radiation-induced xerostomia. Photomed Laser Surg 28(3):357–363

    Article  PubMed  Google Scholar 

  53. Ruiz-Esquide G, Nervi B, Vargas A, Maíz A (2011) Treatment and prevention of cancer treatment related oral mucositis. Rev Med Chil 139(3):373–381, Epub 2011 Aug 25

    Article  PubMed  CAS  Google Scholar 

  54. Dodd MJ, Dibble SL, Miaskowski C, MacPhail L, Greenspan D, Paul SM, Shiba G, Larson P (2000) Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90(1):39–47

    Article  PubMed  CAS  Google Scholar 

  55. Yen SH, Wang LW, Lin YH, Jen YM, Chung YL (2011) Phenylbutyrate mouthwash mitigates oral mucositis during radiotherapy or chemoradiotherapy in patients with head and neck cancer. Int J Radiat Oncol Biol Phys

    Google Scholar 

  56. Potting CM, Uitterhoeve R, Op Reimer WS, Van Achterberg T (2006) The effectiveness of commonly used mouthwashes for the prevention of chemotherapy-induced oral mucositis: a systematic review. Eur J Cancer Care (Engl) 15(5):431–439

    Article  CAS  Google Scholar 

  57. Nashwan AJ (2011) Use of chlorhexidine mouthwash in children receiving chemotherapy: a review of literature. J Pediatr Oncol Nurs 28(5):295–299

    Article  PubMed  Google Scholar 

  58. Soares AF, Aquino AR, Carvalho CH, Nonaka CF, Almeida D, Pinto LP (2011) Frequency of oral mucositis and microbiological analysis in children with acute lymphoblastic leukemia treated with 0.12% chlorhexidine gluconate. Braz Dent J 22(4):312–316

    Article  PubMed  Google Scholar 

  59. Alterovitz G, Tuthill C, Rios I, Modelska K, Sonis S (2011) Personalized medicine for mucositis: Bayesian networks identify unique gene clusters which predict the response to gamma-d-glutamyl-l-tryptophan (SCV-07) for the attenuation of chemoradiation-induced oral mucositis. Oral Oncol 47(10):951–955

    Article  PubMed  CAS  Google Scholar 

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  1. University of South Florida, Heather Oak Place, 33647, Tampa, Florida, USA

    Nagi B. Kumar Ph.D

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Kumar, N.B. (2012). Oral Mucositis. In: Nutritional Management of Cancer Treatment Effects. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27233-2_5

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  • DOI: https://doi.org/10.1007/978-3-642-27233-2_5

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