Pharmacological modulation of radiation-induced oral mucosal complications

Cancer Radiother. 2018 Sep;22(5):429-437. doi: 10.1016/j.canrad.2017.11.006. Epub 2018 May 26.

Abstract

Radiation-induced mucositis is a common toxicity, especially in patients with head and neck cancers. Despite recent technological advances in radiation therapy, such as intensity-modulated radiotherapy, radiation-induced mucositis is still causing treatment disruptions, negatively affecting patients' long and short term quality of life, and impacting medical resources use with economic consequences. The objective of this article was to review the latest updates in the management of radiation-induced mucositis, with a focus on pharmaceutical strategies for the prevention or treatment of mucositis. Although numerous studies analysing the prevention and management of oral radiation-induced mucositis have been conducted, there are still few reliable data to guide daily clinical practice. Furthermore, most of the tested drugs have shown no (anti-inflammatory cytokine, growth factors) or limited (palifermin) effect. Therapies for acute oral mucositis are predominantly focused on improving oral hygiene and providing symptoms control. Although low-level laser therapy proved efficient in preventing radiation-induced oral mucositis in patients with head and neck cancer, this intervention requires equipment and trained medical staff, and is therefore insufficiently developed in clinical routine. New effective pharmacological agents able to prevent or reverse radio-induced mucositis are required.

Keywords: Clinical management; Mucite orale; Oral mucositis; Radiotherapy; Radiothérapie; Soins de support; Supportive care; Traitement médical.

Publication types

  • Review

MeSH terms

  • Amifostine / therapeutic use
  • Analgesics / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Benzydamine / therapeutic use
  • Dietary Supplements
  • Fibroblast Growth Factor 7 / therapeutic use
  • Glutamine / therapeutic use
  • Humans
  • Low-Level Light Therapy
  • Mouthwashes
  • Mucositis / etiology*
  • Mucositis / therapy*
  • Oral Hygiene
  • Radiation-Protective Agents / therapeutic use
  • Radiotherapy / adverse effects*
  • Risk Factors
  • Zinc / therapeutic use

Substances

  • Analgesics
  • Anti-Inflammatory Agents
  • Mouthwashes
  • Radiation-Protective Agents
  • Glutamine
  • Fibroblast Growth Factor 7
  • Benzydamine
  • Zinc
  • Amifostine