Oral mucositis is a common and debilitating complication of cancer treatment caused by the disruption of rapidly dividing epithelial progenitor cells.
Mucositis can occur anywhere along the gastrointestinal tract, but oral mucositis refers to painful inflammation and ulceration which occurs in the mucous membranes of the mouth.
The consequences of mucositis can be far-reaching and include administration of opioids, morbidity, and hospitalization.
- Up to 100% of patients receiving Head and Neck radiotherapy.1,2
- Up to 100% of patients undergoing high-dose chemotherapy with hematopoietic stem cell transplantation.3,4
- 30-75% of patients receiving chemotherapy.
The severity and duration of Oral Mucositis in patients treated with chemotherapy depend upon the antineoplastic agents, treatment combinations, dosages and number of cycles:
- Lesions are seen mostly on the movable mucosae of the buccal mucosae and lateral and ventral surfaces of the tongue. The hard palate and gingiva appear not susceptible to CT-induced mucositis.
- The early clinical sign of mucositis is erythema, presenting about 4-5 days following CT infusion; 7 to 10 days after CT, ulcers develop, often requiring opioid intervention.
- CT-induced mucositis lasts approximately 1 week and generally heals spontaneously by 21 days after infusion.
Oral Mucositis will develop in nearly all patients receiving radiation therapy for head and neck cancer, and in most patients undergoing total body irradiation therapy.
Mucositis severity and duration in patients treated with RT depend upon radioactive source, cumulative dosage, dose intensity and volume of the irradiated mucosa:
- Inflammation appears at week 1-2 and can persist for 4-6 weeks.
- The most acute period is generally at the end of RT (4 weeks’ treatment).
- Nearly all patients will experience mucositis during RT (head and neck cancer).
- 88% of patients may experience grades III or IV mucositis with particularly aggressive therapy.
- Epstein, Schubert. Oncology 2003; 17:1767-82;
- Peterson et al. Ann Oncol 2009; 20(supp4):174-7;
- Sonis. J Support Oncol 2004; 2(6 suppl 3):3-8;
- Silverman. J Support Oncol 2007; 2(2 Suppl 1):13-21
Both patient and treatment-related factors are associated with increased risk of oral mucositis.
The presence and severity of oral mucositis may be determined by clinician-based scoring or by patient-reported outcomes.
There are three major reasons to assess mucositis severity:
- to determine the stomatotoxicity of a particular cancer-treatment regimen
- to help in the management of the patient
- to evaluate the efficacy of a potential mucositis intervention.
World Health Organization
The World Health Organization has developed a grading system for mucositis based on clinical appearance and functional status.
The WHO scale is dependent on both objective and subjective variables, and measures anatomical, symptomatic and functional components of oral mucositis.
WHO Oral Mucositis Grading Scale
|I (mild)||Oral soreness, erythema|
|II (moderate)||Oral erythema, ulcers, solid diet tolerated|
|III (severe)||Oral ulcers, liquid diet only|
|IV (life-threatening)||Oral alimentation impossible|
- WHO: http://www.who.int/en/