Strategies for managing radiation-induced mucositis in head and neck cancer.
Radiation-induced mucositis (RIM) is a common toxicity for head and neck cancer (HNC) patients. The frequency has increased because of the use of more intensive altered radiation fractionation and concurrent chemotherapy regimens. The extent of the injury is directly related to the mucosal volume irradiated, anatomic subsite exposed, treatment intensity, and individual patient predisposition. The consequences of mucositis include pain, dysphagia including feeding tube dependency, dehydration, micronutrient deficiencies, weight loss, and potentially life-threatening aspiration. Currently, there is no Food and Drug Administration-approved cytoprotective agent that reliably prevents RIM for HNC, but several are under investigation. Strategies to limit the extent of mucositis and to manage its symptoms include basic oral care and supportive medications. Limiting the use of aggressive treatments to truly high-risk cancers and special attention to radiation therapy planning techniques can also help restrict the scope of the problem. This review focuses on mucositis recognition, patient treatment selection, and RIM symptom-management strategies.
Rosenthal
David I
DI
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. dirosenthal@mdanderson.org
Trotti
Andrea
A
D000111:Acetylcysteine / Q000627:therapeutic use; D004999:Amifostine / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D005973:Glutamine / Q000627:therapeutic use; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use; D028022:Low-Level Light Therapy; D009067:Mouthwashes; D009910:Oral Hygiene; D059408:Pain Management; D012307:Risk Factors; D013280:Stomatitis / Q000209:etiology* / Q000628:therapy*
D036341:Intercellular Signaling Peptides and Proteins; D009067:Mouthwashes; D005973:Glutamine; D004999:Amifostine; D000111:Acetylcysteine