Prevention and treatment of chemotherapy- and radiotherapy-induced oral mucositis: a review

Oral mucositis is a distressing toxic effect of systemic chemotherapy with many commonly utilized drugs and of head and neck irradiation in patients w ith cancer. The agents and methods that have been used and studied in chemo therapy- and radiotherapy-induced oral mucositis, their mechanisms of actio n, and the current knowledge of their efficiency to reduce the incidence, s everity or shorten the duration of oral mucositis are reviewed in this arti cle. Oral cooling is a cheap and available method to lower the severity of bolus 5-fluorouracil-induced oral mucositis. However, more effective method s are needed. Results of studies with granulocyte-macrophage colony-stimula ting factor or granulocyte colony-stimulating factor are promising. Lasers are partly beneficial, but equipment-demanding. Modification of the chemoth erapy regimen resulting in shortening of the exposition time to chemotherap y agents or chronomodulation of chemotherapy has been shown to lower mucosa l toxicity of some regimens. Results of animal studies with locally applied transforming growth factor beta 3 and interleukin-11 are also promising. B ased on the findings of the role of the inflammatory cascade in the respons e of normal tissues to chemotherapy and radiotherapy, anti-inflammatory dru gs might be beneficial. At the present time, no agent has been shown to be uniformly efficacious and can be accepted as standard therapy of chemothera py- and radiotherapy-induced oral mucositis. Further intensive research is needed. (C) 1999 Elsevier Science Ltd. All rights reserved.