Prophylaxis and treatment of chemo- and radiotherapy-induced oral mucositis - are there new strategies?

Oral mucositis is a major dose-limiting toxic effect of intensive cancer ch emotherapy, Oral complications may lead to dose reduction or delay in furth er cancer treatment. Mucositis can be caused directly by cytotoxic effects and indirectly by sustained neutropenia after cytostatic therapy, An impair ed mucosal barrier predisposes to life-threatening septic complications dur ing aplasia, The prevalence of an oral focus in febrile neutropenia has bee n reported in up to 30% of cases and also reduces quality of life. The basi c strategies aim at pain relief and prevention of bacterial and fungal infe ctious complications. However, no effective causal prophylaxis or treatment of oral mucositis is widely accepted. The introduction of cytokines, eg gr anulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte col ony-stimulating factor (G-CSF) for oral mucositis may be particularly effec tive and offer a new and hopeful approach. At present, the optimal growth f actor, best schedule, effective dosage and best mode of application is not known.