Anderson Carryn, Saunders Deborah
Department of Radiation Oncology, University of Iowa Hospitals & Clinics, Iowa City, IA..
Department of Dental Oncology, North East Cancer Centre, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON.
Semin Radiat Oncol. 2025 Apr;35(2):271-277. doi: 10.1016/j.semradonc.2025.02.011.
Oral mucositis (OM) is a common side effect of radiation therapy for head and neck cancer (HNC). Despite the medical advances in cancer therapy, OM is still virtually inevitable in patients being irradiated for neoplasms of the head and neck. The initial signs of oral mucositis typically manifest after cumulative doses between 15 and 20 Gy, with ulceration formation by 30 Gy and reaching peak severity in the week after radiation treatment completion (generally 60-72 Gy in management of HNC), then resolving over the 3-4 weeks following treatment completion. Severe oral mucositis (SOM), defined as WHO grade 3 and grade 4, occurs in 65-70% of patients receiving concurrent cisplatin and radiation therapy for locoregionally advanced HNC. WHO grade 3 or 4 oral mucositis leads to risk of systemic infection, severe pain, reduced oral intake which can lead to dehydration, significant weight loss and malnutrition, need for feeding tube placement and hospitalization. The clinical and economic impact, not to mention the impact on patient quality of life from oral mucositis has been well studied. As mucositis is commonly the dose-limiting factor leading to disruption or delay in cancer therapy, establishment of evidence-based guidelines has been paramount in supportive care management of these patients. Improvements in the prevention and treatment of oral mucositis remain essential to better patient outcomes. Here we review the current standard of care, recent successes and failures in development of therapies to mitigate OM, share patient and provider educational resources, and describe on-going and future directions of research in this area.
口腔黏膜炎（OM）是头颈部癌（HNC）放射治疗的常见副作用。尽管癌症治疗取得了医学进展，但对于接受头颈部肿瘤放射治疗的患者来说，口腔黏膜炎实际上仍然不可避免。口腔黏膜炎的初始症状通常在累积剂量达到15至20 Gy后出现，30 Gy时形成溃疡，并在放疗结束后一周达到严重程度峰值（头颈部癌治疗中一般为60 - 72 Gy），然后在治疗结束后的3 - 4周内消退。严重口腔黏膜炎（SOM）定义为世界卫生组织（WHO）3级和4级，在接受顺铂和放疗联合治疗局部晚期头颈部癌的患者中发生率为65% - 70%。WHO 3级或4级口腔黏膜炎会导致全身感染风险、剧痛、口腔摄入量减少，进而可能导致脱水、显著体重减轻和营养不良，需要放置饲管并住院治疗。口腔黏膜炎对临床和经济的影响，更不用说对患者生活质量的影响，已经得到了充分研究。由于黏膜炎通常是导致癌症治疗中断或延迟的剂量限制因素，制定基于证据的指南对于这些患者的支持性护理管理至关重要。改善口腔黏膜炎的预防和治疗对于提高患者预后仍然至关重要。在此，我们回顾当前的护理标准、减轻口腔黏膜炎的治疗方法开发的近期成败、分享患者和医护人员的教育资源，并描述该领域正在进行的研究和未来方向。
