Head and neck radiation and mucositis

Abstract

We will review the recent literature that has provided new insights into the pathogenesis, metrics and therapeutics of mucositis. Radiation techniques include conformal therapy and intensity modulated therapy that attempt to minimize dose to normal tissues while still delivering high doses to tumor targets. Drugs used to prevent or treat mucositis typically fall into three classes: antimicrobials, growth factors and radioprotectors. To date, drugs in all three categories have had little success in preventing radiation-induced mucositis, but palifermin, a keratinocyte growth factor, and RK-0202, a topical radioprotector, hold promise and are under investigation. Treatment of patients with head and neck cancers often requires multimodality therapy, and radiotherapy is often a critical component of this approach. Unfortunately, the dose intense regimens required to treat patients often results in mucositis. While this treatment sequela has long been recognized, only recently have researchers clearly identified its incidence and developed metrics to quantify mucositis and its resultant symptoms. Efforts to minimize mucositis have involved both advances in radiation physics, and the development of pharmacologic agents to prevent or treat mucositis. While no drug to date has shown significant efficacy in reducing the incidence of radiation-induced mucositis for head and neck cancer patients, several agents are currently being tested and hold promise.