Mucositis as a Complication of Radiation Therapy in Nasopharyngeal Carcinoma: A Systematic Review

Abstract

Objectives: 1) Review the current literature on mucositis in patients with nasopharyngeal carcinoma (NPC) treated with radiation therapy. 2) Describe the rate of mucositis, grade, mucositis sequelae, dose-limiting mucositis toxicity, and overall survival during radiation therapy for NPC. Methods: A systematic review of studies published regarding the treatment of NPC from 1990 to 2012 was conducted. A PubMed search for articles using the search terms “mucositis,” “radiation therapy,” and “nasopharyngeal carcinoma,” along with a review of the articles’ bibliographies was performed. Criteria for inclusion were clinical trials that reported radiation therapy as a treatment modality, and mucositis as a complication. Demographics, treatment type, treatment order, mucositis grade, percentage of mucositis sufferers, mucositis sequelae, dose-limiting mucositis toxicity, and overall survival rates were recorded. Results: A total of 50 journal articles were included representing 4621 patients. Radiation therapy only was used in 1942 patients, and some combination of radiation therapy and chemotherapy was seen in 2679 patients. Grade 1 or higher mucositis was reported in 3441 patients, and 1588 patients reported Grade 3 or higher mucositis. On average, 76.8% of patients treated for NPC developed some level of mucositis. Dose-limiting mucositis toxicity was reported in 95 patients. Alternate feeding methods due to mucositis (nasogastric tube placement or percutaneous endoscopic gastrostomy) were needed in 99 patients. Conclusions: This study is the first to examine mucositis as a complication of radiation therapy specifically for NPC. Mucositis is a serious complication in treatment of NPC, affecting the majority of patients and limiting their treatment.