Abstract
Mucositis is a common complication of chemotherapy, radiotherapy and targeted agents. It often affects compliance to anticancer therapies as it frequently causes schedule delays, interruptions or discontinuations of treatment. Moreover, the economic impact related to the management of mucositis is topical and several estimations of additional hospital costs due to this clinical condition have been recently reported. The ability to determine risk factors for mucositis, to early detect its onset, to assess correctly the degree of this toxicity and to plan its multidisciplinary management are all key elements to guarantee the quality of life of patients and to avoid useless dose reduction or interruption of treatment. The pathogenesis of mucositis is multifactorial and it is classily subdivided into oral and gastrointestinal mucositis according to its anatomic presentation. Treatment and patients’ related factors might help in predicting the frequency and the potential degree of symptoms onset. Here we discuss about clinical presentation and pathogenesis of mucositis in relation to different kinds of treatments. Moreover, we focus on therapeutic and prevention strategies, describing past and present management according to international guidelines and the most promising new data about agents potentially able to further improve the treatment of mucositis in the next future.
Highlights
Mucositis is a common and clinically significant side effect of both anticancer chemotherapy (CT) and radiation therapy (RT) that can affect any portion of the gastrointestinal (GI) tract
Mucositis has been described by its anatomical distribution: oral mucositis (OM) for involvement of the tissues of the upper aerodigestive tract, gastrointestinal mucositis (GIM) for lesions dominantly in the small intestine, and proctitis for injury of the rectal mucosa
NCT01707641 (ClinicalTrials. gov, 2016c) is an ongoing trial evaluating the preventive effect of Lactobacillus on RT-CT-induced OM in HN cancer patients, while NCT02819960 trial is investigating the role of probiotics in preventing irinotecan-induced diarrhea (Mego et al, 2015)
Summary
Mucositis is a common and clinically significant side effect of both anticancer chemotherapy (CT) and radiation therapy (RT) that can affect any portion of the gastrointestinal (GI) tract. It is associated with an adverse symptom profile, and it may limit patients’ ability to tolerate treatment if not adequately prevented and managed. It may be associated with secondary local and systemic infection and poor health outcomes, and generates additional use of healthcare resources resulting in additional costs (Villa and Sonis, 2015). The incidence and course of mucositis is site-dependent and related to the cancer treatment regimen
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