Abstract
The current treatment for cervico-facial cancer involves radio and/or chemotherapy. Unfortunately, cancer therapies can lead to local and systemic complications such as mucositis, which is the most common dose-dependent complication in the oral cavity and gastrointestinal tract. Mucositis can cause a considerably reduced quality of life in cancer patients already suffering from physical and psychological exhaustion. However, the role of melatonin in the treatment of mucositis has recently been investigated, and offers an effective alternative therapy in the prevention and/or management of radio and/or chemotherapy-induced mucositis. This review focuses on the pathobiology and management of mucositis in order to improve the quality of cancer patients’ lives.
Highlights
Mucositis, one of the most severe toxic side effects of cancer therapy, can affect the entire gastrointestinal tract, with the oral cavity being the most common affected site
This is followed by the signaling and amplification phase, during which, once activated by chemotherapy and reactive oxygen species (ROS), NF-κB promotes the expression of multiple pro-inflammatory molecules, including inducible nitric oxide synthase, cyclooxygenase-2 (COX-2), TNF-α, and pro-IL-1β, and ensures feedback amplification of the NF-κB-dependent signaling pathway [10]
NLRP3 inflammasome assembly leads to caspase-1 activation and subsequent cleavage of pro-cytokines such as pro-IL-1β, pro-IL-18, and pro-IL-33 into their mature form [11,12] resulting in ulceration
Summary
One of the most severe toxic side effects of cancer therapy, can affect the entire gastrointestinal tract, with the oral cavity being the most common affected site. It presents in virtually all head and neck cancer patients receiving chemo and/or radiotherapy, in 60–85% of those receiving myeloablative therapy for stem-cell transplantation, and in 20–40% of patients receiving conventional chemotherapy [1,2,3]. Mucositis lesions may represent a gateway for opportunistic infections, can complicate cancer treatment, and extend hospitalization [5,6]. Given its dose-limiting toxicity for both chemo and radiotherapy, mucositis can have a direct impact on survival rates [7]
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