Mucositis: current management and investigations

Oral and pharyngeal mucositis present significant management problems for patients undergoing radiation for head and neck cancers. The incidence and severity of these sequelae of radiation have increased with the use of altered fractionated schedules and concurrent chemotherapy. Directed therapies for the prevention of mucositis have yet to be established. Over the past several decades, therapies have been and continue to be designed that interfere with the causative factors of mucositis in an effort to diminish its incidence. These novel therapies protect normal mucosa either through direct radioprotection or manipulation of growth factors and cytokines that are involved in mucosal repopulation. Other therapies have tried to counter inflammation or infection with the belief that the insult from radiation is exacerbated by these normal response mechanisms to injury. It has become clear that the quality of life of patients and the economic costs of supportive therapies needed because of toxicities of cancer therapies are significant concerns. Research leading to a better understanding of the mechanisms of mucosal injury will ideally result in more specific, more targeted, and effective strategies for prevention of mucositis rather than current management algorithms that rely primarily on costly symptom management.