Oral Mucositis in Head and Neck Cancer Patients

Oral mucositis (OM) is a common side effect of radiation therapy for head and neck cancer (HNC). Despite the medical advances in cancer therapy, OM is still virtually inevitable in patients being irradiated for neoplasms of the head and neck. The initial signs of oral mucositis typically manifest after cumulative doses between 15 and 20 Gy, with ulceration formation by 30 Gy and reaching peak severity in the week after radiation treatment completion (generally 60-72 Gy in management of HNC), then resolving over the 3-4 weeks following treatment completion. Severe oral mucositis (SOM), defined as WHO grade 3 and grade 4, occurs in 65-70% of patients receiving concurrent cisplatin and radiation therapy for locoregionally advanced HNC. WHO grade 3 or 4 oral mucositis leads to risk of systemic infection, severe pain, reduced oral intake which can lead to dehydration, significant weight loss and malnutrition, need for feeding tube placement and hospitalization. The clinical and economic impact, not to mention the impact on patient quality of life from oral mucositis has been well studied. As mucositis is commonly the dose-limiting factor leading to disruption or delay in cancer therapy, establishment of evidence-based guidelines has been paramount in supportive care management of these patients. Improvements in the prevention and treatment of oral mucositis remain essential to better patient outcomes. Here we review the current standard of care, recent successes and failures in development of therapies to mitigate OM, share patient and provider educational resources, and describe on-going and future directions of research in this area.