Oral radiation mucositis is one of the debilitating and dose-limiting acute toxicity during (chemo) radiation or for HNC having a major impact on the patient daily functioning, well-being and quality of life. The unplanned interruption of treatment secondary to mucositis may compromise the treatment and the outcomes if not adequately addressed. Recently, the integrated pathophysiological mechanism of radiation injury has been proposed, aiding development of certain targeted therapies for the prevention and treatment of oral mucositis. Although there are currently no approved agents or strategies that can reliably prevent or treat oral mucositis, there are several agents are under investigation and development. This is an exciting juncture in the development of drugs and drug delivery agents for radiation oral mucositis. This review is to have a peep into currently available options at present to optimally know when these agents can be used and what should be the direction of future research to maximize the therapeutic benefit.
Radiotherapy and concurrent chemotherapy: A strategy that improves locoregional control and survival in oropharyngeal cancer. J Natl Cancer Inst 1999;91:2065-66.
Toxicity in head and neck cancer: A review of trends and issues. Int J Radiat Oncol Biol Phys 2000;47:1-12.
Scoring oral mucositis. Oral Oncol 1998;34:63-71.
Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: A systematic literature review. Radiotherapy Oncology 2003;66(3):253-62.
Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer 15 Jan; 2006;106(2):329-36.
Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head and neck malignancies. Int J Radiat Oncol Biol Phys 2007;28;200-09.
Research controversies in management of oral mucositis. Support Care Cancer 2000;8:68-71.
Prevention of mucositis in cancer patients. J Natl Cancer Inst Monogr 2001;29:1-2.
Modifications of the microflora of the oral cavity arising during immunosuppressive chemotherapy. Oral Oncol 1996;32: 306-10.
Stratergies for managing radiation induced mucositis in head and neck cancers. Sem in Rad oncol 2009:19;29-34.
New strategies in the treatment and prophylaxis of chemo- and radiotherapy-induced oral mucositis. Antibiot Chemother 200;50:115-32.
Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol 2006;24:2636-43.
The MD anderson symptom inventory–head and neck module, a patientreported outcome instrument, accurately predicts the severity of radiation-induced mucositis. Int J Radiat Oncol Biol Phys 2008;21:21-35.
Preliminary investigation of symptom distress in the head and neck patient population: Validation of a measurement instrument. Am J Clin Oncol 2006;29:158-62.
Topical application of honey in the management of radiation mucositis: A preliminary study. Support Care Cancer 2003;11:242-48.
Scoring oral mucositis. Oral Oncol 1998;34:63-71.
Implications of treatment-induced mucosal barrier injury. Curr Opin Oncol 2005;17:605-10.
The pathobiology of mucositis. Nat Rev Cancer 2004;4:277-84.
Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis Study Group. Cancer 1999;85(10):2103-13.
Mucositis as a biological process: A new hypothesis for the development of chemotherapy-induced stomatotoxicity. Oral Oncol 1998;34:39-43.
Gene expression changes in peripheral blood cells provide insight into the biological mechanisms associated with regimen-related toxicities in patients being treated for head and neck cancers. Oral Oncol Mar 2007; 43(3):289-300.
Nuclear factor- kappaB (NF-kappaB) and cyclooxygenase-2 (COX-2) expression in the oral mucosa following cancer chemotherapy. Oral Oncol Apr 2007;43(4):395-401.
Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 2007;109:820-31.
NCCN task force report. Prevention and management of mucositis in cancer care. J Natl Compr Canc Netw 2008;6:S1-21.
Interventions for treating oral mucositis for patients with cancer receiving treatment. Cochrane database of systematic reviews 2010, Issue 8. Art. No.: CD001973. DOI: 10.1002/ 14651858.CD001973.pub4.
Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane database of systematic reviews 2007, Issue 4. Art. No.: CD000978. DOI: 10.1002/14651858. CD000978. pub3.
Comparing pain control and ability to eat and drink with standard therapy vs Gelclair: A preliminary, double centre, randomised controlled trial on patients with radiotherapy-induced oral mucositis. Supportive Care in Cancer 2007;15(4):427-40.
Radiation-induced mucositis: A randomized clinical trial of micronized sucralfate versus salt and soda mouthwashes. Cancer Invest 2003;21(1): 21-33.
Sucralfate mouthwash for prevention and treatment of 5-fluorouracilinduced mucositis: A randomized, placebo-controlled trial. Support Care Cancer Jan 2003;11(1):41-47.
Patient-controlled versus staff-controlled analgesia with pethidine after allogeneic bone marrow transplantation. Pain 1998; 75(2-3):305-12.
Randomized clinical trial of the effectiveness of three commonly used mouthwashes to treat chemotherapy- induced mucositis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 2000;90(1):39-47.
Efficacy of chlorhexidine and nystatin rinses in prevention of oral complications in leukemia and bone marrow transplantation. Oral Surg Oral Med Oral Pathol 1992;73(6):682-89.
Effect of fluconazole antifungal prophylaxis on oral mucositis in head and neck cancer patients receiving radiotherapy. Support Care Cancer Jan 2006;14(1):44-51.
Antimicrobials, mucosal coating agents, anesthetics, analgesics, and nutritional supplements for alimentary tract mucositis. Support Care Cancer Jun 2006;14(6):528-32.
Acyclovir prophylaxis against herpes simplex virus infection in patients with leukemia. A randomized, double-blind, placebo-controlled study. Ann Intern Med Dec 1983;99(6):773-76.
Acyclovir prophylaxis of herpes-simplex virus infections. N Engl J Med 9 Jul 1981;305(2):63-67.
A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation. Support Care Cancer 2007; 15:1145-54.
Benzydamine HCl for prophylaxis of radiationinduced oral mucositis: Results from a multicenter, randomized, double-blind, placebocontrolled clinical trial. Cancer 2001;92(4):875-85.
A pilot study of the effect of granulocyte-macrophage colony-stimulating factor on oral mucositis in head and neck cancer patients during X-radiation therapy: A preliminary report. Int J Radiat Oncol Biol Phys 1998;42:551-56.
Low-power laser in the prevention of induced oral mucositis in bone marrow transplantation patients: A randomized trial. Blood 2007;109:2250-55.
A phase III randomized double-blind placebo-controlled clinical trial to determine the efficacy of low level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation. Support Care Cancer 2007;1145-54.