Klin Onkol 2007; 20(1): 23-28.
Summary
Oral and gastrointestinal mucositis represent clinically significant damage of both mucosa and submucosa caused by chemotherapy or radiotherapy. Pathophysiology of mucositis is complex and complicated and several stages of the process can be recognized. Oral mucositis impairs therapy schedule in thousands of oncology patients every year. It can be accompanied by oral discomfort or pain usually lasting several days, accompanied by reduced oral intake and higher risk of infectious complications. The severity and extent of mucosal damage varies from slight edema and redness to defects often covered by pseudomembrane. No international consensus has been generally set out and accepted to evaluate severity of mucositis, however, the WHO scoring is one of the most frequently used. Similarly, no general consensus and confidence exist in recognition of factors leading to individually worse course of this complication in patients treated with the same kind of chemotherapy. Most observations are either controversial or unconfirmed. Recently, only a minimum of interventions such as cryotherapy or He-Ne laser, and only in some specific situations, are able to significantly reduce the incidence of this complication. Palifermin, representing the large group of keratinocyte growth factors (KGF), also significantly reduced the occurrence and duration of oral mucositis and pain in the phase III trial in patients after autologous stem cell transplantation (total body irradiation + etoposide + cyclophosphamide conditioning regimen). Apart from the fact that various oral solutions and rinses, including antimicrobial ones, may help to keep good oral hygiene and treat local infections, their effect on mucositis reduction is dubious. For the future, it is very important to carry on learning the pathophysiology of this complication, try to define individual risk factors, and look for new interventions.
