Mucositis Oral: Actualización en el Diagnóstico, Prevención y Tratamiento

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Abstract

RESUMEN: La mucositis oral (MO) es la reacción secundaria aguda más frecuente en la cavidad oral y tracto gastrointestinal en pacientes oncológicos sometidos a quimioterapia o radioterapia de cabeza y cuello que incide negativamente en la calidad de vida del paciente. Su tratamiento requiere de un manejo multidisciplinario con el objetivo de minimizar la incidencia y severidad de esta patología. El desconocimiento parcial respecto de su etiopatogenia imposibilita la realización de protocolos para el manejo de esta complicación. Si bien existe evidencia científica respecto a las alternativas de prevención y tratamiento, éstas dependen de la evaluación individual que haga el clínico con cada paciente. A continuación, se presenta una revisión bibliográfica actualizada de la literatura científica publicada y se discuten aquellos aspectos más relevantes en torno a la prevención y tratamiento de la mucositis oral.

Translated abstract

ABSTRACT: Oral mucositis (OM) is the most common acute secondary reaction in the oral cavity and gastrointestinal tract in cancer patients undergoing chemotherapy or radiotherapy to the head and neck, which adversely affects the patient's quality of life even at the risk of death. This requires multidisciplinary knowledge and management in order to minimize the incidence and severity of this pathology. The partial lack of knowledge regarding its etiopathogenesis makes it impossible to establish standardized guidelines for the management of this complication. Although there is scientific evidence regarding prevention and treatment alternatives, these depend on the individual evaluation of each patient and the clinical scenario in which they are presented. An updated review of the published scientific literature is presented below and those aspects most relevant to the prevention and treatment of oral mucositis are discussed.

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Most cited references 25

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A systematic review with meta-analysis of the effect of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis.

Rodrigo A P Martins, Lucio Frigo, Kjersti Gjerde … (2011)

The purpose of this study is to review the effects of low-level laser therapy (LLLT) in the prevention and treatment of cancer therapy-induced oral mucositis (OM). A systematic review and meta-analysis of randomised placebo-controlled trials of LLLT performed during chemotherapy or radiation therapy in head and neck cancer patients. We found 11 randomised placebo-controlled trials with a total of 415 patients; methodological quality was acceptable at 4.10 (SD ± 0.74) on the 5-point Jadad scale. The relative risk (RR) for developing OM was significantly (p = 0.02) reduced after LLLT compared with placebo LLLT (RR = 2.03 (95% CI, 1.11 to 3.69)). This preventive effect of LLLT improved to RR = 2.72 (95% CI, 1.98 to 3.74) when only trials with adequate doses above 1 J were included. For treatment of OM ulcers, the number of days with OM grade 2 or worse was significantly reduced after LLLT to 4.38 (95% CI, 3.35 to 5.40) days less than placebo LLLT. Oral mucositis severity was also reduced after LLLT with a standardised mean difference of 1.33 (95% CI, 0.68 to 1.98) over placebo LLLT. All studies registered possible side-effects, but they were not significantly different from placebo LLLT. There is consistent evidence from small high-quality studies that red and infrared LLLT can partly prevent development of cancer therapy-induced OM. LLLT also significantly reduced pain, severity and duration of symptoms in patients with cancer therapy-induced OM.

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Radiation induced oral mucositis: a review of current literature on prevention and management.

Supriya Mallick, Rony Benson, G K Rath (2016)

Oral mucositis (OM) is a major limiting acute side effect of radiotherapy for head and neck cancer. The spectrum of problems associated with mucositis includes oral pain, odynophagia, reduced oral intake, and secondary infections. Incidence of mucositis is increased with addition of concurrent chemotherapy as well as altered fractionation schedules. This leads to treatment interruption and suboptimal disease control. Hence, prevention as well as timely management of OM is necessary for optimum tumor control. We reviewed the English literature with key words "Radiation induced mucositis, Mucositis, Oral Mucositis" to find relevant articles describing incidence, pathophysiology, prophylaxis, and treatment of oral mucositis. Prevention and treatment of OM is an active area of research. Maintenance of oral hygiene is an important part in prevention of OM. A battery of agents including normal saline and alkali (soda bicarbonate) mouth washes, low level laser therapy, and benzydamine (non-steroidal analgesic and anti-inflammatory) have effectiveness in the prevention and treatment of radiation induced oral mucositis. Chlorhexidine mouth gargles are recommended for prevention of chemotherapy induced oral mucositis but is not recommended for radiotherapy associated mucositis. Treatment of co-existing infection is also important and both topical (povidone iodine) and systemic anti fungals should be used judiciously. Radiation induced oral mucositis is a common problem limiting the efficacy of radiation by increasing treatment breaks. Adequate prophylaxis and treatment may limit the severity of radiation mucositis and improve compliance to radiation which may translate in better disease control and survival.

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A prospective, randomized study of cryotherapy during administration of high-dose melphalan to decrease the severity and duration of oral mucositis in patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation.

T Gooley, Fernanda Garcia, W Bensinger … (2006)

Forty patients with multiple myeloma scheduled to receive melphalan 200 mg/m(2) followed by autologous stem cell transplantation were randomly assigned to receive oral cryotherapy or room temperature normal saline rinses 30 min before and for 6 h after high-dose therapy. Patients were evaluated for the development of mucositis using the National Cancer Institute grading system as well as evaluation of secondary measures such as days of total parenteral nutrition (TPN), narcotic use, hospitalization, weight loss and resumption of oral caloric intake for 28 days after transplant. Patients self-scored their pain, swallowing, drinking, eating, sleeping and taste alterations for 28 days. The primary end point of this trial was the incidence of grades 3-4 mucositis. Compared to the normal saline group, patients using cryotherapy experienced less grade 3-4 mucositis, 14 vs 74%, P=0.0005. Patients receiving cryotherapy also had statistically lower uses of narcotics and TPN, although there were no differences in length of hospitalization or weight loss. Patient-reported pain was significantly lower and activities were significantly better in the cryotherapy group.