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Oral toxicity associated with chemotherapy

Authors
Robert S Negrin, MD
Joseph A Toljanic, DDS
Section Editor
Reed E Drews, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Oral complications resulting from cancer and its therapy can cause both acute (mucositis, saliva changes, taste alterations, infection, bleeding) and late toxicities (mucosal atrophy, xerostomia) [1]. Disruptions in the function and/or integrity of the mucosal lining of the gastrointestinal (GI) tract are a particularly important problem in patients receiving chemotherapy and/or radiotherapy. Mucositis, which reflects a short-term, self-limited adverse effect of treatment, can affect the entire alimentary tract. The range of symptoms includes oral ulcerations, dysphagia and odynophagia, gastritis, diarrhea, and malabsorption. (See "Enterotoxicity of chemotherapeutic agents" and "Overview of gastrointestinal toxicity of radiation therapy".)

Mucositis is the principal manifestation of acute oral toxicity related to chemotherapy, while much less commonly, xerostomia (dry mouth) results. Among the other potential oral consequences of chemotherapy are infection of oral soft tissues, gingival bleeding, and alterations in taste; all of these complications can cause pain and impair nutrition.

Chemotherapy-associated acute oral toxicity will be reviewed here. Oral mucositis in the setting of high-dose chemotherapy and hematopoietic cell transplantation (HCT) is discussed in detail elsewhere, as are radiation-induced oral mucositis, osteonecrosis of the jaw related to use of antiresorptive therapy and angiogenesis inhibitors in patients with advanced cancer, and late oral toxicities in cancer survivors. (See "Management and prevention of complications during initial treatment of head and neck cancer" and "Management of the hematopoietic cell transplant recipient in the immediate post-transplant period", section on 'Mucositis and nutritional support' and "Management and prevention of complications during initial treatment of head and neck cancer", section on 'Mucositis' and "Oral health in cancer survivors" and "Medication-related osteonecrosis of the jaw in patients with cancer".)

MUCOSITIS

Oral mucositis affects on average 20 to 40 percent of patients receiving conventional-dose cytotoxic chemotherapy [2-4]. The frequency is higher (up to 80 percent) in those undergoing hematopoietic cell transplantation (HCT), particularly myeloablative allogeneic HCT, and in those who are prepared with radiation-containing regimens and with the use of methotrexate for graft-versus-host disease (GVHD) prophylaxis. An exception is in the setting of reduced-intensity or non-myeloablative allogeneic HCT, where mucositis is rare. (See "Management of the hematopoietic cell transplant recipient in the immediate post-transplant period", section on 'Mucositis and nutritional support'.)

Pathobiology — The pathobiology underlying damage to the oral mucosal barrier is complex, and a series of stages has been described, summarized as follows [2,3]:

                                     

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