Oral mucositis severity in patient with head and neck cancer undergoing chemotherapy and/or radiotherapy

Dewi Oktafia Traktama; Irna Sufiawati

doi:10.22146/majkedgiind.33709

Oral mucositis severity in patient with head and neck cancer undergoing chemotherapy and/or radiotherapy

https://doi.org/10.22146/majkedgiind.33709

Dewi Oktafia Traktama⁽¹⁾, Irna Sufiawati^(2*)

(1) Program Pendidikan Dokter Gigi Spesialis Penyakit Mulut, Fakultas Kedokteran Gigi, Universitas Padjadjaran, Bandung, Jawa Barat
(2) Departemen Ilmu Penyakit Mulut, Fakultas Kedokteran Gigi, Universitas Padjadjaran Bandung, Jawa Barat
(*) Corresponding Author

Abstract

Oral mucositis is an inflammatory process and ulcerative of the oral mucosa due to chemotherapy and/or radiotherapy. The incidence and severity of oral mucositis might be influenced by a variety of risk factors, related to the host and treatment of the cancer. This aim of the case report is to evaluate risk factors that affect the severity of oral mucositis in two patients with nasopharyngeal cancer undergoing chemotherapy and/or radiotherapy. The first case, oral mucositis grade III and oral candidiasis to a 54-year old woman undergoing 16 times radiotherapy for nasopharyngeal cancer stage IV. The second case, oral mucositis grade I and oral candidiasis were found in a 55-year old man suffering from nasopharyngeal cancer stage IV who has been treated 10 times with chemotherapy and radiotherapy. Both patients had a similar age range and cancer stage. The differences of severity oral mucositis in both cases were suspected due to the host factors-related that are gender and nutritional status. In addition, intra-oral condition (poor oral hygiene, xerostomia), smoking habits and patient compliance may also affect the severity of oral mucositis in the second case. Treatment factors such as the type, dose and duration of chemotherapy t, might also affect the severity in both cases. Both patients were given chlorhexidine gluconate 0.2%, nystatin oral suspension, vitamin B12, and folic acid for treating oral mucositis. In conclusion, the understanding of risk factors oral mucositis is deemed necessary to control the severity and to provide an appropriate management to improve the quality of patients’ life.

Keywords

risk factors; chemotherapy; oral mucositis; radiotherapy

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References

1. Jham BC, Chen H, Carvalho AL, Freire AR. A randomized phase III prospective trial of bethanechol to prevent mucositis, candidiasis, and taste loss in patients with head and neck cancer undergoing radiotherapy: a secondary analysis. J Oral Sci. 2009; 51(4): 565 - 572.

2. Umameshwar M, Naidu R, Ramana GV, Rani PU, Mohan IK. Chemotherapy-Induced and/or Radiation Therapy – Induced Oral Mucositis — Complicating the Treatment of Cancer. 2004; 6(5): 423 - 431.

3. Khan M, Gupta N. Oral mucositis. European Journal Dentistry. 2013; 3(3): 405 - 411.

4. Alvariño-martín C. Prevention and treatment of oral mucositis in patients receiving chemotherapy. J Clin Exp Dent. 2014; 6(1): e74 - 80.

5. Cawley MM, Benson LM. Current trends in managing oral mucositis. Clin J Oncol Nurs. 2005; 9(5): 584 - 592.

6. Eilers J. Nursing interventions and supportive care for the prevention and treatment of oral mucositis associated with cancer treatment. Oncol Nurs Forum. 2004; 31(4 Suppl): 13 - 23.

7. Dodd MJ. The pathogenesis and characterization of oral mucositis associated with cancer therapy. Oncol Nurs Forum. 2004; 31(4 Suppl): 5 - 11.

8. Sufiawati I, Subita GP. Identifikasi dan pengendalian faktor risiko mukositis oral selama radioterapi kanker nasofaring. Indones J Dent. 2008; 15(40212): 155 – 162. Available from: http//www.fkg.ui.edu. Diunduh 6 Oktober 2016.

9. Lalla RV, Peterson DE. Management of oral mucositis in patients with cancer. Dent Clin North Am. 2008; 52(1): 61 - 65.

10. Hondt D. Oral mucositis induced by anticancer treatments : physiopathology and treatments. Ther Clin Risk Manag. 2006; 159 - 168.

11. Panghal M, Kaushal V, Kadayan S, Yadav JP. Incidence and risk factors for infection in oral cancer patients undergoing different treatments protocols. BMC Oral Health. 2012; 12(1): 22.

12. Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol [Internet]. 2003; 66(3): 253 - 262. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12742264

13. Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, McGuire DB, Migliorati C, Nicolatou-Galitis O, Peterson DE, Raber-Durlacher JE, Sonis ST, Elad S. MASCC = ISOO Clinical Practice Guidelines for the Management of Mucositis Secondary to Cancer Therapy. Cancer 2014;120(10):1453 - 1461.

14. Mallick S, Benson R, Rath GK. Radiation induced oral mucositis : a review of current literature on prevention and management. Eur Arch Oto-Rhino-Laryngology. 2016; 273(9): 2285-2293. doi: 10.1007/s00405–015–3694–6. Epub 2015.

15. Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Littlewood A, McCabe MG, Meyer S, Khalid T. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane database Syst Rev. 2011; 3(4): CD000978.

16. Epstein JB, Pearsall NN, Truelove EL. Quantitative relationships between Candida albicans in saliva and the clinical status of human subjects. J Clin Microbiol [Internet]. 1980; 12(3): 475 - 476. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7012183

17. Horizonte B, Micology C, Horizonte B, Hospital EDM, Horizonte B, Horizonte B. Incidence and anatomic localization of oral candidiasis in patients with aids hospitalized in a public hospital in belo horizonte. MG , Brazil. 2008; 16(4): 247250.

18. Gow NAR, Hube B. Importance of the Candida albicans cell wall during commensalism and infection. Curr Opin Microbiol. 2012; 15(4): 406 - 412.

19. De Freitas EM, Nobre SaM, De Oliveira Pires MB, Faria RVJ, Batista AUD, Bonan PRF. Oral Candida species in head and neck cancer patients treated by radiotherapy. Auris Nasus Larynx. 2013; 40(4): 400 - 404.

20. Sardi JCO, Scorzoni L, Bernardi T, Fusco-Almeida AM, Mendes GMJS. Candida species: Current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. J Med Microbiol. 2013; 62(Pt 1): 10 - 24.

21. Epstein JB, Thariat J, Bensadoun RJ, Barasch A, Murphy Ba, Kolnick L, Popplewell L, Maghami E. Oral complications of cancer and cancer therapy : from cancer treatment to survivorship. A Cancer J Clin. 2012; 62(6): 400 - 422.

22. Radoï L, Paget-Bailly S, Guida F, Cyr D, Menvielle G, Schmaus A, Carton M, Cénée S, Sanchez M, Guizard AV, Trétarre B, Stücker I, Luce D. Family history of cancer, personal history of medical conditions and risk of oral cavity cancer in France: the ICARE study. BMC Cancer. 2013; 13: 560.

23. Rosenthal DI, Trotti A. Strategies for managing radiation-induced mucositis in head and neck cancer. YSRAO. 19(1): 29 - 34.

24. Hancock PJ, Epstein JB, Frcd C, Sadler GR. Oral and dental management related to radiation therapy for head and neck cancer. J Can Dent Assoc. 2003; 69(9): 585 - 590.

25. Hejna M, Wenzel C, Zielinski CC. Oral mucositis complicating chemotherapy and/ or radiotherapy : options for prevention and treatment. Ca Cancer J Clin. 2001.

26. Balagopal S, Arjunkumar R. Chlorhexidine: The gold standard antiplaque agent. J Pharm Sci Res. 2013; 5(12): 270 - 274.

27. Cardona A, Balouch A, Abdul MM, Sedghizadeh PP, Enciso R. Efficacy of chlorhexidine for the prevention and treatment of oral mucositis in cancer patients: a systematic review with meta-analyses. J Oral Pathol Med. 2017; 46(9): 680 - 688.

28. Elad S, Thierer T. Cost-effective analysis of topical chlorhexidine in hematologic patients at risk for oral mucositis. Clin Oral Investig. 2015; 19(8): 1843 - 1850.

29. Koury MJ, Ponka P. New insights into erythropoiesis: The Roles of Folate, Vitamin B₁₂, and Iron. Annu Rev Nutr. 2004; 24(1): 105 - 131.

30. Collins CD, Cookinham S, Smith J. Management of oropharyngeal candidiasis with localized oral miconazole therapy: efficacy, safety, and patient acceptability. Patient Prefer Adherence. 2011; 5: 369 - 374.

DOI: https://doi.org/10.22146/majkedgiind.33709