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Home » Long Term Weight Loss » No Silver Bullet for Radiotherapy-Associated Oral Mucositis or Lock Jaw in Head and Neck Cancer – Oncology Nurse Advisor

Head and neckcancers and their treatment can cause painful and functionally significantacute and long-term oropharyngeal impairments, including oral mucositis andimpaired tongue function, swallowing and jaw opening (trismus, or lock jaw).1,2Acute radiation mucositis involves scarring of the mucosal lining of the mouth,throat, and gastrointestinal tract. Radiation-induced trismus (RIT) is a lateside effect of treatment that results from scarring and contraction of jawmuscles, resulting in a patients limited ability to open their mouths; onsettypically occurs between 9 and 12 months after radiotherapy is completed and overtime, both musculature and mandibular joints degenerate.2

Unfortunately,researchers have yet to identify a definitive preventive strategy or cure foreither condition. Treatment remains largely palliative, centering around painmanagement and avoiding malnutrition.

Oral mucositis (OM)is common in patients undergoing systemic chemotherapy, affecting up to 40% ofpatients, and is ubiquitous in patients undergoing head and neck external-beamradiotherapy.3 OM involves progressive and increasingly painfuldamage to the oral cavity, pharyngeal, nasopharyngeal, laryngeal, salivarygland and/or hypopharyngeal tissues.1 Worsening mucosal inflammationand, frequently, ulceration, often begin to appear after the first 10 Gy (1 to2 weeks, depending on fractionation schedule) of external-beam radiotherapy.1Tongue, palate and gum ulcerations can proliferate and merge by the time acumulative radiation dose of 30 Gy has been delivered to oropharyngeal targetvolumes (typically, week 3 of radiotherapy).1 Both OM and RITrepresent management challenges and appear to be related to one-another; acuteOM severity is believed to be associated with the risk of RIT.2

Both RIT and OM areprogressive and can degrade a patients and survivors nutritional status andquality of life. OM is a dose-limiting toxicity of both chemotherapy andradiotherapy and can lead to dose reductions and treatment interruptions, whichin turn can affect treatment efficacy.1 Symptoms include pain,dehydration, anorexia and weight loss, dysphagia, and infection risk.1Patients with RIT experience difficulty eating, drinking, speaking, andmaintaining oral hygiene (eg, tooth brushing), which can lead to malnutritionand social isolation.2 In contrast to RIT, which is a late adverseevent for many patients undergoing head and neck radiotherapy, OM can sometimesbegin to heal up to 4 weeks after radiotherapy is completed.1

Because of thetreatment challenges of OM and RIT, much research effort has focused onidentifying effective strategies for preventing these conditions and thepalliative management of symptoms (for example, morphine-based analgesia).1,3

Not surprisingly,the most effective prevention strategy for OM involves minimizing thenontarget, healthy oral tissues that are included in high-dose radiationfields.1

Oral hygiene mayalso be important.1,3 The Multinational Association of SupportiveCare in Cancer and International Society of Oral Oncology (MASCC/ISOO) havepromulgated clinical guidelines for preventing and managing OM that suggested,based on limited available evidence, flossing and tooth brushing withsoft-bristled toothbrushes, and mouth rinsing with saline or sodium bicarbonatewashes.1,3 In clinical practice, patients are usually advised toundergo dental corrections ahead of radiotherapy and to observe vigilant oralhygiene practices.1

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No Silver Bullet for Radiotherapy-Associated Oral Mucositis or Lock Jaw in Head and Neck Cancer - Oncology Nurse Advisor

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Home » Long Term Weight Loss » No Silver Bullet for Radiotherapy-Associated Oral Mucositis or Lock Jaw in Head and Neck Cancer – Oncology Nurse Advisor