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Review
. 2023 Dec 19;32(1):38.
doi: 10.1007/s00520-023-08185-5.

Management of radiation-induced oral mucositis in head and neck cancer patients: a real-life survey among 25 Italian radiation oncology centers

Luca Bergamaschi  1 , Maria Giulia Vincini  2 , Mattia Zaffaroni  1 , Matteo Pepa  1 , Ilaria Angelicone  3 , Antonio Astone  4 , Cristiana Bergamini  5 , Sergio Buonopane  6 , Mario Conte  7 , Nicola De Rosa  8 , Chiara Deantoni  9 , Italo Dell'Oca  9 , Davide Di Gennaro  10 , Nadia Di Muzio  9 , Mattia Falchetto Osti  3 , Manuela Federico  11 , Gianluca Ferini  12 , Ciro Franzese  13   14 , Marco Gatti  15 , Antonietta Grillo  16 , Vincenzo Iorio  7 , Roberto Manzo  6 , Luca Marmiroli  17 , Giuseppe Martin  18 , Federica Mazzuca  3 , Maria Angela Molinaro  19 , Matteo Muto  20 , Roberto Pacelli  21 , Alfonsina Pepe  22 , Annarita Perillo  8   23 , Donatella Russo  24 , Francesca Salerno  25 , Pietro Spadaro  26 , Anna Viola  27 , Giuseppe Carlo Iorio  28 , Paolo Muto  6 , Umberto Ricardi  28 , Daniela Alterio  1
Affiliations
Review

Management of radiation-induced oral mucositis in head and neck cancer patients: a real-life survey among 25 Italian radiation oncology centers

Luca Bergamaschi et al. Support Care Cancer. .

Abstract

Aim: Radiation-induced oral mucositis (RIOM) is the most frequent side effect in head and neck cancer (HNC) patients treated with curative radiotherapy (RT). A standardized strategy for preventing and treating RIOM has not been defined. Aim of this study was to perform a real-life survey on RIOM management among Italian RT centers.

Methods: A 40-question survey was administered to 25 radiation oncologists working in 25 different RT centers across Italy.

Results: A total of 1554 HNC patients have been treated in the participating centers in 2021, the majority (median across the centers 91%) with curative intent. Median treatment time was 41 days, with a mean percentage of interruption due to toxicity of 14.5%. Eighty percent of responders provide written oral cavity hygiene recommendations. Regarding RIOM prevention, sodium bicarbonate mouthwashes, oral mucosa barrier agents, and hyaluronic acid-based mouthwashes were the most frequent topic agents used. Regarding RIOM treatment, 14 (56%) centers relied on literature evidence, while internal guidelines were available in 13 centers (44%). Grade (G)1 mucositis is mostly treated with sodium bicarbonate mouthwashes, oral mucosa barrier agents, and steroids, while hyaluronic acid-based agents, local anesthetics, and benzydamine were the most used in mucositis G2/G3. Steroids, painkillers, and anti-inflammatory drugs were the most frequent systemic agents used independently from the RIOM severity.

Conclusion: Great variety of strategies exist among Italian centers in RIOM management for HNC patients. Whether different strategies could impact patients' compliance and overall treatment time of the radiation course is still unclear and needs further investigation.

Keywords: Head and neck cancer; Radiation-induced oral mucositis; Real-life survey.

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Conflict of interest statement

The Division of Radiation Oncology of IEO received institutional grants from Accuray Inc. and Ion Beam Applications (IBA). Alterio D. received an uncoditional financial support by Medizioni srl for the current study.

Figures

Fig. 1
Fig. 1
Summary of the products and agents for the prevention of oral mucositis (left) and the percentage of centers in which they are indicated (right)*. Percentages are calculated on 23 centers that reported using prevention products
Fig. 2
Fig. 2
Topic agents for mucositis grades 1, 2, and 3
Fig. 3
Fig. 3
Systemic agents for mucositis grades 1, 2, and 3
Fig. 4
Fig. 4
Summary of the topical agents used for the treatment of radiation-induced oral mucositis
Fig. 5
Fig. 5
Summary of the systemic agents used for the treatment of radiation-induced oral mucositis
See this image and copyright information in PMC

References

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