Practice Guideline

. 2025 Jul 15;17(1):54.

doi: 10.1038/s41368-025-00382-8.

Expert consensus on the prevention and treatment of radiochemotherapy-induced oral mucositis

Juan Xia^#¹, Xiaoan Tao^#¹, Qinchao Hu^#¹, Wei Luo², Xiuzhen Tong³, Gang Zhou⁴, Hongmei Zhou⁵, Hong Hua⁶, Guoyao Tang⁷, Tong Wu¹, Qianming Chen^{5

8}, Yuan Fan⁹, Xiaobing Guan¹⁰, Hongwei Liu⁶, Chaosu Hu¹¹, Yongmei Zhou¹², Xuemin Shen¹², Lan Wu¹², Xin Zeng⁵, Qing Liu¹³, Renchuan Tao¹⁴, Yuan He¹⁵, Yang Cai¹⁶, Wenmei Wang¹⁷, Ying Zhang¹⁸, Yingfang Wu¹⁹, Minhai Nie²⁰, Xin Jin²¹, Xiufeng Wei²², Yongzhan Nie²³, Changqing Yuan²⁴, Bin Cheng²⁵

Affiliations

¹ Department of Oral Medicine, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
² Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
³ Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
⁴ Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
⁵ State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
⁶ Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, China.
⁷ Department of Stomatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁸ Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China.
⁹ Department of Oral Medicine, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.
¹⁰ Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
¹¹ Department of Radiation Oncology, Fudan University Shanghai Cancer Centre, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
¹² Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹³ The Third Affiliated Hospital of Air Force Medical University, Xi'an, China.
¹⁴ Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, China.
¹⁵ Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Oral Medicine, School of Stomatology, Tongji University, Shanghai, China.
¹⁶ Hospital and School of Stomatology, Guizhou Medical University, Guiyang, China.
¹⁷ Department of Oral Medicine, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
¹⁸ Department of Oral Emergency and Mucosal Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China.
¹⁹ Centre of Stomatology, Xiangya Hospital, Cental South University, Changsha, China.
²⁰ Department of Periodontics & Oral Mucosal Diseases, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou, China.
²¹ Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, Chongqing, China.
²² School of Stomatology, Jilin University, Changchun, China.
²³ State Key Laboratory of Cancer Biology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
²⁴ Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
²⁵ Department of Oral Medicine, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China. chengbin@mail.sysu.edu.cn.

^# Contributed equally.

PMID: 40664676
PMCID: PMC12264017
DOI: 10.1038/s41368-025-00382-8

Practice Guideline

Expert consensus on the prevention and treatment of radiochemotherapy-induced oral mucositis

Juan Xia et al. Int J Oral Sci. 2025.

. 2025 Jul 15;17(1):54.

doi: 10.1038/s41368-025-00382-8.

Authors

Affiliations

¹ Department of Oral Medicine, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
² Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
³ Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
⁴ Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
⁵ State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
⁶ Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, China.
⁷ Department of Stomatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁸ Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China.
⁹ Department of Oral Medicine, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.
¹⁰ Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
¹¹ Department of Radiation Oncology, Fudan University Shanghai Cancer Centre, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
¹² Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹³ The Third Affiliated Hospital of Air Force Medical University, Xi'an, China.
¹⁴ Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, China.
¹⁵ Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Oral Medicine, School of Stomatology, Tongji University, Shanghai, China.
¹⁶ Hospital and School of Stomatology, Guizhou Medical University, Guiyang, China.
¹⁷ Department of Oral Medicine, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
¹⁸ Department of Oral Emergency and Mucosal Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China.
¹⁹ Centre of Stomatology, Xiangya Hospital, Cental South University, Changsha, China.
²⁰ Department of Periodontics & Oral Mucosal Diseases, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou, China.
²¹ Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, College of Stomatology, Chongqing Medical University, Chongqing, China.
²² School of Stomatology, Jilin University, Changchun, China.
²³ State Key Laboratory of Cancer Biology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
²⁴ Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
²⁵ Department of Oral Medicine, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China. chengbin@mail.sysu.edu.cn.

^# Contributed equally.

PMID: 40664676
PMCID: PMC12264017
DOI: 10.1038/s41368-025-00382-8

Abstract

Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
Risk level assessment of radiochemotherapy-induced oral mucositis. Created using Figdraw

**Fig. 2**
Radiotherapy-induced oral mucositis. Female, 3 months after surgery and radiotherapy for the breast tumor. Painful oral erosions appeared during radiotherapy and persisted for a long time, accompanied by dry mouth. Large areas of congestion and scattered erosions were observed in the cheeks, with fine white lines around the cheeks. White lines with a few scales were observed on the lips. a Left cheek; b upper right cheek; c lower right cheek; d lips

**Fig. 3**
Chemotherapy-induced oral mucositis. Male, postoperative liver cancer and were taking chemotherapy drugs for 9 months, large erosions and ulcers were observed on both the cheeks and the back of the tongue, and thicker blood crusts were observed on the lower lip. a Left cheek; b right cheek; c dorsum of the tongue; d lips

**Fig. 4**
Criteria and Illustrations for the Clinical Grade of Oral Mucositis. WHO World Health Organization, RTOG Radiation Therapy Oncology Group, NCI National Cancer Institute, CTCAE Common Terminology Criteria for Adverse Events

**Fig. 5**
Guidelines for the clinical prevention and management of radiochemotherapy-induced oral mucositis

See this image and copyright information in PMC

References

1. Elad, S., Yarom, N., Zadik, Y., Kuten-Shorrer, M. & Sonis, S. T. The broadening scope of oral mucositis and oral ulcerative mucosal toxicities of anticancer therapies. Ca. Cancer J. Clin.72, 57–77 (2022). - PubMed
1. Sonis, S. T. Oral mucositis. Anticancer. Drugs22, 607–612 (2011). - PubMed
1. Sonis, S. T. et al. Oral Mucositis and the Clinical and Economic Outcomes of Hematopoietic Stem-Cell Transplantation. J. Clin. Oncol.19, 2201–2205 (2001). - PubMed
1. Rubenstein, E. B. et al. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer100, 2026–2046 (2004). - PubMed
1. Keefe, D. M. et al. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer109, 820–831 (2007). - PubMed

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Expert consensus on the prevention and treatment of radiochemotherapy-induced oral mucositis

Affiliations

Expert consensus on the prevention and treatment of radiochemotherapy-induced oral mucositis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources