查看文章

Oral mucositis is a common and debilitatingly painful side effect of many forms of chemotherapy and radiation therapy. The erythematous, atrophic, and ulcerative lesions that develop are a consequence of epithelial damage and death mediated through a complex series of molecular and cellular events. The consequences of mucositis are farreaching and include chemotherapy dose reductions, breaks in radiation treatment, cessation of cancer therapy, reliance on parenteral nutrition, administration of narcotics, hospitalization, and morbidity. In this review, the underlying molecular and cellular pathobiology of oral mucositis is characterized in five phases: initiation, the primary damage response, signaling and amplification, ulceration, and healing. The roles of reactive oxygen species, transduction and transcription pathways, signaling and functional mediators, and bacteria on the development and resolution of mucositis are described as a dynamic process in which epithelial stem cells are the targets. Insights into the mechanisms of oral mucositis are generating new approaches for effective, targeted treatment. almost all cases, ulceration is seen by 30 Gy (the end of the third week of treatment). Chemotherapy-induced mucositis typically begins 4 to 5 days following infusion and peaks about 5 days later. 7 The severe, intractable pain associated with mucositis is often of such severity that patients elect to take treatment breaks from radiation therapy or need dose de-escalation in cycled chemotherapy. In either case, the indirect consequence is that patients receive suboptimal cancer treatment. Mucositis is not only an important driver of patients …