Radiation Mucositis Management

Basic Oral Care

The American Society of Clinical Oncology recommends implementing multidisciplinary oral care protocols that include frequent use of non-medicated saline mouth rinses (4-6 times/day) to reduce severity of oral mucositis 1, 2
Use a soft toothbrush that is replaced regularly as part of systematic oral care protocols 1, 3
Avoid alcohol-based mouth rinses as they can irritate damaged mucosa 2, 3
Regular oral pain assessment using validated instruments for self-reporting is essential for proper management 1, 2

Patient-controlled analgesia with morphine is recommended as the treatment of choice for severe oral mucositis pain, particularly in patients undergoing hematopoietic stem cell transplantation (HSCT) 1, 3
Topical anesthetics can provide short-term pain relief for oral mucositis on an empiric basis 1, 2
Follow the modified WHO analgesia ladder for symptomatic treatment 4

Use midline radiation blocks and three-dimensional radiation treatment techniques to reduce mucosal injury 1, 5, 6
Benzydamine oral rinse is recommended for prevention of radiation-induced mucositis in patients with head and neck cancer receiving moderate-dose radiation therapy 1, 5, 6
Low-level laser therapy (LLLT) is suggested to reduce incidence of oral mucositis and associated pain in patients receiving high-dose chemotherapy or chemoradiotherapy 7, 8

Chlorhexidine is not recommended for prevention or treatment of oral mucositis in patients with solid tumors of the head and neck who are undergoing radiotherapy 5, 6
Antimicrobial lozenges are not recommended for prevention of radiation-induced oral mucositis 1, 5
Sucralfate is not recommended for prevention of radiation-induced oral mucositis 5, 6

Screen all patients for nutritional risk due to high risk of malnutrition following chemoradiotherapy 1, 3
Initiate early enteral nutrition in case of swallowing problems 1, 2
Consider referral to a nutrition team for patients at risk of malnutrition 4

Oral cryotherapy (30 minutes) is recommended for prevention of oral mucositis in patients receiving bolus 5-FU chemotherapy 5, 6
Palifermin (keratinocyte growth factor-1) is recommended at a dose of 60 μg/kg/day for 3 days before conditioning treatment and for 3 days post-transplant for prevention of oral mucositis in patients with hematological malignancies receiving high-dose chemotherapy and total body irradiation with autologous stem cell transplant 7
Cryotherapy is suggested to prevent oral mucositis in patients receiving high-dose melphalan 7, 8

Exclude HSV, CMV, and extensive candidiasis in patients with persistent painful mucositis 4
For patients with radiation-induced proctitis who have rectal bleeding, sucralfate enemas are suggested 5, 7

Avoid chlorhexidine for treatment of established oral mucositis as it has been shown to be ineffective 7, 6