Management of radiation-induced oral mucositis in head and neck cancer patients: a real-life survey among 25 Italian radiation oncology centers
Luca Bergamaschi, Maria Giulia Vincini, Mattia Zaffaroni, Matteo Pepa, Ilaria Angelicone, Antonio Astone, Cristiana Bergamini, Sergio Buonopane, Mario Conte, Nicola De Rosa, Chiara Lucrezia Deantoni, I. Dell’Oca, Davide Di Gennaro, N. Di Muzio, Mattia Falchetto Osti, Manuela Federico, Gianluca Ferini, Ciro Franzese, Marco Gatti, A. Grillo, Vincenzo Iorio, Roberto Manzo, L Marmiroli, Giuseppe Martin, Federica Mazzuca, Maria Angela Molinaro, Matteo Muto, Roberto Pacelli, A. Pepe, Annarita Perillo, Donatella Russo, Francesca Salerno, P. Spadaro, Anna Viola, Giuseppe Carlo Iorio, Paolo Muto, Umberto Ricardi, Daniela Alterio
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.