Radiotherapy Mucositis

What are mucositis?

Mucositis are described as an inflammation and ulceration of the mucosal membrane of the oral cavity and throat. It can represent a serious and common side effect during radiotherapy and chemotherapy treatments, which hinder the reproductive capacity of basal epithelial cells.

This condition can limit the normal nutritional intake and lead to the discontinue or abandon of the cycle of therapy, compromising patient’s quality of life.

RISK FACTORS

The main risk factors are
Age, with an increase in the younger (<20 years) and elderly (> 65 years) population
Sex, the highest risk is for women
Poor diet, pre-existing oral problems (including drug-related xerostomia and infections caused by myelosuppressive diseases or treatments), excessive consumption of tobacco or alcohol
Type of tumor
Genetic factors
Poor oral hygiene
Oral mucositis compromises the functionality of patients, with an impact on the Quality of Life proportional to the severity of the disease.

According to the most recent pathogenetic theories, oral mucositis is described as a dynamic process developed through 5 stages

Start: RT and TC

• Directly damage DNA and cause strand breaks with consequent clonogenic death of basal epithelial cells;
•Generate reactive oxygen species (ROS) within cells, which lead to complex interacting biological events and consequent mucosal lesions

Damage response:

• Biological events initiated by RT, CT and ROS require the activation of transcription factors (NFκB) and the release of proinflammatory cytokines (IL and TNF-α)
• These in turn trigger pathways that damage surrounding epithelial cells and fibroblasts, leading to tissue injury and apoptosis

Amplification

Ulceration

• The ulcer develops as a consequence of the direct and indirect mechanisms of tissue damage and cell death
•The ulcers are:
- deep and painful, extending from the epithelium to the submucosa, with exposure of the neuronal endings
- rapidly colonized by oral bacteria, which actively contribute to the mucositis process, further stimulating the secretion of proinflammatory cytokines

Healing

RT e TC:

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STEP #1 - Start: RT and TC

• Directly damage DNA and cause strand breaks with consequent clonogenic death of basal epithelial cells;
• Generate reactive oxygen species (ROS) within cells, which lead to complex interacting biological events and consequent mucosal lesions

STEP #2 - Damage response

• Biological events initiated by RT, CT and ROS require the activation of transcription factors (NFκB) and the release of proinflammatory cytokines (IL and TNF-α)
• These in turn trigger pathways that damage surrounding epithelial cells and fibroblasts, leading to tissue injury and apoptosis

STEP #3 – Amplification

STEP #4 - Ulceration

• The ulcer develops as a consequence of the direct and indirect mechanisms of tissue damage and cell death
• The ulcers are:
– deep and painful, extending from the epithelium to the submucosa, with exposure of the neuronal endings
– rapidly colonized by oral bacteria, which actively contribute to the mucositis process, further stimulating the secretion of proinflammatory cytokines

STEP #5 – Healing

Step #1

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Step #2

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Step #3

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Step #4

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Although no complex physiological process can be compartmentalized, this step-by-step approach provides a channel for understanding the events underlying the oral mucositis sequence2

MAIN SYMPTOMS

Among the main symptoms there are:
Burning and itching
Dry mouth and cracked lips
Difficulty swallowing
Pain, redness and swelling
Sores and bleeding
White patches

CONSEQUENCES

IMPACT ON THE QoL

Mucositis severity and duration in patients treated with CT depend on antineoplastic agents, treatment, combinations, dosages and number of cycles

Lesions are seen mostly on the movable mucosae of the buccal mucosae and lateral and ventral surfaces of the tongue. The hard palate and gingiva appear not susceptible to CT-induced mucositis

The early clinical sign of mucositis is erythema, presenting about 4-5 days following CT infusion; 7 to 10 days after CT, ulcers develop, often requiring opioid intervention

CT-induced mucositis last approximately 1 week and generally heals spontaneously by 21 days after infusion

Neutropenia caused by high dose CT, can predispose the bacteraemia, septicaemia and fungaemia, which may even be life threatening.

OUR PROPOSAL

Jalosome Oral Barrier is a medical device indicated for the treatment of painful symptoms of oral mucositis. It offers a pain-relieving action thanks to its strong mucoadhesive properties that form a protective barrier on the oral mucosa.

The protective film defends the mucosa from external insults, promoting wound healing by keeping the environment hydrated and lubricated

Active Ingredients

HOW TO USE

Wash the hands carefully

Squeeze all the gel contained in the stickpack inside the mouth, uniformly impregnate all the oral cavity

Expel any excess

Do not drink or eat at least for 30 minutes after

TIPS FOR A PROPER ORAL HYGIENE

Use a soft toothbrush or swab after meals and before sleep

Clean the dentition and gingiva with mild fluoride-containing, non-foaming toothpaste

Drink ample amount of fluids to keep the mouth moist

Rinse the toothbrush thoroughly after use with water and store it in a cup head facing upward

Radiotherapy Mucositis

Don't lose your smile during the treatment

DON'T LOSE YOUR SMILE DURING THE TREATMENT

What are mucositis?

OF PATIENTS UNDERGOING
RADIOTHERAPY DIAGNOSED
WITH HEAD AND NECK CANCER

MUCOSITIS OF THE ORAL CAVITY AFFECT ABOUT

OF PATIENTS UNDERGOING
HIGH-DOSE CHEMOTHERAPY
WITH STEM CELL TRANSPLANTATION

UP TO

OF PATIENTS UNDERGOING
CHEMOTHERAPY

RISK FACTORS

Start: RT and TC

Damage response:

Amplification

Ulceration

Healing

RT e TC:

MAIN SYMPTOMS

CONSEQUENCES

Ache

Difficulty in eating

Burning

Difficulty speaking

IMPACT ON THE QoL

OUR PROPOSAL

Active Ingredients

HYALURONIC ACID

ALOE VERA GEL (20% ACEMANNAN)

PANTHENOL

ALTHAEA PHYTOCOMPLEX

HOW TO USE

TIPS FOR A PROPER ORAL HYGIENE

Radiotherapy Mucositis

Don't lose your smile during the treatment

DON'T LOSE YOUR SMILE DURING THE TREATMENT

What are mucositis?

OF PATIENTS UNDERGOING RADIOTHERAPY DIAGNOSED WITH HEAD AND NECK CANCER

MUCOSITIS OF THE ORAL CAVITY AFFECT ABOUT

OF PATIENTS UNDERGOING HIGH-DOSE CHEMOTHERAPY WITH STEM CELL TRANSPLANTATION

UP TO

OF PATIENTS UNDERGOING CHEMOTHERAPY

RISK FACTORS

Start: RT and TC

Damage response:

Amplification

Ulceration

Healing

RT e TC:

MAIN SYMPTOMS

CONSEQUENCES

Ache

Difficulty in eating

Burning

Difficulty speaking

IMPACT ON THE QoL

OUR PROPOSAL

Active Ingredients

HYALURONIC ACID

ALOE VERA GEL (20% ACEMANNAN)

PANTHENOL

ALTHAEA PHYTOCOMPLEX

HOW TO USE

TIPS FOR A PROPER ORAL HYGIENE

OF PATIENTS UNDERGOING
RADIOTHERAPY DIAGNOSED
WITH HEAD AND NECK CANCER

OF PATIENTS UNDERGOING
HIGH-DOSE CHEMOTHERAPY
WITH STEM CELL TRANSPLANTATION

OF PATIENTS UNDERGOING
CHEMOTHERAPY