Background: Oro-pharyngeal mucositis is a common complication of radical radiotherapy for head and neck cancer and may be the major treatment dose-limiting factor. Symptomatic treatment, however, appears variable and often ineffective.
Aim: To assess current UK practice, review published literature to assess the evidence base for current mucositis interventions and develop an evidence-based protocol for local use based on this knowledge.
Methods: An open-ended, qualitative questionnaire was sent to twenty UK Radiotherapy Departments to provide a sample of the current use of symptomatic treatments, including analgesia. A literature search was conducted using Medline and Cochrane databases to provide an evidence-based recommendation for the development of an effective local management protocol.
Results: Sixteen departments returned completed questionnaires (80% response rate). Eleven different pharmaceutical preparations were being used for symptomatic relief, with benzydamine (Difflam Oral Rinse) and Mucaine being the most commonly prescribed (in five departments each). Eleven different analgesics were being prescribed ranging from soluble aspirin to continuous infusion of diamorphine. The conclusion of a Cochrane Collaboration systematic review of the literature found weak or no evidence for the use of current interventions as effective agents for the relief or eradication of treatment-related mucositis.
Conclusions: For such a common and important treatment toxicity, there is no consistent symptomatic management and there is no good evidence-base for the use of any of the presently prescribed medications. Clinical trials have involved small samples and little replication of studies. Evidence does exist for the importance of good oral hygiene before, during and after treatment, and this has formed the basis of our new departmental protocol with discontinuation of the use of commercial mouthwashes.
