Radiation-induced Oral Mucositis is a Critical Dilemma for Patients and Physicians During Radiotherapy for Nasopharyngeal Carcinoma

The combination of radiotherapy (RT) and chemotherapy is associated with a high cure rate but an increased risk of radiation-induced oral mucositis (RIOM) in patients with nasopharyngeal carcinoma (NPC). As a dose-limiting complication, RIOM remains a critical dilemma for patients and physicians, potentially leading to radiation interruptions and compromised tumor control. In this review, we discuss and analyze the pathological mechanisms and factors affecting prevention/treatment of RIOM. RT may induce RIOM via a positive feedback loop, consequently amplifying superoxide production, the immunoinflammatory response, dysbacteriosis, infection, and epithelial basal cell death. Routine interventions for RIOM focus on oral care, oral-pain relief, nutritional support, and infection control; however, recent novel and effective methods have been proposed according to the pathological mechanisms and influencing factors. Some patients with low-recurrence-risk NPCs may be treated with reduced-dose RT, reduced-dose chemotherapy, or RT alone (without chemotherapy) to prevent severe RIOM. Furthermore, traditional herbal medicine extracts, such as Kangfuxin and honey, may help to control RIOM. In addition to the routine application of antibiotics to treat oral dysbacteriosis and hormones to suppress immune inflammatory responses, edaravone and GC4419 can also be used to scavenge oxygen free radicals and reduce superoxide ions to protect the oral mucosa and limit the occurrence of RIOM.