Abstract
Oral and esophageal mucosal injuries are inevitable postradiation changes, encountered in daily radiation therapy. Mucositis has remained a morbid side effect of radiation therapy since its first clinical use as an agent effective against cancer. Mucosal injury is the first change that is observed as the radiation beam enters the human tissues. Alimentary mucositis (AM) is the recommended term to describe cancer therapy–associated mucosal injury of the alimentary tract (mouth to anus). This unifying term acknowledges the similarities along the entire gastrointestinal (GI) tract while allowing for regional differences that require discussion of oral and GI mucositis separately at times, based on pathophysiological responses, clinical characteristics, and management options. In almost all patients, AM is associated with considerable pain and, thus, can significantly impair quality of life; in neutropenic patients with cancer, mucositis represents a clinically significant risk factor for sepsis (Elting L, 2003). Furthermore, in some patients, it becomes a dose‐limiting toxicity, slowing or preventing continuation of selected cancer therapies, including accelerated fractionation and hyperfractionation in radiotherapy and interventions that combine chemotherapy and radiotherapy. The major determinants of mucosal injury are total dose of radiation, daily radiation dose, and additional concurrent chemotherapy, in addition to an individual’s inherent sensitivity to radiation. The incidence of AM depends on the above-mentioned factors. Lower grade reactions are extremely common in nearly all patients receiving radiation with an incidence of almost 80% to 100%, with almost a third of these patients experiencing severe mucosal injury (Trotti et al., 2003) (Montserrat Vera-Llonch, 2006).