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Therapeutische Beeinflussung der radiogenen oralen Mukositis

Therapeutic management of radiation-induced oral mucositis

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Zusammenfassung

Hintergrund

Die akute Reaktion der Mundschleimhaut ist eine regelmäßige Nebenwirkung der klinischen Strahlentherapie von Kopf-Hals-Tumoren, die in vielen Fällen eine Unterbrechung der Behandlung erzwingt. In den Behandlungspausen besteht gerade bei den im Kopf-Hals-Bereich häufigen Plattenepithelkarzinomen die Gefahr der verstärkten Proliferation von Tumorstammzellen, die in der Folge die Tumorheilungsaussichten drastisch verringern kann. Zudem führen überschießende Akutreaktionen in vielen Fällen zu einer Verstärkung von späten Strahlenfolgen („consequential damage”). Die Verminderung der Schleimhautreaktion mit dem Ziel der Vermeidung von Bestrahlungspausen und der Verminderung von Spätschäden kann den therapeutischen Erfolg der Radiotherapie entscheidend verbessern.

Patienten und Methode

Verschiedene Ansätze zur Beeinflussung der strahleninduzierten Mukositis auf symptomatischer oder strahlen- und epithelbiologischer Grundlage wurden zusammengefaßt und systematisch dargestellt.

Ergebnisse

Es existiert eine Vielzahl prophylaktischer und therapeutischer Ansätze zur Verminderung akuter radiogener Reaktionen der Mundschleimhaut. Häufig ist die Wirksamkeit jedoch nur für Chemotherapie oder im Zusammenhang mit einer immunsuppressiven Therapie nachgewiesen, so daß oft eher ein systemischer als ein lokaler Effekt angenommen werden muß.

Schlußfolgerungen

Als allgemeine Mukositisprophylaxe können neben einer Zahnsanierung regelmäßige mundhygienische Maßnahmen nach den Mahlzeiten sowie antiseptische Spülungen herangezogen werden. Die Bedeutung einer engmaschigen persönlichen Betreuung der Patienten ist zu betonen. Das Anlegen eines perkutanen endoskopischen Gastrostoma muß am Zustand des Patienten sowie an der Ausdehnung und Lage des Bestrahlungsfeldes und damit der zu erwartenden Beeinträchtigung der Nahrungsaufnahme orientiert werden. Als therapeutische Maßnahmen bei manifesten Schleimhautreaktionen kommen eine lokale bzw. systemische Schmerzbehandlung sowie die lokale Applikation von Antimykotika und Antibiotika in Betracht.

Abstract

Background

Acute reactions of oral mucosa are a frequent side effect of radiotherapy, which often necessitates interruption of the treatment. Marked proliferation of tumor stem cells during treatment interruptions may occur in squamous cell carcinomata, which represent the majority of tumors in the head and neck area. Hence a fatal consequence of treatment breaks may be a significant decrease in tumor cure rates. Furthermore, marked acute responses frequently result in increased late sequelae (“consequential damage”). Therefore, amelioration of the mucosal response aiming at avoiding treatment breaks and at reduction of late reactions could definitely increase the therapeutic success of radiation treatment.

Patients and Method

Various possibilities for the therapeutic management of radiation-induced oral mucositis with a symptomatic or radio- and epithelial biological background are summarized and presented systematically.

Results

A variety of prophylactic and therapeutic methods have been proposed for the management of acute radiation reactions of the oral mucosa. Frequently, their efficacy has been established for chemotherapy or in combination with other immunosuppressive treatments. Hence, systemical rather than local effects have to be considered.

Conclusions

In general, prophylaxis of oral mucositis is mainly based on dental restoration or edentation, in combination with frequent oral hygienic measures after the meals and with antiseptic mouthwashes. Intensive personal care is recommended. The necessity of a percutaneous endoscopic gastrostoma is dependent on the status of the patient and on size and localization of the treatment area, i. e. the impairment of food uptake which is to be expected. therapeutic intervention is restricted to local or systemic treatment of pain and local application of antimycotics and antibiotics.

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    W. Dörr, I. Dölling-Jochem, M. Baumann & Th. Herrmann

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Dörr, W., Dölling-Jochem, I., Baumann, M. et al. Therapeutische Beeinflussung der radiogenen oralen Mukositis. Strahlenther. Onkol. 173, 183–192 (1997). https://doi.org/10.1007/BF03039287

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  • DOI: https://doi.org/10.1007/BF03039287

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