Mucosal protectants and their application for head and neck chemoirradiation

Mucosal injury due to ionizing radiation or cytotoxic agents begins with damage to stem cells in the basal epithelium, progresses as these cells are depleted, and is complicated by inflammation and superimposed infection. Suppression of oral and pharyngeal infection, cytokine stimulation of neutrophils, and protection of basal epithelium by chemical or physical means have been developed to protect mucosa from the acute effects of chemoirradiation. Although no method has been capable of preventing mucosal injury or its inflammatory consequences, many have proven partially effective and are reviewed in this article. Introduction of mucosal protectants into clinical use is needed to reduce the morbidity of chemoirradiation and to enhance its effectiveness by dose intensification, accelerated delivery, and simultaneous use.