Int J Stomatol

Int J Stomatol ›› 2023, Vol. 50 ›› Issue (1): 43-51.doi: 10.7518/gjkq.2023012

• Oral Microbiology • Previous Articles     Next Articles

Research progress on oral flora changes affecting the course of radiotherapy and chemotherapy-related oral mucositis

Yang Mingyan1(),Zhang Fan2,Zhao Lei1()   

  1. 1.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.Health Management Center of West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2022-06-30 Revised:2022-09-12 Online:2023-01-01 Published:2023-01-09
  • Contact: Lei Zhao E-mail:1469691138@qq.com;jollyzldoc@163.com
  • Supported by:
    Sichuan Province Cadre Health Care Scientific Research Project-Popularization and Application Project(2022-109)

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Abstract:

Head and neck radiotherapy and chemotherapy (referred to as chemoradiotherapy) can cause changes in oral microbiota diversity and community structure, including decreased abundance of health-related commensal bacteria, increased abundance of some Gram-negative bacteria, and changes in the fungal community dominated by increase in Candida albicans. These changes can lead to an increase in the risk and severity of oral mucositis (OM). Chemoradiotherapy causes direct or indirect DNA damage through reactive oxygen species, promotes the dysbacteriosis of microbial flora, destroys the immune system, and enhances inflammation. Cell damage forms ulcers, leading to bacterial translocation and colonization. In addition, nuclear factor-κB, Toll-like receptor, and other signaling pathways are activated, thus inducing the expression of pro-inflammatory cytokines and promoting the development of OM. The treatment of OM is currently a research hotspot for oral flora regulation. Probiotics or probiotic mixtures can be used to prevent and treat OM, and the prophylactic use of antifungal agents can reduce the number of oral Candida infections. This paper reviews the effects of head and neck chemoradiotherapy on oral microflora changes and their correlation with OM to provide new ideas for the prevention and treatment of chemotherapy-related OM.

Key words: radiotherapy, chemotherapy, head and neck cancer, changes in oral flora, oral mucositis

CLC Number: 

  • R 780.2

TrendMD: 

Tab 1

Grading of OM related to radiotherapy and chemotherapy"

分级标准分级临床表现
RTOG[21]急性放射性黏膜炎分级标准1红斑
2斑点反应（<1.5 cm，不连续）
3融合性黏膜炎（>1.5 cm，连续）
4溃疡、坏死、出血
WHO[22]口腔毒性量表0无明显症状
1口腔酸痛，红斑
2口腔红斑、溃疡，可以吃固体
3口腔溃疡，只能进食流质饮食
4不能从口腔摄入营养
NCI—不良事件通用术语标准（5.0版[23]和4.0版[21]）1无症状或轻微症状；无需治疗
2不影响经口摄入的中度疼痛或溃疡；需改变饮食
3严重的疼痛；干扰经口摄入营养
4危及生命的后果；需紧急干预治疗
5死亡
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