Skip to main content

Advertisement

SpringerLink
Log in

Emerging evidence on the pathobiology of mucositis

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

Considerable progress has been made in our understanding of the biological basis for cancer therapy-induced mucosal barrier injury (mucositis). The last formal review of the subject by MASCC/ISOO was published in 2007; consequently, an update is timely.

Methods

Panel members reviewed the biomedical literature on mucositis pathobiology published between January 2005 and December 2011.

Results

Recent research has provided data on the contribution of tissue structure changes, inflammation and microbiome changes to the development of mucositis. Additional research has focused on targeted therapy-induced toxicity, toxicity clustering and the investigation of genetic polymorphisms in toxicity prediction. This review paper summarizes the recent evidence on these aspects of mucositis pathobiology.

Conclusion

The ultimate goal of mucositis researchers is to identify the most appropriate targets for therapeutic interventions and to be able to predict toxicity risk and personalize interventions to genetically suitable patients. Continuing research efforts are needed to further our understanding of mucositis pathobiology and the pharmacogenomics of toxicity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Elting L et al (2003) The burdens of cancer therapy: clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 98:1531–1539

    Article  PubMed  Google Scholar 

  2. Sonis S et al (2004) Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 100:1995–2025

    Article  PubMed  Google Scholar 

  3. Capp A et al (2009) Is there more than one proctitis syndrome? A revisitation using data from the TROG 96.01 trial. Radiother Oncol 90:400–407

    Article  PubMed  Google Scholar 

  4. Keefe D et al (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109:820–831

    Article  PubMed  CAS  Google Scholar 

  5. Aprile G et al (2008) Application of distance matrices to define associations between acute toxicities in colorectal cancer patients receiving chemotherapy. Cancer 112:284–292

    Article  PubMed  Google Scholar 

  6. Murphy B (2007) Clinical and economic consequences of mucositis induced by chemotherapy and/or radiation therapy. J Support Oncol 5:13–21

    PubMed  Google Scholar 

  7. Sonis S (2004) The pathobiology of mucositis. Nat Rev Cancer 4:277–284

    Article  PubMed  CAS  Google Scholar 

  8. Sonis S et al (2002) The gene expression sequence of radiated mucosa in an animal mucositis model. Cell Prolif 35:s92–s102

    Article  Google Scholar 

  9. Sonis S et al (1990) An animal model for mucositis induced by cancer chemotherapy. Oral Surg, Oral Med, Oral Pathol 69:437–443

    Article  CAS  Google Scholar 

  10. Paris F et al (2001) Endothelial apoptosis as the primary lesion initiating intestinal radiation damage in mice. Science 293:293–297

    Article  PubMed  CAS  Google Scholar 

  11. Logan R et al (2009) Is the pathobiology of chemotherapy-induced alimentary tract mucositis influenced by the type of mucotoxic drug administered? Cancer Chemother Pharmacol 63:239–251

    Article  PubMed  CAS  Google Scholar 

  12. Sonis S et al (2000) Defining mechanisms of action of interleukin-11 on the progression of radiation-induced oral mucositis in hamsters. Oral Oncol 36:373–381

    Article  PubMed  CAS  Google Scholar 

  13. Yeoh A et al (2005) Nuclear factor κB (NFκB) and cyclooxygenase-2 (COX-2) expression in the irradiated colorectum is associated with subsequent histopathological changes. Int J Radiat Oncol Biol Phys 63:1295–1303

    Article  PubMed  CAS  Google Scholar 

  14. Manzano M et al (2007) Intestinal toxicity induced by 5-fluorouracil in pigs: a new preclinical model. Chemotherapy 53:344–355

    Article  PubMed  CAS  Google Scholar 

  15. Stringer A et al (2009) Irinotecan-induced mucositis manifesting as diarrhoea corresponds with an amended intestinal flora and mucin profile. Int J Exp Pathol 90:489–499

    Article  PubMed  CAS  Google Scholar 

  16. Stringer A et al (2009) Chemotherapy-induced changes to microflora: evidence and implications of change. Curr Drug Metab 10:79–83

    Article  PubMed  CAS  Google Scholar 

  17. Stringer A et al (2007) Chemotherapy-induced diarrhea is associated with changes in the luminal environment in the DA rat. Exp Biol Med 232:96–106

    CAS  Google Scholar 

  18. Al-Dasooqi N et al (2011) Irinotecan-induced alterations in intestinal cell kinetics and extracellular matrix component expression in the dark agouti rat. Int J Exp Pathol 92:357–365

    Article  PubMed  CAS  Google Scholar 

  19. Al-Dasooqi N et al (2010) Matrix metalloproteinases are possible mediators for the development of alimentary tract mucositis in the DA rat. Exp Biol Med 235:1244–1256

    Article  CAS  Google Scholar 

  20. Anthony L et al (2007) New thoughts on the pathobiology of regimen-related mucosal injury. Support Care Cancer 14:516–518

    Article  Google Scholar 

  21. Hannum Y (1997) Apoptosis and the dilemma of cancer chemotherapy. Blood 89:1845–1853

    Google Scholar 

  22. Kerr J, Winterford C, Harmon B (1994) Apoptosis: its significant in cancer and cancer therapy. Cancer 73:2013–2026

    Article  PubMed  CAS  Google Scholar 

  23. Gibson R et al (2005) Relationship between dose of methotrexate, apoptosis, p53/p21 expression and intestinal crypt proliferation in the rat. Clin Exp Med 4:188–195

    Article  PubMed  CAS  Google Scholar 

  24. Bowen J et al (2005) Cytotoxic chemotherapy up-regulates pro-apoptotic Bax and Bak in the small intestine of rats and humans. Pathology 37:56–62

    Article  PubMed  CAS  Google Scholar 

  25. Keefe D (2000) Chemotherapy for cancer causes apoptosis that precedes hypoplasia in crypts of the small intestine in humans. Gut 47:632–637

    Article  PubMed  CAS  Google Scholar 

  26. Sonis S et al (1992) Effect of epidermal gorwth factor on ulcerative mucositis in hamsters that receive chemotherapy. Oral Surg, Oral Med, Oral Pathol 74:749–755

    Article  CAS  Google Scholar 

  27. Gibson R et al (2007) Establishment of a single-dose irinotecan model of gastrointestinal mucositis. Chemotherapy 53:360–369

    Article  PubMed  CAS  Google Scholar 

  28. Gibson R et al (2006) Apoptosis occurs early in the basal layer of the oral mucosa following cancer chemotherapy. Asia Pac J Clin Oncol 2:39–49

    Article  Google Scholar 

  29. Li C et al (2011) The correlation between the severity of radiotherapy-induced glossitis and endothelial cell injury in local tissues in a rat model. Med Oral Pathol Oral Cir Bucal 16:e711–e715

    Article  Google Scholar 

  30. Carneiro-Filho B et al (2004) Intestinal barrier function and secretion in methotrexate-induced rat intestinal mucositis. Dig Dis Sci 49:65–72

    Article  PubMed  CAS  Google Scholar 

  31. Chen P et al (2011) Role of AMP-18 in oral mucositis. Oral Oncol 47:831–839

    Article  PubMed  CAS  Google Scholar 

  32. Huang T et al (2009) Minocycline attenuates 5-fluorouracil-induced small intestinal mucositis in mouse model. Biochem Biophys Res Commun 389:634–639

    Article  PubMed  CAS  Google Scholar 

  33. Meredith J, Fazeli B, Schwartz M (1993) The extracellular matrix as a cell survival factor. Mol Biol Cell 4:953–961

    PubMed  CAS  Google Scholar 

  34. Afshar S, Phelan K, O'Donnell C, Bragdon C, Castro D, Sonis S (2002) A new in vivo model for the study of mucosal disease. International Association for Dental Research Meeting Abstract 16220

  35. Phelan S, Afshar S, O'Donnell C, Bragdon C, Castro D, Shklar G, Sonis S (2002) A mucosal graft model to evaluate radiation induced injury. International Association for Dental Research Meeting Abstract 0221

  36. Beutheu Youmba S et al (2012) Methotrexate modulates tight junctions through NFkB, MEK, and JNK pathways. J Pediatric Gastroenterol Nutr 54:463–470

    Article  CAS  Google Scholar 

  37. Hamada K et al (2010) Zonula Occluden-1 alterations and enhances intestinal permeability in methotrexate-treated rats. Cancer Chemother Pharmacol 66:1031–1038

    Article  PubMed  CAS  Google Scholar 

  38. Al-Sadi R et al (2010) IL-1beta-induced increase in intestinal epithelial tight junction permeability is mediated by MEKK-1 activation of canonical NF-kappaB pathway. Am J Pathol 177:2310–2322

    Article  PubMed  CAS  Google Scholar 

  39. Al-Sadi R et al (2008) Mechanism of IL-1beta-induced increase in intestinal epithelial tight junction permeability. J Immunol 180:5653–5661

    PubMed  CAS  Google Scholar 

  40. Ma T et al (2004) TNF-alpha-induced increase in intestinal epithelial tight junction permeability requires NF-kappa B activation. Am J Physiol Gastrointest Liver Physiol 286:G367–G376

    Article  PubMed  CAS  Google Scholar 

  41. Han X, Fink M, Delude R (2003) Proinflammatory cytokines cause NO*-dependent and -independent changes in expression and localization of tight junction proteins in intestinal epithelial cells. Shock 19:229–237

    Article  PubMed  CAS  Google Scholar 

  42. Melichar B et al (2005) Intestinal permeability in the assessment of intestinal toxicity of cytotoxic agents. Chemotherapy 51:336–338

    Article  PubMed  CAS  Google Scholar 

  43. Logan R et al (2008) Characterisation of mucosal changes in the alimentary tract following administration of irinotecan: implications for the pathobiology of mucositis. Cancer Chemother Pharmacol 62:33–41

    Article  PubMed  CAS  Google Scholar 

  44. Sonis S (2002) The biologic role for nuclear factor-kappaB in disease and its potential involvement in mucosal injury associated with anti-neoplastic therapy. Crit Rev Oral BiolMed 13:380–389

    Article  Google Scholar 

  45. Sonis S (2004) A biological approach to mucositis. J Support Oncol 2:21–32

    PubMed  Google Scholar 

  46. Sonis S et al (2004) The relationship between mucosal cyclooxygenase-2 (COX-2) expression and experimental radiation-induced mucositis. Oral Oncol 40:170–176

    Article  PubMed  CAS  Google Scholar 

  47. Logan R et al (2007) Nuclear factor-kB (NFkB) and cyclooxygenase-2 expression in the oral mucosa following cancer chemotherapy. Oral Oncol 43:395–401

    Article  PubMed  CAS  Google Scholar 

  48. Haagen J et al (2009) Effect of selective inhibitors of inflammation on oral mucositis: preclinical studies. Radiother Oncol 92:472–476

    Article  PubMed  CAS  Google Scholar 

  49. Ong Z et al (2010) Pro-inflammatory cytokines play a key role in the development of radiotherapy-induced gastrointestinal mucositis. Radiat Oncol 16:22

    Article  Google Scholar 

  50. Logan R et al (2007) The role of pro-inflammatory cytokines in cancer treatment-induced alimentary tract mucositis: pathobiology, animal models and cytotoxic drugs. Cancer Treat Rev 33:448–460

    Article  PubMed  CAS  Google Scholar 

  51. Logan R et al (2008) Serum levels of NFkappaB and pro-inflammatory cytokines following administration of mucotoxic drugs. Cancer Biol Ther 7:1139–1145

    Article  PubMed  CAS  Google Scholar 

  52. Lima V et al (2005) Effects of tumour necrosis factor-alpha inhibitors pentoxifylline and thalidomide in short-term experimental oral mucositis in hamsters. Eur J Oral Sci 113:210–217

    Article  PubMed  CAS  Google Scholar 

  53. Melo M et al (2008) Role of cytokines (TNF-alpha, IL-1beta and KC) in the pathogenesis of CPT-11-induced intestinal mucositis in mice: effect of pentoxifylline and thalidomide. Cancer Chemother Pharmacol 61:775–784

    Article  PubMed  CAS  Google Scholar 

  54. Fiochhi C (1998) Inflammatory bowel disease: etiology and pathogenesis. Gastroenterology 115:182–205

    Article  Google Scholar 

  55. de Koning B et al (2006) Contributions of mucosal immune cells to methotrexate-induced mucositis. Int Immunol 18:941–949

    Article  PubMed  Google Scholar 

  56. Bultzingslowen I et al (2006) Growth factors and cytokines in the prevention and treatment of oral and gastrointestinal mucositis. Support Care Cancer 14:519–527

    Article  Google Scholar 

  57. Gibson R et al (2002) Effect of interleukin-11 on ameliorating intestinal damage after methotrexate treatment of breast cancer in rats. Dig Dis Sci 47:2751–2757

    Article  PubMed  CAS  Google Scholar 

  58. Antin J et al (2002) A phase I/II double-blind, placebo-controlled study of recombinant human interleukin-11 for mucositis and acute GVHD prevention in allogeneic stem cell transplantation. Bone Marrow Transplant 29:373–377

    Article  PubMed  CAS  Google Scholar 

  59. Zhao J et al (2004) Oral RDP58 allows CPT-11 dose intensification for enhanced tumor response by decreasing gastrointestinal toxicity. Clin Cancer Res 10:2851–2859

    Article  PubMed  CAS  Google Scholar 

  60. Frei E et al (1965) The nature and control of infections in patients with acute leukemia. Cancer Res 25:1511–1515

    PubMed  Google Scholar 

  61. Dreizen S, Bodey G, Brown L (1974) Opportunistic gram-negative bacillary infections in leukemia. Oral manifestations during myelosuppression. Post Med 55:133–139

    CAS  Google Scholar 

  62. Stringer A et al (2008) Faecal microflora and β-glucuronidase expression are altered in an irinotecan-induced diarrhoea model in rats. Cancer Biol Ther 7:1919–1925

    Article  PubMed  CAS  Google Scholar 

  63. Stringer A et al (2009) Gastrointestinal microflora and mucins play a role in the development of 5-fluorouracil-induced gastrointestinal mucositis in rats. Exp Biol Med 234:430–441

    Article  CAS  Google Scholar 

  64. Shao Z et al (2011) Effects of intensity-modulated radiotherapy on human oral microflora. J Radiat Res 52:834–839

    Article  PubMed  CAS  Google Scholar 

  65. Napenas J et al (2010) Molecular methodology to assess the impact of cancer chemotherapy on the oral bacterial flora: a pilot study. Oral Surg, Oral Med, Oral Pathol, Oral Radiol Endodentics 109:554–560

    Article  Google Scholar 

  66. van Vliet M et al. (2010) The role of intestinal microbiota in the development and severity of chemotherapy-induced mucositis. PLoS Pathog 6(5): e1000879

    Google Scholar 

  67. Martin M, van Saene H (1992) The role of oral microorganisms in cancer therapy. Curr Opin Dent 2:81–84

    PubMed  CAS  Google Scholar 

  68. Bochud P et al (1994) Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors. Clin Infect Dis 18:25–31

    Article  PubMed  CAS  Google Scholar 

  69. Ruescher T et al (1998) The impact of mucositis on alpha-hemolytic streptococcal infection in patients undergoing autologous bone marrow transplantation for hematologic malignancies. Cancer 82:2275–2281

    Article  PubMed  CAS  Google Scholar 

  70. Soga Y et al (2011) Bacterial substitution of coagulase-negative staphylococci for streptococci on the oral mucosa after hematopoietic cell transplantation. Support Care Cancer 19:995–1000

    Article  PubMed  Google Scholar 

  71. van der Velden W, Donnelly J, Blijlevens N (2012) Lymphocyte subsets, granulocyte-colony-stimulating factor responsiveness and post-stem cell transplantation infections: mucositis is the underestimated confounder? Cytotherapy 14:381–383

    Article  PubMed  Google Scholar 

  72. Sonis S (2009) Mucositis: the impact, biology and therapeutic opportunities of oral mucositis. Oral Oncol 45:1015–1020

    Article  PubMed  CAS  Google Scholar 

  73. Barasch A et al (2006) Antimicrobials, mucosal coating agents, anesthetics, analgesics, and nutritional supplements for alimentary tract mucositis. Support Care Cancer 14:528–532

    Article  PubMed  Google Scholar 

  74. Blijlevens N, Donnelly J, DePauw B (2000) Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant 25:1269–1278

    Article  PubMed  CAS  Google Scholar 

  75. Prisciandaro L et al (2011) Probiotic factors partially improve parameters of 5-fluorouracil-induced intestinal mucositis in rats. Cancer Biol Ther 11:671–677

    Article  PubMed  CAS  Google Scholar 

  76. Gibson R et al. (2013) Systematic review of agents for the management of gastrointestinal mucositis in cancer patients. Supportive Care Cancer 21(1):313-26

    Google Scholar 

  77. Blijlevens N, Donnelly J (2011) Mucosal barrier injury and infections. In: Safdar A (ed) Principles and practice of cancer infectious diseases, current clinical oncology. Springer Science, New York

  78. Wisplinghoff H et al (2003) Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis 36:1103–1110

    Article  PubMed  Google Scholar 

  79. Keefe D, Bateman E (2011) Tumor control versus adverse events with targeted anticancer therapies. Nat Rev Clin Oncol 9:98–109

    Article  PubMed  Google Scholar 

  80. Sonis S et al (2010) Preliminary characterization of oral lesions associated with inhibitors of mammalian target of rapamycin in cancer patients. Cancer 116:210–215

    PubMed  CAS  Google Scholar 

  81. Toi M et al (2009) Lapatinib monotherapy in patients with relapsed, advanced, or metastatic breast cancer: efficacy, safety, and biomarker results from Japanese patients phase II studies. Br J Cancer 101(10):1676–1682

    Article  PubMed  CAS  Google Scholar 

  82. Sawaki M et al (2004) Efficacy and safety of trastuzumab as a single agent in heavily pretreated patients with HER-2/neu-overexpressing metastatic breast cancer. Tumori 90(1):40–43

    PubMed  CAS  Google Scholar 

  83. Keefe D, Gibson R (2007) Mucosal injury from targeted anticancer therapy. Support Care Cancer 15:483–490

    Article  PubMed  Google Scholar 

  84. Burris H (2004) Dual kinase inhibition in the treatment of breast cancer: initial experience with the EGFR/ErbB-2 inhibitor lapatinib. Oncologist 9:10–15

    Article  PubMed  CAS  Google Scholar 

  85. Geyer CE et al (2006) Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med 355(26):2733–2743

    Article  PubMed  CAS  Google Scholar 

  86. Al-Dasooqi N et al (2008) Trastuzumab induces gastrointestinal side effects in HER2-overexpressing breast cancer patients. Investig New Drugs 27:173–178

    Article  Google Scholar 

  87. Fountzilas G et al (2001) Weekly paclitaxel as first-line chemotherapy and trastuzumab in patients with advanced breast cancer. A Hellenic Cooperative Oncology Group phase II study. Ann Oncol 12:1545–1551

    Article  PubMed  CAS  Google Scholar 

  88. Bartsch R et al (2007) Capecitabine and trastuzumab in heavily pretreated metastatic breast cancer. J Clin Oncol 25:3853–3858

    Article  PubMed  CAS  Google Scholar 

  89. Ruiz M et al (2008) Phase-II study of weekly schedule of trastuzumab, paclitaxel, and carboplatin followed by a week off every 28 days for HER2+ metastatic breast cancer. Cancer Chemother Pharmacol 62:1085–1090

    Article  PubMed  CAS  Google Scholar 

  90. Bowen J et al (2012) Development of a rat model of oral small molecule receptor tyrosine kinase inhibitor-induced diarrhoea. Cancer Biol Ther 13(13):1269-75

    Google Scholar 

  91. Peterson D, Keefe D, Sonis S (2012) New frontiers in mucositis. ASCO Educational Book. American Society of Clinical Oncology, Alexandria, pp. 545–61

  92. Keefe D (1998) The effect of cytotoxic chemotherapy on the mucosa of the small intestine. Department of Medicine University of Adelaide, Adelaide

  93. Pico J, Avila-Garavito A, Naccache P (1998) Mucositis: its occurence, consequences and treatment in the oncology setting. The Oncologist volume 3:p446–451

    Google Scholar 

  94. Sloan J et al (2002) Women experience greater toxicity with fluorouracil-based chemotherapy for colorectal cancer. J Clin Oncol 20:1491–1498

    Article  PubMed  CAS  Google Scholar 

  95. Pratesi N et al (2011) Association between single nucleotide polymorphisms in XRCC1 and RAD51 genes and clinical radiosensitivity in head and neck cancer. Radiother Oncol 99:356–362

    Article  PubMed  CAS  Google Scholar 

  96. West C, Dunning A, Rosenstein (2012) Genome-wide association studies and prediction of normal tissue toxicity. Sem Radiat Oncol 22:91–99

    Article  Google Scholar 

  97. Thomas F et al (2011) Methylenetetrahydrofolate reductase genetic polymorphisms and toxicity to 5-FU-based chemoradiation in rectal cancer. Br J Cancer 105:1654–1662

    Article  PubMed  CAS  Google Scholar 

  98. Werbrouck J et al (2009) Acute normal tissue reactions in head-and-neck cancer patients treated with IMRT: influence of dose and association with genetic polymorphisms in DNA DSB repair genes. Int J Radiat Oncol Biol Phys 73:1187–1195

    Article  PubMed  CAS  Google Scholar 

  99. Schwab M et al (2008) Role of genetic and nongenetic factors for fluorouracil treatment-related severe toxicity: a prospective clinical trial by the German 5-FU Toxicity Study Group. J Clin Oncol 26:2131–2138

    Article  PubMed  CAS  Google Scholar 

  100. Cho H et al (2010) Glutathione-S-transferase genotypes influence the risk of chemotherapy-related toxicities and prognosis in Korean patients with diffuse large B-cell lymphoma. Cancer CGenet Cytogenet 198:40–46

    Article  CAS  Google Scholar 

  101. Hahn T et al (2010) A deletion polymorphism in glutathione-S-transferase mu (GSTM1) and/or theta (GSTT1) is associated with an increased risk of toxicity after autologous blood and marrow transplantation. Biol Blood Marrow Transplant 16:801–808

    Article  PubMed  CAS  Google Scholar 

  102. Alterovitz G et al (2011) Personalized medicine for mucositis: bayesian networks identify unique gene clusters which predict the response to gamma-D-glutamyl-L-tryptophan (SCV-07) for the attenuation of chemoradiation-induced oral mucositis. Oral Oncol 47:951–955

    Article  PubMed  CAS  Google Scholar 

  103. Roseth A (2003) Determination of faecal calprotectin, a novel marker of organic gastrointestinal disorders. Dig Liver Dis 35:607–609

    Article  PubMed  CAS  Google Scholar 

  104. Lutgens L et al. (2005) Monitoring myeloablative therapy-induced small bowel toxicity by serum citrulline concentration: a comparison with sugar permeability tests. Cancer 103(1):191–9

    Google Scholar 

  105. Xanthinaki A et al (2008) Apoptosis and inflammation markers in oral mucositis in head and neck cancer patients receiving radiotherapy: preliminary report. Support Care Cancer 16:1025–1033

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

This project was carried out as part of the MASCC/ISOO Mucositis Guidelines Update, which was supported by BioAlliance Pharma and Helsinn Healthcare, NA. No industry representatives participated in the development of this manuscript in any way.

Author information

Authors and Affiliations

  1. Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, SA, 5000, USA

    Noor Al-Dasooqi & Emma Bateman

  2. Brigham and Women’s Hospital, Dana-Farber Cancer Institute, 75 Francis Street, Boston, MA, 02115, USA

    Stephen T. Sonis

  3. Discipline of Physiology, University of Adelaide, North Terrace, Adelaide, SA, 5000, USA

    Joanne M. Bowen

  4. Department of Haematology, University Medical Center Nijmegen, 6500HB, Nijmegen, The Netherlands

    Nicole Blijlevens

  5. Discipline of Anatomy and Pathology, University of Adelaide, North Terrace, Adelaide, SA, 5000, USA

    Rachel J. Gibson

  6. School of Dentistry, University of Adelaide, North Terrace, Adelaide, SA, 5005, USA

    Richard M. Logan

  7. Discipline of Oral Medicine, Griffith University and Department of Haematology and Oncology, Queensland Health, Gold Coast, QLD, Australia

    Raj G. Nair

  8. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia

    Andrea M. Stringer & Roger Yazbeck

  9. Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

    Sharon Elad

  10. Section of Oral Medicine and Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington Avenue, Farmington, CT, 06030, USA

    Rajesh V. Lalla

Authors
  1. Noor Al-Dasooqi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen T. Sonis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joanne M. Bowen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emma Bateman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicole Blijlevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rachel J. Gibson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard M. Logan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Raj G. Nair
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andrea M. Stringer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Roger Yazbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sharon Elad
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rajesh V. Lalla
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

For The Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO)

Corresponding author

Correspondence to Noor Al-Dasooqi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Al-Dasooqi, N., Sonis, S.T., Bowen, J.M. et al. Emerging evidence on the pathobiology of mucositis. Support Care Cancer 21, 2075–2083 (2013). https://doi.org/10.1007/s00520-013-1810-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-1810-y

Keywords

Search

Navigation