What is radiation stomatitis?

Radiation stomatitis, a type of oral mucositis, is a complication that occurs in cancer patients after systemic chemotherapy or radiotherapy. It is characterized by non-infectious acute inflammation and pain in the oral mucosa. Clinical symptoms typically appear within the first week of chemotherapy/radiotherapy and worsen as treatment continues.

Which department should I visit for radiation stomatitis?

English name: Oral mucositis.

Alias: Chemotherapy-related oral disease.

Departments: Stomatology, Oncology.

What causes radiation stomatitis?

• High-dose chemotherapy targeting rapidly dividing cells;
• Radiotherapy in the head and neck region;
• Common chemotherapy drugs such as everolimus, sorafenib, regorafenib, doxorubicin, fluorouracil, and methotrexate, even at standard doses, can easily trigger it.

Who is prone to radiation stomatitis?

On average, 20%–40% of patients receiving standard-dose chemotherapy develop radiation stomatitis. The incidence rises to 80% in those undergoing combined radiotherapy and chemotherapy, and almost all patients receiving head and neck radiotherapy experience oral mucositis.

What are the main symptoms of radiation stomatitis?

It primarily manifests as non-infectious mucositis and pain, sometimes progressing to erosion and secondary infections.

• Oral ulcers often appear days after radiotherapy/chemotherapy. Initial symptoms may include mild to moderate burning or discomfort in the oral mucosa. As the condition worsens, inflammation and pain intensify, eventually interfering with speaking, eating, and swallowing.
• By the third week of treatment, half of the patients experience unbearable pain, requiring analgesic medication.

The incidence and severity of radiation stomatitis correlate with the radiation field, total dose, and duration. Secondary bacterial or fungal infections may exacerbate or prolong the pain.

A few patients develop erosive mucositis with severe pain, making eating or drinking impossible. When blood counts reach their lowest post-chemotherapy (absolute neutrophil count below 1000/uL), the risk and severity of infections increase.

How is radiation stomatitis diagnosed?

A history of radiotherapy/chemotherapy accompanied by mild oral pain and lack of clinical manifestations confirms the diagnosis. In rare cases, oral examination may reveal gingival bleeding.

How is radiation stomatitis treated?

Radiation stomatitis is self-limiting, with mucosal lesions beginning to heal spontaneously within days and typically resolving within 10–14 days post-chemotherapy. Proactively addressing oral inflammatory conditions (e.g., caries, periodontitis) before treatment can reduce its occurrence.

Severe symptoms affecting eating or speaking may require dose reduction in subsequent chemotherapy cycles.

In rare severe cases, chemotherapy/radiotherapy may need to be discontinued. Treatment focuses on local anti-inflammatory measures, pain relief, and preventing secondary infections.

What is the prognosis for radiation stomatitis?

The prognosis is generally good, with no impact on daily life. Even severe cases often resolve spontaneously after discontinuing radiotherapy/chemotherapy.

How can radiation stomatitis be prevented?

• Maintain strict oral hygiene during radiotherapy/chemotherapy.
• Avoid acidic, spicy, or sharp foods, caffeine, alcoholic beverages, and alcohol-containing mouthwashes.
• Use long-acting analgesics as needed during treatment.