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Acute mucositis is the main intensity-limiting toxicity in the management of head and neck (H&N) and digestive track carcinomas with radiotherapy. New radiation modalities (hyperfractionation and/or acceleration) as well as combined modality regimens in this situation induce higher rates of acute toxicity. Hyperfractionation for example allows higher control rates, with few late toxicities, but it slightly increases acute mucositis. The addition of chemotherapy introduces systemic toxicity and can exacerbate local tissue reactions when used concurrently with radiation. Mucositis is recognized as the principal limiting factor to further treatment intensification. As local-regional control and overall survival are related to dose-intensity in this case, further research into the assessment, analysis, prevention and treatment of mucosal toxicity is not only crucial to the improvement in quality of life, but certainly to improved rates of disease control as well. Several topical and systemic treatments are directed to the decrease and the acceptance of this acute toxicity, but few have shown significant preventive effect. Improvement of technical aspects of H&N radiotherapy (3D conformal radiation, intensity-modulated radiotherapy) should have a major impact in the prevention of mucositis. The efficacy of low level laser therapy in the management of such a toxicity could hence yield important development of this method in the field of oncology. MASCC/ISOO mucositis group's recommendations for the management of acute radiation-induced mucositis are here summarized.

The appearance of mucositis is a frequent and painful secondary effect of anticancer chemotherapy. Patients who develop oral toxicity during the first course of treatment will almost assuredly show identical side effects during each subsequent course unless the drugs are changed or the doses are lowered. In the absence of an efficacious antidote or preventive prophylaxis for such lesions to date, this report presents the results of a preliminary retrospective non-randomized study of the effect of soft-laser treatments on mucositis in cancer patients receiving combination chemotherapy, including 5-fluorouracil. Iatrogenic mucositis was observed during 43% of 53 chemotherapy cycles in the case control population. Curative laser therapy reduced the time to repair lesions and the rate of therapeutic modifications. For patients who received soft-laser therapy as a preventive measure, the incidence of oral complications was reduced to 6% during 101 cycles of chemotherapy. All of these patients, even those who have encountered mucositis before receiving preventive laser therapy, terminated their cancer therapy as originally scheduled. Well designed and carefully controlled trials will be necessary to define the place of helium-neon laser therapy in the repair and prevention of oral complications due to cancer chemotherapy.