Severe mucositis induced by hepatic arterial infusion therapy: a case report

Abstract

Background: Mucositis induced by chemotherapy is an adverse drug effect that affects the quality of life of patients. Mucositis Guidelines was published in 2013; however, the preventions and treatments are not adapted to all chemotherapy regimens. We present a case of severe mucositis induced by hepatic arterial infusion therapy. Case: A 70-year-old female with recurrent hepatocellular carcinoma following hepatic surgical resection, transcatheter arterial chemoembolization, and radiofrequency ablation received 14 d of arterial infusion therapy with 500 mg of 5-fluorouracil (interval, 28 d). Sodium azulene sulfonate was used as a gargle from day 1 of chemotherapy. An oral mucositis (grade 1) developed on day 3. The inflammation of mucositis was temporally alleviated with topical triamcinolone acetonide but worsened until grade 3 after discharge from the hospital and healed before the second cycle started. During the second cycle, the same clinical course of mucositis was repeated. Oral mucositis and esophagitis, which developed on day 3 during the third cycle, were treated with sodium alginate, resulting in grade 4 mucositis on day 14. Her mucositis pain required 10 mg of oxycodone for 12 d. She was unable to continue eating during the treatment. Conclusion: Although interventions including cryotherapy are recommended in the guidelines, these were inappropriate in our patient. Her severe mucositis induced by chemotherapy caused uncontrolled pain and affected the quality of life. Thus, other approaches for severe mucositis, which is supported by evidence and further research on exacerbation factors, are required.