Evaluation of oral mucositis in oral cancer patients undergoing radiotherapy
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Abstract:
Introduction: The present study was conducted to evaluate oral mucositis in oral cancer patients receiving head and neck radiotherapy.
Methods: Sixty oral cancer patients who had received at least 40 grays of radiation were included in the study. Mucositis was scored by oroscopy using WHO scale. Grades of mucositis were then compared with total dose of radiation received by the patients.
Results: The cases were receiving the mean cumulative dose of standard radiation therapy of 2Gy per fraction, 5 fractions per week. All the patients developed oral mucositis. The majority had grade I mucositis, followed by grade III, II and IV. The grade of mucositis was directly proportional to the dose of radiation exposure.
Conclusion: Oral mucositis occurs among all the patients undergoing head and neck radiotherapy and grade of mucositis is proportional to the dose of radiation exposure.Keywords:
Mucositis
Cumulative dose
Background: Oral mucositis is a major problem affecting all head and neck cancer (HNC) patients received radiotherapy. Till now, available treatment is just symptomatic with limited effects. Preventive strategies may be better to avoid this complication. Animal models studies have illustrated that anti-cancer treatment toxicity display prominent daily variations; therefore, undesirable side effects could be significantly reduced by administration of radiotherapy at specific times when they are better tolerated.
Aim: To compare “soreness quality score” (SQS) between 2 groups of head and neck cancer patients received radiotherapy at different daily time.
Methods: 2 groups of head neck cancer patients treated at Mansoura university hospital; each group included 80 cases. Group A received radiotherapy at early morning between 6 and 8 am, while Group B received radiotherapy in the afternoon between 1 and 3 pm. Oral mucositis survey was self-reported weekly during and at the end of treatment by using “soreness quality score” (SQS).
Results: For group A, mild mucositis (score 1 and 2) was recorded in 53 cases (66%) and severe mucositis was recorded in 27 cases (34%). For group B, mild mucositis was recorded in 29 cases (36%) and severe mucositis was recorded in 51 cases (64%). There was statistically significant difference (0.003) between both groups as regards development of severe oral mucositis.
Conclusion: Better toxicity profile as regards oral mucositis could be obtained by giving radiotherapy for (HNC) patients at early morning compared to late afternoon. Further studies are worthwhile to confirm our findings.
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Oral mucositis is a frequent adverse event in patients receiving concurrent chemoradiotherapy for head and neck cancer. Although the management of oral mucositis is essential to improve treatment completion rates, no detailed studies on the time of oral mucositis appearance have been reported. We conducted a retrospective study on the timing of the appearance of oral mucositis induced by concurrent chemoradiotherapy with S-1 for head and neck cancer. A total of 11 patients with head and neck cancer who received concurrent chemoradiotherapy with S-1 were examined. All patients developed oral mucositis within 13.8 ± 5.6 days after the initiation of radiotherapy (20.4 ± 8.1 Gy). In addition, the effects of pain-associated symptoms caused by oral mucositis on the patients' nutritional status, including reduction in caloric intake (24.4% ± 31.1%), weight loss (5.2% ± 5.2%), and duration of a regular diet (24.5 ± 17.1 days), were observed and lasted until the completion of radiation therapy. The delineation of the timing of oral mucositis appearance has become a key motivator for the patients to perform oral care proactively to limit severity and serves as a necessary index for monitoring oral health and managing pain and nutrition.
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Objective To explore the effects of two different gargles on acute oral mucositis during radiotherapy in patients with head and neck cancer.Methods A total of 87 patients with head and neck cancer were randomly assigned to receive either self-made gargle(n=43) or chlorhexidine mouthwash(n=44) within 1 week from the beginning of radiotherapy until week 7(4~5 times per day,10 mL per time).The curative effect and oral mucosa injury were assessed according to the RTOG/EORTC acute radiation mucositis grading standard.Results Compared with chlorhexidine mouthwash group,the self-made gargle induced an increase in the efficiency and a decrease in the incidence of grade Ⅲ acute radiation mucositis(P0.05).Conclusion Oral mucositis is an inevitable complication of radiation therapy for head and neck cancer.The self-made gargle is simple,cheap and effective in prevention and treatment of radiotherapy-induced oral mucositis in patients with head and neck cancer.
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Aims: The present study was done to assess the effect of three alcohol-free mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies.Materials and Methods: Eighty patients with head and neck malignancies, scheduled to undergo curative radiotherapy, were randomly assigned to receive one of the three alcohol-free test mouthwashes (0.12% chlorhexidine, 1% povidone-iodine, or salt/soda) or a control. The patients were instructed to rinse with 10 ml of the mouthwash, twice a day, for a period of 6 weeks. Mucositis was assessed at baseline and at weekly intervals during radiation therapy, using the World Health Organization criteria for grading of mucositis. The baseline demography of the four groups was matched for age, sex, stage of cancer, and whether the patient had cancer of oral or extraoral regions. A post hoc test for repeated measures was used to find the difference of mean mucositis scores between the groups at various week intervals.Results: Among the 76 patients who completed the study, patients in the povidone-iodine group had significantly lower mucositis scores when compared to the control group from the first week of radiotherapy. Their scores were also significantly lower when compared to the salt/soda and chlorhexidine groups from the fourth and fifth week, respectively, after radiotherapy.Conclusions: This study demonstrates that use of alcohol-free povidone-iodine mouthwash can reduce the severity and delay the onset of oral mucositis due to antineoplastic radiotherapy.
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Background Radiation-induced oral mucositis is one of the major ionizing radiation toxicities and normal tissue injuries resulting from radiotherapy. It occurs in up to 80% of head and neck cancer irradiated patients, reaching up to 100% in patients with altered fractionation. Objective To assess the grade of Radiation induced oral mucositis as per World Health Organization grading system among post-radiotherapy patients of Head and Neck cancer. Method World Health Organization grading for oral mucositis was done in patients reporting to Department of Radiation oncology for radiotherapy at BP Koirala Memorial Cancer Hospital, Bharatpur. A total of 71 patients in 1 month duration were included. Result Grade 2 mucositis was most common, 52.11% followed by grade 1 (22.5%), grade 3 (18.3%) and grade 4 (7.04%). There were no post-radiotherapy patients who presented without mucositis. Conclusion Radiation induced oral mucositis is a common adverse reaction of radiotherapy. With increase in dose and duration of radiotherapy, grade of mucositis was increasing.
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Objectives: This study aimed at identifying and describing self reported oral pain and dysfunctions associated with oral mucositis among patients with head and neck cancer treated with radiation . Method: A prospective observational study was conducted on 30 head and neck cancer patients who were undergoing radiation therapy and consented to participate. Data was collected by using a baseline proforma, WHO Oral Toxicity scale and Patient reported oral mucositis symptom scale .The patients were followed up during the entire course of radiation therapy and were monitored for the development of oral mucositis and were asked to rate their pain and associated dysfunctions on 100 mm scale. Result: The present study findings revealed that all the subjects developed oral mucositis at the end of third week which was progressed to grade 3 or 4 mucositis by the end of therapy. The scores of oral pain and oral dysfunctions were progressively increased during the course of treatment with its peak at the end of treatment. Cumulative dose of radiation therapy and receipt of concurrent chemotherapy were found to have a significant association with oral dysfunction. The study also noted a significant positive correlation with severity of mucositis and oral dysfunctions. Conclusion: Severe and painful oral mucositis is a dose limiting adverse effect of radiation therapy and its detrimental effect on oral functions is significant .Hence adequate preventive measures of mucositis to be identified to enhance the quality of life of head and neck cancer patients receiving radiation therapy.
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Objective
To describe the characteristics of radiation induced mucositis in patients with head and neck cancer (HNC) during radiotherapy, and analyze the effect of radiation induced mucositis on diet patterns and weight change and the influencing factors for radiation induced mucositis.
Methods
Patients with HNC treated with radiotherapy in one cancer hospital were recruited. Data were collected before, during and at the end of the radiotherapy, which included radiation induced oral and pharyngeal mucositis, pain during eating, diet patterns and weight.
Results
Two hundred and two patients were completely investigated and 43.5% and 34.2% of the patients suffered from moderate to severe(≥grade 2) oral mucositis and pharyngeal mucositis, respectively during the radiotherapy. At the end of radiotherapy, 53.5% and 51.5% of the patients suffered from moderate to severe oral mucositis and pharyngeal mucositis (≥grade 2), respectively. Oral and pharyngeal mucositis were significantly correlated with pain during eating, diet patterns and weight(P<0.05). Tumor site was the main reason that affected the severity of mucositis(Wald χ2=26.033, 14.216; P<0.001).
Conclusion
Radiation induced mucositis was gradually aggravated with radiotherapy progress, which is closely related to pain during eating, change of diet patterns and weight loss. The severity of mucositis is related to the tumor site. Measures should be taken to strengthen the management of adverse reactions and nutritional status of patients.
Key words:
Head and Neck Cancer; Radiation Induced Mucositis; Pain; Diet Pattern; Weight
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Objectives This study evaluated the relationship between oral hygiene and health status and radiation-induced mucositis among patients with head and neck cancer over an 8-week period. Methods We recruited 40 patients with head and neck cancer scheduled to receive radiation therapy (RT), and 25 patients were included in the study. Before commencing RT, a dentist examined the patients for plaque, and determined the gingival index and pocket depth. A dental hygienist assessed the patients for radiation-induced mucositis once weekly, for 8 weeks, during RT. Results The mean patient age was 60.96 (±8.47) years, and 21 (87.5%) patients were male. Twenty patients (83.3%) had been diagnosed with squamous cell carcinoma. Patients with cancer located in the head region had more severe mucositis than those with cancer in the neck region, but this was not significant statistically (P=0.053). However, toothbrushing frequency, plaque, gingival index, and pocket depth were not related to radiation-induced mucositis. During RT, the severity of mucositis significantly worsened compared to that at baseline. Conclusions Mucositis severity worsened during RT, but this was not related to oral hygiene and health status among patients with head and neck cancer.
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Objective To evaluate the effect of ice compress before radiotherapy on the symptoms of oral mucositis in patients with nasoplaryngeal cancer.Methods Eighty nasoplaryngeal cancer patients receiving first radiotherapy were randomly divided into two groups.The patients in the control group received routine treatment and nursing care.In addition,the patients in the experimental group received ice compress on the irradiation field skin 30 minutes before radiotherapy.When the oral mucositis occurred,firstly we dried the surface of oral mucositis with swabs,then sprayed recombinat human epidermal growth factor twice a day.The oropharyngeal samples were collected for microbiological monitoring seven days after radiotherapy.Results The symptoms of oral mucositis in the experimental group were obviously lighter than those of control group at the third and seventh week of radiotherapy,and one week after radiotherapy.The positive rate of throat swab bacteria culture in experimental group(17.5%) was significanlty lower than that of control group(37.5%).Conclusions Ice compress before radiotherapy can effectively prevent and relieve the symptoms of radiotherapy-induced oral mucositis,and reduce the incidence of oral cavity fungal infection.
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