Radiation induced mucositis and its relationship with nutritional status in head and neck cancer patients treated with radiotherapy
Lichuan ZhangYujie WangBing ZhuangHongmei LiLiqing GongYanli WangYu Ming Victor FangYan SunShaowen XiaoBaomin Zheng
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Abstract:
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; WeightKeywords:
Mucositis
17024 Background: Mucositis is a primary factor limiting the dose intensity of radiation therapy (RT) in H&N cancer. Because reduced dose intensity can affect survival, we studied whether mucositis affected dose intensity in patients treated for H&N cancer. Methods: Patients with H&N cancer (or family members) who had registered to use NexCura’s online NexProfiler Treatment Option Tool for H&N Cancer between Aug 2001 & Oct 2006 and previously opted to participate in surveys were invited to complete an online survey about their treatment experience. Of the 5246 individuals invited, 233 completed the survey of 84 questions during a 4 week period in Jan-Feb 2007. All eligible patients had received RT as part of their treatment. Results: 74% of respondents were male. 86% had completed treatment in 2001–2006. 15% received RT alone, 85% received RT + chemotherapy. 77% of all patients rated mucositis as the most severe treatment side effect. 30% of patients had an RT break to recover from a side effect. Of these, 38% said RT was stopped ≥2 times and 43% said RT was stopped for ≥5 days (4% for ≥10 days). The top 3 reasons for RT breaks were mouth pain, skin burn, and dehydration. 46% of patients cited some form of mucositis (difficulty/pain on swallowing; mouth soreness; mouth sores/ulcers; pain and/or burning; throat soreness; inability to swallow food/solids, liquids, or own saliva) as the primary or secondary reason for RT breaks. 33% of 199 patients had delays or early termination of chemotherapy due to side effects; the top 3 reasons were neutropenia, dehydration, and anemia. 13% reported mouth sores/ulcers, mouth pain, or swallowing difficulty as a primary or secondary reason for interruption of chemotherapy. Conclusions: In a large survey of patients who had undergone treatment for H&N cancer, the patients felt that mucositis was the most common reason for interruption of RT. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen, Medimmune Amgen Amgen, Medimmune
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Limited treatment options are available for oral mucositis, a common, debilitating complication of cancer therapy. We examined the association between daily delivery time of radiotherapy and the severity of oral mucositis in patients with head and neck cancer.We used electronic medical records of 190 patients with head and neck squamous cell carcinoma who completed radiotherapy, with or without concurrent chemotherapy, at Roswell Park Comprehensive Cancer Center (Buffalo, NY) between 2015 and 2017. Throughout a 7-week treatment course, patient mouth and throat soreness (MTS) was self-reported weekly using a validated oral mucositis questionnaire, with responses 0 (no) to 4 (extreme). Average treatment times from day 1 until the day before each mucositis survey were categorized into seven groups. Multivariable-adjusted marginal average scores (LSmeans) were estimated for the repeated- and maximum-MTS, using a linear-mixed model and generalized-linear model, respectively.Radiation treatment time was significantly associated with oral mucositis severity using both repeated-MTS (n = 1,156; P = 0.02) and maximum-MTS (n = 190; P = 0.04), with consistent patterns. The severity was lowest for patients treated during 8:30 to <9:30 am (LSmeans for maximum-MTS = 2.24; SE = 0.15), increased at later treatment times and peaked at early afternoon (11:30 am to <3:00 pm, LSmeans = 2.66-2.71; SEs = 0.16/0.17), and then decreased substantially after 3 pm.We report a significant association between radiation treatment time and oral mucositis severity in patients with head and neck cancer.Although additional studies are needed, these data suggest a potential simple treatment time solution to limit severity of oral mucositis during radiotherapy without increasing cost.
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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.
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Objective: To estimate the efficacy of traditional Chinese medicine (Chining decoction, CHIN) for radiation-induced oral mucositis in patients with head and neck cancer. Methods: From May 2014 to December 2015, 70 consecutive patients were randomly assigned to receive CHIN (treatment group) or recombinant human epidermal growth factor (rhEGF) spray (control group) at a 1:1 ratio. CHIN was administered to treatment group from the first day of radiotherapy until the completion of radiotherapy. Simultaneously, the rhEGF spray was administered to control group on the oral mucosa of irradiated area. The clinical benefit was determined by gradation of mucositis (Common Terminology Criteria for Adverse Events v4.0), oral pain, and xerostomia (visual analysis scale) for each week during radiotherapy. Body mass index was evaluated before and after radiotherapy. Results: Patients in the treatment group had prominent remission of oral pain and grade of mucositis on each observing point compared with those in control group ( P < .01). Xerostomia was decreased notably in treatment group compared with control group ( P < .01). Body mass index in the treatment group exhibited advantage over control group after radiotherapy, but there was no statistical significance (19.8 ± 3.26 vs 18.8 ± 2.5 kg/m 2 , P = .153, >.05). Conclusions: CHIN presented an obvious advantage in preventing radiation-induced oral mucositis compared with rhEGF spray.
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Oral mucositis is a common debilitating complication of radiotherapy occurring in about 60 per cent of cancer patients. Considerable buccal toxicity of radiotherapy or chemotherapy in cancer patients to become discouraged and can affect their quality of life. In addition, such toxicity can alter the treatment plan. At present, there is no clinically appropriate prophylaxis efficacious antidote for mucositis. The low level laser (LEL) appears to be a simple, non-traumatic technique for the prevention and treatment of radiation induced mucositis. Therefore the present study was carried out to find out the effect of low-level helium-neon (He-Ne) laser in the prevention and treatment of radiation induced mucositis in head and neck cancer patients.The patients with carcinoma of oral cavity with stages II-IV a being uniformly treated with curative total tumour dose of 66 Gy in 33 fractions over 6 wk were selected for the study. The patients were divided based on computer generated randamosization into laser (study group) and control groups with 25 patients in each group. Both study and control groups were comparable in terms of site of the lesion, stage of the cancer and histology. The study group patients were treated with He-Ne laser (wavelength 632.8 nm and output of 10mW) and control group patients were given oral analgesics, local application of anaesthetics, 0.9 per cent saline and povidine wash during the course of radiotherapy.All patients tolerated the laser treatment without any adverse effect or reactions. The result showed a significant difference in pain and mucositis (P<0.001) between the two groups. At the end of radiotherapy (after 6 wk) mean pain sure and mucositis grade were significantly lower (P<0.001) in the study group compared to control.The low-level He-Ne laser therapy during the radiotherapy treatment was found to be effective in preventing and treating the mucositis in head and neck cancer patients. Further studies need to be done on a larger sample to find the mechanism.
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Objective To explore the diagnosis criterion of acute and chronic radiation oral mucositis induced by ionazition correctly. Methods 40 patients who were given radiotherapy because of head-neck cancer and 40 patients who were irradiated in the whole body for hematogenic stem cell transplant pretreatment were observed and analyzed. They were diagnosed by symptom and sign. Results 28 patients who were given radiotherapy were found acute oral mucous membrane change when cumulate radiation dose attained 30 Gy. The incidence of acute radiation oral mucositis was 70 percent. 20 TBI patients were found oral ulcer in 7 to 8 Gy radiation dose. The incidence of oral ulce was 50 percent. Conclusion The advance limit of irradiated dose for acute and chronic radiation oral mucositis are 20～30 Gy and 50～60 Gy.
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