Radiation Oncology/Toxicity/Mucositis

Mucositis

• Minimal mucositis if oral cavity dose <32 Gy
• Anterior mandible dose >34 Gy and/or oral cavity dose >39 Gy results in long-duration of mucositis

• Complutense University, Spain -- antiseptic mouth rinse vs placebo
  • Randomized. 36 patients, RT for HNC. Arm 1) antiseptic mouth rinse vs Arm 2) placebo
  • 2010 PMID 20173709 -- "Mucositis in irradiated cancer patients: effects of an antiseptic mouthrinse." (Lanzos I, Med Oral Patol Oral Cir Bucal. 2010 Feb 21. [Epub ahead of print])
    • Outcome: No difference in degree of mucositis; 2-week mucositis worse in placebo group
    • Conclusion: Mouth rinse may lead to some improvement

• MD Anderson; 2008 PMID 18455324 -- "Beam Path Toxicities to Non-Target Structures During Intensity-Modulated Radiation Therapy for Head And Neck Cancer." (Rosenthal DI, Int J Radiat Oncol Biol Phys. 2008 May 1. [Epub ahead of print])
  • Retrospective. 160 patients, oropharynx, treated with IMRT and 3D-CRT
  • Nausea: Higher nausea and vomiting if mean brainstem dose >36 Gy.
  • Occipital alopecial: if occipital scalp dose >30 Gy
  • Anterior mucositis: if anterior mandible dose >34 Gy
  • Conclusion: Dose reduction during IMRT implies increased beam path dose to alternate structure that may result in toxicities uncommon with previous approaches

• UCSD; 2008 PMID 18417299 -- "Prospective Evaluation to Establish a Dose Response for Clinical Oral Mucositis in Patients Undergoing Head-and-Neck Conformal Radiotherapy." (Narayan S, Int J Radiat Oncol Biol Phys. 2008 Apr 14. [Epub ahead of print])
  • Prospective. 12 patients, 4 sites in oral cavity, MSFET dosimeters and Eclipse dose distributions. Buccal sampling for RNA analysis
  • Outcome: Point dose >39.1 Gy resulted in mucositis 3+ weeks. Point dose <32 Gy resulted in mild (<= G1) mucositis for <=1 week
  • Conclusion: Dose <32 Gy minimal acute mucositis, dose >39 Gy longer duration of mucositis