Confounding factors associated with oral mucositis assessment in patients receiving chemoradiotherapy for head and neck cancer

Chung, Yih-Lin; Pui, Newman N.M.

doi:10.1007/s00520-017-3684-x

Cited by 6 publications

(7 citation statements)

References 30 publications

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“…It could be difficult for either physician or patient to distinguish mucosal injury and symptoms related to OM due to chemo-RT or previous exposition to factors that affect mucosal status. HNC usually had previous exposure to alcohol or smoke that can cause erythroplakia, oral ulcers, mucosal fibrosis, and xerostomia; moreover, the tumor itself could invade the oral cavity or oropharyngeal structures, such as muscles, nerves, vessels, and bone causing dysphagia and pain; normal mucosal status could be damaged by production pro-inflammatory cytokines by tumors itself; finally, normal structure or oral cavity could be altered by previous surgery or RT [ 63 ].…”

Section: Treatment-related Confounding Factorsmentioning

confidence: 99%

Confounding factors in the assessment of oral mucositis in head and neck cancer

Lorini

Perri

Vecchio

et al. 2022

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Treatment of locally advanced head and neck carcinoma not amenable for surgical resection or resected with high-risk features is usually based on (chemo-)radiation treatment. Oral mucositis represents one of the main side effects of (chemo-)radiation, with an important impact on quality of life and causing approximately 20% of early interruption of treatment, leading to a suboptimal dose administered. Treatment and prevention of oral mucositis have a central role in the therapeutic pathways of head and neck cancer patients but remains quite challenging. Although extensive research is conducted to identify interventions for the management of mucositis, very few interventions had sufficient evidence to generate an international expert consensus. This may be partially explained by confounding factors that could influence the development and assessment of oral mucositis. Little is known about the confounding factors of oral mucositis, which, if not well balanced in an experimental study, could lead to non-solid results. The current paper aims to review the main oral mucositis confounding factors related to head and neck cancer patients.

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Section: Treatment-related Confounding Factorsmentioning

confidence: 99%

Confounding factors in the assessment of oral mucositis in head and neck cancer

Lorini

Perri

Vecchio

et al. 2022

Support Care Cancer

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“…Although regarded as a severe and potentially dose limiting acute side effect of radiotherapy for oropharyngeal cancer, there is uncertainty in defining the delineation of the oral cavity as an OAR to enable oral mucositis reduction [ 20 , 21 , 22 ]. The reasons for this uncertainty can be elucidated from a consideration of the history of head and neck radiotherapy over the last 30 years.…”

Section: Oral Cavity Oar Definitionmentioning

confidence: 99%

“…More recently, systems relying on physician scoring of patient symptoms have been developed including the WHO system where grade 3 equates with ulceration sufficient to prevent the patient swallowing food and the CTCAE version 4 where grade 3 is defined by the patient requiring strong analgesia for their mucositis [ 21 , 43 ].…”

Section: Measurement Of the Acute Mucosal Reactionmentioning

confidence: 99%

“…Chung et al re-analysed a randomised trial examining the effect of 5% phenylbutyrate mouthwash on the rates of physician scored (RTOG and OMAS) and patient reported mucositis during head and neck chemoradiation [ 21 ]. The initial study showed no benefit on the mucosal endpoints used but the subsequent analysis showed that despite mucosal appearance and patient reported symptoms being similar between the arms of the study, there were less radiotherapy interruptions and a greater compliance to synchronous chemotherapy in the experimental arm.…”

Section: Measurement Of the Acute Mucosal Reactionmentioning

confidence: 99%

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Assessing Novel Drugs and Radiation Technology in the Chemoradiation of Oropharyngeal Cancer

et al. 2018

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Integrating immunotherapy, proton therapy and biological dose escalation into the definitive chemoradiation of oropharyngeal cancer poses several challenges. Reliable and reproducible data must be obtained in a timely fashion. However, despite recent international radiotherapy contouring guidelines, controversy persists as to the applicability of such guidelines to all cases. Similarly, a lack of consensus exists concerning both the definition of the organ at risk for oral mucositis and the most appropriate endpoint to measure for this critical toxicity. Finally, the correlation between early markers of efficacy such as complete response on PET CT following treatment and subsequent survival needs elucidation for biological subsets of oropharyngeal cancer.

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“…[15] The oral gel containing glycyrrhetinic acid, hyaluronic acid and polyvinylpyrrolidone (GelClair®) was provided from the severity and frequency of mucositis are described in the literature, but none of them are completely effective or strongly recommended. [4][5][6][7] The total radiation dose for oral mucosa is one of the most important factors in mucositis. Therefore, a severe side-effect is inevitable during definitive radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Mucositis-Induced Pain due to Barrier Dysfunction may have a Direct Effect on Nutritional Status and Quality of Life in Head and Neck Cancer Patients Receiving Radiotherapy

Atasoy¹

2020

TJ Oncol

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To maintain the barrier function against mucositis-induced pain and to improve the nutritional status and quality of life in head and neck cancer patients during radiotherapy. METHODS All patients (n=30) used oral gel to reduce mucositis-induced pain. Patients were examined weekly for the severity of mucositis, pain and nutritional status. The quality of life parameters was measured at the beginning and at the end of treatment. There was no restriction for pain killers against mucositis. RESULTS The only significant factor affecting the severity and frequency of mucositis was the cumulative radiation dose (p<0.001). Despite the regular use of oral gel, weight loss was observed in 65% of the patients. There was no difference concerning the severity of mucositis, cumulative radiation doses, or mean dose of oral mucosa between patients with no risk or at risk, according to SGA. However, self-assessment pain scores were significantly better in the well-nourished group (p=0.05 vs. 0.015) with better scores for dry mouth (p=0.043), social eating (p=0.006), swallowing difficulties (p=0.001) and communication (p=0.049). CONCLUSION Supporting the barrier function alone does not help to reduce the severity and frequency of mucositis, nor the oral pain in high doses. Mucositis-induced pain may have a direct effect on malnutrition risk and quality of life in head and neck cancer patients. Powerful strategies are required to manage pain due to mucositis during curative radiotherapy.

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Confounding factors associated with oral mucositis assessment in patients receiving chemoradiotherapy for head and neck cancer

Cited by 6 publications

References 30 publications

Confounding factors in the assessment of oral mucositis in head and neck cancer

Confounding factors in the assessment of oral mucositis in head and neck cancer

Assessing Novel Drugs and Radiation Technology in the Chemoradiation of Oropharyngeal Cancer

Mucositis-Induced Pain due to Barrier Dysfunction may have a Direct Effect on Nutritional Status and Quality of Life in Head and Neck Cancer Patients Receiving Radiotherapy

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