Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review

Trotti, Andy; Bellm, Lisa A.; Epstein, Joel B.; Frame, Diana; Fuchs, Henry J.; Gwede, Clement K.; Komaroff, Eugene; Nalysnyk, Luba; Zilberberg, Marya D.

doi:10.1016/s0167-8140(02)00404-8

Cited by 1,042 publications

(865 citation statements)

References 39 publications

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“…Among them, a systematic review by Trotti et al showed that xerostomia was frequently found [24]. In the study by Cardoso et al the authors observed that 100% of the patients irradiated with doses superior or equal to 60 Gy presented xerostomia [25], which was also observed in our study as all patients presented some degree of xerostomia.…”

Section: Discussionsupporting

confidence: 83%

“…In our study, we have observed the first reports of xerostomia in the first week of RT, with three patients (15%) presenting xerostomia grade 1. The authors also reported that xerostomia can be transient or permanent, depending on the irradiated field [12,24,25]. In our study, despite the short period of control after RT, 100% of the patients still had some degree of xerostomia in the follow-up visit, that is, one month after RT.…”

Section: Discussionmentioning

confidence: 45%

“…In the study by Cardoso et al the authors observed that 100% of the patients irradiated with doses superior or equal to 60 Gy presented xerostomia [25], which was also observed in our study as all patients presented some degree of xerostomia. According to studies by Mosel et al and Trotti et al the sensation of dry mouth is usually observed in the third or fourth session of radiotherapy due to the lower secretion of saliva by the glands involved in the radiation field [12,24]. This dry mouth sensation impairs greatly the quality of life of the patients, interfering not only with chewing and swallowing, but also with speech, which limits their social life.…”

Section: Discussionmentioning

confidence: 99%

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Oral shedding of human herpesviruses in patients undergoing radiotherapy/chemotherapy for head and neck squamous cell carcinoma is not affected by xerostomia

Palmieri

Ornaghi

Martins

et al. 2018

Journal of Oral Microbiology

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Background: Xerostomia is a very relevant and frequent complication of radiotherapy, causing the irradiated oral mucosa to be affected by bacterial, fungal and viral infections. Objective: The objective of this study was to evaluate a possible relationship between oral shedding of human herpesviruses and xerostomia in patients with squamous cell carcinoma of head and neck submitted to radio/chemotherapy. Methods: In this study, oral rinse samples were collected weekly from 20 patients during radiotherapy. The samples were submitted to PCR and enzymatic digestion for detection of human herpesviruses. Xerostomia was evaluated according to the Seminars in Radiation Oncology criteria. Results: There was a higher frequency of grade 1 xerostomia (51.4%), observed first in the 1st week of radiotherapy. In the 4th week of radiotherapy, all patients presented some degree of xerostomia. Analysis of herpesviruses showed oral shedding of EBV, HHV-6 and HHV-7 in all weeks. Considering all the periods, the highest frequency was in patients with EBV excretion (55.0%), which was significantly higher than that of other viruses. Conclusion: We observed that oral shedding of herpesviruses was not affected by xerostomia as there was a progression in their excretion, even with the evolution of xerostomia. This suggested that there is a local replication in the oral cavity that is not completely dependent of salivary excretion.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 99%

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Oral shedding of human herpesviruses in patients undergoing radiotherapy/chemotherapy for head and neck squamous cell carcinoma is not affected by xerostomia

Palmieri

Ornaghi

Martins

et al. 2018

Journal of Oral Microbiology

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“…OM is a toxicity of radiation and chemotherapy for HNC patients and is associated with pain, functional impairment, treatment interruptions and increased use of costly healthcare resources 8, 9, 10. Dental fillings are a known factor that can exacerbate mucosal toxicity since it generates unpredictable scattering of the radiation and compromises the accuracy of the dose calculation to the adjacent sites due to the imaging artifact that is produced by these fillings on CT scan 6, 7.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of optimizing intensity‐modulated radiation therapy plans based on measured mucosal dose adjacent to dental fillings and toxicity outcomes

Seol

Aggarwal

Eyben

et al. 2018

J Applied Clin Med Phys

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We prospectively investigated the feasibility of IMRT treatment plan optimization based on dosimeter measurements of lateral tongue mucosal dose adjacent to the dental fillings and evaluated dose‐toxicity relationship and factors affecting oral mucositis (OM) in head and neck cancer patients. Twenty‐nine head and neck cancer patients with metallic dental fillings who were scheduled to undergo fractionated external beam radiation therapy (RT) ± chemotherapy were enrolled. The lateral tongue dose was measured and if the calculated dose for the entire treatment was ≥35 Gy, a re‐plan was generated to reduce the lateral tongue mucosal dose. OM was graded weekly according to Common Terminology Criteria for Adverse Events version 4.0 and the patients completed the Oral Mucositis Weekly Questionnaire‐Head and Neck Cancer. The result showed that it was not feasible to optimize the IMRT plan based on measured tongue dose in most of the patients who needed re‐plan as re‐planning compromised the target coverage in 60% of these patients. The duration of grade (Gr) 2 OM was correlated with measured lateral tongue dose (P = 0.050). Concurrent cetuximab was significantly associated with faster onset of Gr2 OM than concurrent cisplatin (P = 0.006) and with longer duration of OM (P = 0.041) compared to concurrent cisplatin or IMRT‐alone. The pattern of reported pain over time was significantly different for each treatment type (RT and cetuximab, RT and cisplatin and RT‐alone) and depending on the dose level (P = 0.006). In conclusion, optimizing the IMRT plan based on measured lateral tongue dose was not feasible. Measured lateral tongue dose was significantly correlated with longer duration of OM ≥Gr2, and concurrent cetuximab was associated with earlier onset and longer duration of OM ≥Gr2.

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“…In patients undergoing RT for head and neck cancer, oral mucositis (OM) is the most common acute adverse effect [3]. More aggressive tumor treatment methods in recent years, above all increased use of concomitant chemotherapy, have lead to increased severity of OM [4][5][6] and increased mean incidence of OM (80%) [4].…”

Section: Introductionmentioning

confidence: 99%

Individualized pharmacological treatment of oral mucositis pain in patients with head and neck cancer receiving radiotherapy

Ling

Larsson

2010

Support Care Cancer

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Results: Worsening of soreness in mouth and overall worsening of swallowing difficulties were seen in the patients referred within the third week of radiotherapy, showing increased severity of OM during the current week (n=59). Pain and swallowing difficulties were unchanged in patients referred later than the third week, showing unchanged severity of OM during the current week (n=23). Conclusion:The answers to the questionnaire showed that the individualized pain treatment with systemic analgesics exploited to the highest degree was insufficient. Future development of pharmacological possibilities for treatment of OM related pain is urgent. In addition, development of structured nursing care and patient selfcare can contribute to improved pain relief.

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Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review

Cited by 1,042 publications

References 39 publications

Oral shedding of human herpesviruses in patients undergoing radiotherapy/chemotherapy for head and neck squamous cell carcinoma is not affected by xerostomia

Oral shedding of human herpesviruses in patients undergoing radiotherapy/chemotherapy for head and neck squamous cell carcinoma is not affected by xerostomia

Feasibility of optimizing intensity‐modulated radiation therapy plans based on measured mucosal dose adjacent to dental fillings and toxicity outcomes

Individualized pharmacological treatment of oral mucositis pain in patients with head and neck cancer receiving radiotherapy

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