The association between cumulative radiation dose and the incidence of severe oral mucositis in head and neck cancers during radiotherapy

Abstract

Background Quality of life can be influenced by oral mucositis (OM), and it is necessary to implement OM management strategies before the initiation of radiotherapy (RT) in patients with head and neck cancer (HNC). Aims To examine the association between the cumulative radiation dose and the incidence of severe OM in HNC patients receiving RT. Methods and results A retrospective observational cohort study was conducted in a Showa University Fujigaoka Hospital, in Japan. We retrospectively analyzed 94 patients with HNC who developed OM during RT. We defined OM as a more than grade 2 OM. The cumulative incidence of OM curves of the two categories was estimated using the Kaplan–Meier method and compared using the log‐rank test. We estimated the hazard ratio (HR) for OM after the adjustment of factors for covariates using Cox's regression analysis. Patients with smoking history had a significantly later development of OM than those with no smoking history (20 Gy‐incidence OM 68.7% vs 39.7%, P = .003). In contrast, patients undergoing concurrent chemotherapy had an earlier development of OM than those undergoing RT alone (20 Gy‐incidence OM 24.2% vs 55.7%, P < .001). Multivariate analysis revealed that no smoking history and concurrent chemotherapy were independent predictive factors, with a HR of 0.526 (P = .025) and 2.690 (P < .001), respectively. Conclusion We demonstrated that no smoking history and concurrent chemotherapy may be predictive of OM in HNC patients.

The Treatment of Hexavalent Chromium Induced Ovarian Cancer in Albino Rats with Emblica Officinalis. A Comparative Study

“…Numerous risk factors have been identified by researchers that could raise a woman's chances of acquiring epithelial ovarian cancer 3 . Other less prevalent forms of ovarian cancer include germ cell tumors and stromal tumors are not affected by these risk factors.…”

“…Important cellular processes, including as inflammation, cellular proliferation, and apoptosis, as well as the cell cycle and response indicators, are influenced by phytochemicals in emblica officinalis extracts 1,18 . Human colorectal (SW620), lung (A549), breast (MDA-MB-231), cervical (HeLa), ovarian (SK-OV3), and liver (HepG2) cancer cell lines are significantly inhibited in their ability to proliferate by Emblica officinalis 3,16 . This suppression was linked to the death receptormediated apoptosis pathway; apoptosis was brought on by the activation of caspase-3, caspase-7, and caspase-8 14,15 .…”

“…Cancer is a condition in which the body's aberrant cells proliferate uncontrollably 2 . Even if it later spreads to other body areas, cancer is typically termed after the area of the body where it first develops 3 . A category of illnesses known as ovarian cancer start in the ovaries or in nearby organs like the fallopian tubes and the peritoneum.…”

Precision medicine for risk prediction of oral complications of cancer therapy–The example of oral mucositis in patients receiving radiation therapy for cancers of the head and neck

“…The stomatotoxic effects of radiation have been extensively described and are associated with the cumulative dose, daily fraction size and schedule, and field [ 16 ]. While the administration of concomitant chemotherapy enhances the tumoricidal effect of radiation [ 17 ], it also increases OM risk by a factor >3 [ 18 ] and hastens it onset [ 19 ].…”

Attempts to Understand Oral Mucositis in Head and Neck Cancer Patients Through Omics Studies

“…In a recent study, up to 90% of patients developed OM, but only 36% developed severe OM [7]. Longitudinal patterns of OM also vary, with some patients experiencing early resolution [8][9][10]whereas others develop chronic [11] OM. Moreover, for some HNSCC patients, visits to the ED for OM-related complaints, including severe pain, occur within 7 days of the initiation of cancer treatment and may persist with pain as a chief complaint across multiple ED visits for up to 23% of HNSCC patients [12].…”