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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 7/2013

01-07-2013 | Original article

Acute mucosal reactions in patients with head and neck cancer

Three patterns of mucositis observed during radiotherapy

Authors: A. Wygoda, M.D., Ph.D., T. Rutkowski, M.D., M. Hutnik, M.D., K. Składowski, M.D., Ph.D., Ph.D., M. Goleń, M.D., Ph.D., B. Pilecki, M.D., Ph.D.

Published in: Strahlentherapie und Onkologie | Issue 7/2013

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Abstract

Purpose

To investigate the individual pattern of acute mucosal radiation reactions (AMRR) in patients with head and neck cancer who were treated with radiotherapy alone. Reactions were evaluated daily on an individual basis according to the Dische scoring system.

Materials and methods

Treatment of 87 head and neck cancer patients comprised either conventional fractionation- (CF; n = 33), accelerated fractionation (AF; n = 33), hyperfractionated- (HPEFX; n = 12) or hypofractionated (HPOFX; n = 9) radiotherapy with radical intent. Daily evaluation of AMRR progression was performed prospectively using a modified, morphologically functional Dische scoring system. The daily sums of the score parameters were subsequently used to construct an individual AMRR course curve for each patient.

Results

A latency period ranging from 3 to 14 days between the start of radiotherapy and the occurrence of the first AMRR symptom was observed in all patients. Based on the three different shapes of AMRR course curve observed during radiotherapy, three types of AMRR course can be described: (1) a continual increase in AMRR intensity until the completion of radiotherapy; (2) the incidence of a plateau phase following the increase in AMRR (increase–plateau course) and (3) decreasing AMRR intensity with a healing phase. A continual increase in AMRR intensity was observed in about 25 % of CF and AF patients and in more than 50 % of HPOFX treatments. This type of reaction was not observed in the HPEFX group. The increase–plateau course was noted in the majority of AF and CF patients; in almost half of those treated with HPOFX and in all HPEFX patients. A decreasing AMRR intensity course was observed in 23 % of all patients, although not observed at all in the HPEFX and HPOFX fractionation groups.

Conclusion

The course of AMRR during radiotherapy can differ between individual patients. After the initial increase in AMRR intensity, a stabilization of the reaction—visible as a plateau phase on the course curve—is observed in the majority of patients. A proportion of the irradiated patients experience a continual increase in AMRR intensity up until the end of radiotherapy. A further group of patients exists in whom signs of AMRR healing are observed during the final stages of radiotherapy.
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Metadata
Title
Acute mucosal reactions in patients with head and neck cancer
Three patterns of mucositis observed during radiotherapy
Authors
A. Wygoda, M.D., Ph.D.
T. Rutkowski, M.D.
M. Hutnik, M.D.
K. Składowski, M.D., Ph.D., Ph.D.
M. Goleń, M.D., Ph.D.
B. Pilecki, M.D., Ph.D.
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
Strahlentherapie und Onkologie / Issue 7/2013
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-013-0311-8

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