Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma - Risk factors and clinical consequences

BACKGROUND. The current study was conducted to characterize the risks and clinical consequences of oral mucositis (OM) in patients with head and neck carcinoma (HNC) who are receiving radiation therapy. METHODS. Data regarding 450 HNC patients who had received radiation therapy were collected via chart review from 154 U.S. medical and radiation oncologists. Information obtained included patient characteristics, treatments received, highest recorded grade of OM during radiation therapy (none, mild, moderate, or severe), and outcomes potentially associated with mucosal injury. RESULTS. The mean age (+/- standard deviation [SD]) of the study subjects was 61.3 years (12.3 yrs); the majority of patients (80%) were men. Primary tumor locations included the oropharynx (26.4%), larynx (26.4%), oral cavity including the lip (24.4%), hypopharynx (13.6%), and nasopharynx (9.1%). The majority of tumors were new and were classified as AJCC Stages III or IV. The majority of patients (83%) received standard radiation therapy; the mean (+/- SD) Cumulative dose was 6285 centigrays (cGy) (+/- 1158 cGy). Approximately 33% of the patients received concomitant chemotherapy. The majority of patients (83%) developed OM; 29% developed severe OM. Patients with severe OM were more likely to have nasopharyngeal or oropharyngeal tumors (adjusted odds ratio [OR] of 10.1 [95% confidence interval (95% CI), 2.1-49.9] and 6.9 [95% Cl, 2.4-19.7], respectively), and to have received cumulative radiation doses > 5000 cGy (OR of 10.4; 95% Cl, 2.9-37.1) and concomitant chemotherapy (OR of 3.3; 95% Cl, 1.4-8.0). Patients with OM had more unplanned breaks in radiation therapy (OR of 3.8; 95% Cl, 1.7-8.5) and hospital admissions (OR of 3.5; 95% Cl, 1.3-9.5). CONCLUSIONS. HNC patients with nasopharyngeal or oropharyngeal tumors, and those who receive cumulative radiation doses > 5000 cGy or concomitant chemotherapy, are more likely to develop OM. Patients with OM are at a higher risk of unplanned breaks in radiation therapy and hospitalization.