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Acute mucosal reactions in patients with head and neck cancer

Three patterns of mucositis observed during radiotherapy

Akute Schleimhautreaktion bei Patienten mit Kopf-Hals-Tumoren

Drei Mukositis-Muster während Strahlentherapie beobachtet

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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.

Zusammenfassung

Ziel

Die Beurteilung des individuellen Verlaufs einer akuten Schleimhäutreaktion nach der Strahlentherapie („acute mucosal radiation reactions“, AMRR) bei Patienten mit einer Tumorerkrankung im Kopf- und Halsbereich, die nur mit einer Strahlentherapie behandelt wurden. Die Reaktionen wurden täglich individuell mit Hilfe der Dische-Probe bewertet.

Material und Methoden

Die Behandlung von 87 Patienten mit einem Tumor im Kopf- und Halsbereich bestand entweder aus einer konventionellen (CF; n=33), einer beschleunigten (AF; n=33), einer hyperfraktionierten (HPEFX; n=12) oder einer hypofraktionierten (HPOFX; n=9) Strahlentherapie. Bei allen Patienten wurde jeden Tag mithilfe der morphologisch-funktionellen Dische-Probe die AMRR-Steigerung beurteilt. Anhand der täglich ermittelten Summe der Probenparameter wurde eine individuelle AMRR-Verlaufskurve für jeden Patienten erstellt.

Ergebnisse

Der Zeitraum zwischen dem Beginn der Strahlentherapie und dem Auftreten des ersten AMRR-Symptoms lag großräumig zwischen 3 und 14 Tagen. Anhand der Beobachtung von drei individuellen Kurven wurden 3 Typen bezeichnet, die den Verlauf von AMRR während der Strahlentherapie charakterisieren: (1). eine stetige Steigerung von AMRR bis zum Abschluss der Strahlentherapie; (2). das Vorhandensein der Plateauphase nach der AMRR-Steigerung; (3). der Rückgang (Heilung) von AMRR. Eine stetige Steigerung der AMRR wurden bei ca. 25% der mit CF und AF sowie bei über 50 % der mit HPOFX bestrahlten Patienten beobachtet. Dieser Reaktionsverlaufstyp wurde nicht in der HPEFX-Gruppe festgestellt. Die Plateauphase wurde bei den meisten der mit CF und AF behandelten Patienten, bei fast der Hälfte der mit der HPOFX-Methode und bei allen mit der HPEFX-Methode behandelten Patienten festgestellt. Den Rückgang der Reaktion und die Heilung beobachtete man bei 23 % aller Patienten, allerdings unter dem Ausschluss der HPEFX- und HPOFX-Gruppen.

Schlussfolgerungen

Der Steigerungsverlauf der AMRR-Reaktion während der Strahlentherapie kann bei einzelnen Patienten unterschiedlich ausfallen. Nach dem Anfangswachstum unterliegt er einer Stabilisierung, die man anhand der Plateauphase auf der Kurve darstellen kann. Bei einem Teil der bestrahlten Patienten wird die stetige AMMR-Steigerung bis zum Ende der Strahlentherapie beobachtet. Es ist eine Gruppe von bestrahlten Patienten vorhanden, bei der man die Heilungsmerkmale der akuten Schleimhautreaktion bereits während der Strahlenbehandlung in ihrer Endphase diagnostizieren kann.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Ist Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland, Ul. Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland

    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.

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  1. A. Wygoda M.D., Ph.D.
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  2. T. Rutkowski M.D.
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  3. M. Hutnik M.D.
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  4. K. Składowski M.D., Ph.D., Ph.D.
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  5. M. Goleń M.D., Ph.D.
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  6. B. Pilecki M.D., Ph.D.
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Correspondence to A. Wygoda M.D., Ph.D..

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Wygoda, A., Rutkowski, T., Hutnik, M. et al. Acute mucosal reactions in patients with head and neck cancer. Strahlenther Onkol 189, 547–551 (2013). https://doi.org/10.1007/s00066-013-0311-8

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  • DOI: https://doi.org/10.1007/s00066-013-0311-8

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