Oral Mucositis, Pain and Xerostomia in 135 Head and Neck Cancer Patients Receiving Radiotherapy with or without Chemotherapy

ABSTRACT

Goal of work: This study compared the severity of oral mucositis, pain and xerostomia during and at the completion of radiotherapy in head and neck cancer patients who had received antifungal and antiviral treatment. Patients: The study included 135 patients. Mean total radiotherapy dose was 62.4 Gray. Chemotherapy was administered to 47% of patients. Methods: Oral mucositis was scored weekly, while patients self-evaluated their pain and xerostomia. Cytology smears for the assessment of herpetic infection complicating the ulcers of mucositis were taken from 46 patients. Systemic antifungals and antivirals were administered during radiotherapy, upon clinical, presumptive diagnosis of candidiasis and herpetic infection. Antifungals and antivirals were continued to the end of radiotherapy. Results: Radiotherapy was completed within the preplanned time in 117 patients (87%). During radiotherapy, the prevalence of severe mucositis, pain and xerostomia was 57%, 43% and 29% respectively, and was significantly reduced to 33%, (P<0.001), to 24%, (P<0.001), and to 18%, (P<0.05) at the end of radiotherapy. Antifungals and antivirals were utilized in 70% and 71% of patients, respectively. Viral cytology was positive in 14 of 46 (30.4%) patients. Conclusions: The significant reduction of severe oral mucositis, pain and xerostomia at time of completion of radiotherapy, as compared to during the course of radiotherapy, after the treatment and prevention of candidiasis and herpes, denotes an important role of these infections in radiation-induced mucositis. Limitations of the study are the practical issues of the lack of the verification of the fungal status before and after treatment and of the verification of the viral status in only 47.9% (46 of 96) of the patients with a clinical suspicion of herpetic infection. A controlled study is needed to investigate and further clarify the role of antifungal and antiviral prophylaxis relative to oral mucositis, pain and xerostomia during head and neck RT.