Radiation Oncology/Toxicity/Mucositis

Mucositis
 * Minimal mucositis if oral cavity dose <32 Gy
 * Anterior mandible dose >34 Gy and/or oral cavity dose >39 Gy results in long-duration of mucositis


 * Sichuan University; 2024 PMID 38215354 -- "Streptococcus salivarius K12 Alleviates Oral Mucositis in Patients Undergoing Radiotherapy for Malignant Head and Neck Tumors: A Randomized Controlled Trial" (Peng X, J Clin Oncol. 2024 Apr 20;42(12):1426-1435. doi: 10.1200/JCO.23.00837. Epub 2024 Jan 12.)
 * Randomized. 160 patients with H&N cancer, undergoing definitive or postop RT. Arm 1) SsK12 probiotic vs Arm 2) Placebo.
 * Outcome: Severe oral mucositis SsK12 37% vs placebo 54% (SS). Duration and time to mucositis less.
 * Toxicity: Other toxicity similar
 * Conclusion: SsK12 probiotic significantly reduced incidence, onset and duration of severe oral mucositis, with good safety profile


 * Complutense University, Spain -- antiseptic mouth rinse vs placebo
 * Randomized. 36 patients, RT for HNC. Arm 1) antiseptic mouth rinse vs Arm 2) placebo
 * 2010 PMID 20173709 -- "Mucositis in irradiated cancer patients: effects of an antiseptic mouthrinse." (Lanzos I, Med Oral Patol Oral Cir Bucal. 2010 Feb 21. [Epub ahead of print])
 * Outcome: No difference in degree of mucositis; 2-week mucositis worse in placebo group
 * Conclusion: Mouth rinse may lead to some improvement


 * MD Anderson; 2008 PMID 18455324 -- "Beam Path Toxicities to Non-Target Structures During Intensity-Modulated Radiation Therapy for Head And Neck Cancer." (Rosenthal DI, Int J Radiat Oncol Biol Phys. 2008 May 1. [Epub ahead of print])
 * Retrospective. 160 patients, oropharynx, treated with IMRT and 3D-CRT
 * Nausea: Higher nausea and vomiting if mean brainstem dose >36 Gy.
 * Occipital alopecial: if occipital scalp dose >30 Gy
 * Anterior mucositis : if anterior mandible dose >34 Gy
 * Conclusion: Dose reduction during IMRT implies increased beam path dose to alternate structure that may result in toxicities uncommon with previous approaches


 * UCSD; 2008 PMID 18417299 -- "Prospective Evaluation to Establish a Dose Response for Clinical Oral Mucositis in Patients Undergoing Head-and-Neck Conformal Radiotherapy." (Narayan S, Int J Radiat Oncol Biol Phys. 2008 Apr 14. [Epub ahead of print])
 * Prospective. 12 patients, 4 sites in oral cavity, MSFET dosimeters and Eclipse dose distributions. Buccal sampling for RNA analysis
 * Outcome: Point dose >39.1 Gy resulted in mucositis 3+ weeks. Point dose <32 Gy resulted in mild (<= G1) mucositis for <=1 week
 * Conclusion: Dose <32 Gy minimal acute mucositis, dose >39 Gy longer duration of mucositis