The kinetics of γ-H2AX during radiotherapy of head and neck cancer potentially allow for prediction of severe mucositis
, , , , and | Feb 14, 2020
About this article
Article Category: Research Article
Published Online: Feb 14, 2020
Page range: 96 - 102
Received: Dec 12, 2019
Accepted: Jan 16, 2020
DOI: https://doi.org/10.2478/raon-2020-0005
Keywords
© 2020 Joanna Kazmierska, Wojciech Barczak, Tomasz Winiecki, Łukasz Łuczewski, Magdalena Marciniak, Wiktoria Suchorska, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Figure 1
Figure 2
Demographics, staging and treatment information of studied patients
| Characteristics | Total | M 0-2 | M 3 | ||
|---|---|---|---|---|---|
| N = 50 (%) | N = 35 (%) | N = 15 (%) | |||
| Male | 44 (88) | 30 (85.7) | 14 (93.3) | 0.44 | |
| Female | 6 (12) | 5 (14.2) | 1 (6.6) | ||
| Parotid | 5 (10) | 5 (14.3) | 0 (0) | ||
| Oral cavity | 11 (22) | 7 (20) | 4 (26.7) | ||
| Larynx | 14 (28) | 10 (28.6) | 4 (26.7) | ||
| Hypopharynx | 4 (8) | 4 (11.4) | 0 (0) | 0.27 | |
| Oropharynx | 12 (24) | 6 (17.1) | 6 (40) | ||
| CUP | 2 (4) | 1 (2.8) | 1 (6.7) | ||
| Nasalcavity/paranasal sinuses | 2 (4) | 2 (5.7) | 0 (0) | ||
| T1 | 4 (8) | 2 (5.7) | 2 (13.3) | ||
| T2 | 17 (34) | 11 (31.4) | 6 (40) | ||
| T3 | 8 (16) | 7 (20) | 1 (6.7) | 0.49 | |
| T4 | 19 (38) | 14 (40) | 5 (33.3) | ||
| Tx | 2 (4) | 1 (2.8) | 1 (6.7) | ||
| N0 | 26 (52) | 19 (54.3) | 7 (46.7) | ||
| N1 | 4 (8) | 4 (11.4) | 0 (0) | 0.25 | |
| N2 | 20 (40) | 12 (34.3) | 8 (53.3) | ||
| Yes | 28 (56) | 22 (62.85) | 6 (40) | 0.13 | |
| No | 22 (44) | 13 (37.1) | 9 (60) | ||
| Yes | 33 (66) | 26 (74.3) | 7 (46.7) | 0.06 | |
| No | 17 (34) | 9 (25.7) | 8 (53.3) | ||
| Yes | 34 (68) | 21 (60) | 13 (86.7) | 0.06 | |
| No | 16 (32) | 14 (40) | 2 (13.3) | ||
| Diabetes type II | 6 (12) | 5 (14.3) | 1 (6.7) | ||
| Hypertension | 17 (34) | 12 (34.3) | 5 (33.3) | 0.09 | |
| Ischemic heart disease | 11 (22) | 4 (11.1) | 7 (46.7) |
Level of γ-H2AX in peripheral blood lymphocytes before and during treatment
| Week of radiotherapy | Mild mucositis | Severe mucositis | No. of samples | |||
|---|---|---|---|---|---|---|
| Mean | SD | Mean | SD | |||
| Before | 10.64 | 16.38 | 11.40 | 11.71 | 48 | 0.868 |
| Week 1 | 8.48 | 8.99 | 11.24 | 10.78 | 48 | 0.347 |
| Week 2 | 7.22 | 9.86 | 13.27 | 11.94 | 48 | 0.065 |
| Week 3 | 9.45 | 11.46 | 12.44 | 12.16 | 48 | 0.403 |
| Week 4 | 10.81 | 14.10 | 11.87 | 15.46 | 48 | 0.812 |
| Week 5 | 14.95 | 19.88 | 11.97 | 19.60 | 47 | 0.624 |
| Week 6 | 18.25 | 20.96 | 8.90 | 15.62 | 47 | 0.121 |
| Week 7 | 20.50 | 23.13 | 3.81 | 4.78 | 39 | 0.011* |
| Week 8 | 13.23 | 10.82 | 5.46 | 8.83 | 8 | 0.268 |
Grading of radiation-induced oral mucositis according to CTCAE v4 and EORTC/RTOG scales.6,7
| Mucositis (oral) | Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 |
|---|---|---|---|---|---|
| Asymptomatic/mild symptoms, intervention not indicated | Moderate pain not interfering with oral intake, modified diet indicated | Severe pain interfering with oral intake | Life-threating consequences, urgent intervention indicated | Death | |
| Irritation, may experience slight pain, not requiring analgesic | Patchy mucositis that may produce inflammatory serosanquinitis discharge, may experience moderate pain requiring analgesia | Confluent, fibrinous mucositis, may include severe pain requiring narcotic | Ulceration, haemorrhage or necrosis | N/A |