Weekly Assessment of Acute Oral Mucositis on Concurrent Chemo Radiotherapy in Oral Cavity Cancers
Acute Oral Mucositis in Oral Cancer Patients
Abstract
Objective: This study aimed to assess the weekly progression of acute oral mucositis in patients with oral cavity cancer undergoing concurrent chemoradiotherapy.
Methodology: A descriptive study was conducted at the Department of Oncology, Dr Ziauddin University Hospital from September 2020 to December 2021. Patients with SCC of oral cavity with ages between 18 and 70 years, planned for radiation therapy as adjuvant (after surgery) with chemotherapy were recruited. The severity of mucositis was evaluated weekly during the treatment according to RTOG/EORTC criteria of adverse events. The severity of mucositis was compared between patients aged below and above 45 years and between genders.
Results: Total 126 patients were included in the study. At Week 07, Grade 3 radiation induced oral mucositis constituted the highest proportion in patients aged <45 years, i.e. 74.4%, followed by Grade 4 (23.3%), and Grade 2 (2.3%) oral mucositis, which seemed similar to the oral mucositis grades in patients who are >45 years of age. The p-value (0.783) indicated that the observed differences in grade distribution between the age groups were not statistically significant. At Week 07, the percentage of Grade 3 XRT induced oral mucositis was higher than Grade 4 and Grade 2 oral mucositis in both female and male patients. The p-value (0.979) indicated that the observed differences in grade distribution between genders were not statistically significant.
Conclusion: Acute oral mucositis is a common and severe toxicity in oral cavity cancer patients undergoing concurrent chemoradiotherapy, typically peaking at Grade 3 by Week 7, with no significant differences observed across age or gender, highlighting the need for uniform supportive care strategies.
References
Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144(8):1941-1953.
Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191-e203.
Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, et al. Global Cancer Observatory: Cancer Today. Lyon: International Agency for Research on Cancer; 2020.
Pulito C, Cristaudo A, Porta CL, Zapperi S, Blandino G, Morrone A, et al. Oral mucositis: the hidden side of cancer therapy. J Exp Clin Cancer Res. 2020;39(1):210.
Xiang M, Gensheimer MF, Pollom EL, Holsinger FC, Colevas AD, Le QT, et al. Prolongation of definitive head and neck cancer radiotherapy: survival impact and predisposing factors. Radiother Oncol. 2021;156:201-208.
Blakaj A, Bonomi M, Gamez ME, Blakaj DM. Oral mucositis in head and neck cancer: evidence-based management and review of clinical trial data. Oral Oncol. 2019;95:29-34.
Judge LF, Farrugia MK, Singh AK. Narrative review of the management of oral mucositis during chemoradiation for head and neck cancer. Ann Transl Med. 2021;9(10):916.
Li E, Zeng J, Hong F, Chen P, Yu X. The prevalence of oral mucositis after radiotherapy in patients with head and neck cancer and its associated factors: a meta-analysis. Clin Transl Oncol. 2025;27(4):1767-1778.
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
Pulito C, Cristaudo A, Porta CL, Zapperi S, Blandino G, Morrone A, et al. Oral mucositis: the hidden side of cancer therapy. J Exp Clin Cancer Res. 2020;39(1):210.
Liu M, An R, Wu Z, Dai L, Zeng Q, Chen W. The trajectory of oral mucositis in head and neck cancer patients undergoing radiotherapy and its influencing factors. Ear Nose Throat J. 2025;104(5):NP257-NP269.
Alterio D, Marvaso G, Ferrari A, Volpe S, Orecchia R, Jereczek-Fossa BA. Modern radiotherapy for head and neck cancer. Semin Oncol. 2019;46(3):233-245.
Nicol AJ, Ching JC, Tam VC, Liu KC, Leung VW, Cai J, et al. Predictive factors for chemoradiation-induced oral mucositis and dysphagia in head and neck cancer: a scoping review. Cancers (Basel). 2023;15(23):5705.
Windon MJ, D'Souza G, Rettig EM, Westra WH, van Zante A, Wang SJ, et al. Increasing prevalence of human papillomavirus-positive oropharyngeal cancers among older adults. Cancer. 2018;124(14):2993-2999.
Fung SY, Lam JW, Chan KC. Clinical utility of circulating Epstein-Barr virus DNA analysis for the management of nasopharyngeal carcinoma. Chin Clin Oncol. 2016;5(2):18.
Porock D. Factors influencing the severity of radiation skin and oral mucosal reactions: development of a conceptual framework. Eur J Cancer Care (Engl). 2002;11(1):33-43.
Santos RC, Dias RS, Giordani AJ, Segreto RA, Segreto HR. Mucositis in head and neck cancer patients undergoing radiochemotherapy. Rev Esc Enferm USP. 2011;45:1338-1344.
Vera-Llonch M, Oster G, Hagiwara M, Sonis S. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma: risk factors and clinical consequences. Cancer. 2006;106(2):329-336.
Pereira IF, Firmino RT, Meira HC, Vasconcelos BC, Noronha VR, Santos VR. Radiation-induced oral mucositis in Brazilian patients: prevalence and associated factors. In Vivo. 2019;33(2):605-609.
Hammad AM, Abrar S, Tahseen R, Qureshi BM, Hafiz A, Abbasi AN. Acute oral mucositis during hypofractionated radiation in squamous cell carcinoma of oral cavity. Surgery. 2023;11:100.
Rangineni S, Lahiri D, Misra B, Maji T, Roy S, Ray DK, et al. Hypofractionated intensity-modulated radiation therapy with concurrent cisplatin in locally advanced oropharyngeal cancer: feasibility experience from a government cancer centre of Eastern India in a resource-constrained setting. J Radiother Pract. 2020;19(1):59-64.
Parra-Rojas S, Cassol Spanemberg J, del Mar Díaz Robayna N, Peralta-Mamani M, Velázquez Cayón RT. Assessing the cost-effectiveness of photobiomodulation for oral mucositis prevention and treatment: a systematic review. Biomedicines. 2024;12(10):2366.
Hirna HA, Maltsev DV, Rozhko MM, Kostyshyn ID. Results of the study of mucosal immunity indices in patients with cancer of the oral cavity and oropharynx during radiotherapy or chemoradiotherapy and immunotherapy with α/β-defensins. Klin Onkol. 2023;36(2):112-123.
Schack LM, Naderi E, Fachal L, Dorling L, Luccarini C, Dunning AM, et al. A genome-wide association study of radiotherapy-induced toxicity in head and neck cancer patients identifies a susceptibility locus associated with mucositis. Br J Cancer. 2022;126(7):1082-1090.
Iovoli AJ, Turecki L, Qiu ML, Khan M, Smith K, Yu H, et al. Severe oral mucositis after intensity-modulated radiation therapy for head and neck cancer. JAMA Netw Open. 2023;6(10):e2337265.
Yang DW, Wang TM, Zhang JB, Li XZ, He YQ, Xiao R, et al. Genome-wide association study identifies genetic susceptibility loci and pathways of radiation-induced acute oral mucositis. J Transl Med. 2020;18(1):224.
Copyright (c) 2026 Annals of Jinnah Sindh Medical University
This work is licensed under a Creative Commons Attribution 4.0 International License.
