Abstract
Oral mucositis (OM) is a common and severe complication of many cancer therapies. Currently, prediction and early detection are not possible and objective monitoring remains problematic. Goal of this prospective study is to assess non-invasive imaging using optical coherence tomography (OCT) for early detection and evaluation of chemotherapy-induced OM in 48 patients, 12 of whom developed clinical mucositis. In 48 patients receiving neoadjuvant chemotherapy for primary breast cancer, oral mucosal health was assessed clinically, and imaged using non-invasive OCT. Images were evaluated for mucositis using an imaging-based scoring system ranging from 0 to 6. Conventional clinical assessment using the OM assessment scale (OMAS) was used as the gold standard. Patients were evaluated on Days 0-11 after commencement of chemotherapy. OCT images were visually scored by three blinded investigators. The following events were identified from OCT images (1) change in epithelial thickness and subepithelial tissue integrity (beginning on Day 2), (2) loss of surface keratinized layer continuity (beginning on Day 4), (3) loss of epithelial integrity (beginning on Day 4). Imaging data gave higher scores compared to clinical scores early in treatment, suggesting that the imaging-based diagnostic scoring was more sensitive to early mucositic change than the clinical scoring system. Once mucositis was established, imaging and clinical scores converged. Using OCT imaging and a novel scoring system, earlier, more sensitive detection of mucositis was possible than using OMAS. Specific imaging-based changes were a consistent predictor of clinical mucositis.
Highlights
IntroductionOropharyngeal mucositis (OM) occurs in up to 75% of chemotherapy patients or those receiving hematopoietic cell transplant (HCT), and in essentially all patients receiving head and neck radiation in doses over 5,000 cGy. Ulcerative mucositis is the most common cause of severe pain in HCT and treatments for hematologic cancer
Oropharyngeal MucositisOropharyngeal mucositis (OM) occurs in up to 75% of chemotherapy patients or those receiving hematopoietic cell transplant (HCT), and in essentially all patients receiving head and neck radiation in doses over 5,000 cGy
Using optical coherence tomography (OCT) imaging and a novel scoring system, earlier, more sensitive detection of mucositis was possible than using OM assessment scale (OMAS)
Summary
Oropharyngeal mucositis (OM) occurs in up to 75% of chemotherapy patients or those receiving hematopoietic cell transplant (HCT), and in essentially all patients receiving head and neck radiation in doses over 5,000 cGy. Ulcerative mucositis is the most common cause of severe pain in HCT and treatments for hematologic cancer. While advances in HCT have led to a modest reduction in the frequency of severe oral ulcerative mucositis, changes in treatment of head and neck cancer including combined chemotherapy and irradiation as well as changes in radiation therapy dosing schedules have increased the severity and duration of mucositis in these patients [1]. Prediction and early detection are not possible and objective monitoring remains problematic Goal of this prospective study is to assess non-invasive imaging using optical coherence tomography (OCT) for early detection and evaluation of chemotherapyinduced OM in 48 patients, 12 of whom developed clinical mucositis
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