Burden of oral mucositis and/or esophagitis in patients undergoing radiation treatment for head and neck cancer or non-small cell lung cancer

Abstract

8104 Background: To assess risk factors for and consequences of oral mucositis (OM) and/or esophagitis (E) in patients undergoing radiation treatment (RT) for head and neck cancer (HNC) or nonsmall cell lung cancer (NSCLC). Methods: Subjects were aged >18 years and had received RT for HNC (n=450) or NSCLC (n=310). Information on highest grade of OM/E, and potential risk factors for and consequences of OM/E, were collected via chart review. Chi-square statistics and ANOVA were used to assess the relationship between the highest grade of OM/E and age, gender, weight, tobacco use, tumor location, RT type (standard, hyperfractionated, accelerated) and cumulative dose, and timing of any chemotherapy (CT). Techniques of logistic regression were used to examine the independent contribution of OM/E to breaks/delays in treatment, receipt of feeding tubes/total parenteral nutrition, placement of indwelling IV lines, chemotherapy dose reduction, and hospitalization. Results: Mean age of HNC patients was 60 years. Most received standard RT (mean cumulative dose, 63,000 cGy); more than one-half did not receive CT. Most patients (83%) developed OM/E (mild 19%; moderate 35%; severe 29%). Patients with OM/E were younger than those without (p<0.01), and more likely to have naso/oropharyngeal tumors (p=0.013), mean cumulative RT dose >50,000 cGy (p<0.001), and concomitant CT (p<0.01). Patients with OM/E were about 4-fold more likely to have unplanned RT breaks (adjusted odds ratio=3.8 [95% CI=1.7, 8.5]) and >3 times as likely to be hospitalized (3.5 [1.3, 9.5]). Findings for NSCLC patients were similar. Those with OM/E had more unplanned breaks in RT (adjusted odds ratio 2.2 [1.0, 4.6]) and CT (2.7 [1.3, 5.7]) and were more likely to have indwelling lines (2.7 [1.2, 4.9]). Conclusions: OM/E is a frequent complication of RT in patients with HNC and NSCLC. Tumor location, radiation type and dose, and concomitant CT are risk factors for OM/E. Patients with OM/E are at significantly higher risk of hospitalization and unplanned breaks/delays in RT and CT. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Clinical Assistance Programs/payments to hospital Amgen