Abstract
A preliminary study to assess noninvasive optical coherence tomography (OCT) for early detection and evaluation of chemotherapy-induced oral mucositis in five patients. In five patients receiving neoadjuvant chemotherapy for primary breast cancer, oral mucositis was assessed clinically, and imaged using noninvasive OCT. Imaging was scored using a novel imaging-based scoring system. Conventional clinical assessment using the Oral Mucositis Assessment Scale was used as the gold standard. Patients were evaluated on days 0, 2, 4, 7, and 11 after commencement of chemotherapy. OCT images were visually examined by one blinded investigator. The following events were identified using OCT: (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 earlier 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. Chemotherapy-induced oral changes were identified prior to their clinical manifestation using OCT, and the proposed scoring system for oral mucositis was validated for the semiquantification of mucositic change.
Highlights
1.1 Oropharyngeal MucositisOropharyngeal mucositisOMoccurs in 30 to 75% of chemotherapy patients, in up to 75% of patients receiving hematopoietic cell transplantHCT, and in essentially all patients receiving head and neck radiation in doses over 5000 cGy
The likelihood of developing mucositis is high in patients who have suffered from mucositis during the previous cycle of chemotherapy
We had anticipated potential movement artifacts during OCT registration in human subjects, when patients were seated in a chair with a headrest and neck support, this was not a problem at all, as evidenced by Fig. 1
Summary
1.1 Oropharyngeal MucositisOropharyngeal mucositisOMoccurs in 30 to 75% of chemotherapy patients, in up to 75% of patients receiving hematopoietic cell transplantHCT, and in essentially all patients receiving head and neck radiation in doses over 5000 cGy. 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 and changes in radiation therapy dosing schedules have increased the severity and duration of mucositis in these patients.[1]. OM may lead to alterations in cancer therapy, dose reduction, delay in scheduled therapy, and may require interruption or termination of planned therapy, with the potential for impact on patient cure. OM is associated with a negative impact on quality of lifeQOLand increased cost of care.[2,3,4,5] OM is the most common distressing and disabling acute complication of cancer chemotherapy,[6] and radiotherapy,[7] as reported by patients, and is among the most
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