Abstract
PurposeTo explore risk factors for severe acute oral mucositis of nasopharyngeal carcinoma (NPC) patients receiving chemo-radiotherapy, build predictive models and determine preventive measures.Methods and MaterialsTwo hundred and seventy NPC patients receiving radical chemo-radiotherapy were included. Oral mucosa structure was contoured by oral cavity contour (OCC) and mucosa surface contour (MSC) methods. Oral mucositis during treatment was prospectively evaluated and divided into severe mucositis group (grade ≥ 3) and non-severe mucositis group (grade < 3) according to RTOG Acute Reaction Scoring System. Nineteen clinical features and nineteen dosimetric parameters were included in analysis, least absolute shrinkage and selection operator (LASSO) logistic regression model was used to construct a risk score (RS) system.ResultsTwo predictive models were built based on the two delineation methods. MSC based model is more simplified one, it includes body mass index (BMI) classification before radiation, retropharyngeal lymph node (RLN) area irradiation status and MSC V55%, RS = −1.480 + (0.021 × BMI classification before RT) + (0.126 × RLN irradiation) + (0.052 × MSC V55%). The cut-off of MSC based RS is −1.011, with an area under curve (AUC) of 0.737 (95%CI: 0.672-0.801), a specificity of 0.595 and a sensitivity of 0.786. OCC based model involved more variables, RS= −4.805+ (0.152 × BMI classification before RT) + (0.080 × RT Technique) + (0.097 × Concurrent Nimotuzumab) + (0.163 × RLN irradiation) + (0.028 × OCC V15%) + (0.120 × OCC V60%). The cut-off of OCC based RS is −0.950, with an AUC of 0.767 (95%CI: 0.702–0.831), a specificity of 0.602 and a sensitivity of 0.819. Analysis in testing set shown higher AUC of MSC based model than that of OCC based model (AUC: 0.782 vs 0.553). Analysis in entire set shown AUC in these two method-based models were close (AUC: 0.744 vs 0.717).ConclusionWe constructed two risk score predictive models for severe oral mucositis based on clinical features and dosimetric parameters of nasopharyngeal carcinoma patients receiving chemo-radiotherapy. These models might help to discriminate high risk population in clinical practice that susceptible to severe oral mucositis and individualize treatment plan to prevent it.
Highlights
Nasopharyngeal carcinoma (NPC) has an extremely uneven endemic distribution within Southern China and Southeast Asia [1]
Most dosimetric parameters were significantly correlated with the occurrence of severe oral mucositis (P < 0.05)
Better performance can be observed in objectives under MSC method in general in terms of predicting severe oral mucositis and the highest area under curve (AUC) was seen in MSC V55%
Summary
Nasopharyngeal carcinoma (NPC) has an extremely uneven endemic distribution within Southern China and Southeast Asia [1]. The mainstay treatment for this disease is chemo-radiotherapy. Both traditional intensity-modulated radiation therapy (IMRT) including volumetric-modulated arc therapy and fixed-field intensity-modulated radiotherapy and advanced IMRT technique like helical tomography radiotherapy (TOMO) are commonly used in the treatment of NPC. Almost all NPC patients receiving chemo-radiotherapy will develop into a certain degree of acute oral mucositis during treatment. Morbidity of severely acute oral mucositis is 20%–40% [2,3,4]. Severe oral mucositis causes pain, reduces oral intake, impairs quality of life, affects treatment compliance, gives raise to secondary infection, all of which lead to increase treatment cost and might impact prognosis of the disease [5,6,7,8,9]. Available medicine for prevention and treatment of oral mucositis are not effective enough according to MASCC/ISOO clinical practice guidelines [13]
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