title: Prospective evaluation to establish a dose response for clinical oral mucositis in patients undergoing head-and-neck conformal radiotherapy.
abstract: OBJECTIVE
  We conducted a clinical study to correlate oral cavity dose with clinical mucositis, perform in vivo dosimetry, and determine the feasibility of obtaining buccal mucosal cell samples in patients undergoing head-and-neck radiation therapy. The main objective is to establish a quantitative dose response for clinical oral mucositis.
  
  
  METHODS
  Twelve patients undergoing radiation therapy for head-and-neck cancer were prospectively studied. Four points were chosen in separate quadrants of the oral cavity. Calculated dose distributions were generated by using AcQPlan and Eclipse treatment planning systems. MOSFET dosimeters were used to measure dose at each sampled point. Each patient underwent buccal sampling for future RNA analysis before and after the first radiation treatment at the four selected points. Clinical and functional mucositis were assessed weekly according to National Cancer Institute Common Toxicity Criteria, Version 3.
  
  
  RESULTS
  Maximum and average doses for sampled sites ranged from 7.4-62.3 and 3.0-54.3 Gy, respectively. A cumulative point dose of 39.1 Gy resulted in mucositis for 3 weeks or longer. Mild severity (Grade </= 1) and short duration (</=1 week) of mucositis were found at cumulative point doses less than 32 Gy. Polymerase chain reaction consistently was able to detect basal levels of two known radiation responsive genes.
  
  
  CONCLUSIONS
  In our sample, cumulative doses to the oral cavity of less than 32 Gy were associated with minimal acute mucositis. A dose greater than 39 Gy was associated with longer duration of mucositis. Our technique for sampling buccal mucosa yielded sufficient cells for RNA analysis using polymerase chain reaction.
authors.affiliation: Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Narayan
authors.forename: Joerg
authors.initials: J
authors.lastname: Lehmann
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Coleman
authors.forename: Andrew
authors.initials: A
authors.lastname: Vaughan
authors.forename: Claus Chunli
authors.initials: CC
authors.lastname: Yang
authors.forename: Danny
authors.initials: D
authors.lastname: Enepekides
authors.forename: Gregory
authors.initials: G
authors.lastname: Farwell
authors.forename: James A
authors.initials: JA
authors.lastname: Purdy
authors.forename: Grace
authors.initials: G
authors.lastname: Laredo
authors.forename: Kerry
authors.initials: K
authors.lastname: Nolan
authors.forename: Francesca S
authors.initials: FS
authors.lastname: Pearson
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Vijayakumar
mesh_terms: D000199:Actins / Q000235:genetics; D004261:DNA Replication / Q000528:radiation effects; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D009061:Mouth Mucosa / Q000473:pathology / Q000528:radiation effects; D018579:Patient Selection; D016133:Polymerase Chain Reaction; D012313:RNA / Q000235:genetics / Q000302:isolation & purification; D012337:RNA, Ribosomal, 18S / Q000235:genetics; D044469:Racial Groups; D011877:Radionuclide Imaging; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D013280:Stomatitis / Q000000981:diagnostic imaging* / Q000453:epidemiology*
chemical_list: D000199:Actins; D012337:RNA, Ribosomal, 18S; D012313:RNA