Microvascular changes in radiation-induced oral mucositis.
BACKGROUND
Mucositis is one of the most debilitating side effects of head and neck cancer therapy and is currently believed to arise from an inflammatory cascade leading to cellular damage. However, no effective treatment has been identified despite extensive attempts with anti-inflammatory medications.


OBJECTIVE
To compare real-time microvascular inflammatory changes with oral mucositis levels in patients undergoing radiotherapy or chemoradiotherapy for head and neck tumours.


METHODS
Prospective, longitudinal, cohort, observational study.


METHODS
Regional cancer program.


METHODS
Twenty patients with head and neck tumours were assessed on a weekly basis throughout the course of radiotherapy. Levels of mucositis were graded objectively using the Oral Mucositis Assessment Scale and subjectively using a patient symptom questionnaire. Video imaging of the sublingual microcirculation was obtained using orthogonal polarized spectral imaging to quantify inflammatory markers such as microcirculatory velocity, white blood cell margination, and extravasation.


RESULTS
Despite very high levels of objective and subjective mucositis, inflammatory changes were not present in the microcirculation.


CONCLUSIONS
Typical microvascular inflammatory changes are not demonstrated in radiation-induced mucositis. These findings contradict the currently proposed mechanism of mucosal damage and may therefore have important implications in the development of novel therapeutic interventions.
Hamilton
Scott
S
Department of Otolaryngology, London Health Sciences Centre, London, ON.
Yoo
John
J
Hammond
Alexander
A
Read
Nancy
N
Venkatesan
Varagur
V
Franklin
Jason
J
Fung
Kevin
K
Gray
Daryl
D
Parry
Neil
N
Van Diepen
Kristen
K
Baswick
Brenda Lee
BL
Badhwar
Amit
A
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011832:Radiation Injuries / Q000150:complications* / Q000175:diagnosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012039:Regional Blood Flow; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013280:Stomatitis / Q000209:etiology* / Q000473:pathology