title: Microvascular changes in radiation-induced oral mucositis.
abstract: 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.
authors.affiliation: Department of Otolaryngology, London Health Sciences Centre, London, ON.
authors.forename: Scott
authors.initials: S
authors.lastname: Hamilton
authors.forename: John
authors.initials: J
authors.lastname: Yoo
authors.forename: Alexander
authors.initials: A
authors.lastname: Hammond
authors.forename: Nancy
authors.initials: N
authors.lastname: Read
authors.forename: Varagur
authors.initials: V
authors.lastname: Venkatesan
authors.forename: Jason
authors.initials: J
authors.lastname: Franklin
authors.forename: Kevin
authors.initials: K
authors.lastname: Fung
authors.forename: Daryl
authors.initials: D
authors.lastname: Gray
authors.forename: Neil
authors.initials: N
authors.lastname: Parry
authors.forename: Kristen
authors.initials: K
authors.lastname: Van Diepen
authors.forename: Brenda Lee
authors.initials: BL
authors.lastname: Baswick
authors.forename: Amit
authors.initials: A
authors.lastname: Badhwar
mesh_terms: 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