title: Characteristics of response of oral and pharyngeal mucosa in patients receiving chemo-IMRT for head and neck cancer using hypofractionated accelerated radiotherapy.
abstract: OBJECTIVE
  This study describes the acute response of oral and pharyngeal mucosa to chemo-IMRT schedules using different doses per fraction.
  
  
  METHODS
  Patients, treated in prospective trials of concomitant chemo-IMRT with 2.17 Gy, 2.25 Gy and 2.4 Gy per fraction and identical dose of cisplatin, were included in this study. Acute toxicity was recorded prospectively using the CTCAE v2.0. We describe the incidence and prevalence of grade 3 oral mucositis and dysphagia over time and report the influence of overall treatment time (OTT). The association between the lengths of pharyngeal mucosa receiving 50 Gy (L50) and 60 Gy (L60) and grade 3 dysphagia was tested.
  
  
  RESULTS
  The incidence and the peak prevalence of grade 3 dysphagia were significantly higher in patients receiving 2.4 Gy per fraction. The peak prevalence of grade 3 dysphagia was higher and the recovery was slower in patients with lower OTT (median 38 days vs. 42 days) treatment. There was a significant correlation between L50, L60 and grade 3 dysphagia. A L50 and L60 greater than 8 cm resulted in greater than 60% and 70% incidence of grade 3 dysphagia, respectively.
  
  
  CONCLUSIONS
  The length of pharyngeal mucosa receiving doses close to the prescription dose correlates with grade 3 dysphagia. It was observed that incidence of grade 3 dysphagia was lower and recovery from it was quicker in patients with greater OTT.
authors.affiliation: Royal Marsden Hospital, London, UK. sabhide@yahoo.com
authors.forename: Shreerang A
authors.initials: SA
authors.lastname: Bhide
authors.forename: Sarah
authors.initials: S
authors.lastname: Gulliford
authors.forename: Jack
authors.initials: J
authors.lastname: Fowler
authors.forename: Nicola
authors.initials: N
authors.lastname: Rosenfelder
authors.forename: Katie
authors.initials: K
authors.lastname: Newbold
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Harrington
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Nutting
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology*; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000528:radiation effects*; D010614:Pharynx / Q000528:radiation effects*; D015995:Prevalence; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D013280:Stomatitis / Q000453:epidemiology / Q000209:etiology*
chemical_list: D002945:Cisplatin; D005472:Fluorouracil