title: Acute-phase response reactants as objective biomarkers of radiation-induced mucositis in head and neck cancer.
abstract: BACKGROUND
  Current evaluation of radiation-induced mucositis in head and neck cancer relies on subjective scoring with interrater variability. We evaluated serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as objective markers of radiation-induced mucositis.
  
  
  METHODS
  Weekly serum CRP and ESR levels were measured in patients treated for head and neck cancer with radiation ± chemotherapy. Acute radiation toxicity was evaluated using National Cancer Institute of Canada-Common Toxicity Criteria (NCIC-CTC) version 2.0 and the Head and Neck Radiotherapy Questionnaire (HNRQ).
  
  
  RESULTS
  ESR and CRP levels were significantly elevated by 3 weeks (p = .01) and 6 weeks (p = .0002), respectively, and independent of age or pretreatment surgery. ESR was significantly dependent on radiation dose (p = .0004) and significantly higher with chemoradiation (p = .03).
  
  
  CONCLUSIONS
  Serum ESR and CRP rise reliably in a radiation dose-dependent manner. ESR correlated with clinical symptoms and distinguished patients receiving chemoradiation. ESR and CRP may be an objective and sensitive marker of radiation-induced mucositis.
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Fazilat F
authors.initials: FF
authors.lastname: Mohammed
authors.forename: Ian
authors.initials: I
authors.lastname: Poon
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.forename: Liz
authors.initials: L
authors.lastname: Elliott
authors.forename: Ian D
authors.initials: ID
authors.lastname: Hodson
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sagar
authors.forename: James
authors.initials: J
authors.lastname: Wright
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D052016:Mucositis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011832:Radiation Injuries / Q000097:blood*; D011795:Surveys and Questionnaires
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D002097:C-Reactive Protein