Suresh A V S, Varma P Pratap, Sinha Sudha, Deepika Satya, Raman Raghu, Srinivasan M, Mandapal T, Reddy C Obula, Anand B B
Department of Medical Oncology, MNJ Institute of Oncology, Hyderabad, India.
J Cancer Res Ther. 2010 Oct-Dec;6(4):448-51. doi: 10.4103/0973-1482.77100.
One of the most distressing complications of head and neck cancer patients on chemoradiotherapy is mucositis. There is no proper tool to predict its occurrence in these patients.
This study was conducted to develop a risk-scoring system to predict probable incidence and severity of mucositis in head and neck cancer patients on chemoradiotherapy.
This is a retrospective analysis conducted at a tertiary care cancer center with approximately 2,000 new cases of head and neck cancer patients annually. We Hypothesized were age, comorbid conditions, leukocyte count, nutritional status, oral hygiene, tobacco use, erythrocyte sedimentation rate (ESR); Eastern cooperative oncology group (ECOG) performance status (PS) and TNM (tumor, node, metastasis) stage as possible risk factors. Receiver operating characteristic (ROC) curves were drawn to predict the cutoff values for risk factors, and a final scoring system was developed with sensitivity and specificity data.
A total of 218 patients on chemoradiation receiving cisplatin 40 mg/m2 /week along with local radiation of 60-70 Gy depending on primary site were analyzed. Based on ROC analysis, the following cutoff values were selected: age > 40 years, ECOG PS > 2, WBC < 3000/μL, elevated ESR, albumin < 3 gm/dL and > stage III disease. The remaining factors were indicated as present or absent. A score of 1 was assigned for the above risk factors. For patients, the final score of 3 or less there is 17% probability of developing grade 3 or 4 mucositis, while patients having score of 6 or more have 76% probability.
The current tool is fairly accurate in predicting development of mucositis in head and neck cancer patients on chemoradiotherapy. This will further help clinicians to adopt preventive strategies as well as better counseling.
头颈部癌患者接受放化疗时最令人痛苦的并发症之一是黏膜炎。目前尚无合适的工具来预测这些患者中黏膜炎的发生情况。
本研究旨在开发一种风险评分系统，以预测头颈部癌患者接受放化疗时黏膜炎的可能发生率和严重程度。
这是一项在一家三级癌症护理中心进行的回顾性分析，该中心每年约有2000例新的头颈部癌患者。我们假设年龄、合并症、白细胞计数、营养状况、口腔卫生、吸烟情况、红细胞沉降率（ESR）、东部肿瘤协作组（ECOG）体能状态（PS）以及TNM（肿瘤、淋巴结、转移）分期为可能的风险因素。绘制受试者工作特征（ROC）曲线以预测风险因素的临界值，并根据敏感性和特异性数据开发最终的评分系统。
总共分析了218例接受化疗放疗的患者，他们每周接受40mg/m²顺铂治疗，并根据原发部位接受60 - 70Gy的局部放疗。基于ROC分析，选择了以下临界值：年龄>40岁、ECOG PS>2、白细胞计数<3000/μL、ESR升高、白蛋白<3g/dL以及疾病分期>III期。其余因素标记为存在或不存在。上述风险因素每项得1分。对于患者而言，最终得分3分及以下者发生3级或4级黏膜炎的概率为17%，而得分6分及以上者发生概率为76%。
目前的工具在预测头颈部癌患者接受放化疗时黏膜炎的发生方面相当准确。这将进一步帮助临床医生采取预防策略以及进行更好的咨询。
