Oral mucositis in morning vs. evening irradiated patients: A randomised prospective study

Abstract

The observed incidence of grade III/IV mucositis in morning vs. evening irradiated patients may be because of the existence of circadian rhythm in the cell cycle of normal mucosa. This knowledge may provide a possibility of treating the patients with decreased toxicity to oral mucosa.

Acute mucosal radiation reactions in patients with head and neck cancer

“…Significantly less weight loss after 5 months and reduction of oral mucositis in a subset of patients irradiated in the morning was observed. Similar observations were noted by Goyal et al [6]. In this randomized prospective study, the authors reported marginally higher grades of mucositis in the evening-irradiated group than in the morning-irradiated group (38% vs. 26%, p=0.08).…”

Comparison of acute skin reaction following morning versus late afternoon radiotherapy in patients with breast cancer who have undergone curative surgical resection

“…In addition to these factors, circadian rhythm in the cell cycle could also influence acute reactions [14, 15]. Based on observations that the most radiosensitive phase of the cell cycle (G2-M) occurs in the late afternoon, two randomized studies have evaluated acute oral mucositis in patients who have received head and neck RT [19, 20]. Grade 3 or greater oral mucositis was more prevalent in the evening RT group than in the morning RT group, although this was not statistically significant.…”

Systematic review of miscellaneous agents for the management of oral mucositis in cancer patients

“…The two studies suggesting that altering the timing of RT delivery can impact severity of OM are intriguing [33,34]. However, this may not be a strategy that is practically feasible to implement since at most centers, patients are scheduled for RT all through the day.…”

“…Two randomized, controlled trials assessed the influence of RT administered in the morning versus late afternoon on prevention of OM. One study did not find a significant effect on grades of OM [33]. Also, the other study did not find an overall effect, but reported a reduction in severity of OM in a subgroup of patients receiving ≥66 Gy and in patients who smoked during RT [34].…”