Scoring irradiation mucositis in head and neck cancer patients

Spijkervet, F. K. L.; Saene, H. K. F. van; Panders, Ak; Vermey, A; Mehta, D. M.

doi:10.1111/j.1600-0714.1989.tb00756.x

Cited by 83 publications

(77 citation statements)

References 15 publications

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“…Therefore, mucositis can easily be under-or overestimated. In some scales, local mucositis signs at distinct areas of the mouth are scored separately and subsequently a semi-quantitative score is obtained (Spijkervet et al, 1989;Schubert et al, 1992).However, all these scoring systems remain subjective. In addition, in most scoring systems, the differences between the succeeding toxicity levels are quite large and, in consequence, such systems are not ideally suited to the development and recognition of preventive methods.…”

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confidence: 99%

A new in vitro assay for quantitation of chemotherapy-induced mucositis

Wymenga

Vandergraaf²,

Spijkervet

et al. 1997

Br J Cancer

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Summary Patients receiving high-dose chemotherapy (HD-CT) are at risk of severe mucositis. Most prevention studies evaluate the degree of mucositis on clinical, and therefore subjective, measurements. The aim of this study was to develop an objective in vitro assay of chemotherapy-induced mucositis. Twelve patients with locally advanced breast carcinoma received HD-CT followed by peripheral stem cell reinfusion. Before and twice weekly after HD-CT, the mucosa was evaluated by an oral washing, a buccal smear and the World Health Organization (WHO) toxicity grading; furthermore, blood leucocyte levels were determined. For the oral washings, the percentage of viable epithelial cells was determined by trypan blue dye exclusion and leucocytes were counted by fluorescence microscopy after incubation with acridine orange. Maturity of buccal cells was assessed by staining buccal smears for morphology according to Papanicolaou (Whitacker D and Williams V, 1994). Eight healthy volunteers served as controls. The mean percentage (± s.e.m.) of viable oral epithelial cells was stable in controls (44 ± 2%). In patients, they increased after HD-CT, which was significant after day 7 compared with pretreatment (P < 0.05). In addition, a shift from mature to immature epithelial cells in buccal smears was observed. Oral leucocyte levels were closely correlated with the blood leucocyte counts. The WHO score followed the results of these other evaluations with some delay. The viability of buccal cells obtained by oral washings increases after HD-CT. This is possibly because of desquamation of the upper oral mucosa layer, with a shift from mature to more immature cells. These data can be quantitated, and this assay may therefore be useful in studies aimed at prevention of mucositis.Keywords: mucositis; in vitro assay; quantitation Mucositis is a common, always unpleasant, sometimes unbearable toxic side-effect of chemotherapy. In particular, in patients receiving high-dose chemotherapy followed by bone marrow or peripheral stem cell transplantation, mucositis can be dose limiting. Chemotherapy causes a direct toxic effect on the rapidly dividing cells of the basal oral epithelium, which can result in mucosal atrophy, erythema and ulceration. The severe stages of mucositis with disruption of the oral mucosal barrier can lead to mucosal ulcers and secondary infection. In addition, it can provide a portal of entry for micro-organisms into the systemic circulation, which can lead to life-threatening septicaemia in myelosuppressed patients. Mucositis causes major discomfort, such as pain requiring intensive analgesia, and may restrict or even prohibit normal oral feeding and drug intake (Sonis, 1989;Sonis et al, 1990;Toth et al, 1990;Peterson, 1992; Woo et al, 1993).Grading of mucositis is necessary to document its degree and to evaluate the effect of measures for prevention or intervention. Most available scoring systems are based on a combination of objective changes in the mucosa (e.g. erythema, ulceration), subjective complaints (e.g....

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confidence: 99%

A new in vitro assay for quantitation of chemotherapy-induced mucositis

Wymenga

Vandergraaf²,

Spijkervet

et al. 1997

Br J Cancer

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“…earlier publications (Spijkervet et al, 1989b;Parulekar et al, 1998). For future studies, we recommend the use of the OMAS-score from the mucositis study group because this scoring method is a reliable, well-validated and widely accepted method (Sonis et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

“…The WHO score is a widely accepted method, but this score is a combination of local mucositis signs and general complaints (Anonymous, 1979). The other scoring method in the current study is based only on mucosal signs of mucositis (Spijkervet et al, 1989b). It therefore provides a more precise estimation of the mucositis development at the mucosal level.…”

Section: Discussionmentioning

confidence: 99%

“…Mucositis The mean mucositis was scored by using qualitative and quantitative parameters (Spijkervet et al, 1989b). Four different local signs of mucositis (k) might be distinguished: 1 ¼ white discoloration; 2 ¼ erythema; 3 ¼ formation of pseudomembranes; 4 ¼ ulceration.…”

Section: Assessmentsmentioning

confidence: 99%

“…The next stage is a deepening erythema followed by the development of pseudomembranes and ulcerations. Severe mucositis, appearing as pseudomembranes, will develop at the end of the third week of radiation, after about 30 Gy (Baker, 1982;Spijkervet et al, 1989b). Prevention of severe mucositis is important because mucositis affects the patient's feeding status, physical and mental well-being and it can influence the course of radiotherapy (Sutherland and Browman, 2001).…”

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confidence: 99%

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Oral mucositis and selective elimination of oral flora in head and neck cancer patients receiving radiotherapy: a double-blind randomised clinical trial

Stokman¹,

Spijkervet²,

Burlage³

et al. 2003

Br J Cancer

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Mucositis is an acute inflammation of the oral mucosa because of radiotherapy and/or chemotherapy. All patients receiving radiotherapy in the head and neck region develop oral mucositis. The aim of this study was to analyse the effects of selective oral flora elimination on radiotherapy-induced oral mucositis, in a double-blind, randomised, placebo-controlled trial. Sixty-five patients with a malignant tumour in the head and neck regions to be treated with primary curative or postoperative radiotherapy participated in this study. The patients received either the active lozenges of 1 g containing polymyxin E 2 mg, tobramycin 1.8 mg and amphotericin B 10 mg (PTA) (33 patients) or the placebo lozenges (32 patients), four times daily during the full course of radiotherapy. Mucositis, changes in the oral flora, quality of feeding and changes of total body weight were assessed. Mucositis score did not differ between the groups during the first 5 weeks of radiotherapy. Nasogastric tube feeding was needed in six patients (19%) of the placebo group and two patients (6%) of the PTA group (P ¼ 0.08). Mean weight loss after 5 weeks of radiation was less in the PTA group (1.3 kg) (s.d.: 3.0) than in the placebo group (2.8 kg) (s.d.: 2.9) (P ¼ 0.05). Colonisation index of Candida species and Gram-negative bacilli was reduced in the PTA group and not in the placebo group (Po0.05). No effect on other microorganisms was detected. In conclusion, selective oral flora elimination in head and neck irradiation patients does not prevent the development of severe mucositis.

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