Evaluation of Oral Mucositis and its Risk Factors in Patients with Head and Neck Cancer Undergoing Radiotherapy Treatment
DOI:
https://doi.org/10.32635/2176-9745.RBC.2025v71n3.5267Keywords:
Mouth Neoplasms, Radiotherapy, Stomatitis, Risk FactorsAbstract
Introduction: Oral mucositis is a painful and debilitating condition, often observed as an acute adverse effect of antineoplastic treatment. Patient-related risk factors, as age and gender, as well as treatment variables, as dose and irradiated area, can influence the severity of mucositis, negatively impacting the quality of life of cancer patients and the progress of the treatment. Objective: To analyze the prevalence of oral mucositis and identify the main risk factors associated with its occurrence and severity in patients with head and neck cancer undergoing radiotherapy. Method: Cross-sectional observational retrospective study, based on the analysis of 209 medical records of patients treated at the “Hospital do Câncer de Muriaé” between 2018 and 2022. Results: The results showed a significant association between female gender and the occurrence of mucositis (p=0.020), as well as tumors located in the tongue and mouth (p=0.022). The use of nasogastric tubes was also associated with worsening of mucositis (p<0.001), and increased use according to the severity of the lesion. Patients with xerostomia were more likely to develop the condition (p=0.019). Furthermore, mucositis was more prevalent and severe in patients undergoing radiotherapy for curative purposes, compared to palliative (p=0.001 and p=0.013, respectively). Conclusion: Factors as gender, tumor location, xerostomia, use of tubes and type of radiotherapy directly influence the occurrence and severity of oral mucositis. These findings reinforce the importance of individualized prevention strategies for more effective management of this condition.
Downloads
References
Cohen N, Fedewa S, Chen AY. Epidemiology and demographics of the head and neck cancer population. Oral Maxillofac Surg Clin North Am. 2018;30(4):381-95. doi: https://doi.org/10.1016/j.coms.2018.06.001 DOI: https://doi.org/10.1016/j.coms.2018.06.001
Seiwert TY, Burtness B, Mehra R, et al. Safety and clinical activity of pembrolizumab for treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-012): an open-label, multicentre, phase 1b trial. Lancet Oncol. 2016;17(7):956-65. doi: https://doi.org/10.1016/s1470-2045(16)30066-3 DOI: https://doi.org/10.1016/S1470-2045(16)30066-3
Kaidar-Person O, Gil Z, Billan S. Precision medicine in head and neck cancer. Drug Resist Updat. 2018;40:13-6. doi: https://doi.org/10.1016/j.drup.2018.09.001 DOI: https://doi.org/10.1016/j.drup.2018.09.001
Karam SD, Raben D. Radioimmunotherapy for the treatment of head and neck cancer. Lancet Oncol. 2019;20(8):e404-16. doi: https://doi.org/10.1016/s1470-2045(19)30306-7 DOI: https://doi.org/10.1016/S1470-2045(19)30306-7
Amit M, Na’ara S, Gil Z. Mechanisms of cancer dissemination along nerves. Nat Rev Cancer. 2016;16(6):399-408. doi: https://doi.org/10.1038/nrc.2016.38 DOI: https://doi.org/10.1038/nrc.2016.38
Giafferis RBL, Soares Junior LAV, Santos PSS, et al. Estratégias terapêuticas disponíveis para xerostomia e hipossalivação em pacientes irradiados de cabeça e pescoço: manual para profissionais da saúde. Rev. Uningá. 2017;54(1):45-58. doi: https://doi.org/10.46311/2318-0579.54.eUJ6 DOI: https://doi.org/10.46311/2318-0579.54.eUJ6
Eilers J, Million R. Prevention and management of oral mucositis in patients with cancer. Semin Oncol Nurs. 2007;23(3):201-12. doi: https://doi.org/10.1016/j.soncn.2007.05.005 DOI: https://doi.org/10.1016/j.soncn.2007.05.005
Li K, Yang L, Xin P, et al. Impact of dose volume parameters and clinical factors on acute radiation oral mucositis for locally advanced nasopharyngeal carcinoma patients treated with concurrent intensity-modulated radiation therapy and chemoradiotherapy. Oral Oncol. 2017;72:32-7. doi: https://doi.org/10.1016/j.oraloncology.2017.06.026 DOI: https://doi.org/10.1016/j.oraloncology.2017.06.026
Thomsen M, Vitetta L. Adjunctive treatments for the prevention of chemotherapy-and radiotherapy-induced mucositis. Integr Cancer Ther. 2018;17(4):1027-47. doi: https://doi.org/10.1177/1534735418794885 DOI: https://doi.org/10.1177/1534735418794885
Yao Z, Zhang B, Huang J, et al. Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a prospective cohort study. Sci Rep. 2021;11(1):7693. doi: https://doi.org/10.1038/s41598-021-87170-6 DOI: https://doi.org/10.1038/s41598-021-87170-6
Bossola M, Antocicco M, Pepe G. Tube feeding in patients with head and neck cancer undergoing chemoradiotherapy: a systematic review. JPEN J Parenter Enteral Nutr. 2022;46(6):1258-69. doi: https://doi.org/10.1002/jpen.2360 DOI: https://doi.org/10.1002/jpen.2360
Li J, Chaunmei Z, Zhang Y. Incidence and risk factors for radiotherapy-induced oral mucositis among patients with nasopharyngeal carcinoma: a meta-analysis. Asian Nurs Res. 2023;17(2):70-82. doi: https://doi.org/10.1016/j.anr.2023.04.002 DOI: https://doi.org/10.1016/j.anr.2023.04.002
Gabriel AF, Silveira FM, Curra M, et al. Risk factors associated with the development of oral mucositis in pediatric oncology patients: systematic review and meta‐analysis. Oral Dis. 2022;28(4):1068-84. doi: https://doi.org/10.1111/odi.13863 DOI: https://doi.org/10.1111/odi.13863
Nishii M, Soutome S, Kawakita A, et al. Factors associated with severe oral mucositis and candidiasis in patients undergoing radiotherapy for oral and oropharyngeal carcinomas: a retrospective multicenter study of 326 patients. Support Care Cancer. 2020;28(3):1069-75. doi: https://doi.org/10.1007/s00520-019-04885-z DOI: https://doi.org/10.1007/s00520-019-04885-z
University of Bern. STROBE: Strengthening the Reporting of Observational Studies in Epidemiology [Internet]. Mittelstrasse: Institute of Social and Preventive Medicine; 2024©. [acesso 2024 jul 25]. Disponível em: https://www.strobe-statement.org/
SOUL MV Hospitalar [Internet]. Pernambuco: SOUL MV; [data desconhecida]. [Acesso 2025 fev 25]. Disponível em: https://mv.com.br/solucao/soul-mv-hospitalar
MVPEP [Internet]. Pernambuco: SOUL MV; [data desconhecida]. [Acesso 2025 fev 25]. Disponível em: https://mv.com.br/produto/pep
Fay MP, Brittain EH, Shih JH, et al. Causal estimands and confidence intervals associated with Wilcoxon-Mann-Whitney tests in randomized experiments. Stat Med. 2018;37(20):2923–37. doi: https://doi.org/10.1002/sim.7799 DOI: https://doi.org/10.1002/sim.7799
R: The R Project for Statistical Computing [Internet]. Version 4.3.1 [place unknown]: The R foundation; 2023 jun 6. [Acesso em 2025 jan 6]. Disponível em: https://www.r-project.org/
Conselho Nacional de Saúde (BR). Resolução n° 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos [Internet]. Diário Oficial da União, Brasília, DF. 2013 jun 13 [acesso 2024 nov 12]; Seção 1:59. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html
Pfister DG, Spencer S, Adelstein D, et al. Head and neck cancers, version 2.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2020;18(7):873-98. doi: http://dx.doi.org/10.6004/jnccn.2020.0031 DOI: https://doi.org/10.6004/jnccn.2020.0031
Pulito C, Cristaudo A, Porta C, et al. Oral mucositis: the hidden side of cancer therapy. J Exp Clin Cancer Res. 2020;39:(1):210. doi: https://doi.org/10.1186/s13046-020-01715-7 DOI: https://doi.org/10.1186/s13046-020-01715-7
Lalla RV, Peterson DE. Oral mucositis. Dent Clin North Am. 2005;49(1):167-84. doi: https://doi.org/10.1016/j.cden.2004.07.009 DOI: https://doi.org/10.1016/j.cden.2004.07.009
Epstein JB, Gorsky M, Guglietta A, et al. The correlation between epidermal growth factor levels in saliva and the severity of oral mucositis during oropharyngeal radiation therapy. Cancer. 2000;89(11):2258-65. doi: https://doi.org/10.1002/1097-0142(20001201)89:11%3C2258::aid-cncr14%3E3.0.co;2-z DOI: https://doi.org/10.1002/1097-0142(20001201)89:11<2258::AID-CNCR14>3.0.CO;2-Z
Nascimento RB, Neri BP, Moutinho MM, et al. Might photobiomodulation therapy interfere with the frequency of severe mucositis and oral candidiasis? A retrospective analysis in patients with head and neck carcinoma. Support Care Cancer. 2024;32:508. doi: http://dx.doi.org/10.1007/s00520-024-08724-8 DOI: https://doi.org/10.1007/s00520-024-08724-8
Sanguineti G, Sormani MP, Marur S, et al. Effect of radiotherapy and chemotherapy on the risk of mucositis during intensity-modulated radiation therapy for oropharyngeal cancer. Int J Radiat Oncol Biol Phys. 2012;83(1):235-42. doi: https://doi.org/10.1016/j.ijrobp.2011.06.2000 DOI: https://doi.org/10.1016/j.ijrobp.2011.06.2000
Iovoli AJ, Turecki L, Qiu ML et al. Severe oral mucositis after intensity-modulated radiation therapy for head and neck cancer. JAMA Netw Open. 2023;6(10):e2337265. doi: https://doi.org/10.1001/jamanetworkopen.2023.37265 DOI: https://doi.org/10.1001/jamanetworkopen.2023.37265
Gebri E, Kiss A, Tóth F, et al. Female sex as an independent prognostic factor in the development of oral mucositis during autologous peripheral stem cell transplantation. Sci Rep. 2020;10:15898. doi: https://doi.org/10.1038/s41598-020-72592-5 DOI: https://doi.org/10.1038/s41598-020-72592-5
Staruch M, Speth MM, Neyer P, et al. Radiation-associated changes in saliva composition of head and neck cancer patients: a systematic review. Radiother Oncol. 2024;196:110279. doi: https://doi.org/10.1016/j.radonc.2024.110279 DOI: https://doi.org/10.1016/j.radonc.2024.110279
Reyes-Gibby CC, Wang J, Zhang L, et al. Oral microbiome and onset of oral mucositis in patients with squamous cell carcinoma of the head and neck. Cancer. 2020;126(23):5124-36. doi: https://doi.org/10.1002/cncr.33161 DOI: https://doi.org/10.1002/cncr.33161
Kiyomi A, Yoshida K, Arai C, et al. Salivary inflammatory mediators as biomarkers for oral mucositis and oral mucosal dryness in cancer patients: a pilot study. PLoS One. 2022;17(4):e0267092. doi: https://doi.org/10.1371/journal.pone.0267092 DOI: https://doi.org/10.1371/journal.pone.0267092
Meca LB, Souza FRN, Tanimoto HM, et al. Influence of preventive dental treatment on mutans streptococci counts in patients undergoing head and neck radiotherapy. J Appl Oral Sci. 2009;17:5-12. doi: https://doi.org/10.1590/S1678-77572009000700003 DOI: https://doi.org/10.1590/S1678-77572009000700003
Vera-Llonch M, Oster G, Hagiwara M, et al. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma: risk factors and clinical consequences. Cancer. 2006;106(2):329-36. doi: https://doi.org/10.1002/cncr.21622 DOI: https://doi.org/10.1002/cncr.21622
Mazzola R, Ricchetti F, Fersino S, et al. Predictors of mucositis in oropharyngeal and oral cavity cancer in patients treated with volumetric modulated radiation treatment: a dose–volume analysis. Head Neck. 2016;38(S1):E815-9. doi: https://doi.org/10.1002/hed.24106 DOI: https://doi.org/10.1002/hed.24106
Published
How to Cite
Issue
Section
License
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.

This work is licensed under a Creative Commons Attribution 4.0 International License.