A Retrospective Cohort Study of Acute Radiotherapy Induced Mucositis, Radiodermatitis and Dental Disorders in Brazilian Head and Neck Cancer Patients

Tatiane Sorribas da Silva; Denis Oliveira dos  Santos; Célia Soares; Carla Daruich de Souza

doi:10.32635/2176-9745.RBC.2026v72n4.5719

Autores

Tatiane Sorribas da Silva Hospital Santa Marcelina. São Paulo (SP), Brasil. Instituto de Pesquisas Energéticas e Nucleares (IPEN). São Paulo (SP), Brasil. https://orcid.org/0009-0003-1776-6985
Denis Oliveira dos Santos Hospital Santa Marcelina. São Paulo (SP), Brasil. https://orcid.org/0009-0004-1279-2946
Célia Soares Hospital Santa Marcelina. São Paulo (SP), Brasil. https://orcid.org/0009-0001-7097-8800
Carla Daruich de Souza Instituto de Pesquisas Energéticas e Nucleares (IPEN). São Paulo (SP), Brasil. https://orcid.org/0000-0003-1335-8864

DOI:

https://doi.org/10.32635/2176-9745.RBC.2026v72n4.5719

Palavras-chave:

Lesões por Radiação, Neoplasias de Cabeça e Pescoço/complicações, Mucosite, Radiodermatite/complicações, Toxicidade

Resumo

Introdução: A radioterapia para câncer de cabeça e pescoço frequentemente causa toxicidades agudas que comprometem a continuidade do tratamento e a qualidade de vida. Entretanto, dados integrados sobre a ocorrência simultânea de mucosite, radiodermatite e distúrbios dentários no Sistema Único de Saúde (SUS) ainda são escassos. Objetivo: Avaliar a incidência e a gravidade desses eventos adversos, além de identificar fatores clínicos e de tratamento associados. Método: Estudo de coorte retrospectivo conduzido em um único centro de radioterapia em São Paulo, Brasil, entre janeiro de 2021 e dezembro de 2024. Regressão logística multivariada foi utilizada para identificar preditores independentes de mucosite severa e radiodermatite, ajustando para idade dose de radiação e quimioterapia concomitante. Resultados: Dos 180 pacientes avaliados, 146 foram analisados (34 excluídos: 18 em razão de prontuários incompletos, 10 por causa de óbito ou abandono do tratamento antes da fração 10 e 6 por conta de transferência). Mucosite ocorreu em 142 pacientes (97,3%; grau 3 em 28,8%). Radiodermatite ocorreu em 138 pacientes (94,5%; grau 3 em 13,7%). Distúrbios dentários foram documentados em todos os 146 pacientes (100%), impulsionados principalmente por hipossalivação (98,6%), cáries por radiação (42,5%) e doença periodontal (31,5%). Na análise multivariada, a quimioterapia concomitante foi um preditor independente de mucosite moderada a severa (OR=4,42; IC 95% 2,01–9,71; p<0,001), enquanto a dose total de radiação ≥60 Gy foi independentemente associada à radiodermatite severa (OR=3,08; IC 95% 1,28–7,41; p=0,012). Conclusão: A alta prevalência e gravidade das toxicidades agudas reforçam a necessidade de um cuidado de suporte multidisciplinar estruturado. A taxa de 100% de distúrbios dentários reflete a vulnerabilidade da saúde bucal dos pacientes atendidos pelo SUS. Esses dados de mundo real oferecem evidências aplicáveis para protocolos clínicos e políticas públicas de saúde.

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Referências

Silva TS. Analysis of short-term adverse reactions during radiotherapy treatment in adults with head and neck cancer [dissertation]. Rio de Janeiro: Instituto Nacional de Câncer; 2024.

Alfouzan AF. Radiation therapy in head and neck cancer. Saudi Med J. 2021;42(3):247-54. doi: https://doi.org/10.15537/smj.2021.42.3.20210660 DOI: https://doi.org/10.15537/smj.2021.42.3.20210660

Van den Bosch L, van der Schaaf A, van der Laan HP, et al. Comprehensive toxicity risk profiling in radiation therapy for head and neck cancer: a new concept for individually optimised treatment. Radiother Oncol. 2021;157:147-54. doi: https://doi.org/10.1016/j.radonc.2021.01.024 DOI: https://doi.org/10.1016/j.radonc.2021.01.024

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

Cardozo AS, Simões FV, Santos VO, et al. Severe radiodermatitis and risk factors associated in head and neck cancer patients. Texto Contexto Enferm. 2020;29:e20180343. doi: https://doi.org/10.1590/1980-265X-TCE-2018-0343 DOI: https://doi.org/10.1590/1980-265x-tce-2018-0343

Jarrell DK, Drake S, Brown MA. Advancing therapies for cancer—from mustard gas to CAR T. Sci. 2020;2(4):90. doi: https://doi.org/10.3390/sci2040090 DOI: https://doi.org/10.3390/sci2040090

Mathew JM, Ringash J, Su J, et al. Risk factors and survival impact of severe radiation-related late toxicities in head and neck cancer: a cohort study. Lancet Reg Health Am. 2025;50:101218. doi: https://doi.org/10.1016/j.lana.2025.101218 DOI: https://doi.org/10.1016/j.lana.2025.101218

Anderson C, Saunders D. Oral mucositis in head and neck cancer patients. Semin Radiat Oncol. 2025;35(2):271-7. doi: https://doi.org/10.1016/j.semradonc.2025.02.011 DOI: https://doi.org/10.1016/j.semradonc.2025.02.011

Brook I. Early side effects of radiation treatment for head and neck cancer. Cancer Radiother. 2021;25(5):507-13. doi: https://doi.org/10.1016/j.canrad.2020.12.005 DOI: https://doi.org/10.1016/j.canrad.2021.02.001

Di Lalla V, Lagman M, Patrick H, et al. Head and neck cancer patient's preparedness for radiation therapy: a patient survey before and after implementation of a prehabilitation education class. Support Care Cancer. 2025;33(11):1000. doi: https://doi.org/10.1007/s00520-025-10055-1 DOI: https://doi.org/10.1007/s00520-025-10055-1

Matos LL, Kowalski LP, Chaves ALF, et al. Latin American consensus on the treatment of head and neck cancer. JCO Glob Oncol. 2024;10:e2300343. doi: https://doi.org/10.1200/GO.23.00343 DOI: https://doi.org/10.1200/GO.23.00343

França SR, Pinto FC, Oliveira VB, et al. Dose-dependence relationship between radiotherapy and oral mucositis in patients with head and neck cancer: a retrospective study. Int J Dent. 2026;2026:3972232. doi: https://doi.org/10.1155/ijod/3972232 DOI: https://doi.org/10.1155/ijod/3972232

Salem PP, Chami P, Daou R, et al. Proton radiation therapy: a systematic review of treatment-related side effects and toxicities. Int J Mol Sci. 2024;25(20):10969. doi: https://doi.org/10.3390/ijms252010969 DOI: https://doi.org/10.3390/ijms252010969

Krommenhoek KB, Foster-Thomas E, Davey A, et al. Systematic review of late dental effects following head and neck radiation therapy in childhood cancer survivors. Pract Radiat Oncol. 2026;16(4):e265-81. doi: https://doi.org/10.1016/j.prro.2025.12.011 DOI: https://doi.org/10.1016/j.prro.2025.12.011

Zhang S, Zeng N, Yang J, et al. Advancements of radiotherapy for recurrent head and neck cancer in modern era. Radiat Oncol. 2023;18(1):166. doi: https://doi.org/10.1186/s13014-023-02342-0 DOI: https://doi.org/10.1186/s13014-023-02342-0

Pedroso MNM, Rech A, Casagrande N, et al. Effects of photobiomodulation on oral mucositis, oral pain, xerostomia, salivary flow rate, and quality of life in patients with head and neck cancer: a systematic review and meta-analysis. Support Care Cancer. 2026;34(4):364. doi: https://doi.org/10.1007/s00520-026-10575-4 DOI: https://doi.org/10.1007/s00520-026-10575-4

University of Bern. STROBE: Strengthening the Reporting of Observational Studies in Epidemiology [Internet]. Bern: Institute of Social and Preventive Medicine, University of Bern; 2024 [cited 2024 Jul 25]. Available from: https://www.strobe-statement.org/

Payne M, Woodcock V, editors. Common Terminology Criteria for Adverse Events, version 5.0. In: Oxford Handbook of Oncology. doi: https://doi.org/10.1093/med/9780198847168.005.0001 DOI: https://doi.org/10.1093/med/9780198847168.005.0001

Radiation Therapy Oncology Group. RTOG website [Internet]. Philadelphia: Radiation Therapy Oncology Group; 2025 [cited 2025 May 27]. Available from: https://www.rtog.org

World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human participants. JAMA. 2025;333(1):71-4. doi: https://doi.org/10.1001/jama.2024.21972 DOI: https://doi.org/10.1001/jama.2024.21972

Conselho Nacional de Saúde (BR). Resolução nº 466, de 12 de dezembro de 2012. Aprova diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, Brasília, DF. 2013 jun 13; Seção 1:59.

National Institutes of Health. Lead organizations: NCI Network trial development and conduct [Internet]. Bethesda: National Cancer Institute; 2025 [cited 2025 May 27]. Available from: https://dctd.cancer.gov/research/ctep-trials/trial-development

Monsen RE, Kristoffersen AK, Gay CL, et al. Identification and susceptibility testing of oral candidiasis in advanced cancer patients. BMC Oral Health. 2023;23(1):223. doi: https://doi.org/10.1186/s12903-023-02925-7

Dikmen B. ICDAS II criteria (International Caries Detection and Assessment System). J Istanb Univ Fac Dent. 2015;49(3):63-72. doi: https://doi.org/10.17096/jiufd.38691 DOI: https://doi.org/10.17096/jiufd.38691

Monsen RE, Kristoffersen AK, Gay CL, et al. Identification and susceptibility testing of oral candidiasis in advanced cancer patients. BMC Oral Health. 2023;23(1):223. doi: https://doi.org/10.1186/s12903-023-02950-y DOI: https://doi.org/10.1186/s12903-023-02950-y

Hebert KA, Jaramillo S, Yu W, et al. Esomeprazole enhances the effect of ionizing radiation to improve tumor control. Oncotarget. 2021;12(14):1339-53. doi: https://doi.org/10.18632/oncotarget.28008 DOI: https://doi.org/10.18632/oncotarget.28008

Campos GM. Estatística prática para docentes e pós-graduandos. 1st ed. São Paulo: Universidade de São Paulo; 2020.

Multinational Association of Supportive Care in Cancer. About MASCC [Internet]. Toronto: MASCC; 2026 [cited 2026 Jan 30]. Available from: https://mascc.org/

International Society of Oral Oncology. About ISOO [Internet]. Vancouver: ISOO; 2026 [cited 2026 Jan 30]. Available from: https://isoo.world/