Advertisement

AACR 2019: Effect of Timing of Radiotherapy on Mucositis in Patients With Head and Neck Cancer

Advertisement

Key Points

  • The lowest maximum “soreness quality score” (MSQS) was seen in patients treated in the early morning (8:30 AM to before 9:30 AM).
  • MSQS increased in patients treated at later times, peaking in the early afternoon for patients treated from 12:00 noon to 1:30 PM and 1:30 PM to 3:00 PM, and then decreased for patients treated in late afternoon.
  • Among patients treated between 8:30­ AM and 9:30 AM, 43.2% developed severe oral mucositis (SQS grade 3 or 4), compared to 69.2% among those treated between 1:30 PM and 3:00 PM.

New research presented by Gu et al at the American Association for Cancer Research (AACR) Annual Meeting 2019 found that administering radiation treatments in the morning as opposed to later in the day may significantly reduce the severity of mucositis and its related impacts (Abstract 4860). 

Oral mucositis is one of the most common adverse side effects caused by radiation therapy, which is a mainstay of treatment for most cancers of the head and neck. This condition frequently causes quality-of-life issues, such as difficulty swallowing or eating and interrupted sleep, and often necessitates the prescription of opioids or other analgesics for pain control. 

“Acute oral mucositis is not only extremely painful for patients—it also interferes with their care and recovery in a number of ways, from impaired nutritional intake and treatment delays, to a higher chance of infection, hospitalization, and use of opioids, which comes with a host of additional side effects and risks,” said senior study author Anurag Singh, MD, Professor of Oncology and Director of Radiation Research at Roswell Park Comprehensive Cancer Center, Buffalo, New York. “While these factors double the costs of supportive care in comparison to milder cases, the few prevention and treatment options available for this condition have limited efficacy and/or supporting evidence.”

Study Methods and Findings

Hypothesizing that the timing of radiation treatments could be impacting the severity of mucositis, the team studied patterns of oral mucositis in 190 patients with head and neck cancer treated at Roswell Park. They found a significant association between radiation treatment timing and oral mucositis severity.

The lowest maximum “soreness quality score” (MSQS) was seen in patients treated in the early morning (8:30 AM to 9:30 AM). MSQS increased in patients treated at later times, peaking in the early afternoon for patients treated from 12:00 noon  to 1:30 PM and 1:30 PM to 3:00 PM, and then decreased for patients treated in late afternoon.

Among patients treated between 8:30­ AM and 9:30 AM, 43.2% developed severe oral mucositis (SQS grade 3 or 4), compared to 69.2% among those treated between 1:30 PM and 3:00 PM.

“We found that the severity of oral mucositis increased as the time at which radiation treatments were administered got later, peaking at early afternoon,” said Dr. Singh. “Our findings highlight a simple and easily implementable solution for reducing severe oral mucositis in [patients with] head and neck cancer, and one that may have significant clinical and quality-of-life benefits for patients.”

“Identifying an optimal time of a day for radiotherapy may substantially prevent severe oral mucositis in [patients with] head and neck cancer,” said first study author Fangyi Gu, MD, ScD, Assistant Professor of Oncology in the Department of Cancer Prevention and Control at Roswell Park. “Further studies are worthwhile to confirm our findings and to find optimal treatment times for individual patients.”

Disclosure: The study authors’ full disclosures can be found at abstractsonline.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


Advertisement

Advertisement



Advertisement