Evaluation of radiation planning in the development of acute radiation oral mucositis in head and neck cancer patients: A case series

Background

Radiation planning is a way to optimize dose at the radiation target volume and reduce the risk of radiotherapy side effects in the management of Head and Neck Cancer (HNC) obtained from the Treatment Planning System (TPS) process. It shows various distributions of radiation doses and can predict the location of toxicity that appears in the oral cavity. The purpose of this report was to describe the isodose curve as part of TPS to predict the severity of oral mucositis.

Case series presentation

Four patients with HNC aged 40–60 years, complained of canker sores and taste loss during radiotherapy for 3–6 weeks with exposure to 30–50 Gray radiation doses. Intraoral examination in all cases found ulceration covered by a yellowish-white pseudomembranous, surrounded by an erythematous erosive area. Three cases also found yellowish-white plaques that could be wiped leaving erythema areas. The diagnosis of oral mucositis grade 2–4 on the Radiation Therapy Oncology Group (RTOG) scale, oral candidiasis, and dysgeusia were made. Various distributions of radiation doses received in the oral cavity were as predicted at TPS and according to the location and severity of oral mucositis that occurs in patients.

Case management

All patients were given 0.025 % hyaluronic acid mouthwash, multivitamins, and instructions for maintaining oral hygiene and a balanced diet. Three patients with oral candidiasis were also given nystatin oral suspension 100.000 IU

Conclusion

Managing oral mucositis in radiotherapy for HNC patients remains challenging. Utilizing TPS results during radiation planning enables the prediction and prevention of oral mucositis.