Prediction of Acute Radiation Mucositis using an Oral Mucosal Dose Surface Model in Carbon Ion Radiotherapy for Head and Neck Tumors

• Published in: PloS one 2015-10, Vol.10 (10), p.e0141734-e0141734
• Main Authors: Musha, Atsushi, Shimada, Hirofumi, Shirai, Katsuyuki, Saitoh, Jun-Ichi, Yokoo, Satoshi, Chikamatsu, Kazuaki, Ohno, Tatsuya, Nakano, Takashi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological effects; Cancer; Cancer therapies; Carbon; Chemotherapy; Dose-Response Relationship, Radiation; Drug dosages; Female; Head; Head & neck cancer; Head and neck cancer; Head and Neck Neoplasms - complications; Head and Neck Neoplasms - radiotherapy; Heavy Ion Radiotherapy - adverse effects; Humans; Incidence; Irradiation; Life assessment; Male; Mathematical models; Maxillofacial surgery; Middle Aged; Models, Theoretical; Mouth Mucosa - pathology; Mouth Mucosa - radiation effects; Mucosa; Mucositis; Mucositis - diagnosis; Mucositis - epidemiology; Mucositis - etiology; Palate; Patients; Predictions; Radiation; Radiation Injuries - diagnosis; Radiation Injuries - epidemiology; Radiation therapy; Radiotherapy Dosage; Relative biological effectiveness (RBE); Severity of Illness Index; Surgery; System effectiveness; Terminology; Tongue; Tumors; University graduates
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0141734

To evaluate the dose-response relationship for development of acute radiation mucositis (ARM) using an oral mucosal dose surface model (OMDS-model) in carbon ion radiotherapy (C-ion RT) for head and neck tumors. Thirty-nine patients receiving C-ion RT for head and neck cancer were evaluated for ARM (once per week for 6 weeks) according to the Common Terminology Criteria for Adverse Events (CTCAE), version 4.0, and the Radiation Therapy Oncology Group (RTOG) scoring systems. The irradiation schedule typically used was 64 Gy [relative biological effectiveness (RBE)] in 16 fractions for 4 weeks. Maximum point doses in the palate and tongue were compared with ARM in each patient. The location of the ARM coincided with the high-dose area in the OMDS-model. There was a clear dose-response relationship between maximum point dose and ARM grade assessed using the RTOG criteria but not the CTCAE. The threshold doses for grade 2-3 ARM in the palate and tongue were 43.0 Gy(RBE) and 54.3 Gy(RBE), respectively. The OMDS-model was useful for predicting the location and severity of ARM. Maximum point doses in the model correlated well with grade 2-3 ARM.