Acute-phase response reactants as objective biomarkers of radiation-induced mucositis in head and neck cancer.

BACKGROUND: Current evaluation of radiation-induced mucositis in head and neck cancer relies on subjective scoring with interrater variability. We evaluated serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as objective markers of radiation-induced mucositis. METHODS: Weekly serum CRP and ESR levels were measured in patients treated for head and neck cancer with radiation ± chemotherapy. Acute radiation toxicity was evaluated using National Cancer Institute of Canada-Common Toxicity Criteria (NCIC-CTC) version 2.0 and the Head and Neck Radiotherapy Questionnaire (HNRQ). RESULTS: ESR and CRP levels were significantly elevated by 3 weeks (p = .01) and 6 weeks (p = .0002), respectively, and independent of age or pretreatment surgery. ESR was significantly dependent on radiation dose (p = .0004) and significantly higher with chemoradiation (p = .03). CONCLUSION: Serum ESR and CRP rise reliably in a radiation dose-dependent manner. ESR correlated with clinical symptoms and distinguished patients receiving chemoradiation. ESR and CRP may be an objective and sensitive marker of radiation-induced mucositis.

Comparison of toxicity associated with early morning versus late afternoon radiotherapy in patients with head-and-neck cancer: a prospective randomized trial of the National Cancer Institute of Canada Clinical Trials Group (HN3).

PURPOSE: Based on our demonstration of a circadian rhythm in the human oral mucosa cell cycle, with most cells in the G(1) phase in the morning and M phase at night, we hypothesized that morning radiotherapy (RT) would lead to less oral mucositis than afternoon RT. METHODS AND MATERIALS: A total of 216 patients were randomized to morning (8-10 AM) vs. afternoon (4-6 PM) RT and stratified by radiation dose, smoking status, and center. Patients receiving primary or postoperative RT alone were eligible. Oral mucositis was scored using the Radiation Therapy Oncology Group (RTOG) criteria and a validated scoring system. RESULTS: Of 205 evaluable patients, 52.9% vs. 62.4% developed RTOG Grade 3 or greater mucositis after morning vs. afternoon RT, respectively (p = 0.17). Morning RT was also associated with significantly less weight loss after 5 months (p = 0.024). In a subgroup of 111 patients treated to a dose of 66-70 Gy in 33-35 fractions, exploratory analyses revealed a significant reduction in Grade 3 or greater mucositis with morning RT (44.6% vs. 67.3%, p = 0.022) and a longer interval to the development of Grade 3 or greater mucositis (median, >7.9 vs. 5.6 weeks, p = 0.033). In 53 patients, who smoked during therapy, a significant reduction was found in Grade 3 or greater mucositis with morning RT (42.9% vs. 76%, p = 0.025). CONCLUSION: In this proof of principle study, morning RT was associated with significantly less weight loss after 5 months and an apparent reduction in oral mucositis in a subset of patients receiving >/=66 Gy and in patients who smoked during therapy.