Predictive factors for chemoradiotherapy-induced oral mucositis: Human papillomavirus influence
África Fernández Forné,
Spain
PO-0989
Abstract
Predictive factors for chemoradiotherapy-induced oral mucositis: Human papillomavirus influence
Authors: África Fernández Forné1, María Jesús García Anaya1, María Dolores Toledo Serrano1, Marina Muñoz Lupiáñez1, Jose Antonio Medina Carmona1, Jaime Gómez-Millán Barrachina1
1Hospital Universitario Virgen de la Victoria, Radiation Oncology, Málaga, Spain
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Purpose or Objective
The growing role of Human Papillomavirus (HPV), as a different entity, has led us to find head and neck cancer (HNC) in population without the usually associated risk factors. Mucositis is the most common, debilitating, and painful toxicity related to HNC chemoradiotherapy. Intensity Modulated Radiation Therapy (IMRT) allows us to offer greater precision, although has not been shown to reduce acute mucositis severity. The main objective of this study is to investigate predictive factors of severe mucositis in patients with locally advanced HNC treated with curative-intent radiotherapy, including the role of HPV status.
Material and Methods
A prospective cohort study was designed. From April 2019 to December 2020, 45 HNC patients were enrolled. The primary endpoint was the development of Grade-3 (G-3) mucositis evaluated using the CTCAE V5.0 and RTOG scales. All patients received radical radiotherapy ± concomitant chemotherapy. Clinical and analytical factors were analyzed. This study has obtained the approval of the center's ethics committee and all patients were given informed consent.
Results
Mean age was 60 years and 68,9% were male. ECOG was ≤1 in 97,8% patients and the most frequent tumor sites were oropharynx (35,6%) followed by larynx (26,7%) and oral cavity (20%). Prescribed dose was 65,1Gy in 91,1% patients. With a mean follow-up of 13,6 months, we observed that 62,2% patients developed G-3 mucositis during antineoplastic treatment beginning at a median cumulative dose of 36,8Gy±11,2Gy. Multivariate regression analysis showed that oropharynx and oral cavity tumor sites (p=0,05) and HPV- (p=0,064) were correlated with the development of severe mucositis. In a subgroup analysis of oropharynx and oral cavity patients we found that 83,3% of HPV- developed severe mucositis compared to 41,7% in HPV+ group (p=0,08; RR: 2 [IC 95%: 0,97- 4,09]). Receiving a mean dose >40Gy or >8Gy per week to 21cc oral cavity was also associated with higher rates of mucositis (70% vs 31,8%; p = 0.03 and 75% vs 25%; p = 0.006, respectively).
Conclusion
To identify predictive factors that could determine the development of this severe toxicity would help us to establish prognostic groups and prevention strategies. Our first results suggest that HPV status might be associated to the acute mucositis grade. This study is currently under progress and further research is needed to confirm these findings.