Radiation-induced mucositis in patients with head and neck cancer

Uvod i cilj rada: Oralni mukozitis (OM) upala je koju prate bolne ulceracije u usnoj šupljini narušavajući tako njezinu funkciju i onemogućujući osnovne radnje poput konzumiranja hrane, gutanja i govora. Javlja se u više od 95 % pacijenata zaraženih u području glave i vrata i jedna je od najteže podnošljivih nuspojava. Obično se javlja na kraju prvog tjedna radioterapije (RT) i traje nekoliko tjedana nakon prestanka terapije. Intenzitet OM-a ponekad može dovesti do prekida radioterapije. Cilj ovog istraživanja jest utvrditi pojavnost i karakteristike OM-a kod pacijenata s karcinomom glave i vrata liječenih zračenjem, kao i uključenost stomatologa/specijalista oralne medicine u liječenju takvih pacijenata. Ispitanici i postupci: Za potrebe ove studije kreiran je anketni upitnik s pitanjima koja se posredno ili neposredno odnose na problematiku OM-a. Upitnik je ispunilo 30 pacijenata s anamnezom karcinoma glave i vrata koji su bili zračeni s ili bez adjuvantne kemoterapije. Rezultati: Oralni mukozitis razvilo je 22 pacijenta. Najveći broj pacijenata razvilo je treći stupanj OM-a, odnosno, mogli su konzumirati samo tekuću hranu. Najviše pacijenata razvilo ga je unutar deset dana od početka radioterapije/kemoradioterapije. Kod najvećeg broja ispitanika OM je trajao dva tjedna nakon prekida kemoterapije/radioterapije. Deset pacijenata liječilo ga je prema uputama specijalista oralne medicine, osmero prema uputama specijalista nadležnog za osnovnu bolest, a četvero ga uopće nije liječilo. Najčešće korišten lijek je gel na bazi polivinil pirolidona (Gelclair). Zaključak: Iako je OM najčešća neželjena nuspojava zračenja i kemoterapije u pacijenata s karcinomom glave i vrata, stomatolozi i specijalisti oralne medicine kao najbolji poznavatelji prevencije i liječenja OM-a i dalje nisu dovoljno zastupljeni u uobičajenu sastavu onkološkog tima.Introduction and aim of the work: Oral mucositis (OM) occurs in more than 95% of patients irradiated in the head and neck area and is one of the most difficult to tolerate side effects. OM represents inflammation accompanied by painful ulcerations in the oral cavity, disrupting its function and preventing basic functions such as eating, swallowing, and speaking. It occurs at the end of the first week of RT and lasts for several weeks after stopping. The intensity of OM can sometimes lead to the interruption of RT. The aim of this thesis was to determine the occurrence and characteristics of OM in patients with head and neck cancer, as well as the involvement of dentists/oral medicine specialists in the treatment of such patients. Respondents and procedures: For the purposes of this thesis, a unique survey questionnaire was created with questions that are directly or indirectly related to the issue of OM. The questionnaire was completed by 30 patients with a history of head and neck cancer who were irradiated and/or receiving chemotherapy. Results: 22 patients developed OM. The largest number of patients developed the third degree of OM, that is, they could only consume liquid food. The largest number of patients developed OM up to ten days after the start of radiotherapy/chemoradiotherapy. In the largest number of subjects, OM lasted for two weeks after cessation of radiotherapy/chemotherapy. Ten patients were treated by OM according to the instructions of an oral medicine specialist, eight according to the instructions of a specialist responsible for the underlying disease, and four were not treated by OM at all. The most commonly used agent is a gel based on polyvinyl pyrrolidone (Gelclair). Conclusion: Although OM is the most common unwanted side effect of radiation and chemotherapy in head and neck cancer, dentists and oral medicine specialists, as the best experts in the prevention and treatment of OM, are still not sufficiently involved in the oncology team