MICROCIRCULATORY ALTERATIONS IN PATIENTS WITH OROPHARYNGEAL CANCER AFTER RADIATION THERAPY: A POSSIBLE CORRELATION WITH MUCOSITIS?
BACKGROUND: Patients affected by several forms of malignant neoplasms receive chemotherapy (CT) or radiation therapy (RT). These treatments can cause many side effects, such as oral mucositis (OM). Mucositis is the most frequently occurring early side effect of conservative treatment of patients with malignant tumors in the head and neck, and it is registered in more than 60% of cases. It occurs due to the effect of chemotherapeutic drugs on the cells of the mucous membrane, which causes their death, and to a greater extent, due to the effect of ionizing radiation on the endothelium of the blood vessels and the basal cells of the mucous membrane the submucosa. OBJECTIVES: To assess the correlation between the indicators of hemomicrocirculation of the oral mucosa and the intensity of the clinical manifestations of oral mucositis. MATERIALS AND METHODS: This study included 48 patients who had a morphologically confirmed diagnosis of squamous cell carcinoma and received radiation therapy at National Medical Research Radiological Centre (Moscow, Russia). RESULTS: It was found that, in all the subgroups, the severity index of mucositis National Cancer Institute (NCI) clearly correlated with the indicators of the flow of microcirculation through the study area at point A (r = -0.85, -0.99 and -0.77). At point A, blood perfusion in the study of hemomicrocirculation in all the subgroups 18-44 g in Ia, 45-59 g and 60-74 g in Ic was the opposite of the value of the severity of mucositis. A strong negative correlation was found between the severity of mucositis and the perfusion index at point B in subgroup Ia : (r = -0.99) along with, a moderate inverse correlation in subgroups Ib (r = -0.69) and Ic (r = -0.36). At point B, a strong inverse correlation was found in subgroups Ib and Ic (r = -0.72 and -0.65, respectively), and a moderate inverse correlation was found in subgroup Ia - NCI where r = -0.32. CONCLUSIONS: There is a negative correlation between the indicators of hemomicrocirculation of the oral mucosa and the severity of oral mucositis. It was found that the higher the lesions of the microvasculature, the lower the intensity of mucositis. These data have important prognostic value and make it possible to recommend the determination of hemomicrocirculation as a screening test.