PHOTOGRAPHIC DOCUMENTATION OF ACUTE RADIATION-INDUCED SIDE-EFFECTS OFTHE ORAL-MUCOSA

Background: Radiotherapy in cancer of the head and neck induces cutane ous and mucosal reactions. These must be carefully assessed and docume ntated to control the accuracy of individual treatment, the overall to xicity of particular treatment schedules, the efficacy of prophylaxis and treatment and to determine the adequate therapy of treatment seque lae depending on the severity of the reactions. The accurate classific ation of lesions according to internationally accepted schedules (WHO/ RTOG/CTC) is indispensable for the comparison of radiotherapy treatmen t results and efficacy of supportive care. Methods: While the treatmen t of cancer depends on tumor stage and medical circumstances of the pa tient and is more or less standardized, prophylaxis and treatment of s ide-effects is highly variable. Discussing an optimized prophylaxis an d therapy of oral mucositis, the problem of accurate classification an d documentation emerged. The verbal description of mucosal lesions is open to many subjective interpretations. Photographic documentation se ems a suitable method to optimize the grading of toxicity. Results: A photographic survey of typical lesions for each grade of toxicity is a tool to reach several aims in one step. Toxicity of an individual pat ient may be compared with representative photographic examples in dail y routine to decide quickly on the grade of toxicity. Subjective diffe rences due to intra- and interpersonal variability of the evaluating r a diooncologist will be reduced. The efficacy of treatment can be prov en by accurate documentation. Randomized clinical studies concerning p rophylaxis and treatment of oral mucositis will provide more reliable results if evaluation of toxicity grading is standardized by photograp hs. Conclusions: Photographic documentation of lesions of the oral muc osa might be the best means to reduce interindividual subjectivity in grading. It is a valuable appendix to standard classification systems and only concerns the visible signs of mucosal lesions. However, the e xact grading of mucositis is only possible with additional clinical in formation about pain and nutritional situation.