DOCUMENTATION OF RADIATION-INDUCED ORAL MUCOSITIS - SCORING SYSTEMS

Background: Radiation therapy of tumors in the head and neck region is frequently associated with severe side effects in the oral mucosa whi ch often necessitate interruption of the prescribed treatment protocol . In order to compare therapeutic strategies and, more important, in o rder to perform multi center studies. generally accepted scoring syste ms have to be applied for uniform documentation of the oral mucosal re sponse. Methods: Different scoring protocols are found in the literatu re. The scoring protocols most widely accepted are the CTC classificat ion and the RTOG/EORTC classification. These are compared with more de tailed systems. Results: In the CTC classification. grading of stomati tis is included in the responses of the gastrointestinal tract and emp hasizes dietary effects. For effects of radiation alone or of radioche motherapy, the RTOG/EORTC system, focusing on therapeutic intervention s, has been established. However, there are only minor differences in the grading of mucositis between these 2 protocols. Based on the RTOG/ EORTC classification, Maciejewski et al. introduced a classification s ystem with inclusion of the area affected, but also changed the sensit ivity of the scores. The latter may be confusing if the source of the system used is not cited in a report. An alternative system was propos ed by Dische, which in addition to objective morphologic criteria also includes the symptoms induced by the mucosal response, and hence incl udes some subjective aspects reported by the patient. Conclusions: For routine documentation of acute radiation side effects in the oral cav ity, the German version of the RTOG/EORTC classification can be recomm ended. In studies with particular interest in oral mucositis. a more s ensitive scoring system may be applied. In any publication concerning mucositis, a table or a detailed description of the system used should be included.