Anticipating oral mucositis in oral cancer patients undergoing fractionated radiotherapy: A cytological correlation

Oral mucositis is one of the most common side effects of fractionated radiation therapy. Along with clinical changes, radiation also induces cytological changes which include both cytoplasmic as well as nuclear alterations. The present study was carried out todocument and correlate theclinical and cytological changes in the oral epithelial cells of patients undergoing fractionated radiation therapy for head and neck malignancies. 24 patients undergoing fractionated radiotherapy for head and neck malignancies were selected and observed during the course of therapy for development of clinical changes like erythema, ulceration and trismus. Simultaneously smears from oral mucosa were taken and studied for increase in cell size, cytoplasmic changes like granularity, vacuolization and fragmentation and nuclear changes like micronuclei, binucleation and multinucleation. Significant linear dose dependant correlation was seen between the radiation doses and clinical and cytological changes. The present study is critical in its method to predict the development of erythema and ulceration by assessing genotoxic cellular markers like micronuclei, binucleation and multinucleation which are direct indicators of molecular changes. As these markers correlate well with the molecular changes, namely the reactive oxygen species (ROS), nuclear factor kappa β (NF-kβ) and cytokines, the treatment regime to improve control of pain and irritation during mucositis can be planned more efficiently.