Risk scoring for predicting mucositis in Indian patients with esophageal carcinoma receiving concurrent chemoradiotherapy.

OBJECTIVE

Mucositis is a common and troublesome adverse effect of concurrent chemoradiotherapy, often causing treatment interruption and compromising treatment outcome. We sought to identify predictors of mucositis in southern Indian patients treated for gastroesophageal carcinoma.

METHODS

Patients (N = 90) receiving cisplatin 40 mg/m(2) and concurrent local radiotherapy at 40 to 50 Gy for esophageal carcinoma were retrospectively assessed for predictors of mucositis. Hypothesized risk factors were age, presence of comorbid conditions, low white blood cell (WBC) count, nutritional status (assessed by serum albumin level), continuing tobacco use, elevated erythrocyte sedimentation rate (ESR) as a measure of acute inflammation, World Health Organization (WHO) performance status, and disease stage. Receiver operating characteristic (ROC) curves were drawn to identify cut-off values for risk factors, and a risk scoring model was developed.

RESULTS

On the basis of cutoff values on ROC analysis, a risk score of 1 was assigned for each risk factor as follows: age > 50 years, ESR > 3 times upper limit of normal, albumin < 3.3 g/dL, WBC < 2.5 x10(9)/L, WHO performance status > 2, and > stage III disease, with use of tobacco and presence of any comorbid condition also each being assigned a score of 1. For individual patients, a score of < 3 was associated with a 25% risk of grade 3 or 4 mucositis, whereas a score of >/= 6 was associated with 80% risk.

CONCLUSIONS

The scoring system is accurate in predicting the development of mucositis in southern Indian patients receiving concurrent chemoradiotherapy for esophageal carcinoma.