Oral dose-volume parameters as independent predictors of severe radiation-induced mucositis in nasopharyngeal carcinoma patients: a retrospective study.

Objective: To investigate the association between clinical factors, oral dose-volume parameters during radiotherapy for nasopharyngeal carcinoma (NPC), and the development of severe radiation-induced oral mucositis (ROM). It also aims to identify predictive risk factors for severe ROM to support preventive strategies.

Methods: Clinical data from 175 NPC patients treated at Jiangxi Cancer Hospital between July 2023 and February 2024 were analyzed. The associations between clinical factors, oral dose-volume parameters, and severe ROM were assessed using univariate and multivariate logistic regression analyses.

Results: The incidence of severe ROM was 34.3% (60/175). Univariate analysis demonstrated significant correlations between severe ROM and dose-volume parameters, including V (t = 2.497, P = 0.013), V (t = 3.348, P = 0.001), V (t = 3.344, P = 0.001), V (t = 3.289, P = 0.001), V (t = 3.291, P = 0.001), and the mean dose (D) (t = 3.863, P < 0.001). Multivariate analysis identified oral mucosal V and D as independent risk factors for severe ROM. Receiver operating characteristic (ROC) curve analysis determined a cutoff value of 37.38% for oral V, with an area under the curve (AUC) of 0.652 (95% CI: 0.565-0.738, P = 0.044). For D, the cutoff value was 3471.4 cGy, with an AUC of 0.666 (95% CI: 0.580-0.751, P < 0.001).

Conclusion: The irradiated oral mucosa volume at V and D are independent predictors of severe oral mucositis in NPC patients undergoing radiotherapy. These findings highlight the importance of optimizing oral dose constraints to mitigate ROM severity and improve treatment tolerability.