Risk Factors for Radiation-Induced Oral Mucositis in Patients With Head and Neck Cancer Undergoing Intensity-Modulated Radiotherapy

OBJECTIVE: To investigate the incidence and risk factors of radiation-induced oral mucositis (RTOM) in patients with head and neck cancer (HNC) undergoing intensity-modulated radiotherapy (IMRT), and to provide evidence for early prediction and prevention. SUBJECTS AND METHODS: In this prospective observational study, 134 HNC patients receiving IMRT were enrolled. The incidence, time to onset, and severity of RTOM were recorded. Univariate and multivariate logistic regression analyses were performed using SPSS 28.0 to assess the association between RTOM and 16 potential variables, including demographics, clinical parameters, oral hygiene index (OHI), tumour site, and mean cumulative oral radiation dose. RESULTS: The overall incidence of RTOM was 79.9% (107/134). RTOM typically developed during the second week of RT, peaked in the third week, and most commonly presented as Grade 2 (45.5%). Univariate analysis indicated that tumour site, OHI, and mean cumulative oral radiation dose were significantly associated with RTOM (P < .05). However, multivariate analysis identified mean cumulative oral radiation dose as the sole independent risk factor (OR = 1.105, 95% CI: 1.016-1.203, P = .020), corresponding to a 10.5% increase in risk per Gy. Tumour site and OHI were not statistically significant in the multivariate model. CONCLUSIONS: Patients with HNC undergoing IMRT exhibit a high incidence (79.9%) of RTOM. Cumulative oral radiation dose is a critical independent risk factor. Although tumour site and oral hygiene were associated with RTOM in univariate analysis, they were not independent predictors in the multivariate model. Clinical management should prioritize rigorous dose monitoring and early intervention for patients who require relativley high oral doses.