Toxicity syndrome and early competing deaths in head-and-neck cancer undergoing radiation therapy: Observation and hypothesis

Sandeep Muzumder; Nirmala Srikantia

doi:10.1016/j.mehy.2020.110145

Toxicity syndrome and early competing deaths in head-and-neck cancer undergoing radiation therapy: Observation and hypothesis

Med Hypotheses. 2020 Oct:143:110145. doi: 10.1016/j.mehy.2020.110145. Epub 2020 Jul 30.

Authors

Sandeep Muzumder¹, Nirmala Srikantia²

Affiliations

¹ Department of Radiation Oncology, St John's Medical College and Hospital, Bengaluru, India. Electronic address: sandeepmuzumder@gmail.com.
² Department of Radiation Oncology, St John's Medical College and Hospital, Bengaluru, India.

PMID: 32759015
DOI: 10.1016/j.mehy.2020.110145

Abstract

Radiotherapy (RT) and/or concurrent chemoradiation (CRT) is the mainstay for the treatment of locally advanced head-and-neck cancer (LAHNC). Sepsis remains a poorly understood and unrecognized event in head-and-neck cancer. The study aims to hypothesize a 'toxicity syndrome' leading to sepsis and subsequent sepsis-related deaths. A retrospective audit of all 125 LAHNC patients treated radically from January 2013 to June 2017 was conducted. A total of fifteen toxic deaths were reported. Thirteen deaths were attributed to sepsis. Individual toxicity for death was ascertained only for three cases. A toxicity syndrome namely 'mucositis-dysphagia-aspiration-sepsis (MDAS) complex' was proposed as the cause of death in the rest ten cases. The authors recommend the surveillance of the 'MDAS complex' for the prevention of early toxicity-related deaths in patients with LAHNC undergoing RT or CRT.

Keywords: Chemoradiation; Head-and-neck cancer; Mortality; Radiation therapy; Sepsis; Toxicity syndrome.

MeSH terms

Carcinoma, Squamous Cell* / drug therapy
Chemoradiotherapy / adverse effects
Head and Neck Neoplasms* / radiotherapy
Humans
Mucositis*
Retrospective Studies