1968 Volume 9 Pages 8-17
A hundred patients with malignant tumors of head and neck regions treated by irradiation at the Department of Radiology, Osaka University Medical School, from January 1965 to December 1966, were reviewed and discussed on radiation stomatitis.
A criteria of stage-classification for radiation stomatitis according to objective and subjective symptoms adding to pathological findings was proposed by the authors.
The course of stomatitic changes was divided into five stages. the latent stage, the initial stage, the middle stage, the maximal stage, and the reparative stage. And according to the intensity of lesion, the middle stage was subdiv lied into two grades: the early middle stage and late middle stage.
The initial stage is indicated by thirstiness due to the disturbance of salivary secretion, disgeusia, hyperemia, and marked edema. The middle stage is indicated by dysgeusia or hypogeusia, causlgia, and spontaneous and stinging pain subjectively, and objectively thin pseudomembrane, and small erosion and ulcer; the early middle stage is indicated by a solitary pseudomembrane, erosion and ulcer, and in the late middle stage, those are widespread pan-orally. The maximal stage is indicated by ageusia, severe pain, wide and thick pseudo-membrane, hemorrhagic ulcer and necrosis.
Acording to this criteria, those cases were analysed, and radiation stomatitis associated with radiation therapy was studied with reg ard to the site of lesion, the irradiation method, and the dose-time relationship.
Ninety-nine of 100 cases revealed the early middle stage of radiation stomatitis with an administered dose of 1500-2500 R/5-22 days. And 57 of 99 cases of the early middle stage advanced to the late middle stage in 2400-5800 R/16-45 days level. the maximal stage of radiation stomatitis was found in 13 of 100 cases.
The repair of stomatitic changes used to occur for 1 or 2 weeks after irradiation discontinued. In cases the muosal reaction was below the early middle stage, it finishes a primary healing for 2 or 3 weeks. It, however, asks for 1 or 3 months to repair the disturbance of salivary secretion and dysgeusia. On the other hand, in cases the mucosal reaction was above the late middle stage, it is scarecely found the repairing signs of irradiated salivary glands clinically and histologically (experimental study) after a year or more the radiation therapy discontinued.
A relationship between the advance of radiation stomatitis and the irradiated site was as follows in cases irradiated upper half of oral cavity such as carcinomas of maxillary antrum or hard palate, mucosal reaction appeared later, allowing larger administered dose, than in cases irradiated lower half of oral cavity chiefly, such as carcinomas of lower jaw, tongue and floor of the mouth, or than in cases of tonsil and pharynx tumors irradiated nasopharynx chiefly.
And it was found that in cases irradiated with large field, mucosal reaction appeared more early and severely than in cases with small field.
