Stomatitis from therapy for breast cancer might not be dependent on the number or kind of therapy agents – but on what else?

Fragestellung: Although negative drug effects and quality of life are important objectives of almost every clinical breast cancer (BC) trial, there is only few published knowledge of the prevalence of chemotherapy (CT) associated stomatitis, predisposing factors and its effective treatment. To start a systematic investigation of these questions we constructed a questionnaire as a pilot study among patients, who have been treated for BC. Individual problems with oral and pharyngeal mucosa affection during CT and the received supportive treatment were asked to be stated.

Methodik: BC survivors in follow up care were asked to complete a questionnaire retrospectively. Besides literature review descriptive and multivariate statistical analysis on the data was performed for questions of frequency of stomatitis in CT and radiotherapy (RT) and its influencing factors as well as the supportive treatments applied and the subjective efficiency of the last.

Ergebnisse: 234 patients (93.2%) out of 251 returned the questionnaire. The collective is matching common BC patient populations. At the end of their last CT, 194 patients (90.7%) were in an adjuvant and 20 (9.3%) in a palliative situation. 208 patients (96.2%) received polychemotherapy, 8 (3.8%) monotherapy. 4 (1.9%) of these patients received both schemes. 160 patients (68.4%) suffered from stomatitis symptoms of grade I (40 patients, 25,0%), II (17 patients, 10.6%), III (100 patients, 62.5%) or IV (3 patients, 1.9%). Except from the use of epirubicin (p=0.049) none of the tested parameters (age, agents, schemes or number of therapies etc.) reached significance in the impact on frequency or intensity of stomatitis. Lavage fluids (60.6%) and antimycotics (10.0%) were the most often used therapeutics, of which the first subjectively helped the best (79.2%). 130 patients (86.7%) estimated stomatitis from CT worse than the one from RT. 46.3% of the patients who suffered under stomatitis during CT also developed a stomatitis from RT. In regression analysis the correlation between the grade of stomatitis in CT and RT is significant (ß=0.180, p=0.006).

Schlussfolgerung: After this retrospective pilot study it seems necessary to examine other factors than CT agents, numbers and intensity or age, tumor stadium etc. There might be a molecular approach of susceptibility to problems in individual oropharyngeal health during CT. Efforts would be worthwhile. Whether the relation between susceptibility to stomatitis after RT and CT is an effect of predisposition or former mucosa damage cannot be distinguished from the present data. Clinical studies to find an effective supportive stomatitis therapy are urgently needed.