Oral mucositis (OM) emerged in the late 1980s to describe the adverse effects of radiation therapy (RT) on the oral mucosa. OM is the most common and clinically significant acute adverse effect of radiotherapy for head and neck cancer. Symptoms of OM vary from pain and discomfort to an inability to tolerate food or fluids, and it may affect the quality of life, breaks in treatment, hospitalisation, and therefore cancer treatment and outcome. This study aimed to evaluate the pomegranate flower’s efficacy in preventing and treating radiation-induced mucositis due to antioxidant, anti-inflammatory and anti-cancer effects.

This phase II clinical trial was conducted on 50 patients (case and control) with head and neck malignancy. Patients in the case groups were instructed to rinse their mouths with 5 mg Pomegranate powder with 15 cc of sterile water three times a day. The patients in the control group rinsed their mouths with normal saline mouthwash, which is the most relatively accepted preventive and supportive care in this setting. The onset and degree of radiation-induced mucositis were graded during treatment, with ‘WHO mucositis grading’ and the ‘quality of life questionnaire’ (QLQ-OES18).

Forty-eight patients were analysed. There was a significant difference between the two groups on onset and severity of mucositis in the two groups. There were longer intervals for the incidence of different grades of mucositis in the case group, in comparison with the control groups (P value < 0·05). Also, Complaints of dysphagia in the case groups were lower than in the control.

Pomegranate flower seems to be effective at the time of onset, and the severity of oral mucositis during head and neck radiation. It could be a simple, potent, and inexpensive agent, which is easily available.

Dental management is critical prior to radiotherapy (RT) for head and neck cancer (HNC) but cumbersome and time intensive. This qualitative study investigates dentists’ evaluative processes to identify areas for improvement.

Semi-structured interviews were conducted with dentists involved in the care of HNC patients. The interviews were guided by the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to identify factors influencing pre-RT dental management.

Five dentists were participated in the interviews. Key themes were identified through qualitative and quantitative evaluation and are as follows: Coordination among care providers, knowledge of the RT plan, visual depictions of dose distribution and understanding of the patient’s dental history.

This study demonstrates the complexity of pre-RT management and identifies key elements. Knowledge of the RT plan and improved interdisciplinary coordination represents opportunities for improvement. Visual dose prediction methods may expedite and improve pre-RT management.

Radiation dermatitis (RD) is a frequent toxicity during radiotherapy (RT) for head and neck cancer (HNC). We report the first use of KeraStat® Cream (KC), a topical, keratin-based wound dressing, in patients with HNC receiving RT.

This pilot study randomized HNC patients treated with definitive or postoperative RT (≥60 Gy) to KC or standard of care (SOC), applied at least twice daily during and for 1-month after RT. Outcomes of interest included adherence to the assigned regimen (at least 10 applications per week of treatment), clinician- and patient-reported RD, and skin-related quality of life.

24 patients were randomized and completed the study. Most patients had stage III-IV disease and oropharynx cancer. Median RT dose was 68 Gy; the bilateral neck was treated in 19 patients, and 18 patients received concurrent chemotherapy. Complete adherence was observed in 7/12 (SOC) vs. 10/12 (KC, p = 0.65).  Adherence by patient-week was 61/68 versus 64/67, respectively (p = 0.20). No differences in RD were observed between groups.

A randomized trial of KC versus SOC in HNC patients treated with RT is feasible with good adherence to study agent. An adequately powered randomized study is warranted to test the efficacy of KC in reducing RD.

Adaptive radiotherapy (ART) is commonly used to mitigate effects of anatomical change during head and neck (H&N) radiotherapy. The process of identifying patients for ART can be subjective and resource-intensive. This feasibility project aims to design and validate a pipeline to automate the process and use it to assess the current clinical pathway for H&N treatments.

The pipeline analysed patients’ on-set cone-beam CT (CBCT) scans to identify inter-fractional anatomical changes. CBCTs were converted into synthetic CTs, contours were automatically generated, and the original plan was recomputed. Each synthetic CT was evaluated against a set of dosimetric goals, with failed goals causing an ART recommendation.

To validate pipeline performance, a ‘gold standard’ was synthesised by recomputing patients’ original plans on a rescan-CT acquired during treatment and identifying failed clinical goals. The pipeline sensitivity and specificity compared to this ‘gold standard’ were calculated for 12 ART patients. The pipeline was then run on a cohort of 12 ART and 14 non-ART patients, and its sensitivity and specificity were instead calculated against the clinical decision made.

The pipeline showed good agreement with the synthesised ‘gold standard’ with an optimum sensitivity of 0·83 and specificity of 0·67. When run over a cohort containing both ART and non-ART patients and assessed against the subjective clinical decision made, the pipeline showed no predictive power (sensitivity: 0·58, specificity: 0·47).

Good agreement with the ‘gold standard’ gives confidence in pipeline performance and disagreement with clinical decisions implies implementation could help standardise the current clinical pathway.

Head and neck squamous cell carcinomas (HNSCCs) are aggressive tumours lacking a standardised timeline for treatment initiation post-diagnosis. Delays beyond 60 days are linked to poorer outcomes and higher recurrence risk.

A retrospective review was conducted on patients over 18 with HNSCC treated with (chemo)radiation at a rural tertiary care centre (September 2020–2022). Data on patient demographics, oncologic characteristics, treatment details and delay causes were analysed using SPSS.

Out of 93 patients, 35.5% experienced treatment initiation delays (TTIs) over 60 days. Median TTI was 73 days for delayed cases, compared to 41.5 days otherwise. No significant differences in demographics or cancer characteristics were observed between groups. The primary reasons for the delay were care coordination (69.7%) and patient factors (18.2%). AJCC cancer stage showed a trend towards longer delays in advanced stages.

One-third of patients faced delayed TTI, primarily due to care coordination and lack of social support. These findings highlight the need for improved multidisciplinary communication and patient support mechanisms, suggesting potential areas for quality improvement in HNSCC treatment management.

Radiotherapy is a critical component of head and neck cancer (HNC) management that requires reliable patient immobilization. Using thermoplastic masks helps to ensure reproducible patient positioning during radiotherapy, thus reducing the risk of a geographical miss. However, the use of these masks can also induce anxiety and distress, which can negatively impact treatment adherence and quality of life outcomes.

The research was a quantitative cross-sectional study that determined the prevalence and severity of thermoplastic mask-induced anxiety and assessed the scope of coping mechanisms used by HNC patients. Data were collected using a structured questionnaire from recruited participants and analysed with the Statistical Package for Social Sciences software, version 26·0. Relevant clinical and treatment-related data were retrieved from patients’ hospital-based medical records. Descriptive and inferential statistical analyses such as chi-square tests and likelihood ratios were conducted, with p-values < 0·05 considered statistically significant.

In all, there were 145 HNC patients with a male to female ratio of 1·9:1 and a median age of 52·8 years (IQR 20·7), ranging from 18 to 82 years. There was a high prevalence of thermoplastic mask-induced anxiety both during mask moulding (93·8%) and radiation therapy sessions (94·5%). Most participants (95·2%) adopted coping mechanisms including distraction (58%) and visualization techniques (46%).

Even though there was a high level of awareness and utilization of coping mechanisms, the high prevalence of thermoplastic mask-induced anxiety highlights a critical aspect of HNC patient care that may be overlooked in resource-limited settings.

This is a radiobiological modelling study aimed at comparing stereotactic ablative body radiotherapy (SABR) with conventional palliative radiotherapy (CPRT) and curative-dose volumetric-modulated arc therapy (CD-VMAT) in the palliation of patients with previously untreated head and neck cancer.

Three radiotherapy plans were generated for 8 patients with head and neck cancer: SABR, prescribed to 45 Gy in 5 fractions; CPRT, prescribed to 30 Gy in 5 fractions and CD-VMAT, prescribed to 70 Gy in 35 fractions. The tumour control probability (TCP) and normal tissue complication probability for salivary and swallowing function (NTCPsaliva and NTCPswallow, respectively) were determined. From those values, the therapeutic ratio, as measured by the uncomplicated tumour control probability (UTCP), was determined.

Dosimetric objectives were achieved in all treatment plans. SABR had a higher mean TCP compared to CPRT and CD-VMAT (100% vs 81% vs 93%, p = 0·003). There were no statistically significant differences in the mean NTCPs for salivary or swallowing function (mean NTCPsaliva 27% vs 41% vs 36%, p = 0·093 and mean NTCPswallow 9% vs 12% vs 23%, p = 0·093). This resulted in the mean UTCP being statistically significantly higher for SABR plans compared to CPRT and CD-VMAT (66% vs 42% vs 49%, p = 0·004).

It is feasible to create SABR plans that satisfy the dosimetric objectives in this study. Based on radiobiological modelling, SABR has superior TCP and similar NTCP, leading to a better therapeutic ratio than CPRT and CD-VMAT.