Effectiviteit van behandeling bij hoofd-halstumoren

BACKGROUND: Radiation-induced oral mucositis (OM) is a prevalent and debilitating complication of head and neck radiotherapy, yet its severity varies markedly between patients. Emerging evidence suggests that this heterogeneity is influenced by the pre-existing oral microbiome and host inflammatory tone. METHODS: This prospective, pragmatic interventional study grouped nasopharyngeal carcinoma (NPC) patients receiving chemoradiotherapy by probiotic exposure: no probiotic, Streptococcus salivarius K12 (SsK12), or Streptococcus salivarius M18 (SsM18). Weekly oral assessments were used to characterize the onset, duration, and severity of OM. Group-based trajectory modeling (GBTM) was used to identify OM trajectories. Univariate, multivariate, and mediation analyses were used to explore associated factors and potential relationships. RESULTS: Among 69 evaluable patients, OM occurred in 95.7%, with severe OM (SOM) in 42.4%. Compared with non-probiotic group, SsM18 significantly delayed OM onset (p = 0.014), reduced SOM duration (p = 0.019), and shortened total OM duration (p = 0.031), outperforming SsK12. GBTM identified two distinct OM trajectories: 'Rapid-Onset, Severe' group and 'Late-Onset, Mild' group. Multivariate analysis revealed that elevated log-transformed Interleukin-6 levels (odds ratio [OR] = 4.20, p = 0.020), and high Beck Oral Assessment Scale (BOAS) score (OR = 3.06, p = 0.044) as independent predictors of 'Rapid-Onset, Severe' trajectory. The Teeth subdomain of BOAS was identified as an independent predictor for earlier OM onset (p = 0.042). Mediation analysis suggested that the association between a higher Teeth subdomain score and OM was partially mediated by IL-6 elevation (proportion mediated: 30-50%). CONCLUSIONS: Radiotherapy-induced OM was associated with baseline oral health and inflammatory status. SsM18 supplementation was associated with improved OM-related outcomes, suggesting a potential role for precision probiotic strategies. CLINICAL TRIAL INFORMATION: https://www.chictr.org.cn/, identifier ChiCTR2600118357.