Abstract
OBJECTIVE: To investigate the association between clinical factors, oral dose-volume parameters during radiotherapy for nasopharyngeal carcinoma (NPC), and the development of severe radiation-induced oral mucositis (ROM). It also aims to identify predictive risk factors for severe ROM to support preventive strategies. METHODS: Clinical data from 175 NPC patients treated at Jiangxi Cancer Hospital between July 2023 and February 2024 were analyzed. The associations between clinical factors, oral dose-volume parameters, and severe ROM were assessed using univariate and multivariate logistic regression analyses. RESULTS: The incidence of severe ROM was 34.3% (60/175). Univariate analysis demonstrated significant correlations between severe ROM and dose-volume parameters, including V(30) (t = 2.497, P = 0.013), V(35) (t = 3.348, P = 0.001), V(40) (t = 3.344, P = 0.001), V(45) (t = 3.289, P = 0.001), V(50) (t = 3.291, P = 0.001), and the mean dose (D(mean)) (t = 3.863, P < 0.001). Multivariate analysis identified oral mucosal V(35) and D(mean) as independent risk factors for severe ROM. Receiver operating characteristic (ROC) curve analysis determined a cutoff value of 37.38% for oral V(35), with an area under the curve (AUC) of 0.652 (95% CI: 0.565-0.738, P = 0.044). For D(mean), the cutoff value was 3471.4 cGy, with an AUC of 0.666 (95% CI: 0.580-0.751, P < 0.001). CONCLUSION: The irradiated oral mucosa volume at V(35) and D(mean) are independent predictors of severe oral mucositis in NPC patients undergoing radiotherapy. These findings highlight the importance of optimizing oral dose constraints to mitigate ROM severity and improve treatment tolerability.