International Journal of Hematology and Oncology 2024, Vol 34, Num 1 Page(s): 158-169
Systemic Inflammation Score for Predicting Radiation-Induced Trismus and Osteoradionecrosis of the Jaw Rates in Locally Advanced Nasopharyngeal Carcinoma Patients

Efsun SOMAY1, Duygu SEZEN2, Ugur SELEK2, Ali Ayberk BESEN3, Huseyin MERTSOYLU4, Erkan TOPKAN5

1Baskent University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara
2Koc University, Faculty of Medicine, Department of Radiation Oncology
3Adana Medical Park Hospital, Clinics of Medical Oncology, Adana
4Istinye University, Adana Medical Park Hospital, Clinics of Medical Oncology, Adana
5Baskent University, Faculty of Medicine, Department of Radiation Oncology

Keywords: Nasopharyngeal carcinoma, Systemic inflammation score, Radiation-induced trismus, Osteoradionecrosis, Biomarker
We sought to determine the predictive value of the systemic inflammation score (SIS) for radiation-induced trismus (RIT) and osteoradionecrosis of the jaw (ORNJ) in locally advanced nasopharyngeal carcinoma (LA-NPC) patients treated with concurrent chemoradiotherapy (C-CRT). LA-NPC patients (n= 188) who underwent C-CRT and pre- and post-C-CRT oral examinations from August 2010
to January 2022 were included. The three-tiered SIS groups were created using the serum albumin and lymphocyte-to-monocyte ratio (LMR) measures obtained on the first day of C-CRT: SIS-0: Albumin ≥ 40 g/dL and LMR ≥ 4.44); SIS-1: Albumin < 40 g/dL and LMR < 4.44 or albumin ≥ 0 g/dL and LMR ≥ 4.44; and SIS-2: Albumin < 40 g/dL and LMR <4.44. The primary objective was to ascertain whether there were irrefutable associations between pretreatment SIS groups and the respective post-C-CRT RIT and ORNJ rates. RIT and ORNJ were diagnosed in 33 (17.6%) and 21 (11.1%) patients, respectively. There were 12 (32.4%), 13 (12.7%), and 18 (45.0%) cases diagnosed with RIT in the respective SIS-0, SIS-1, and SIS-2 groups (p< 0.001). Similarly, there were 1 (2.7%), 11 (9.9%), and 9 (22.5%) cases with ORNJ diagnoses in the corresponding SIS groups (p< 0.001). The multivariate analysis’s findings revealed that the SIS grouping was an independent predictor of RIT (p< 0.001) and ORNJ incidence rates (p< 0.001). Our study’s findings indicate that the novel pretreatment SIS grouping is a dependable biomarker-based system, which can accurately predict the
rates of RIT and ORNJ in LA-NPC patients who receive definitive C-CRT.