To Explore The Correlation Between TCM Tongue Image And Radiation Oral Mucositis In Patients With Head And Neck Tumors

Background:According to the survey of the Global Burden of Disease,the incidence of head and neck tumors ranks the eighth in China,second only to pancreatic cancer.The main pathological type of head and neck tumors is squamous cell carcinoma,and radiotherapy sensitivity is good,so radiotherapy is widely used in the treatment of head and neck tumors.However,the adverse reactions caused by radiotherapy not only affect the quality of life of patients,but also lead to the delay,reduction or suspension of radiotherapy,which seriously affects the curative effect of radiotherapy.Radioactive oral mucositis is one of the most common adverse reactions of radiotherapy,which can also cause a series of problems such as pain,depression,malnutrition,nasal feeding tube,etc.Currently,symptomatic treatment is mainly used in clinical practice,with relatively limited efficacy.Acute radiation oral mucositis usually disappears within 2-4 weeks after the completion of radiotherapy.If the occurrence and severity of radiation oral mucositis can be predicted effectively,it can facilitate timely intervention to help patients complete the treatment and improve the level of individualized radiotherapy.However,there is a lack of effective clinical indicators for predicting radioactive oral mucositis.Tongue image is an important basis for TCM syndrome differentiation and treatment.The tongue is the place where the Qi and blood of the human body gather,and is nourished by the essence of the viscera,so the shape and color of the tongue is the external expression of the Qi,blood and body fluid of the viscera.The change of tongue coating is mainly affected by diseases and the ups and downs of stomach qi.Traditional Chinese medicine believes that radiotherapy is a heat evil,which will cause significant damage to human body’s qi,blood and body fluid.Tongue image can reflect human body’s good and evil conditions and prognosis,so tongue image may become a traditional Chinese medicine index to predict radioactive oral mucositis.In addition,tongue image is more convenient and non-invasive,which is a good entry point for the prevention and treatment of tumors by integrated traditional Chinese and western medicineObjective:Through a multi-center prospective study,to analyze the distribution of tongue image before radiotherapy and the changes of tongue image during radiotherapy in patients with head and neck tumor,and to explore the correlation and predictive value of TCM tongue image on the incidence and severity of radioactive oral mucositis in patients with head and neck tumor.To provide the basis for reducing the harm of radioactive oral mucositis and improving the quality of radiotherapyMethods:from September 1,2020 to April 15,2021 prospective collection of china-japan friendship hospital radiotherapy,combine traditional Chinese and western medicine and oncology,oncology,radiation therapy of hospital of the Chinese people’s liberation army(PLA)friendship hospital treated 64 cases of conform to the discharge standard of head and neck cancer patients,with complete clinical data and follow-up data.The main data collected included general data,treatment data,tongue image data,the incidence of radioactive oral mucositis,etc.General data included gender,age,weight,history of smoking and alcohol,history of hypertension,history of diabetes mellitus and other patients’ own factors,while treatment data included diagnosis,treatment plan,combination medication and other treatment-related factors.The tongue pattern and other related factors related to radioactive oral mucositis were statistically analyzed.The chi-square test or t test was used for univariate analysis.Factors with univariate analysis results P<0.1 and factors that may have predictive value according to clinical experience were included in the multivariate logistic regression model.According to the regression model,the influence of the type of tongue image and other related factors on radioactive oral mucositis(protective or risk factors)was discussedResults:A total of 64 subjects were included in this study.1.Completion of radiotherapy All the 64 patients completed the radiotherapy plan,and the completion rate of radiotherapy was 100%.Among them,5 patients were interrupted by radiotherapy,and the interruption rate of radiotherapy was 7.8%.The reasons for the interruption included 1 case of severe reflex dermatitis,1 case of severe myelosuppression,1 case of grade 4 RIOM1,1 case of depression and significant weight loss,and 1 case of primary mass hemorrhage.All the other patients completed the treatment according to the original plan.2.Tongue color distribution of patients before radiotherapy:pale white tongue in 6 cases(9.4%),pale red tongue in 29 cases(45.3%),red tongue in 27 cases(42.2%),and the other 2 cases;There were 19 cases with yellow moss(29.6%)and 45 cases with white moss(70.3%).The lichen was thin(56.3%),greasy(23.4%)and peeled(23.4%)in 36 cases.Tongue shape:24 cases of normal tongue(37.5%),9 cases of tooth marks(14.1%),24 cases of cracked tongue(37.5%),9 cases of punctured tongue(14.1%),and 6 cases of other tongue.3.Radioactive oral mucositis occurred in 49 cases(76.6%),while no oral mucositis occurred in 16 cases(23.4%).There was no statistical significance in pale white tongue,light red tongue,yellow tongue,white tongue,thin tongue,greasy tongue,peeled-off tongue,normal tongue,tooth mark tongue,cracked tongue,punctured tongue,etc.,between the two groups(P>0.05),but there was statistical significance in red tongue(P<0.05).P<0.1 for pre-radiotherapy chemotherapy and smoking history in both groups.4.Multivariate binomial logistic regression results showed that red tongue was significantly associated with the occurrence of radioactive oral mucositis,and was an independent risk factor for radioactive oral mucositis in patients with radiotherapy for head and neck tumors.Conclusion:Red tongue is an independent risk factor for radiation oral mucositis in patients with head and neck cancer treated with radiotherapy.