Timing of Daily Radiotherapy for Cases of Head and Neck Cancer: Does It Make Difference?

Main Article Content

Mohamed Saad Eldeen Elzahi
Shimaa E. Attia
Skoukri H. Elazab


Background: Oral mucositis is a major problem affecting all head and neck cancer (HNC) patients received radiotherapy. Till now, available treatment is just symptomatic with limited effects. Preventive strategies may be better to avoid this complication. Animal models studies have illustrated that anti-cancer treatment toxicity display prominent daily variations; therefore, undesirable side effects could be significantly reduced by administration of radiotherapy at specific times when they are better tolerated.

Aim: To compare “soreness quality score” (SQS) between 2 groups of head and neck cancer patients received radiotherapy at different daily time.

Methods: 2 groups of head neck cancer patients treated at Mansoura university hospital; each group included 80 cases. Group A received radiotherapy at early morning between 6 and 8 am, while Group B received radiotherapy in the afternoon between 1 and 3 pm. Oral mucositis survey was self-reported weekly during and at the end of treatment by using “soreness quality score” (SQS).

Results: For group A, mild mucositis (score 1 and 2) was recorded in 53 cases (66%) and severe mucositis was recorded in 27 cases (34%). For group B, mild mucositis was recorded in 29 cases (36%) and severe mucositis was recorded in 51 cases (64%). There was statistically significant difference (0.003) between both groups as regards development of severe oral mucositis.

Conclusion: Better toxicity profile as regards oral mucositis could be obtained by giving radiotherapy for (HNC) patients at early morning compared to late afternoon. Further studies are worthwhile to confirm our findings.

Head and neck cancer, radiotherapy, oral mucositis.

Article Details

How to Cite
Elzahi, M. S. E., Attia, S. E., & Elazab, S. H. (2020). Timing of Daily Radiotherapy for Cases of Head and Neck Cancer: Does It Make Difference?. Journal of Cancer and Tumor International, 10(1), 12-16. https://doi.org/10.9734/jcti/2020/v10i130118
Original Research Article


Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020; 70:7.

Gatta G, Botta L, Sánchez MJ, et al. Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: The EUROCARE-5 population-based study. Eur J Cancer. 2015; 51:2130.

Khaled K El Din, Mohamed A El-Fetouh, Suzan Ahmed, Amira H Hegazy. Clinical outcome and survival of head and neck cancer patients treated at Clinical Oncology Department, Menoufia University. MMJ. 2014;27:359-362.

Wheless SA, McKinney KA, Zanation AM. A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngol Head Neck Surg. 2010; 143:650.

Denaro N, Russi EG, Lefebvre JL, Merlano MC. A systematic review of current and emerging approaches in the field of larynx preservation. Radiother Oncol. 2014;110: 16–24.

Sonis ST. Oral mucositis in head and neck cancer: Risk, biology, and management. Am. Soc. Clin. Oncol. Educ. Book. 2013;33:e236.
DOI: 10.1200/EdBook_AM.2013.33.e236

Marina P. Antoch, Roman V. Kondratov. Pharmacological modulators of the circadian clock as a potential therapeutic drugs: Focus on genotoxic/anti-cancer therapy. PMC 2014;27.
DOI: 10.1007/978-3-642-25950-0_12

Vissink A, Burlage FR, Spijkervet FK, Jansma RP. Coppes prevention and treatment of the consequences of head and neck radiotherapy Crit Rev Oral Biol Med. 2003;14:213-225.

Yokota T, Tachibana H, Konishi T, Yurikusa T, Hamauchi S, Sakai K, et al. Multicenter phase II study of an oral care program for patients with head and neck cancer receiving chemoradiotherapy Support Care Cancer. 2016;24:3029-3036.

Rubenstein EB, Peterson DE, Schubert M, Keefe D, McGuire D, Epstein J, et al. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis Cancer. 2004;100:026-2046.

Fangyi Gu, William D. Duncan, Ying Dong Feng, Austin Miller, Nicolas Schlecht, Alan Hutson, Anurag Singh. Association between timing of radiotherapy and severity of oral mucositis in head-neck cancer patients.
DOI:10.1158/1538-7445.AM2019-4860 Published July 2019

Innominato PF, Levi FA, Bjarnason GA. Chronotherapy and the molecular clock: Clinical implications in oncology. Adv Drug Deliv Rev. 2010;62(9–10):979–1001.
DOI: 10.1016/j.addr.2010.06.002. S0169-409X (10)00138-9