Acute-phase response reactants as objective biomarkers of radiation-induced mucositis in head and neck cancer

Background Current evaluation of radiation‐induced mucositis in head and neck cancer relies on subjective scoring with interrater variability. We evaluated serum erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP) as objective markers of radiation‐induced mucositis. Methods Weekly serum CRP and ESR levels were measured in patients treated for head and neck cancer with radiation ± chemotherapy. Acute radiation toxicity was evaluated using National Cancer Institute of Canada‐Common Toxicity Criteria (NCIC‐CTC) version 2.0 and the Head and Neck Radiotherapy Questionnaire (HNRQ). Results ESR and CRP levels were significantly elevated by 3 weeks (p = .01) and 6 weeks (p = .0002), respectively, and independent of age or pretreatment surgery. ESR was significantly dependent on radiation dose (p = .0004) and significantly higher with chemoradiation (p = .03). Conclusion Serum ESR and CRP rise reliably in a radiation dose‐dependent manner. ESR correlated with clinical symptoms and distinguished patients receiving chemoradiation. ESR and CRP may be an objective and sensitive marker of radiation‐induced mucositis. © 2011 Wiley Periodicals, Inc. Head Neck, 2012