Abstract
Background: Prediction of radiation response before the completion of
the radiotherapy schedule is challenging. Information about radiation
response could help oncologist to choose the appropriate combination
and sequence of therapies in the multidisciplinary management of
cancer. Methods: The study involved 26 patients with squamous cell
cancers of the head and neck region who received radiotherapy to a dose
of 30 Gy in 10 fractions over a 2-week period as part of a split-course
technique. Fine-needle aspiration cytology was performed on day 1 and
day 5 of the schedule. The silver staining of the nuclear organiser
region (AgNOR) and nuclear morphometric study were done on both days.
Results: The median age of the patients was 44 years old. The primary
tumours were distributed in the nasopharynx (n = 11), larynx and
hypopharynx (n = 5), metastatic node (n = 4), and miscellaneous tumours
were found in the head and neck sub sites (n = 6). The mean initial
AgNOR score was 3.0, range 1.2-7.0. The median of nuclear and
nucleolar diameters were 11.07 μm, range 7.70-16.6 μm,
and 2.92 μm, range 1.09-11.66 μm, respectively.
Patients with a pre-radiotherapy AgNOR score of greater than 2.5 were
associated with disease progression and metastasis. However, the
increased of nuclear diameter on day 5 compared with baseline predicted
a good radiation response in patients (P = 0.016). Conclusion:
Intra-radiotherapy nuclear morphometry combined with baseline AgNOR
score could be a simple and useful tool for the prediction of radiation
response in head and neck cancers.