Argenone, A.

Borzillo, V.

Di Franco, R.

Di Paola, F.

Falivene, S.

Fulciniti, F.

Mormile, M.

Muto, P.

Schiavone, C.

Elsevier - Publisher Connector 

EP-1027: Unusual cases of hyperpigmentation of tongue in patients treated for head and neck cancer. 

S390  2nd ESTRO Forum 2013 
dose' was defined as a mean gland dose of above 50 Gy. The four 
groups were: high thyroid and pituitary doses (HTHP group); high 
thyroid and low pituitary doses (HTLP group); low thyroid and high 
pituitary doses (LTHP group) and low thyroid and pituitary doses (LTLP 
group). Repeated measurements of the fT3, fT4 and TSH were taken 
at 3, 6, 12 and 18 months after completion of radiotherapy. Any 
abnormal thyroid hormone levels and incidences of hypothyroidism 
were identified and analysed with respect to the four different 
patient groups defined above.  
Results: In general, the thyroid gland received relatively higher dose 
than the pituitary gland, with the average mean and D50 thyroid dose 
about 60% higher than that of the pituitary. 22 patients (33.8%) and 17 
patients (26.2%) received high mean thyroid and pituitary doses of 
over 50 Gy respectively. At the 18 months post-RT, 4 patients (6.2%) 
developed overt hypothyroidism, 9 (13.8%) developed subclinical 
hypothyroidism and 2 (3.1%) developed central hypothyroidism (Table 
1). The incidence of abnormal thyroid function was highest in the 
HTHP group, in which 5 out of 6 cases (83.3%) developed 
hypothyroidism followed by the HTLP group with an incidence of 50%. 
The LTHP and LTLP groups showed much lower incidence of 
hypothyroidism (<10%). 
 
  
Conclusions: Patients who received both high thyroid and pituitary 
glands doses carried the highest risks of abnormal thyroid functions. 
High thyroid dose was a more influential factor than high pituitary 
dose in inducing post-RT hypothyroidism. Therefore, measure to keep 
the mean thyroid dose below 50 Gy in treatment planning was 
essential to minimize the thyroid complications. 
   
EP-1027   
Unusual cases of hyperpigmentation of tongue in patients treated 
for head and neck cancer. 
S. Falivene1, R. Di Franco1, F. Fulciniti2, V. Borzillo1, F. Di Paola3, M. 
Mormile4, A. Argenone1, C. Schiavone1, P. Muto1 
1Instituto Nazionale dei Tumori Pascale, Radioterapia, Napoli, Italy  
2Instituto Nazionale dei Tumori Pascale, Anatomia Patologica e 
Citopatologia, Napoli, Italy  
3Instituto Nazionale dei Tumori Pascale, Medicina di Laboratorio, 
Napoli, Italy  
4Instituto Nazionale dei Tumori Pascale, Fisica Sanitaria, Napoli, Italy  
 
Purpose/Objective: External radiation therapy (ERT) and 
chemotherapy are currently used for the treatment of head and neck 
cancer. These therapies are often associated with mucositis and 
xerostomia while hyperpigmentation of the tongue is a rare event. 
The aim of our study was to study all cases of dark tongue in patients 
(pts) treated with ERT on the head and neck area by performing a 
routine microbiological test and looking for possible correlations with 
ERT or other therapies administered. 
Materials and Methods: In a period of 9 months we observed 10 cases 
of hyperpigmentation of tongue. Four pts underwent radical surgery 
before ERT, 2 pts had conservative surgery. Six pts were treated 
concurrent with chemotherapy. Eight patients were treated with 
3DCRT, 2 pts with IMRT. The evaluation of acute toxicity was made 
using the RTOG criteria. Lingual swabs were performed at the 
appearance of lingual discoloration. An assessment of the dose-volume 
histogram (DVH) was carried out for each patient. 
  
Results: Pts developed hyperpigmentation of tongue at a mean dose 
of 40,65 Gy (range 22 – 68 Gy). For all pts, the brown coloration was 
on the anterior half of dorsal surface of mobile tongue without pain, 
burning sensation or other type of tongue distress. Mucositides G2 
were observed in 5 pts and G1 in 1 pt. Salivary gland toxicity G2 was 
detected in 5 pts and G1 in 1 pt. No pts developed hematologic 
toxicity. In only one case (5%) an infection by two microorganisms 
(Klebsiella pneumoniae and Candida spp.) was reported, while in all 
other cases there were monomicrobic infections represented in 50% of 
the cases by Candida spp, in the 45% by gram-negative bacterial 
pathogens (Acinetobacter lwoffii, Acinetobacter Baumannii, 
Enterobacter cloacae, Pseudomonas spp.).  From an initial 
assessment, evaluating the DVH data, we did not observe a direct 
correlation between the appearance of hyperpigmentation of tongue 
and the dose absorbed by the tongue nor by parotid glands. We did 
not find a correlation between the initial infection and the 
administration of chemotherapy. All patients assumed topical therapy 
for the prevention and palliative treatment of xerostomia and 
mucositis. In order to treat hyperpigmentation of the dorsal surface of 
tongue, five patients (2 with Candida and 3 with bacterial infection) 
did not assume any therapy while the others were treated with 
systemic antifungal therapy or with antibiotic depending by the 
microbial agent reported. It may be stated that administration of 
systemic targeted therapy did not give any advantage as to the time 
of resolution of the black tongue. 
Conclusions: We believe that for all patients, the hyperpigmentation 
of tongue is related to the changed microenvironmental conditions of 
the oral cavity favoring the development of opportunistic 
microorganisms. We would also like to emphasize the need for a 
microbiological swab test before prescribing any drug to subjects with 
a black tongue discoloration.  
   
EP-1028   
Comparison of quality of life in patients with head and neck cancer 
prior radiotherapy and 1 year after  
P. Milecki1, M. Zmijewska-Tomczak1, A. Rucinska1 
1Greater Poland Cancer Centre, Radiation Oncology Department, 
Poznan, Poland  
 
Purpose/Objective: Radiotherapy alone (RT) or in combination with 
chemotherapy (CRT) is a standard of care for patients in locally 
advanced squamous cell carcinoma head and neck cancer (LA-HNSCC). 
However, RT is associated with side effects, which can have a 
significant impact on the QoL. The purpose of this study was to 
investigate the longitudinal changes in QoL for patients with LA-
HNSCC following RT or CRT. 
Materials and Methods: From September 2008 to February 2010, 205 
patients with LA-HNSCC were included. The data pertaining to their 
QoL were collected using the European Organization for Research and 
Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-
C30) and the EORTC Head and Neck Module(QLQ-H&N35) before RT 
and 12 months after the end of RT. The data of all items and scales of 
the EORTC QLQ-C30 and the EORTC QLQ-H&N35 were transformed to a 
0–100 scale for presentation according to the guidelines of the EORTC. 
For statistical evaluation the student t-test was performed with 
significance level of p< 0.05. 
Results: In general, during the 1 year follow-up after the end of RT 
the QoL of patients increased and the global QoL was not statistically 
different than prior RT. The most significant improvement was 
observed for the following issues: appetite, pain, nausea and 
vomiting, and fatigue. However, after 1 year from the end of RT the 
QoL for many subscales is still lower than prior treatment. For 


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EP-1027: Unusual cases of hyperpigmentation of tongue in patients treated for head and neck cancer.

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