:: By Lydialyle Gibson

:: Image courtesy Argonne National
:: Laboratory

Investigations ::

Hot zones

For some patients with head and neck cancers, the worst ordeal isn’t chemotherapy or radiation, or even the disease itself; it’s the oral ulcers that often accompany treatment. Called mucositis, these sores arise from inflamed mucous membranes in the mouth and soft palate, and they can make eating and talking extraordinarily painful. Some patients find it too excruciating to open their mouths at all and must be fed through a tube. Others may temporarily lose their sense of taste.

A side effect of toxic cancer therapies, mucositis is not always so acute, but nearly three-fourths of patients suffer the condition. Now Chicago oncologist Ezra Cohen is testing an infrared, thermal-imaging camera designed to predict, before symptoms emerge, which patients will develop the worst sores.

Detecting temperature gradations as small as one-twentieth of a degree Celsius, the camera, engineered by Argonne materials scientists Valentyn Novosad and Volodymyr Yefremenko, measures the body’s thermal signature after the first round of chemotherapy or radiation. Usually the tumor shows up as warmer than the surrounding tissue, but a larger area of elevated temperature signifies early inflammation and a higher risk for mucositis. Compare the image (below left) taken before chemotherapy with the two images (center and right) taken afterward. The spread of warmer, pinker areas portends the onset of mucositis.

Doctors could use this information, Cohen says, to tailor a patient’s treatment by scaling back chemo or radiation dosages, installing a feeding tube right away, or setting up early physical-therapy consultations. “The problem has been,” he says, “that we’ve had no way to predict up front who will suffer the most.” After a pilot clinical study of six volunteer patients last year, Cohen is now embarking on a two-year trial of 34 patients, funded by the National Institutes of Health.