Treatment of late sequelae after radiotherapy for head and neck cancer

Cancer Treat Rev. 2017 Sep;59:79-92. doi: 10.1016/j.ctrv.2017.07.003. Epub 2017 Jul 18.

Abstract

Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.

Keywords: Head and neck cancer; Late sequelae; Radiotherapy; Toxicity; Treatment.

Publication types

  • Review

MeSH terms

  • Deglutition Disorders / epidemiology
  • Deglutition Disorders / etiology
  • Deglutition Disorders / physiopathology
  • Disease-Free Survival
  • Dose-Response Relationship, Radiation
  • Female
  • Head and Neck Neoplasms / mortality*
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / radiotherapy*
  • Hearing Loss / epidemiology
  • Hearing Loss / etiology
  • Hearing Loss / physiopathology
  • Humans
  • Male
  • Mandible / pathology
  • Mandible / radiation effects
  • Osteonecrosis / epidemiology
  • Osteonecrosis / etiology
  • Osteonecrosis / physiopathology
  • Prognosis
  • Radiation Injuries / epidemiology
  • Radiation Injuries / physiopathology*
  • Radiation Tolerance
  • Radiotherapy / adverse effects*
  • Radiotherapy / methods
  • Radiotherapy Dosage
  • Risk Assessment
  • Survival Analysis
  • Trismus / epidemiology
  • Trismus / etiology
  • Trismus / physiopathology
  • Xerostomia / epidemiology
  • Xerostomia / etiology
  • Xerostomia / physiopathology