Treatment of late sequelae after radiotherapy for head and neck cancer

• Authors: Primož Strojan, Institute of Oncology; Katherine A. Hutcheson, MD Anderson Cancer Center; Avraham Eisbruch, University of Michigan; Jonathan J Beitler, Emory University; Johannes A. Langendijk, University of Groningen; Anne W. M. Lee, University of Hong Kong; June Corry, Peter MacCallum Cancer Centre; William M. Mendenhall, University of Florida; Robert Smee, The Prince of Wales Cancer Centre; Alessandra Rinaldo, University of Udine; Alfio Ferlito, International Head and Neck Scientific Group
• Journal Title: Cancer Treatment Reviews
• Volume: Volume 59
• Publisher: Elsevier: 12 months | 2017-09-01, Pages 79-92
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.ctrv.2017.07.003
• Subjects: Health Sciences, Oncology; Biology, Radiation
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Head and neck cancer; Radiotherapy; Toxicity; Late sequelae; Treatment; QUALITY-OF-LIFE; RADIATION-INDUCED XEROSTOMIA; HYPERBARIC-OXYGEN THERAPY; INTENSITY-MODULATED RADIOTHERAPY; LOCALLY ADVANCED HEAD; IRRADIATION-INDUCED HYPOSALIVATION; INDUCED SALIVARY HYPOFUNCTION; ADENOVIRAL-MEDIATED TRANSFER; SENSORINEURAL HEARING-LOSS; FREE-FLAP RECONSTRUCTION

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.