Skip to main content
SpringerLink
Log in

How to reduce radiation-related toxicity in patients with cancer of the head and neck

  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Radiation for head and neck cancers is often curative, but high doses are used. Normal tissues, including mucosa, salivary glands, and muscles, are exposed to these high doses, resulting in severe mucositis, xerostomia, and dysphagia. Efforts to minimize toxicity have involved advances in radiation physics and development of pharmacologic agents. Radiation techniques include conformal and intensity-modulated therapy, which minimizes dose to normal tissues while delivering high doses to tumor targets. Drugs used to prevent mucositis have targeted infection, but recently interest has been shown in the use of growth factors. Cholinergic agonists and cytoprotective agents, specifically amifostine, can address xerostomia. Involvement of speech pathologists in evaluation and treatment of patients with dysphagia can minimize swallowing difficulties and identify the tissues most responsible for swallowing. Minimizing radiation dose to these tissues may lower the incidence of radiation-induced dysphagia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Bernier J, Domenge C, Ozsahin M, et al.: Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004, 350:1945–1952.

    Article  PubMed  CAS  Google Scholar 

  2. Forastiere AA, Goepfert H, Maor M, et al.: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003, 349:2091–2098.

    Article  PubMed  CAS  Google Scholar 

  3. Cooper JS, Pajak TF, Forastiere AA, et al.: Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004, 350:1937–1944.

    Article  PubMed  Google Scholar 

  4. Fu KK, Pajak TF, Trotti A, et al.: A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000, 48:7–16.

    Article  PubMed  CAS  Google Scholar 

  5. Trotti A, Bellm LA, Epstein JB, et al.: Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 2003, 66:253–262. A good review summarizing randomized trials that have studied mucositis and the tools used to score this outcome.

    Article  PubMed  Google Scholar 

  6. Sonis ST: The pathobiology of mucositis. Nat Rev Cancer 2004, 4:277–284. An outstanding description of the current model of the pathophysiology of mucositis.

    Article  PubMed  CAS  Google Scholar 

  7. Trotti A, Garden A, Warde P, et al.: A multinational randomized phase III trial of iseganan HCl oral solution for reducing the severity of oral mucositis in patients receiving radiotherapy for head-and-neck malignancy. Int J Radiat Oncol Biol Phys 2004, 58:674–681. Although its results were negative, this was the largest trial to date investigating an experimental therapeutic for the treatment of mucositis.

    Article  PubMed  CAS  Google Scholar 

  8. Donnelly JP, Bellm LA, Epstein JB, et al.: Antimicrobial therapy to prevent or treat oral mucositis. Lancet Infect Dis 2003, 3:405–412. A fine review of antimicrobial therapy and its role (or lack thereof) in prevention or treatment of mucositis.

    Article  PubMed  Google Scholar 

  9. Spielberger R, Stiff P, Bensinger W, et al.: Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med 2004, 351:2590–2598. An important study demonstrating that palifermin can reduce the incidence and duration of mucositis in patients undergoing highdose chemotherapy in the transplant setting. The role of palifermin for minimizing radiation-induced mucositis is under investigation.

    Article  PubMed  CAS  Google Scholar 

  10. Brizel DM, Le QT, Rosenthal D, et al.: andard (SRT) or hyperfractionated irradiation (HRT) & concurrent chemotherapy. Int J Radiat Oncol Biol Phys 2002, 54(Suppl2):285.

    Article  Google Scholar 

  11. Brizel DM, Wasserman TH, Henke M, et al.: Phase III randomized trial of amifostine as a radioprotector in head and neck cancer. J Clin Oncol 2000, 18:3339–3345.

    PubMed  CAS  Google Scholar 

  12. Buentzel J, Micke O, Adamietz IA, et al.: Intravenous amifostine during chemoradiotherapy for head-and-neck cancer: a randomized placebo-controlled phase III study. Int J Radiat Oncol Biol Phys 2005 Oct 20; [Epub ahead of print].

  13. Buntzel J, Schuth J, Kuttner K, et al.: Radiochemotherapy with amifostine cytoprotection for head and neck cancer. Support Care Cancer 1998, 6:155–160.

    Article  PubMed  CAS  Google Scholar 

  14. Antonadou D, Pepelassi M, Synodinou M, et al.: Prophylactic use of amifostine to prevent radiochemotherapy-induced mucositis and xerostomia in head-and-neck cancer. Int J Radiat Oncol Biol Phys 2002, 52:739–737.

    Article  PubMed  CAS  Google Scholar 

  15. Rubenstein EB, Peterson DE, Schubert M, et al.: Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 2004, 100(9suppl):2026–2046. A consensus panel used evidence-based criteria to evaluate all trials that studied agents or other methods for mucositis prevention or treatment. The panel scored the evidence and made recommendations based on the strength of this evidence.

    Article  PubMed  Google Scholar 

  16. Chambers MS, Garden AS, Kies MS, et al.: Radiationinduced xerostomia in patients with head and neck cancer: pathogenesis, impact on quality of life, and management. Head Neck 2004, 26:796–807. An excellent review on radiation-induced xerostomia.

    Article  PubMed  Google Scholar 

  17. Wasserman TH, Brizel DM, Henke M, et al.: Influence of intravenous amifostine on xerostomia, tumor control, and survival after radiotherapy for head-and-neck cancer: 2-year follow-up of a prospective, randomized phase III trial. Int J Radiat Oncol Biol Phys 2005, 63:985–990. This study updates the seminal amifostine trial testing the agent in prevention of xerostomia with 2-year data.

    Article  PubMed  CAS  Google Scholar 

  18. Eisbruch A, Kim H, Terrell J, et al.: Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001, 50:695–704.

    Article  PubMed  CAS  Google Scholar 

  19. Garden AS, Morrison WH, Rosenthal DI, et al.: Target coverage for head and neck cancers treated with IMRT: review of clinical experiences. Semin Radiat Oncol 2004, 14:103–109.

    Article  PubMed  Google Scholar 

  20. Eisbruch A, Ten Haken RK, Kim HM, et al.: Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 1999, 45:577–587.

    Article  PubMed  CAS  Google Scholar 

  21. Blanco AI, Chao KS, El Naqa I, et al.: Dose-volume modeling of salivary function in patients with head-and-neck cancer receiving radiotherapy. Int J Radiat Oncol Biol Phys 2005, 62:1055–1969. This study examines sophisticated mathematical models to determine the relationship of radiation dose and volume on xerostomia.

    Article  PubMed  Google Scholar 

  22. Jabbari S, Kim H, Feng M, et al.: Matched case-control study of quality of life and xerostomia after intensitymodulated radiotherapy or standard radiotherapy for head-and-neck cancer: Initial report. Int J Radiat Oncol Biol Phys 2005, 63:725–731. A nice study evaluating a single institution’s experience using IMRT to minimize xerostomia and correlating this experience with scores on QOL measures.

    Article  PubMed  Google Scholar 

  23. Johnson JT, Ferretti GA, Nethery WJ, et al.: Oral pilocarpine for post-irradiation xerostomia in patients with head and neck cancer. N Engl J Med 1993, 329:390–395.

    Article  PubMed  CAS  Google Scholar 

  24. Chambers MS, Posner MR, Jones CU, et al.: Two phase III clinical studies of cevimeline for post-radiation xerostomia in patients with head and neck cancer [abstract]. Proc ASCO 2005, 23(16S):500.

    Google Scholar 

  25. Eisbruch A, Lyden T, Bradford CR, et al.: Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-andneck cancer. Int J Radiat Oncol Biol Phys 2002, 53:23–28.

    Article  PubMed  Google Scholar 

  26. Eisbruch A, Schwartz M, Rasch C, et al.: Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys 2004, 60:1425–1439. A provocative study with goals to determine the anatomy that contributes to dysphagia and whether radiation oncologists can use newer techniques to minimize the dose to this anatomy.

    Article  PubMed  Google Scholar 

  27. Kotz T, Abraham S, Beitler JJ, et al.: Pharyngeal transport dysfunction consequent to an organ-sparing protocol. Arch Otolaryngol Head Neck Surg 1999, 15:383–388.

    Google Scholar 

  28. Chen A, Frankowski R, Bishop-Leone J, et al.: The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 2001, 127:870–876.

    PubMed  CAS  Google Scholar 

  29. Lazarus CL, Logemann JA, Pauloski BR, et al.: Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy. Laryngoscope 1996, 106:1157–1166.

    Article  PubMed  CAS  Google Scholar 

  30. Pauloski BR, Logemann JA: Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients. Head Neck 2000, 22:120–131.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Radiation Oncology and Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, 77030, Houston, TX, USA

    Adam S. Garden MD

Authors
  1. Adam S. Garden MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan S. Lewin PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark S. Chambers DMD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam S. Garden MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Garden, A.S., Lewin, J.S. & Chambers, M.S. How to reduce radiation-related toxicity in patients with cancer of the head and neck. Curr Oncol Rep 8, 140–145 (2006). https://doi.org/10.1007/s11912-006-0049-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-006-0049-x

Keywords

Search

Navigation