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Oral complications of radiotherapy in head and neck cancer

Strategies for prevention and management

  • Therapy in Practice
  • Published:
American Journal of Cancer

Abstract

Radiotherapy in the head and neck region constitutes a major therapeutic challenge. Tumors and elective nodal areas are often in close proximity to radiosensitive normal tissues, a factor which often limits the success of radiotherapy.

Acute radiation-induced adverse effects such as mucositis and skin reactions occur during the course of treatment. They are generally reversible and patients normally recover from these adverse effects within 3 months. Late radiation reactions such as fibrosis and osteoradionecrosis occur more than 3 months after treatment. Such reactions are characterized by their gradual progression. Xerostomia is the single most important factor leading to chronic loss of quality of life in head and neck cancer patients.

Oral complications can be prevented or modified by altered fractionation, by reducing the irradiated volume, or by pharmacologic intervention. Altered fractionation in the form of acceleration or hyperfractionation has improved the therapeutic ratio in several large clinical studies and a recent meta-analysis. Reducing the high-dose volume, and especially avoiding irradiating sensitive structures, is the basis for the increasing use of conformal and intensity-modulated radiotherapy. Such techniques may eventually allow dose escalation in tumor areas leading to increased local tumor control while keeping morbidity at an acceptable level.

Numerous pharmacologic agents have been evaluated for the prevention and management of both acute and late complications. The only agent with documented radioprotective activity is amifostine, which can reduce late xerostomia. However, it is still unclear whether amifostine also protects tumor cells. Pilocarpine may relieve late xerostomia in some patients with remaining functional salivary gland reserve. Apart from this limited Indication, pharmacologic agents against oral complications should not be used outside of clinical trials.

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Acknowledgment

This review was funded by the Danish Cancer Society. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Department of Oncology and Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark

    Cai Grau, Christian N. Andreassen, Kenneth Jensen & Jacob C. Lindegaard

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  1. Cai Grau
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Correspondence to Cai Grau.

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Grau, C., Andreassen, C.N., Jensen, K. et al. Oral complications of radiotherapy in head and neck cancer. Am J Cancer 3, 291–298 (2004). https://doi.org/10.2165/00024669-200403050-00003

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