Evaluation, Prediction and Treatment of Radiation- Induced Normal Tissue Damage in Head and Neck Cancer

 

Abstract

Locally advanced head and neck squamous cell cancer (HNSCC) requires a multidisciplinary approach and frequently concurrent chemoradiation (CRT) as a definitive or adjuvant treatment. Oral mucositis (OM) affects 80% of patients receiving radiation treatment and about half of the patients receiving CRT experience severe grade 3-4 mucositis. Severe mucositis results in high hospitalization rates and treatment interruptions, which can negatively affect treatment outcomes. The local tumor control rate may be reduced by 0.5 to 1% for each day of unplanned interruption in radiation treatment. Severe late toxicity occurs in about 43% of patients receiving CRT. Careful selection of patients for concurrent chemotherapy with attention to detailed assessment and aggressive supportive care is paramount to minimizing treatment related complications. Here we discuss aspects specific to management of mucositis, radiation dermatitis, nutritional and dysphagia assessment, and early interventions to avoid long term toxicity in the subgroup of patients receiving CRT. Investigational and alternate strategies to systemic treatment with cisplatin that could impact radiation induced normal tissue damage are discussed as well.

Abbreviations: HNSCC: Head and Neck Squamous Cell Cancer; OM: Oral Mucositis; WHO: World Health Organization; CTCAE: Common Toxicity Criteria Adverse Events; HPV: Human Papilloma Virus; QOL: Quality of Life

 

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