Prevention and Treatment of the Consequences of Head and Neck Radiotherapy

Abstract

The location of the primary tumor or lymph node metastases dictates the inclusion of the oral cavity, salivary glands, and jaws in the radiation treatment portals for patients who have head and neck cancer. The clinical sequelae of the radiation treatment include mucositis, hyposalivation, loss of taste, osteoradionecrosis, radiation caries, and trismus. These sequelae may be dose-limiting and have a tremendous effect on the patient's quality of life. Most treatment protocols to prevent these sequelae are still based on clinical experience, but alternatives based on fundamental basic and clinical research are becoming more and more available. Many of these alternatives either need further study before they can be incorporated into the protocols commonly used to prevent and treat the radiation-related oral sequelae or await implementation of these protocols. In this review, the various possibilities for prevention and/or treatment of radiation-induced changes in healthy oral tissues and their consequences are discussed.

Mobilization of Bone Marrow Stem Cells by Granulocyte Colony-Stimulating Factor Ameliorates Radiation-Induced Damage to Salivary Glands

“…Exposure of the salivary gland to radiation often results in a progressive loss of gland function within the first weeks of radiotherapy (1). The reduction in saliva flow rate and alteration of salivary composition may persist during the rest of the patient's life, leading to complications, including oral dryness, nocturnal oral discomfort, increased risk for oral infections, dental caries, and difficulties in speech, which severely hamper the quality of life (2,3).…”

Radiation-Induced Xerostomia: Objective Evaluation of Salivary Gland Injury Using MR Sialography

“…Salivary gland radiation injury leads to salivary secretion dysfunction and induces several clinical symptoms such as dysphagia (swallowing difficulty) and xerostomia (with speech difficulty, sleep disturbance, intraoral infection, and dental caries). 2 There are some clinical procedures to evaluate the severity of salivary gland hypofunction. Common Terminology Criteria for Adverse Events (CTCAE) and Visual Analog Scale (VAS) are representative techniques for adverse event evaluation.…”

Palliative Dental Care- A Boon for Debilitating

“…Marx and Johnson found physical diagnostic signs to correlate with increased degrees of radiation tissue injury which are described as follows: 1) induration of tissue 2) mucosal radiation telengiectasias 3) loss of facial hair growth 4) cutaneous atrophy 5) cutaneous flaking and keratinization 6) profoundness of xerostomia 7) profoundness of taste loss [42]. Radiological investigations may include Orthopantamography (OPG), Computed tomography, magnetic resonance imaging, positron emission tomography and radionucleide bone scanning with 99mTc-MDP and Near infrared spectroscopy.…”