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Late side effects of radiation treatment for head and neck cancer

  • Brook, Itzhak (Department of Pediatrics, Georgetown University School of Medicine)
  • Received : 2020.04.14
  • Accepted : 2020.06.09
  • Published : 2020.06.30

Abstract

Patients undergoing radiation therapy for head and neck cancer (HNC) experience significant early and long-term side effects. The likelihood and severity of complications depends on a number of factors, including the total dose of radiation delivered, over what time it was delivered and what parts of the head and neck received radiation. Late side effects include: permanent loss of saliva; osteoradionecrosis; radiation recall myositis, pharyngoesophageal stenosis; dental caries; oral cavity necrosis; fibrosis; impaired wound healing; skin changes and skin cancer; lymphedema; hypothyroidism, hyperparathyroidism, lightheadedness, dizziness and headaches; secondary cancer; and eye, ear, neurological and neck structures damage. Patients who undergo radiotherapy for nasopharyngeal carcinoma tend to suffer from chronic sinusitis. These side effects present difficult challenges to the patients and their caregivers and require life-long strategies to alleviate their deleterious effect on basic life functions and on the quality of life. This review presents these side effects and their management.

Keywords

References

  1. Morgan HE, Sher DJ. Adaptive radiotherapy for head and neck cancer. Cancers Head Neck 2020;5:1. https://doi.org/10.1186/s41199-019-0046-z
  2. Tolentino Ede S, Centurion BS, Ferreira LH, Souza AP, Damante JH, Rubira-Bullen IR. Oral adverse effects of head and neck radiotherapy: literature review and suggestion of a clinical oral care guideline for irradiated patients. J Appl Oral Sci 2011;19:448-54. https://doi.org/10.1590/S1678-77572011000500003
  3. Stubblefield MD. Clinical evaluation and management of radiation fibrosis syndrome. Phys Med Rehabil Clin N Am 2017;28:89-100. https://doi.org/10.1016/j.pmr.2016.08.003
  4. Sroussi HY, Epstein JB, Bensadoun RJ, et al. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med 2017;6:2918-31. https://doi.org/10.1002/cam4.1221
  5. Brook I. My voice [Internet]. [place unknown]: [publisher Blogger]; c2020 [cited 2020 Jun 10]. Available from: https://dribrook.blogspot.com/.
  6. Pedersen AM, Sorensen CE, Proctor GB, Carpenter GH, Ekstrom J. Salivary secretion in health and disease. J Oral Rehabil 2018;45:730-46. https://doi.org/10.1111/joor.12664
  7. Wu VW, Leung KY. A Review on the assessment of radiation induced salivary gland damage after radiotherapy. Front Oncol 2019;9:1090. https://doi.org/10.3389/fonc.2019.01090
  8. Gupta N, Pal M, Rawat S, et al. Radiation-induced dental caries, prevention and treatment: a systematic review. Natl J Maxillofac Surg 2015;6:160-6. https://doi.org/10.4103/0975-5950.183870
  9. Ma SJ, Rivers CI, Serra LM, Singh AK. Long-term outcomes of interventions for radiation-induced xerostomia: a review. World J Clin Oncol 2019;10:1-13. https://doi.org/10.5306/wjco.v10.i1.1
  10. Gil-Montoya JA, Silvestre FJ, Barrios R, Silvestre-Rangil J. Treatment of xerostomia and hyposalivation in the elderly: a systematic review. Med Oral Patol Oral Cir Bucal 2016;21:e355-66.
  11. Cheng CQ, Xu H, Liu L, et al. Efficacy and safety of pilocarpine for radiation-induced xerostomia in patients with head and neck cancer: a systematic review and meta-analysis. J Am Dent Assoc 2016;147:236-43. https://doi.org/10.1016/j.adaj.2015.09.014
  12. Zhuang L, Yang Z, Zeng X, et al. The preventive and therapeutic effect of acupuncture for radiation-induced xerostomia in patients with head and neck cancer: a systematic review. Integr Cancer Ther 2013;12:197-205. https://doi.org/10.1177/1534735412451321
  13. Fischoff DK, Spivakovsky S. Little evidence to support or refute interventions for the management of burning mouth syndrome. Evid Based Dent 2017;18:57-8. https://doi.org/10.1038/sj.ebd.6401244
  14. Muller VJ, Belibasakis GN, Bosshard PP, et al. Change of saliva composition with radiotherapy. Arch Oral Biol 2019;106:104480. https://doi.org/10.1016/j.archoralbio.2019.104480
  15. Kojima Y, Yanamoto S, Umeda M, et al. Relationship between dental status and development of osteoradionecrosis of the jaw: a multicenter retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;124:139-45. https://doi.org/10.1016/j.oooo.2017.04.012
  16. Seo MH, Eo MY, Myoung H, Kim SM, Lee JH. The effects of pentoxifylline and tocopherol in jaw osteomyelitis. J Korean Assoc Oral Maxillofac Surg 2020;46:19-27. https://doi.org/10.5125/jkaoms.2020.46.1.19
  17. Nadella KR, Kodali RM, Guttikonda LK, Jonnalagadda A. Osteoradionecrosis of the jaws: clinico-therapeutic management: a literature review and update. J Maxillofac Oral Surg 2015;14:891-901. https://doi.org/10.1007/s12663-015-0762-9
  18. Lyons A, Ghazali N. Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg 2008;46:653-60. https://doi.org/10.1016/j.bjoms.2008.04.006
  19. Straub JM, New J, Hamilton CD, Lominska C, Shnayder Y, Thomas SM. Radiation-induced fibrosis: mechanisms and implications for therapy. J Cancer Res Clin Oncol 2015;141:1985-94. https://doi.org/10.1007/s00432-015-1974-6
  20. Stubblefield MD, Levine A, Custodio CM, Fitzpatrick T. The role of botulinum toxin type A in the radiation fibrosis syndrome: a preliminary report. Arch Phys Med Rehabil 2008;89:417-21. https://doi.org/10.1016/j.apmr.2007.11.022
  21. Ortigara GB, Schulz RE, Soldera EB, et al. Association between trismus and dysphagia-related quality of life in survivors of head and neck cancer in Brazil. Oral Surg Oral Med Oral Pathol Oral Radiol 2019;128:235-42. https://doi.org/10.1016/j.oooo.2019.05.009
  22. Loorents V, Rosell J, Karlsson C, Lidback M, Hultman K, Borjeson S. Prophylactic training for the prevention of radiotherapy-induced trismus: a randomised study. Acta Oncol 2014;53:530-8. https://doi.org/10.3109/0284186X.2014.892211
  23. Pauli N, Svensson U, Karlsson T, Finizia C. Exercise intervention for the treatment of trismus in head and neck cancer: a prospective two-year follow-up study. Acta Oncol 2016;55:686-92. https://doi.org/10.3109/0284186X.2015.1133928
  24. Kim A, Stubblefield MD. The role of the headmaster collar (Cervical) for dropped head syndrome in Hodgkin lymphoma survivors. PM R 2019;11:939-43. https://doi.org/10.1002/pmrj.12010
  25. Urken ML, Jacobson AS, Lazarus CL. Comprehensive approach to restoration of function in patients with radiation-induced pharyngoesophageal stenosis: report of 31 patients and proposal of new classification scheme. Head Neck 2012;34:1317-28. https://doi.org/10.1002/hed.21927
  26. Borrelli MR, Shen AH, Lee GK, Momeni A, Longaker MT, Wan DC. Radiation-induced skin fibrosis: pathogenesis, current treatment options, and emerging therapeutics. Ann Plast Surg 2019;83:S59-64. https://doi.org/10.1097/SAP.0000000000002098
  27. Bray FN, Simmons BJ, Wolfson AH, Nouri K. Acute and chronic cutaneous reactions to ionizing radiation therapy. Dermatol Ther (Heidelb) 2016;6:185-206. https://doi.org/10.1007/s13555-016-0120-y
  28. Anand A, Balasubramanian D, Subramanian N, et al. Secondary lymphedema after head and neck cancer therapy: a review. Lymphology 2018;51:109-18.
  29. Boomsma MJ, Bijl HP, Langendijk JA. Radiation-induced hypothyroidism in head and neck cancer patients: a systematic review. Radiother Oncol 2011;99:1-5. https://doi.org/10.1016/j.radonc.2011.03.002
  30. Stephen AE, Chen KT, Milas M, Siperstein AE. The coming of age of radiation-induced hyperparathyroidism: evolving patterns of thyroid and parathyroid disease after head and neck irradiation. Surgery 2004;136:1143-53. https://doi.org/10.1016/j.surg.2004.06.042
  31. Balentova S, Adamkov M. Molecular, cellular and functional effects of radiation-induced brain injury: a review. Int J Mol Sci 2015;16:27796-815. https://doi.org/10.3390/ijms161126068
  32. Ko HC, Powers AR, Sheu RD, et al. Lhermitte's sign following VMAT-based head and neck radiation-insights into mechanism. PLoS One 2015;10:e0139448. https://doi.org/10.1371/journal.pone.0139448
  33. Cai Z, Li Y, Hu Z, Fu R, et al. Radiation-induced brachial plexopathy in patients with nasopharyngeal carcinoma: a retrospective study. Oncotarget 2016;7:18887-95. https://doi.org/10.18632/oncotarget.7748
  34. Dimitrova A, Murchison C, Oken B. Acupuncture for the treatment of peripheral neuropathy: a systematic review and meta-analysis. J Altern Complement Med 2017;23:164-79. https://doi.org/10.1089/acm.2016.0155
  35. Warade AC, Jha AK, Pattankar S, Desai K. Radiation-induced brachial plexus neuropathy: a review. Neurol India 2019;67:S47-52. https://doi.org/10.4103/0028-3886.250704
  36. Reichstein D. Current treatments and preventive strategies for radiation retinopathy. Curr Opin Ophthalmol 2015;26:157-66. https://doi.org/10.1097/ICU.0000000000000141
  37. Landier W. Ototoxicity and cancer therapy. Cancer 2016;122:1647-58. https://doi.org/10.1002/cncr.29779
  38. Nader ME, Gidley PW. Challenges of hearing rehabilitation after radiation and chemotherapy. J Neurol Surg B Skull Base 2019;80:214-24. https://doi.org/10.1055/s-0039-1677865
  39. Coumbe BG, Groarke JD. Cardiovascular autonomic dysfunction in patients with cancer. Curr Cardiol Rep 2018;20:69. https://doi.org/10.1007/s11886-018-1010-y
  40. Mancuso M, Pasquali E, Leonardi S, et al. Oncogenic bystander radiation effects in Patched heterozygous mouse cerebellum. Version 2. Proc Natl Acad Sci U S A 2008;105:12445-50. https://doi.org/10.1073/pnas.0804186105
  41. Shah-Becker S, Pennock M, Sinoway L, Goldenberg D, Goyal N. Baroreceptor reflex failure: review of the literature and the potential impact on patients with head and neck cancer. Head Neck 2017;39:2135-41. https://doi.org/10.1002/hed.24857
  42. Arthurs E, Hanna TP, Zaza K, Peng Y, Hall SF. Stroke after radiation therapy for head and neck cancer: what is the risk? Int J Radiat Oncol Biol Phys 2016;96:589-96. https://doi.org/10.1016/j.ijrobp.2016.07.007
  43. Grandhi R, Brasiliense LB, Williamson R, Zwagerman NT, Sauvageau E, Hanel RA. Delayed pipeline embolization of a ruptured true internal carotid artery aneurysm presenting with epistaxis: case report and review of the literature. World Neurosurg 2019;125:273-6. https://doi.org/10.1016/j.wneu.2019.01.126
  44. Fernandez-Alvarez V, Lopez F, Suarez C, et al. Radiation-induced carotid artery lesions. Strahlenther Onkol 2018;194:699-710. https://doi.org/10.1007/s00066-018-1304-4
  45. Giannopoulos S, Texakalidis P, Jonnalagadda AK, Karasavvidis T, Giannopoulos S, Kokkinidis DG. Revascularization of Radiation-Induced Carotid Artery Stenosis With Carotid Endarterectomy vs. Carotid Artery Stenting: A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med 2018;19:638-44. https://doi.org/10.1016/j.carrev.2018.01.014
  46. Briasoulis A, Silver A, Yano Y, Bakris GL. Orthostatic hypotension associated with baroreceptor dysfunction: treatment approaches. J Clin Hypertens (Greenwich) 2014;16:141-8. https://doi.org/10.1111/jch.12258
  47. Hayat A, Whittam D. Baroreceptor failure related to bilateral carotid artery disease: an uncommon cause of labile hypertension. Intern Med J 2014;44:105-6. https://doi.org/10.1111/imj.12324
  48. Mann SJ. Labile and paroxysmal hypertension: common clinical dilemmas in need of treatment studies. Curr Cardiol Rep 2015;17:99. https://doi.org/10.1007/s11886-015-0646-0
  49. Brook I. Paroxysmal hypertension episodes caused by direct massage of the carotid artery by ultrasound of the neck in a laryngectomee. J Med Ultrasound 2020;28:114-6.
  50. Zhao W, Lei H, Zhu X, et al. The clinical characteristics of secondary primary tumors in patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy: a retrospective analysis. Medicine (Baltimore) 2016;95:e5364. https://doi.org/10.1097/md.0000000000005364

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