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Cancer Treat Rev. 2017 Sep;59:79-92. doi: 10.1016/j.ctrv.2017.07.003. Epub 2017 Jul 18.

Treatment of late sequelae after radiotherapy for head and neck cancer.

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Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia. Electronic address:
Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, MD Anderson Cancer Center, Houston, TX, USA.
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Center of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, Shenzhen, China.
Radiation Oncology, GenesisCare, St. Vincents's Hospital, Melbourne, Victoria, Australia.
Department of Radiation Oncology, University of Florida, Gainesville, FL, USA.
Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia.
University of Udine School of Medicine, Udine, Italy.
Coordinator of the International Head and Neck Scientific Group, Italy.


Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.


Head and neck cancer; Late sequelae; Radiotherapy; Toxicity; Treatment

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