How to reduce radiation-related toxicity in patients with cancer of the head and neck.
Radiation for head and neck cancers is often curative, but high doses are used. Normal tissues, including mucosa, salivary glands, and muscles, are exposed to these high doses, resulting in severe mucositis, xerostomia, and dysphagia. Efforts to minimize toxicity have involved advances in radiation physics and development of pharmacologic agents. Radiation techniques include conformal and intensity-modulated therapy, which minimizes dose to normal tissues while delivering high doses to tumor targets. Drugs used to prevent mucositis have targeted infection, but recently interest has been shown in the use of growth factors. Cholinergic agonists and cytoprotective agents, specifically amifostine, can address xerostomia. Involvement of speech pathologists in evaluation and treatment of patients with dysphagia can minimize swallowing difficulties and identify the tissues most responsible for swallowing. Minimizing radiation dose to these tissues may lower the incidence of radiation-induced dysphagia.
Garden
Adam S
AS
Department of Radiation Oncology and Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston TX, 77030, USA. agarden@mdanderson.org
Lewin
Jan S
JS
Chambers
Mark S
MS
D004999:Amifostine / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D005355:Fibrosis; D016166:Free Radical Scavengers / Q000008:administration & dosage; D006133:Growth Substances / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D052016:Mucositis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D018384:Oxidative Stress; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000150:complications*; D011837:Radiation-Protective Agents / Q000008:administration & dosage; D020266:Radiotherapy, Conformal; D014987:Xerostomia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*
D000890:Anti-Infective Agents; D016166:Free Radical Scavengers; D006133:Growth Substances; D011837:Radiation-Protective Agents; D004999:Amifostine