Supportive care in head and neck oncology.
OBJECTIVE
Survival gains were achieved in head and neck cancer patients treated with a multidisciplinary approach, including platinum-based concurrent chemoradiation, with a substantial increase in toxicity. The prompt diagnosis and treatment of these toxicities - the focus of this review - are essential aspects in the daily care of head and neck squamous cell carcinoma patients.


RESULTS
Low-level laser is a promising therapy for prevention and treatment of mucositis. Amifostine, as an acute and late xerostomia-preventive agent, may be considered in patients undergoing fractionated radiation therapy alone. The incidence of xerostomia was significantly reduced in patients treated with intensity-modulated radiation therapy. Severe cutaneous reactions can occur when epidermal growth factor receptor-targeting agents are administered concurrently to radiation therapy. Erythropoiesis-stimulating agents should not be administered to head and neck cancer patients under radiation therapy or chemotherapy outside of the context of clinical trials.


CONCLUSIONS
The best outcomes in head and neck squamous cell carcinoma patients treated in the multidisciplinary context can only be achieved with an adequate patient selection, an experienced and motivated team and if the best possible supportive care is offered. Randomized studies on promising supportive therapies must be encouraged.
de Castro
Gilberto
G
Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Guindalini
Rodrigo S C
RS
D000970:Antineoplastic Agents / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy*; D006258:Head and Neck Neoplasms / Q000188:drug therapy*; D006801:Humans; D052016:Mucositis / Q000139:chemically induced / Q000517:prevention & control; D011878:Radiotherapy / Q000009:adverse effects*; D014987:Xerostomia / Q000209:etiology / Q000517:prevention & control
D000970:Antineoplastic Agents