title: Dysphagia in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus.
abstract: BACKGROUND
  Head and neck cancer (HNC) and its therapy are associated with acute and late swallowing dysfunction. Consensus guidelines regarding evaluation and management are lacking. To address this gap, a multidisciplinary team of experts (oncologists, practitioners, deglutologists, etc.) met in Milan 17-18 February 2013 with the aim of reaching a consensus on the management of swallowing difficulties in HNC patients treated with radiotherapy with or without systemic therapies (such as chemotherapy and targeted agents). The consensus was focused particularly on those statements with limited evidence. The results of the literature review and the statements that obtained a consensus are reported and discussed in this paper.
  
  
  METHODS
  The Delphi Appropriateness Method was used for this consensus. External expert reviewers then evaluated the conclusions carefully according to their area of expertise.
  
  
  RESULTS
  This paper contains 6 clusters of statements about the management of swallowing problems in radio-treated HNC patients and a review of the recent literature on these topics.
  
  
  CONCLUSIONS
  Dysphagia assessment and its management are difficult and require a multi-team cooperation (ENT specialists, radiation and medical oncologists, deglutologists, etc.).
authors.affiliation: Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy. Electronic address: antonio.schindler@unimi.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Schindler
authors.affiliation: Medical Oncology Department AO. S. Croce e Carle - Cuneo, Italy. Electronic address: nerinadenaro@gmail.com.
authors.forename: Nerina
authors.initials: N
authors.lastname: Denaro
authors.affiliation: Department of Radiation Oncology, A.O. S. Croce e Carle Cuneo, Italy. Electronic address: elviorussi@gmail.com.
authors.forename: Elvio G
authors.initials: EG
authors.lastname: Russi
authors.affiliation: Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy. Electronic address: nicole.pizzorni@virgilio.it.
authors.forename: Nicole
authors.initials: N
authors.lastname: Pizzorni
authors.affiliation: Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. Electronic address: paolo.bossi@istitutotumori.mi.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bossi
authors.affiliation: Radiation Oncology Department, Ospedale di Circolo di Busto Arsizio, Italy. Electronic address: anna.merlotti@virgilio.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Merlotti
authors.affiliation: Department of Audiology-Phoniatrics, Università degli Studi di Torino, Italy. Electronic address: spadola.massimo@alice.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Spadola Bissetti
authors.affiliation: Medical Oncology Unit, Ospedale U. Parini, Viale Ginevra 3, 11100 Aosta, Italy. Electronic address: gnumico@ausl.vda.it.
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.affiliation: Department of Radiation Oncology, Treviso Regional Hospital, Treviso, Italy. Electronic address: agava@ulss.tv.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gava
authors.affiliation: Radio-Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. Electronic address: Ester.Orlandi@istitutotumori.mi.it.
authors.forename: Ester
authors.initials: E
authors.lastname: Orlandi
authors.affiliation: Radiation Oncology Department, Isola Tiberina Fatebenefratelli Hospital, Rome, Italy. Electronic address: Fabriori@libero.it.
authors.forename: Orietta
authors.initials: O
authors.lastname: Caspiani
authors.affiliation: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: michela.buglione@med.unibs.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.affiliation: Advanced Radiotherapy Center, European Institute of Oncology, Milan, Italy. Electronic address: daniela.alterio@ieo.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Alterio
authors.affiliation: Radio-Oncology Department, IRCCS San Martino-IST, Largo R Benzi 10, 16132 Genoa, Italy. Electronic address: almalina.bacigalupo@hsanmartino.it.
authors.forename: Almalina
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: Department of Radiotherapy University "La Sapienza", Rome, Italy. Electronic address: vitaliana.desanctis@uniroma1.it.
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Sanctis
authors.affiliation: Department of Radiotherapy, Ospedale Santa Maria della Misericordia, Rovigo, Italy. Electronic address: pavanato.giovanni@azisanrovigo.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pavanato
authors.affiliation: Supportive Care in Cancer Unit, IRCCS Foundation National Cancer Institute, Milan, Italy. Electronic address: Carla.Ripamonti@istitutotumori.mi.it.
authors.forename: Carla
authors.initials: C
authors.lastname: Ripamonti
authors.affiliation: Medical Oncology Department AO. S. Croce e Carle - Cuneo, Italy. Electronic address: mcmerlano@gmail.com.
authors.forename: Marco C
authors.initials: MC
authors.lastname: Merlano
authors.affiliation: Radiation Oncology Department, Ospedale di Circolo di Busto Arsizio, Italy. Electronic address: Lisa.Licitra@istitutotumori.mi.it.
authors.forename: Lisa
authors.initials: L
authors.lastname: Licitra
authors.affiliation: Department of Radiotherapy, National Cancer Institute Regina Elena, Rome, Italy. Electronic address: gsangui1@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
authors.affiliation: Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: j.a.langendijk@umcg.nl.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, TN, USA. Electronic address: barbara.murphy@vanderbilt.edu.
authors.forename: Barbara
authors.initials: B
authors.lastname: Murphy
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy*; D003697:Delphi Technique; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D011878:Radiotherapy / Q000009:adverse effects
keywords: Chemotherapy; Deglutition; Dysphagia; Head and neck cancer; Radiation oncology; Radiotherapy; Swallowing dysfunction