title: Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement.
abstract: Radiotherapy alone or in combination with chemotherapy and/or surgery is the typical treatment for head and neck cancer patients. Acute side effects (such as oral mucositis, dermatitis, salivary changes, taste alterations, etc.), and late toxicities in particular (such as osteo-radionecrosis, hypo-salivation and xerostomia, trismus, radiation caries etc.), are often debilitating. These effects tend to be underestimated and insufficiently addressed in the medical community. A multidisciplinary group of head and neck cancer specialists met in Milan with the aim of reaching a consensus on clinical definitions and management of these toxicities. The Delphi Appropriateness method was used for developing the consensus, and external experts evaluated the conclusions. This paper contains 10 clusters of statements about the clinical definitions and management of head and neck cancer treatment sequels (dental pathologies and osteo-radionecroses) that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecroses (10 clusters of statements), whereas this second part deals with trismus and xerostomia.
authors: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: michela.buglione@unibs.it.
authors: Michela
authors: M
authors: Buglione
authors: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: rcnero@gmail.com.
authors: Roberta
authors: R
authors: Cavagnini
authors: Department of Oral Diagnosis, Oral Medicine & Oral Pathology, Spedali Civili Hospital, Brescia University, Italy. Electronic address: fedric81@gmail.com.
authors: Federico
authors: F
authors: Di Rosario
authors: Department of Diagnostic Imaging, Spedali Civili Hospital, Brescia University, Italy. Electronic address: lara.sottocornola@gmail.com.
authors: Lara
authors: L
authors: Sottocornola
authors: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: marta.maddalo@gmail.com.
authors: Marta
authors: M
authors: Maddalo
authors: Medical Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: lucia.vassalli@libero.it.
authors: Lucia
authors: L
authors: Vassalli
authors: Medical Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: salvatore.grisanti@tin.it.
authors: Salvatore
authors: S
authors: Grisanti
authors: Department of Oral Diagnosis, Oral Medicine & Oral Pathology, Spedali Civili Hospital, Brescia University, Italy. Electronic address: stefano.salgarello@unibs.it.
authors: Stefano
authors: S
authors: Salgarello
authors: Radio-Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. Electronic address: Ester.Orlandi@istitutotumori.mi.it.
authors: Ester
authors: E
authors: Orlandi
authors: Department of Oral Diagnosis, Oral Medicine & Oral Pathology, Spedali Civili Hospital, Brescia University, Italy. Electronic address: corrado.paganelli@unibs.it.
authors: Corrado
authors: C
authors: Paganelli
authors: Department of Oral Diagnosis, Oral Medicine & Oral Pathology, Spedali Civili Hospital, Brescia University, Italy. Electronic address: alessandra.majorana@unibs.it.
authors: Alessandra
authors: A
authors: Majorana
authors: Department of Oral Diagnosis, Oral Medicine & Oral Pathology, Spedali Civili Hospital, Brescia University, Italy. Electronic address: giorgio.gastaldi@unibs.it.
authors: Giorgio
authors: G
authors: Gastaldi
authors: Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. Electronic address: paolo.bossi@istitutotumori.mi.it.
authors: Paolo
authors: P
authors: Bossi
authors: Medical Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: alfredo.berruti@gmail.com.
authors: Alfredo
authors: A
authors: Berruti
authors: Radiation oncology department, Ospedale S. Maria della Misericordia, Azienda ULSS 18, 45100 Rovigo, Italy. Electronic address: pavanato.giovanni@azisanrovigo.it.
authors: Giovanni
authors: G
authors: Pavanato
authors: ENT Clinic and Head and Neck Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: piero.nicolai@unibs.it.
authors: Piero
authors: P
authors: Nicolai
authors: Department of Diagnostic Imaging, Spedali Civili Hospital, Brescia University, Italy. Electronic address: roberto.maroldi@unibs.it.
authors: Roberto
authors: R
authors: Maroldi
authors: Department of General Dental Sciences, University of Alabama at Birmingham, USA. Electronic address: ABarasch@winthrop.org.
authors: Andrei
authors: A
authors: Barasch
authors: Radiation Oncology Department, AO. S. Croce e Carle, Cuneo, Italy. Electronic address: elviorussi@gmail.com.
authors: Elvio G
authors: EG
authors: Russi
authors: Department of Oral and Maxillofacial Surgery, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Dental Interaction, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands. Electronic address: j.e.raberdurlacher@amc.uva.nl.
authors: Judith
authors: J
authors: Raber-Durlacher
authors: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, TN, USA. Electronic address: barbara.murphy@vanderbilt.edu.
authors: Barbara
authors: B
authors: Murphy
authors: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: stefano.magrini@unibs.it.
authors: Stefano M
authors: SM
authors: Magrini
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D003697:Delphi Technique; D003731:Dental Caries / Q000209:etiology / Q000628:therapy; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D010025:Osteoradionecrosis / Q000209:etiology / Q000628:therapy; D011832:Radiation Injuries / Q000628:therapy; D011878:Radiotherapy / Q000009:adverse effects; D013280:Stomatitis / Q000209:etiology / Q000628:therapy; D014313:Trismus / Q000209:etiology / Q000628:therapy; D014987:Xerostomia / Q000209:etiology / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents
keywords: Caries; Dental pathology; Head and neck cancer; Osteo-radionecrosis; Radionecrosis; Radiotherapy