title: Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (Part 2). Literature review and consensus statement.
abstract: Radiotherapy alone or in combination with chemotherapy and/or surgery is a well-known radical treatment for head and neck cancer patients. Nevertheless acute side effects (such as moist desquamation, skin erythema, loss of taste, mucositis etc.) and in particular late toxicities (osteoradionecrosis, xerostomia, trismus, radiation caries etc.) are often debilitating and underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met in Milan with the aim of reaching a consensus on a clinical definition and management of these toxicities. The Delphi Appropriateness method was used for this consensus and external experts evaluated the conclusions. The paper contains 20 clusters of statements about the clinical definition and management of stomatological issues 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-radionecrosis (10 clusters of statements), whereas this second part deals with trismus and xerostomia (10 clusters of statements).
authors.affiliation: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: michela.buglione@unibs.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.affiliation: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: rcnero@gmail.com.
authors.forename: Roberta
authors.initials: R
authors.lastname: Cavagnini
authors.affiliation: Department of Oral Diagnosis, Oral Medicine & Oral Pathology, Spedali Civili Hospital, Brescia University, Italy. Electronic address: fedric81@gmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Di Rosario
authors.affiliation: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: marta.maddalo@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Maddalo
authors.affiliation: Medical Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: lucia.vassalli@libero.it.
authors.forename: Lucia
authors.initials: L
authors.lastname: Vassalli
authors.affiliation: Medical Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: salvatore.grisanti@tin.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grisanti
authors.affiliation: Department of Oral Diagnosis, Oral Medicine & Oral Pathology, Spedali Civili Hospital, Brescia University, Italy. Electronic address: stefano.salgarello@unibs.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salgarello
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: 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: Department of Oral Diagnosis, Oral Medicine & Oral Pathology, Spedali Civili Hospital, Brescia University, Italy. Electronic address: alessandra.majorana@unibs.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Majorana
authors.affiliation: Department of Oral Diagnosis, Oral Medicine & Oral Pathology, Spedali Civili Hospital, Brescia University, Italy. Electronic address: giorgio.gastaldi@unibs.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gastaldi
authors.affiliation: Medical Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: alfredo.berruti@gmail.com.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berruti
authors.affiliation: Radiation Oncology Department, Azienda Ospedaliera 'S. Maria', TERNI, Italy. Electronic address: f.trippa@aospterni.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Trippa
authors.affiliation: ENT Clinic and Head and Neck Department Spedali Civili Hospital, Brescia University, Italy. Electronic address: piero.nicolai@unibs.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Nicolai
authors.affiliation: Department of General Dental Sciences, University of Alabama at Birmingham, USA. Electronic address: barasaff@cs.com.
authors.forename: Andrei
authors.initials: A
authors.lastname: Barasch
authors.affiliation: Radiation Oncology Department AO. 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 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.forename: Judith
authors.initials: J
authors.lastname: Raber-Durlacher
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
authors.affiliation: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy. Electronic address: stefano.magrini@unibs.it.
authors.forename: Stefano M
authors.initials: SM
authors.lastname: Magrini
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D032921:Consensus; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D011832:Radiation Injuries / Q000628:therapy*; D014313:Trismus / Q000209:etiology / Q000628:therapy*; D014987:Xerostomia / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Head and neck cancer; Radio-induced trismus; Radio-induced xerostomia; Radiotherapy; Trismus; Xerostomia