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Management of late complications of head and neck cancer and its treatment

Authors
Thomas Galloway, MD
Robert J Amdur, MD
Section Editors
Marshall R Posner, MD
David M Brizel, MD
Bruce E Brockstein, MD
Daniel G Deschler, MD, FACS
Patricia A Ganz, MD
Deputy Editor
Michael E Ross, MD

INTRODUCTION

Toxicity from cancer therapy is classified as acute or late based upon when it develops relative to treatment. Acute toxicity develops during or shortly after the completion of treatment and is usually temporary. Late toxicity presents months to years after the completion of treatment and is often permanent. The term "complication" is used for a treatment toxicity that causes an important medical problem.

This topic will review the late complications of treatment for head and neck cancer. The care of patients with head and neck cancer during initial therapy, both to treat acute toxicity and to prevent late complications, is discussed separately. (See "Management and prevention of complications during initial treatment of head and neck cancer", section on 'Amifostine' and "Management and prevention of complications during initial treatment of head and neck cancer", section on 'Submandibular gland transfer'.)

SALIVARY GLAND DAMAGE AND XEROSTOMIA

The most common long-term complication of radiation therapy (RT) and chemoradiotherapy for head and neck cancer is xerostomia, which is the result of damage to the salivary glands.

The magnitude of this damage is dose dependent. Parotid dysfunction can be detectable at a 10 to 15 Gy mean dose, and administration of an approximately 40 to 50 Gy mean dose to a parotid gland typically causes a >75 percent reduction in function [1].

Although xerostomia often improves with time [2], it is a long-lasting and frequently permanent problem that adversely impacts quality of life. The management of patients with established xerostomia includes multiple maneuvers to provide alternative wetting agents and maximize residual function of the salivary glands.

                                       

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Literature review current through: Nov 2016. | This topic last updated: Fri Sep 30 00:00:00 GMT+00:00 2016.
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