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Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®): Supportive care - Health Professional Information [NCI] - Conditions Affected By Both Chemotherapy and Head / Neck Radiation

Salivary Gland Hypofunction and Xerostomia

Radiation therapy can damage salivary glands, causing salivary hypofunction and xerostomia. (Refer to the Oral Complications of Head and Neck Radiation section for more information.) In addition, selected chemotherapeutic agents (singly or in combination) have been implicated in causing salivary dysfunction and xerostomia.[1] However, it has not been possible to draw consistent conclusions about the effects of cancer chemotherapy on salivary gland function.[2]

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Dysphagia

Dysphagia and odynophagia are common in cancer patients and can exist before, during, and after treatment:

  • Dysphagia predisposes to aspiration and potentially life-threatening pulmonary complications.[3]
  • Swallowing disorders may lead to unfavorable dietary changes and decreased oral intake, which may result in dehydration, malnutrition, delayed wound healing, and decreased resistance to infection.
  • Tube feeding may become necessary, which may further compromise swallowing.
  • Opioids administered for the management of odynophagia may cause xerostomia and constipation.
  • Difficulties with speaking, eating and drinking, or drooling may affect mental health and put patients and family members in social isolation.

All of these problems, plus the patient perception of swallowing difficulties, significantly decrease health-related quality of life.[3,4]

Dysphagia is most prominent in patients with head and neck cancers but may also develop in patients with other malignancies as a symptom of oropharyngeal or esophageal mucositis or infection. In addition, dysphagia can be associated with graft-versus-host disease.

The prevalence and severity of pretreatment dysphagia associated with head and neck tumors depend on tumor stage and localization.[5] Pretreatment dysphagia is most prevalent in patients with pharyngeal and laryngeal cancers.[6] Surgical interventions for head and neck tumors result in anatomic or neurologic insults with site-specific patterns of dysphagia.[7] In general, the larger the resection, the more swallowing function will be impaired.

The severity of radiation-induced dysphagia depends on the following:[8]

  • Total radiation dose.
  • Fraction size and schedule.
  • Target volumes.
  • Treatment delivery techniques.
  • Concurrent chemotherapy.
  • Genetic factors.
  • Feeding status (via percutaneous endoscopic gastrostomy [PEG] tube or nil per os [NPO, nothing by mouth]).
  • Smoking status.
  • Psychological coping factors.

Intensified schedules and the use of chemoradiation therapy have been shown to improve locoregional control and survival but come at the cost of more severe acute and chronic side effects. Intensity-modulated radiation therapy (IMRT) has emerged as an effective technique to deliver the full radiation dose to the tumor and regions at risk while reducing exposure of surrounding healthy tissues. However, the preservation of anatomy does not necessarily translate into the preservation of swallowing function.[9]

Mucositis induced by chemoradiation therapy or chemotherapy alone, edema, pain, thickened mucous saliva and hyposalivation, radiation dermatitis, and infection may all contribute to acute dysphagia. The use of epidermal growth factor inhibitors seems not to be associated with increased mucositis and acute dysphagia.[10]

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