Late Complications of Head and Neck Radiation
Some therapeutic interventions seem to show some efficacy in decreasing the intensity of cancer treatment-related trismus (e.g., pentoxifylline,[36,37] Botulinum toxin, exercise using the Therabite device, and the Dynasplint Trismus System ). However, this proposed efficacy must be confirmed by randomized controlled studies, which are lacking in this area.
Recommendations for future research directions
Radiation oncology textbooks often fail to mention trismus as a sequela of radiation therapy for HNC patients, contributing to a lack of recognition of the prevalence and significance of this condition. There has been an ongoing attempt by the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer to develop LENT (late effects in normal tissue) morbidity scales. The National Cancer Institute consensus conferences introduced the SOMA (subjective, objective, management, analysis) classification for late toxicity. However, both scales are focused on major organ and dermatological injuries, and trismus is not addressed. This should be corrected in future revisions of these scales.
Considering the high prevalence of trismus in published studies and the deficits in quality of life associated with trismus, increased efforts for patient education, prevention, and early treatment options are warranted. Larger prospective trials that include the prevention and treatment of trismus are needed to improve management and to confirm the benefit of IMRT in the reduction of radiation-induced trismus and the quality-of-life and economic impact of this common oral sequela of radiation.
- Myers RA, Marx RE: Use of hyperbaric oxygen in postradiation head and neck surgery. NCI Monogr (9): 151-7, 1990.
- Epstein JB, Wong FL, Stevenson-Moore P: Osteoradionecrosis: clinical experience and a proposal for classification. J Oral Maxillofac Surg 45 (2): 104-10, 1987.
- Silverman S Jr: Complications of treatment. In: Silverman S Jr, ed.: Oral Cancer. 5th ed. Hamilton, Canada: BC Decker Inc, 2003, pp 113-28.
- Jensen SB, Pedersen AM, Vissink A, et al.: A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 18 (8): 1039-60, 2010.
- Teguh DN, Levendag PC, Voet P, et al.: Trismus in patients with oropharyngeal cancer: relationship with dose in structures of mastication apparatus. Head Neck 30 (5): 622-30, 2008.
- Jellema AP, Slotman BJ, Doornaert P, et al.: Impact of radiation-induced xerostomia on quality of life after primary radiotherapy among patients with head and neck cancer. Int J Radiat Oncol Biol Phys 69 (3): 751-60, 2007.
- Hyer S, Kong A, Pratt B, et al.: Salivary gland toxicity after radioiodine therapy for thyroid cancer. Clin Oncol (R Coll Radiol) 19 (1): 83-6, 2007.
- Dahllöf G, Bågesund M, Ringdén O: Impact of conditioning regimens on salivary function, caries-associated microorganisms and dental caries in children after bone marrow transplantation. A 4-year longitudinal study. Bone Marrow Transplant 20 (6): 479-83, 1997.
- Jensen SB, Pedersen AM, Vissink A, et al.: A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer 18 (8): 1061-79, 2010.
- Seikaly H, Jha N, Harris JR, et al.: Long-term outcomes of submandibular gland transfer for prevention of postradiation xerostomia. Arch Otolaryngol Head Neck Surg 130 (8): 956-61, 2004.
- Jha N, Seikaly H, Harris J, et al.: Phase III randomized study: oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation-induced xerostomia. Head Neck 31 (2): 234-43, 2009.
- Buentzel J, Micke O, Adamietz IA, et al.: Intravenous amifostine during chemoradiotherapy for head-and-neck cancer: a randomized placebo-controlled phase III study. Int J Radiat Oncol Biol Phys 64 (3): 684-91, 2006.
- Sasse AD, Clark LG, Sasse EC, et al.: Amifostine reduces side effects and improves complete response rate during radiotherapy: results of a meta-analysis. Int J Radiat Oncol Biol Phys 64 (3): 784-91, 2006.
- Wasserman TH, Brizel DM, Henke M, et al.: Influence of intravenous amifostine on xerostomia, tumor control, and survival after radiotherapy for head-and- neck cancer: 2-year follow-up of a prospective, randomized, phase III trial. Int J Radiat Oncol Biol Phys 63 (4): 985-90, 2005.
- Brizel DM, Overgaard J: Does amifostine have a role in chemoradiation treatment? Lancet Oncol 4 (6): 378-81, 2003.
- Rieke JW, Hafermann MD, Johnson JT, et al.: Oral pilocarpine for radiation-induced xerostomia: integrated efficacy and safety results from two prospective randomized clinical trials. Int J Radiat Oncol Biol Phys 31 (3): 661-9, 1995.
- Scarantino C, LeVeque F, Swann RS, et al.: Effect of pilocarpine during radiation therapy: results of RTOG 97-09, a phase III randomized study in head and neck cancer patients. J Support Oncol 4 (5): 252-8, 2006.
- Burlage FR, Roesink JM, Kampinga HH, et al.: Protection of salivary function by concomitant pilocarpine during radiotherapy: a double-blind, randomized, placebo-controlled study. Int J Radiat Oncol Biol Phys 70 (1): 14-22, 2008.
- Chambers MS, Jones CU, Biel MA, et al.: Open-label, long-term safety study of cevimeline in the treatment of postirradiation xerostomia. Int J Radiat Oncol Biol Phys 69 (5): 1369-76, 2007.
- Jham BC, Teixeira IV, Aboud CG, et al.: A randomized phase III prospective trial of bethanechol to prevent radiotherapy-induced salivary gland damage in patients with head and neck cancer. Oral Oncol 43 (2): 137-42, 2007.
- Blom M, Lundeberg T: Long-term follow-up of patients treated with acupuncture for xerostomia and the influence of additional treatment. Oral Dis 6 (1): 15-24, 2000.
- O'Sullivan EM, Higginson IJ: Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med 28 (4): 191-9, 2010.
- Cho JH, Chung WK, Kang W, et al.: Manual acupuncture improved quality of life in cancer patients with radiation-induced xerostomia. J Altern Complement Med 14 (5): 523-6, 2008.
- Strietzel FP, Martín-Granizo R, Fedele S, et al.: Electrostimulating device in the management of xerostomia. Oral Dis 13 (2): 206-13, 2007.
- Strietzel FP, Lafaurie GI, Mendoza GR, et al.: Efficacy and safety of an intraoral electrostimulation device for xerostomia relief: a multicenter, randomized trial. Arthritis Rheum 63 (1): 180-90, 2011.
- Lafaurie G, Fedele S, López RM, et al.: Biotechnological advances in neuro-electro-stimulation for the treatment of hyposalivation and xerostomia. Med Oral Patol Oral Cir Bucal 14 (2): E76-80, 2009.
- Hong CH, Napeñas JJ, Hodgson BD, et al.: A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer 18 (8): 1007-21, 2010.
- Brennan MT, Elting LS, Spijkervet FK: Systematic reviews of oral complications from cancer therapies, Oral Care Study Group, MASCC/ISOO: methodology and quality of the literature. Support Care Cancer 18 (8): 979-84, 2010.
- Peterson DE, Doerr W, Hovan A, et al.: Osteoradionecrosis in cancer patients: the evidence base for treatment-dependent frequency, current management strategies, and future studies. Support Care Cancer 18 (8): 1089-98, 2010.
- Dijkstra PU, Kalk WW, Roodenburg JL: Trismus in head and neck oncology: a systematic review. Oral Oncol 40 (9): 879-89, 2004.
- Louise Kent M, Brennan MT, Noll JL, et al.: Radiation-induced trismus in head and neck cancer patients. Support Care Cancer 16 (3): 305-9, 2008.
- Dijkstra PU, Huisman PM, Roodenburg JL: Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg 35 (4): 337-42, 2006.
- Yeh SA, Tang Y, Lui CC, et al.: Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone. Int J Radiat Oncol Biol Phys 62 (3): 672-9, 2005.
- Hsiung CY, Huang EY, Ting HM, et al.: Intensity-modulated radiotherapy for nasopharyngeal carcinoma: the reduction of radiation-induced trismus. Br J Radiol 81 (970): 809-14, 2008.
- Bensadoun RJ, Riesenbeck D, Lockhart PB, et al.: A systematic review of trismus induced by cancer therapies in head and neck cancer patients. Support Care Cancer 18 (8): 1033-8, 2010.
- Chua DT, Lo C, Yuen J, et al.: A pilot study of pentoxifylline in the treatment of radiation-induced trismus. Am J Clin Oncol 24 (4): 366-9, 2001.
- Grandi G, Silva ML, Streit C, et al.: A mobilization regimen to prevent mandibular hypomobility in irradiated patients: an analysis and comparison of two techniques. Med Oral Patol Oral Cir Bucal 12 (2): E105-9, 2007.
- Hartl DM, Cohen M, Juliéron M, et al.: Botulinum toxin for radiation-induced facial pain and trismus. Otolaryngol Head Neck Surg 138 (4): 459-463, 2008.
- Melchers LJ, Van Weert E, Beurskens CH, et al.: Exercise adherence in patients with trismus due to head and neck oncology: a qualitative study into the use of the Therabite. Int J Oral Maxillofac Surg 38 (9): 947-54, 2009.
- Shulman DH, Shipman B, Willis FB: Treating trismus with dynamic splinting: a cohort, case series. Adv Ther 25 (1): 9-16, 2008.