Management of Radiation-Induced Head and Neck Injury

During the treatment of neoplastic diseases, unavoidable toxicities to normal cells may be produced. The mucosal lining of the upper respiratory and gastrointestinal tracts is a prime target for radiotherapy-related toxicity due to its rapid cell turnover rate. The oral cavity is highly sensitive to direct and indirect toxic effects of radiation therapy (RT); this is attributable to multiple factors such as a diverse and complex microflora, trauma to oral tissues during normal oropharyngeal function, and the high mucosal cell turnover rates.

Radiation of the head and neck (H&N) can irreversibly injure oral mucosa, vasculature, muscle, and bone. This can result in xerostomia, dental caries, trismus, soft tissue necrosis, and osteoradionecrosis (ORN). Severe oral toxicities can compromise delivery of optimal radiation-therapy protocols. For example, dose reduction or treatment schedule modifications may be necessary to allow for resolution of oral lesions. In cases of severe oral morbidity, the patient may no longer be able to continue cancer therapy; treatment is then usually discontinued. These disruptions in dosing due to oral complications can thus directly affect patient survivorship.