Acute Toxicity and Long-Term Sequelae of Chemotherapy in Head and Neck Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • In the curative intent setting:
    • Concurrent chemoradiation is associated with risk of severe acute and long-term toxicities
  • The combined results of four prospective trials:
    • Indicate that the rate of acute treatment-related death for standard cisplatin based chemoradiation:
      • For locally advanced head and neck squamous cell carcinoma:
        • Is approximately 4%:
          • 22 treatment related deaths among 545 patients
  • Acute mucositis in the radiation field:
    • Can compromise nutritional intake severely,  and placement of a percutaneous gastrostomy tube:
      • Often is an effective strategy to improve nutrition in this setting
  • Dermatitis in the radiation field:
    • Varies in severity among patients:
      • This issue has received increasing attention since the 2006 Food and Drug Administration approval for the use of cetuximab concurrent with radiation therapy for persons with head and neck squamous cell carcinoma
  • Long-term complications of chemoradiation can include:
    • Xerostomia
    • Hypothyroidism
    • Trismus
    • Pharyngeal stricture
    • Osteoradionecrosis
  • Although xerostomia remains a common long-term symptom after treatment:
    • The incidence of xerostomia with intensity-modulated radiation therapy:
      • Appears to be lower than the incidence associated with three-dimensional conventional radiotherapy
  • Regarding hypothyroidism, in a review of 118 patients who participated in phase I / II trials of sequential chemotherapy and radiation for stage III / IV head  and neck cancer:
    • Elevated levels of thyroid-stimulating hormone  were detected in 45% of patients:
      • At a median of 24 months after radiation therapy
  • Stricture requiring pharyngoesophageal dilation:
    • May occur in up to 21% of patients who receive definitive radiotherapy
      • The primary tumor site in the hypopharynx or oropharynx:
        • Has been identified as a risk factor for pharyngeal stricture in retrospective studies
  • Fibrosis of the muscles of mastication:
    • As a consequence of chemoradiation may result in trismus:
      • Although the retrospective nature of this data has limited the ability to clearly establish risk factors for trismus
  • For patients receiving combined modality therapy, accurate and comprehensive measurement of treatment-associated adverse events is challenging:
    • In clinical trials, traditional methods of toxicity reporting describe the frequency and severity of cumulative adverse events during the treatment interval.
    • The National Cancer Institute Common Toxicity Criteria for Adverse Events is a widely used method for toxicity reporting of this nature:
      • However, it is recognized that traditional methods probably do not fully summarize the extent and magnitude of acute and long-term adverse events
      • To address these concerns, a new reporting system (“TAME”) designed to account for the multiplicity and time dimensions of adverse events has been developed
  • In a retrospective analysis of five trials for patients with head and neck cancer that was performed by the RTOG, the newer method appeared better able to distinguish between the acute toxicity burdens among treatment groups compared with traditional methods for summarizing adverse events
Risk groups defined by treatment type 
and acute toxicity burden. CB, Concomitant boost; 
CONVENT, conventional; 5FU, 5-fluorouracil; HFX, 
hyperfractionated; HU, hydroxyurea; INDUC, 
induction; PLAT, platinum; POST OP, postoperative; 
RT, radiation therapy; TAXOL, paclitaxel. (Adapted 
from Trotti A, Pajak TF, Gwede CK, et al. TAME: 
development of a new method for summarising adverse 
events of cancer treatment by the Radiation Therapy 
Oncology Group. Lancet Oncol 2007;8:613–624.)
Unknown's avatar

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Leave a comment