Cancer Treatment Reviews (2006) 32, 541– 547

available at www.sciencedirect.com

journal homepage: www.elsevierhealth.com/journals/ctrv

COMPLICATIONS OF TREATMENT

Radiotherapy-induced taste impairment

Maria Grazia Ruo Redda *, Simona Allis

Department of Radiation Oncology and Diagnostic Imaging, University of Turin, S. Luigi Hospital Regione Gonzole 10,
10043 Orbassano, Turin, Italy

Received 3 October 2005; revised 12 June 2006; accepted 14 June 2006

KEYWORDS Summary Changes in taste perception occur in a significant proportion of cancer patients.
Head and neck cancer; Among cancer patients treated with radiotherapy (RT) in head and neck area, the vast majority
Radiotherapy; reports an altered taste sense during and after treatments. Taste impairment starts a few
Oral side effects; weeks after the beginning of irradiation, and almost all such patients experienced loss of taste
Taste impairment acuity at a dose of 60 Gy. Some studies investigated the four basic taste intensities (sweet,
salty, sour and bitter) and the umami taste, and several of these reports identified diminished
threshold sensitivity for at least one taste quality. Six months to one year after RT, taste acuity
recovers to its previous level in many patients, but some patients show incomplete or no recov-
ery even several years later.
Taste impairment has profound effects on patients’ quality of life because is associated with
weight loss through reduced appetite and altered patterns of food intake.
Damage to the major salivary glands during head and neck RT leads to disturbance in taste
acuity. With the implementation of new radiation techniques, such as conformal and intensity-
modulated RT in head and neck irradiation, the late-radiation effects can probably be reduced,
but the remaining sequelae are still bothersome to the patients.
c 2006 Elsevier Ltd. All rights reserved.

Introduction associated discomfort are normal tissue complications

Radiation damage to normal tissues is the most important
dose-limiting factor in radiotherapy (RT). A reduction in
taste sensitivity (hypogeusia), an absence of taste sensation
(ageusia), or a distortion of normal taste (dysgeusia) and the
* Corresponding author. Tel.: +39 0 11 678947; fax: +39 0 11
6638680.
E-mail addresses: mariagrazia.ruoredda@unito.it (M.G. Ruo
Redda), simona.allis@virgilio.it (S. Allis).
accompanying almost all cancer patients who receive RT
in head and neck area. Taste impairments have a great im-
pact on the patients’ quality of life because, coupled with
radiation-induced mucositis, xerostomia and dysphagia, re-
duce food enjoyment and affect the nutritional status of the
patients.1–5
Acute taste complication due to irradiation has been
investigated in several studies and is encountered in daily
clinical practice. However, late taste complication has not
been well investigated, although it is sometimes encoun-
tered in daily clinical practice.6


0305-7372/$ - see front matter c 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctrv.2006.06.003
542
References for this review were identified by a compre-
hensive search of MEDLINE for the years 1980–2005, with
no language restriction. References were supplemented
with relevant citations from older literature and from the
reference list of retrieved papers. Papers were selected
on the basis of their relevance to the topic.
Definition, anatomy and physiology of taste
‘‘. . .exteriori vero parte (papillare corpus) inaequale est,
papillas enim nerveas insignes miro ordine dispositas pro-
mit; hae in bove, capra, ove et ipso etiam homine, ex con-
figuratione et magnitudine sunt in triplice discrimine. . .’’.
Marcello Malpighi, professor of Medicine at the Messina Uni-
versity described in this way his anatomical discovery in a
letter dated 31st October 1664.7
Taste could be defined as a chemical sensation related to
specialized receptors, selectively stimulated by molecules
and ions of solutions in contact with them.
Taste buds are the anatomical structures which contain
the receptor cells that mediate the sense of taste. These
pear-shaped organs are found on the tongue, soft palate,
pharynx, larynx, uvula, the upper third of the esophagus,
lips and cheeks. Taste buds on the tongue are contained
in small specialized structures called papillae (fungiform,
circumvallate, and foliate papillae). Each taste buds consist
of 50–100 taste receptor cells that have a life span of
approximately 10–11 days.8 Taste impulses are carried to
the brain by parasympathetic nerves, many of which travel
with branches of trigeminal nerve. The sensory nerves,
which carry signals in response to stimulation of taste
receptors are, with regards to the tongue, the facial nerve,
whereas the glossopharyngeal nerve innervates the circum-
vallate papillae, the back of the tongue and the palate. Fi-
bers of the vagal nerve innervate taste buds in the tonsillar
region, the epiglottis, the pharynx and esophagus. The taste
pathway activated by inputs from the facial, glossopharyn-
geal and vagal nerves have ipsilateral reflex connections
to salivatory center in the brain stem. Taste information is
transmitted to the postcentral gyrus-facial area via the nu-
cleus of the solitary tract and thalamus, and there are also
projections to the olfactory cortex.
Four main taste modalities can be distinguished: sweet,
sour, salty and bitter. Each modality is based on distinct
transductional systems in the single receptor cell leading
to depolarization of the receptor potential and generation
of action potentials. This facilitates the release of neuro-
transmitters, stimulating gustatory afferent nerve fibers
that then carry the taste signal onto higher-order systems.
Each taste receptor cell responds in varying degrees to sub-
stances that fall into more than one taste category.9
In addition to the four taste qualities, a novel taste, that
is referred by the Japanese word umami, which means deli-
cious, has come to be recognized as a ‘‘fifth taste’’. Umami
taste is found in a diversity of foods (e.g. fish, meat, milk,
tomato and some vegetables) and is elicited by monosodium
glutamate and certain ribonucleotides.10
The sense of taste is activated during the initial stage of
ingestion of food particles and is the main stimulant for for-
mation of saliva. On the other hand, the presence and the
composition of saliva in the oral cavity are also essential
M.G. Ruo Redda, S. Allis
for taste perception, with modulating effects on the four
basic taste modalities. Saliva strongly influences salt taste
threshold levels and provides the ionic environment for
taste cells through signal transduction. The type of taste
stimuli can influence salivary flow rate and composition.
Sour taste induces the highest flow rate and sodium concen-
trations, whereas salt gives rise to high protein and calcium
concentrations.5,9
Risk factors
Taste disorders are wide-spread and associated with a vari-
ety of illnesses. Taste loss occurs as a natural phenomenon
of aging and also in response to normal changes such as
pregnancy and menopause.11 Poor dentition and hygiene,
alcoholism and/or excessive smoking are common condi-
tions that affect taste. Patients with xerostomia, Sjögren
syndrome, vitamin and zinc deficiency may also experience
taste loss. Other conditions in which taste loss may occur in-
clude liver and kidney disorders, endocrine disorders, diabe-
tes mellitus, psychological disorders, central nervous
system disorders, and surgical procedures around the chor-
da tympani or glossopharyngeal nerve. Various types of
drugs and antineoplastic agents are associated with taste
impairment and usually induced a temporary effect which
diminishes after the drug is discontinued.12,13
The finding of dysgeusia and taste threshold abnormality,
anorexia and weight loss is common among patients with
head and neck cancer as well as those with malignancies in
other sites (i.e. esophagus, lung, lymphomas, breast, central
nervous system). In particular, in patients with head and
neck tumours abnormal taste acuity and associated discom-
fort are present even before the beginning of RT or chemo-
therapy for one (88.9%) or more taste qualities (66.7%).14–16
Alteration in taste is an early response to RT and often
precedes mucositis.3,17 Damage to oral mucosa and taste
buds is strongly related to radiation dose, fraction size, vol-
ume of irradiated tissue and technique.
During a course of conventional curative RT of 60–70 Gy
over 6–8 weeks, taste function becomes measurably im-
paired by the first week of treatment for bitter flavour
and becomes worse during the second week of treatment.18
The greatest degree of compromise is reached during the
third and fourth weeks of treatment and lasts throughout
the entire radiation cycle.14,18 Taste loss is not observed un-
til radiation doses of 20 Gy have been administrated to head
and neck regions and is reported to be exponential up to an
accumulated dose of 30 Gy and involves all taste qualities;
however, a dose of 60 Gy causes a relative taste loss in over
90% of patients.10,16,19,20 Regarding taste thresholds, the
bitter and salt qualities show the earliest and the greatest
impairment, the sweet quality the least. The preservation
of the sweet taste quality may be related to the observation
that the greatest number of taste buds in the oral cavity are
devoted to the sensitive perception of sweet taste.18 Unlike
the four basic tastes, umami taste showed a distinctive pat-
tern of impairment with an increased threshold after irradi-
ation at 15 Gy, a significant impairment at 30 Gy and a peak
of mean threshold at 45 Gy. This suggests that the modality
of damage caused by RT may be different between umami
receptor and that of the other four basic tastes.10
Radiotherapy-induced taste impairment
Fernando et al. observed that both objective and subjec-
tive taste loss was significantly associated with the portion
of tongue, but not parotid, contained within the high dose
of the radiation treatment field. This study suggests that
the volume of tongue should be kept to a minimum, provid-
ing that steps to do this do not risk compromising adequate
local control.21,22 This can often be achieved by using spe-
cific positioning techniques, field arrangements (e.g. tongue
depressor or a pair wedge technique) and certain blocks to
avoid a part of the tongue and thus to reduce number of
taste buds irradiated.
Furthermore, radiation-induced changes in quantity and
composition of saliva occur shortly after RT and modify
taste acuity. Saliva acts as a solvent for taste substances
and protects the taste receptor from damage brought about
by dryness and bacterial infection and, as such, might play a
role in taste sensitivity; however, the role of salivary flow in
affecting taste sensitivity is not completely understood. Sal-
ivary glands were damaged permanently by RT, while taste
sensitivity only suffered a temporary impairment. Salivary
secretions reached the minimum after 6 months after irradi-
ation, but taste sensitivity did not show further deteriorate
after RT.5,23–25
The relationship between salivary flow and taste distur-
bance had been reviewed recently by Inokuchi, who con-
cluded that salivary dysfunction was not likely the major
factor in affecting taste disturbance.26
Measurement of taste acuity
Taste, where only specialized taste receptors are stimu-
lated, should be distinguish from ‘‘flavour’’ where other
receptors such us tactile, thermal, pain and smell receptors
are stimulated. This difference should be kept in mind in
taste acuity evaluation in order to avoid interference with
other senses particularly that of smell.
Taste acuity evaluation relies on both subjective and
objective. Subjective evaluation, such as chemical gustom-
etry and electrogustometry, are rather old and to date not
replaced by newer techniques.
Subjective evaluation
Chemical gustometry
Chemical gustometry consists on measurement of detection
and recognition thresholds and taste-intensity responsive-
ness. A threshold is defined as the concentration of a stim-
ulus detected or recognized by a patient in more than 50%
of the performed tests. The detection threshold corre-
sponds to the lowest concentration of the stimulus distin-
guished by a patient as different from water (‘‘yes, I
detect a taste’’). The recognition threshold is the lowest
concentration or the quality and/or the type of the stimulus
that has been correctly recognized by a patient (‘‘this taste
is salt, sweet. . .’’).22
There are four test qualities tested in chemical gustom-
etry, with the recent introduction of umami taste. The most
used taste solutions are sodium chloride for salt, sucrose,
glucose, glycerol and fructose for sweet, citric and chloride
543
acids for acid, quinine sulfate for bitter, mono-sodium L-glu-
tamate for umami taste.27 The solution could be applied di-
rectly on the tongue by a drop, or by paper disks or cotton
swabs on different sectors of the tongue to verify different
taste sites.
Chemical gustometry is used by different authors to study
taste disorders in patients receiving head and neck RT.
Conger used conventional taste-testing procedures to
determine patients’ recognition thresholds for sweet, acid,
and bitter.19 Test solutions were made up with reagent
grade sucrose and hydrochloric acid, and pharmaceutical
grade quinine hydrochloride in boiled distilled water in a
concentration series, each taste solution being one-half
the concentration of its predecessor in the series. These re-
agents are so-called ‘‘pure tastes’’ and are odourless.28
Mossman measured the detection and recognition thresholds
using a forced choice-three stimulus drop technique for rep-
resentatives of each of four taste qualities (salt, sweet, sour
and bitter). The technique consisted of introducing se-
quences of three drops of solutions into the oral cavity,
two of these were water, and one a solute dissolved in
water. For threshold determinations the patient was re-
quired to taste each drop and make two responses: which
of the three drops tasted different from the other two and
what was the characteristic taste of the dissimilar drop
(i.e. was the drop salty, sweet, sour or bitter). Taste loss
for detection and recognition for each taste quality was de-
fined as the increase in threshold above the upper limit of
normal.16,18,22 Some authors used the method of gustatory
test by filter-paper disc, previously described by Okuda,
for detection of threshold for sweet, salt, sour and bitter.29
Each stimulating solutes was diluted to five steps and each of
these reagent concentrations correspond to five scores for
taste thresholds. Gustometry was done on both sides of
the tongue dorsum surface: the mean value of the estimated
thresholds on both sides was considered as the threshold.30
While the sectorial exploration is the most precise
method in the common clinical practice, full/mouth or
whole/mouth techniques exploring the whole taste area
are more easily executed. Yamauchi et al. had used four
tastes in progressive solutions in 13 steps with the whole-
mouth technique. The threshold was measured spraying
1 ml of solution starting with the lower dilution with dis-
tilled water mouth rinse between applications. The test
could be randomised and repeated several times to avoid
simulation phenomenon.10,31
Chemical gustometry could also be executed with supra-
threshold stimuli.2 Two tests are employed to evaluate the
degree of taste impairment. In the first test the patient
should compare increasing concentrations of a solution to
a sound in a 1 to 9 scale, where 9 corresponds to the highest
sound and 1 to the lowest. The second test allows the iden-
tification of non sensitive areas resulted from nerve damage
and is also useful for the evaluation of dysgeusia and focal
small areas of taste loss, that could be important to identify
the cause of taste disorder.
Electrogustometry
The electrogustrometry is a physical method based on the
determination of the recognition threshold of an electrical
544
stimulus such as a continuous wave from a cathode to an an-
ode placed on the tongue while another electrode closes the
circuit on the pulse. In these conditions, the saliva is hydro-
lyzed and a wave of chemical stimulation by ionophoresis is
applied. The recognition threshold is expressed in lA, in
electrogustometric unit or in decibel. The normal values
scale relates to the surface of electrode in contact with
the tongue and varies from 5 to 50 lA. The hypogeusia
threshold is in general placed between 50 and 100 lA and
ageusia is considered for threshold values above 300–
500 lA, depending of the different authors and devices used.
The advantage of this method is the easy and precise indi-
vidualization of the stimulus area limited in general to the
tongue dorsum surface. However, the electrogustrometry
does not allow the identification of different test qualities
and has the limitation of not using a physiological stimulus.
Nevertheless, a good correlation exists among chemical gus-
tometry and electrogustrometry. Given the quantitative
characteristic of the electrogustrometry, it is considered
the ideal for the assessment of taste disturbances.6,14
Taste questionnaires
Taste questionnaires are used to assess subjective aware-
ness of taste impairment or taste loss and the presence of
any distress caused by changes in taste acuity (e.g. de-
creased enjoyment of food and appetite). Self-reports of
various degree of oral dryness are also evaluated in most
of these questionnaires.2,10,16,18,21,22
Objective evaluation
Subjective evaluation is characterized by evident limita-
tions in both medical and juridical extent, because of sub-
jective response of the patient. Therefore, an objective
evaluation should exceed the previously described subjec-
tive tests. Of the objective modalities that have been inves-
tigated, the measurement of gustatory-evoked potentials
has been the most widely studied because it does not re-
quire expensive equipment. Evoked potentials are the ac-
tion potentials that occur in response to stimulation of
sensory receptors or nerves. To obtain gustatory-evoked
potentials that are useful for evaluating taste function, test
subjects need to receive appropriate taste stimuli (electri-
cal stimulation or application of a chemical solution), the
system for presenting stimuli and recording responses must
provide reproducible results and there must be a consensus
concerning how to interpret the results. The techniques
developed to date are not yet clinically useful and are still
under scientific evaluation for improving stimulation meth-
ods and recording equipment.
Other methods that have been considered for objective
evaluation of gustatory function include imaging techniques
such as Positron Emission Tomography and Functional Mag-
netic Resonance scans, used in the study of brain tissue’s
modifications induced by changes in perfusion and oxygena-
tion after the presentation of appropriate taste stimuli. It
would be difficult to evaluate gustatory function using one
of these modalities alone, because it would be difficult to
discriminate the informations related to gustatory or to
other sensory functions. However, the combination of one
M.G. Ruo Redda, S. Allis
of these methods with the measurement of gustatory-
evoked potentials could be useful for evaluating gustatory
function objectively.32–34
Scoring systems
Multiple systems have been developed for grading the ad-
verse effects of cancer treatment and several classifications
have been used for describing the radiation-induced altera-
tions. Obviously, such situation has created difficulties in
routine clinical trials applications and in comparing results
between studies and institutions.
The Radiation Therapy Oncology Group (RTOG) criteria
and the Late Effects of Normal Tissue/Somatic Objective
Management Analytic (LENT/SOMA) scoring system include
taste disturbances in the salivary gland morbidity and in
the oral and pharyngeal mucosa morbidity, respec-
tively.35,36 Also in the Common Toxicity Criteria of the Na-
tional Cancer Institute (NCI-CTC v2.0), modifications of
taste associated with RT are graded under salivary gland
changes in the gastrointestinal category and are focused
on acute effects.37 However, these classification systems
are not appropriate for scoring taste disturbances, although
taste alterations are mentioned.
The NCI Common Terminology Criteria for Adverse Events
(CTCAE v3.0), implemented in 2003 as a multimodality grad-
ing system for reporting both acute and late effects of can-
cer treatment, recognize, within the gastrointestinal
category, an additional subcategory of taste alterations as
a distinctive adverse event, accompanied by a scoring scale
of severity (Table 1).38,39
Furthermore, a Subjective Total Taste Acuity (STTA)
scale, modified from the LENT/SOMA scoring system, is used
to evaluate, in a specific way, the subjective total taste
acuity (Table 2).6
Studies on radiation-induced taste impairment
Impairment of taste and correlated discomforts have been
investigated by several and heterogeneous studies in pa-
tients who receive radiation for treatment of tumors of
the head and neck region.2,10,16,18,19,21,22,40–45
Several of these reports identified diminished threshold
sensitivity for at least one taste quality; however, the sever-
ity and pattern of taste impairments were still in contro-
versy. Some studies reported that the ability to detect
sweet solutions diminished while sensitivity for bitter ones
increased,44,45 but others argued that the bitter and the
Table 1 Taste alteration (dysgeusia) according to the
CTCAE v3.0 criteria
Score Taste alteration (dysgeusia)
Grade 0 None
Grade 1 Altered taste but no change in diet
Grade 2 Altered taste with change in diet
(e.g. oral supplements);
noxious or unpleasant taste; loss of taste
Grade 3 –
Grade 4 –
Radiotherapy-induced taste impairment
Table 2 Scale of Subjective Total Taste Acuity (STTA)
Grade 0 Same taste acuity as before treatment
Grade 1 Mild loss of taste acuity, but not
inconvenient in daily life
Grade 2 Moderate loss of taste acuity, and sometimes
inconvenient in daily life
Grade 3 Severe loss of taste acuity, and frequently
inconvenient in daily life
Grade 4 Almost complete or complete loss of taste
acuity
salty qualities showed the earliest and greatest impairment
while the sweet quality showed the least.16,18,22 Schwartz
et al., however, reported near normal suprathreshold inten-
sity perception of the four basic tastes in patients following
head and neck irradiation.2
In addition to the four basic tastes, Shi et al. investigated
the recognition threshold of umami taste at different irradi-
ation dose intervals during RT in 30 patients with neoplasm
of head and neck. Sweet, sour, salty, and bitter tastes
showed temporarily and slightly increased thresholds during
treatment, but no statistical difference was found between
the threshold at pre-RT and that at 15, 30, 45 and 60 Gy in
any taste quality. Significantly impaired threshold of umami
taste was revealed at 30 Gy and remained throughout the
following treatment. The authors concluded that the clini-
cal impairment pattern of umami taste is different from
that of the other four basic tastes in head and neck cancer
patients during RT, and plays an important role in impacting
the quality of life of the patients.10
Maes et al. evaluated the prevalence and distress of
taste loss at different intervals after RT for head and neck
cancer, in order to quantify the magnitude of the problem,
the impact on the patients’ quality of life and to detect
recovery in time after treatment. Loss of taste after RT
was found to be most pronounced after 2 months. A gradual
improvement of taste function was seen for all four taste
qualities 6 and 12–24 months after RT and further recovery
in the period after 24 months may be possible, even if par-
tial taste loss still persisted 1–2 years after treatment.16
Barbieri et al. reported the maximum compromise for all
four taste categories at 30 days after RT, with complete
recovery of taste function at three months after treat-
ment.14 However, some authors suggest that total recovery
is usually not achieved even in later years after treatment.
Mossman et al. observed objective taste loss in 69% of the
patients up to 7 years after RT, but, in spite of the measur-
able taste loss, only 15% of the patients complained of taste
loss. The discrepancy between measurable taste loss and
subjective awareness of taste loss was explained by a possi-
ble adaptation of the patient to the sensory loss.22
In order to evaluate the impact of treatment fields and
volumes, Fernando et al. reported a significant correlation
between the proportion of tongue contained within the
radiation fields and both objective and subjective taste
loss.21 However, Maes et al. could not show any correlation
between tumor site or radiation dose and the prevalence of
taste loss, because the studied group was too small and all
treated patients received radiation doses over 50 Gy.16
545
Prevention and treatment
Head and neck RT induces damage in normal tissues that may
result in oral sequelae such as mucositis, hyposalivation,
radiation caries, taste loss, trismus, soft-tissue necrosis,
and osteoradionecrosis. These sequelae may be dose-limit-
ing and may cause substantial problems during and after
RT and are major factors in determining the patient’s quality
of life. Acute exacerbation of focal infection, e.g., periapi-
cal and periodontal infection, and severe mucositis occa-
sionally may necessitate an adjustment or an interruption
of the radiation treatment schedule. For these reasons, oral
complications should be prevented or reduced to a minimum
using protocols before, during and after RT. Generally, the
primary issues of patient care before radiation exposure
are screening, consequential treatment, explication, pa-
tient motivation, and initiation of preventive measures.
Management during RT is characterized by prevention and
treatment of acute complications induced by radiation expo-
sure and comprehensive counselling. After RT, the preven-
tion and treatment of chronic and late complications in
conjunction with close follow-up are the main issues of pa-
tient care.3,46
In particular, inadvertent damage to the major salivary
glands, during irradiation of head and neck malignancies,
results in severe reduction of salivary flow and altered sali-
vary composition, leading to disturbance in taste acuity.
The maximum dose delivered to the tumor is generally lim-
ited by the tolerance dose of healthy normal tissues. Radia-
tion dose-response curves have been studied by Mossman
et al.20,22 The maximum tolerance doses resulting in a
50% complication rate 5 years after treatment (TD 50/5)
are estimated to be 40–65 Gy for xerostomia and 50–
65 Gy for taste loss. One of the means of limiting radiation
damage to healthy tissues is to reduce the irradiated volume
by posing constraints on the dose-volume histogram (DVH).
The effect of volume reduction mainly depends on the ana-
tomic structure of the organ. When independent units of
function in an organ (e.g., acini in salivary gland) have a
parallel organization, irradiation of a small part of the organ
has less effect in terms of function loss when the organ has a
serial anatomic organization. At present, prevention of radi-
ation damage to salivary glands is best accomplished by new
radiation techniques, including conformal and intensity-
modulated radiation therapy, designed to spare as much
of major salivary glands as possible.47 However, Konings
et al. found, in rat model studies, regional differences in
radiosensitivity of the parotid gland and suggested that late
radiation damage after partial irradiation of the gland
showed region-dependent volume effects. This finding is ex-
pected to be relevant to the radiosensitivity of human sali-
vary glands and may theoretically have some unexpected
consequences for the clinical outcome of the conformal
and intensity-modulated RT.48
Furthermore, gaining in-depth-knowledge on the mecha-
nism of radiosensitivity will provide informations on the pos-
sibilities of amelioration of acute and late radiation damage
to the salivary glands. Classical ways of protecting salivary
cells from radical-induced DNA damage as well as stimula-
tion of cell proliferation by suitable drugs seem to be the
approach to pursue. Radical scavenging and treatment with
546
transition metal chelators will protect against early as well
as against late radiation damage.49
A cytoprotection against the loss of taste was reported
by the administration of amifostine during a course of radio-
chemotherapy. However, the design of the latter is ques-
tionable, because a wide variety of treatment protocols
was used.47,50
Since taste loss can result in weight loss, the importance
of dietary counselling should be stressed. Indeed, patients
with taste loss had a worse outcome than those did not lose
their sense of taste and were able to maintain their food in-
take and nutritional support.51 Food with pleasing taste,
colour, and smell and substitution of food aromas for the
sense of taste may improve food intake. Dietary counselling
is also of great help in adapting to the taste of food, since in
many patients the perception of the various flavours does
not change to the same extent. Consequently, food that
was enjoyed by the patient before RT can often have a less
pleasant taste after treatment. As the taste perception,
mostly gradually although not completely, returns to nor-
mal, dietary counselling often as to be continued until the
complaints subside or the patient has adapted to the new
situation. Also the use of megesterol acetate during RT is
effective in reversing anorexia and weight loss in spite of
the acute RT effects, and help most patients to suffer and
complain less from the RT-related adverse effects.52
According to different authors, zinc plays an important
role in taste perception.18,53,54 Administration of zinc to
some patients with hypogeusia has normalized serum and
parotid zinc levels, taste perception and taste bud anatomy.
In cancer patients who had received RT to the head and
neck region, the administration of oral zinc sulphate has
been reported both to prevent and correct taste abnormal-
ities. It is probably of more benefit in the acceleration of
taste improvement in the post-radiotherapy period than in
the preservation of taste during radiotherapy.43,55
Conclusions
Head and neck RT may result in several unwanted early
(mucositis, loss of taste, hyposalivation) and late (hyposali-
vation, radiation caries, trismus, osteoradionecrosis) side-
effects. The prevalence of taste loss shortly after RT of
the head and neck is high and occurs in 53–88% of the pa-
tients as a function of the taste quality tested. In particular,
taste loss is most pronounced for bitter and salt qualities.
The taste loss is perceived by the patients, it is responsible
for discomfort and leads to increased use of food sweeten-
ers, supplementary spices and flavourings. Gradual recovery
can be expected slowly in the first year after the treatment.
However, partial taste loss and subjective perception of
taste loss persist 1–2 years after RT and is responsible for
long-term minimal to moderate discomfort in approximately
one-third of the patients.
Prevention or reduction to a minimum of these effects is
possible and should be an integral part of head and neck can-
cer treatment. The introduction of new radiation techniques
is aimed at reducing the radiation dose to the normal tissues
and therefore also to the volume of irradiated oral mucosa.
At present, the effects of RT on salivary glands can be re-
duced to a certain extent, but often not to a level sufficient
M.G. Ruo Redda, S. Allis
to prevent most of the clinical complaints resulting from
hyposalivation. Furthermore, gaining in-depth knowledge
on the mechanism of radiosensitivity may provide means
on protecting salivary glands during the course of RT, and
ultimately will result in less reduction of oral function and
a higher quality of life in head and neck cancer patients.
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