Complications of Radiotherapy for

Head and Neck Cancers,their

Prevention & Management
 POST-RADIATION COMPLICATIONS

ACUTE CHRONIC
 Oral mucositis  Hyposalivation
 Oral infections  Caries
 Osteoradionecrosis
 Taste dysfunction
 Speech and masticatory problems
 Oral infections
 Trismus and muscle pain
RADIATION MUCOSITIS

 Post irradiation mucositis is an effect on oral mucous membrane following radiation therapy.
 It is secondary to therapeutic radiation doses in excess of 3500-4000 Rads.
 After external-beam radiation therapy,the mucous membranes normally heal within 4 to 6 weeks,although an
occasional patient might require up to 12 weeks or even several months.The latter is particularly true of patients
treated with concurrent radiation-sensitizing chemotheraphy.
 The severity of mucositis is related to the daily dose of radiation therapy,the total cumulative dose,the volume
of irrated tissue,and the use of concurrent radiation-sensitizing and/or mucositis-including chemotherapeutic
agents.
 At fractions of 170 to 180 cGy daily ,5 days per week ,the maximal reaction is typically intense erythema with
occasional patchy mucositis.
 If the daily dose is increased to 200cGyor more,as in the case of altered fractionation schedules such as
hyperfractionation (110 to 150 cGy twice a day) or accelerated fractionation (160 cGy in the afternoon ), and
the treatment volume is large (the entire oral cavity), cell killing will exceed the proliferative capacity of the
epithelial stem cells, and almost all patients will have confluent mucositis by the third week of therapy.
MANAGEMENT

 Benzydamine HCL - 0.15% rinse

 Mouth washes
 Three step analgesic protocol(acetaminophen or acetaminophen+codeine suspension or liquid morphine)
 Fentamyl patches
 Sucral fate suspension
 2% silver nitrate solution(stimulates normal mucosa repopulation)
 Low energy lazer
 Zinc sulphate, alpha – tocopherol,intravenous L-alanyl L-glutamine
 radioprotector-amifostime
 Sophisicated radiation thearpy-planning (CT-based target delineation intensity modulated radiation
therapy)
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