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Adverse events common with chemoradiation for head and neck cancer

Reuters Health and The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Nearly all patients have complications from chemoradiation for head and neck cancer, a study in the Archives of Otolaryngology: Head and Neck Surgery for December suggests.

Typically, these events affect oropharyngeal and laryngeal function, senior author Dr. Gerry F. Funk, from University of Iowa Hospitals and Clinics, Iowa City, and colleagues report.

Intensity-modulated radiation therapy (IMRT), a system that reduces the radiation dose to critical nerve and salivary structures, can reduce the toxic effects, they add.

Their study involved 104 patients treated for head and neck cancer between February 1, 2000 and March 1, 2007. Roughly 88% of subjects had oropharyngeal or laryngeal tumors and 75% had advanced-stage disease.

Mucositis was by far the most common adverse event, seen in 92.3% of patients, although just 9.6% of patients had mucositis severe enough to warrant hospital admission.

Hematologic toxicity was the next most common complication, seen in 59.6% of patients, followed by toxicity-related treatment delay, identified in 46.2% of patients.

Other less common side effects included moist desquamation (28.8%), neurotoxicity and/or ototoxicity (26.9%), severe nausea or vomiting (26.9%), severe dehydration or malnutrition (26.0%), pneumonia (25.0%), mild or moderate fever (23.1%), elevated creatinine (19.2%), and severe fever (18.3%). Trismus, osteoradionecrosis, and treatment-related death were each seen in less than 10% of patients.

With IMRT, more toxicity-related treatment delays were noted, but fewer toxicities were seen and functional and quality of life outcomes were enhanced, the report indicates. For instance, the incidence of moist desquamation was 33% with lateral-opposing-fields radiation and 25.7% with the authors’ current IMRT protocol. The incidence of pneumonia fell from 33.3% with lateral-opposing-fields radiation to 20.0% with the current IMRT protocol.

“The results of the present study indicated that patients receiving chemoradiotherapy experience a substantial burden of treatment-related adverse events,” the authors conclude. “Continued efforts to reduce the incidence of these toxicities would not only lessen patients’ short-term pain and discomfort but would also potentially increase the duration of their long-term survival.”

Arch Otolaryngol Head Neck Surg 2009;135:1209-1217.