Late radiation-associated dysphagia in head and neck cancer patients: evidence, research and management

Abstract

In head and neck cancer (HNC) scenario, newer radiotherapy (RT) techniques, such as intensity modulated RT (IMRT), aim to reduce acute and late toxicity without impair tumor response and loco-regional control rates. However, late radiation-associated dysphagia (RAD) remains a major clinical problem and has gained a growing importance in the last few years, especially due to human papilloma virus (HPV)-related HNC favorable prognosis. The aim of this review was to provide clinical information about late RAD. The main anatomical structures involved in swallowing were described, in order to define potential organ at risk and available radiation-dose constraints in IMRT plan. Finally, possible rehabilitation strategies were proposed. This is expected to represent an opportunity for improved multidisciplinary management in HNC patients.

Keywords: Aspiration; Dysphagia; Head and neck cancer; IMRT; Late radiation-associated dysphagia; Organ at risk; Quality of life; Radiotherapy; Structures; Toxicity.