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Multicenter Study
. 2025 Nov 15;157(10):2061-2070.
doi: 10.1002/ijc.70033. Epub 2025 Jul 30.

Toxicities in long-term survivors of head and neck cancer-A multi-national cross-sectional analysis

Katherine J Taylor  1 , Cecilie D Amdal  2   3 , Kristin Bjordal  3   4 , Guro L Astrup  2 , Bente B Herlofson  5   6 , Fréderic Duprez  7 , Ricardo R Gama  8 , Alexandre Jacinto  9 , Eva Hammerlid  10 , Melissa Scricciolo  11 , Femke Jansen  12   13 , Irma M Verdonck-de Leeuw  12   13   14 , Giuseppe Fanetti  15 , Orlando Guntinas-Lichius  16 , Johanna Inhestern  16   17 , Tatiana Dragan  18 , Alexander Fabian  19 , Andreas Boehm  20 , Ulrike Wöhner  20 , Naomi Kiyota  21 , Maximilian Krüger  22 , Pierluigi Bonomo  23 , Monica Pinto  24 , Sandra Nuyts  25   26 , Joaquim Castro Silva  27 , Carmen Stromberger  28   29 , Pol Specenier  30 , Francesco Tramacere  31 , Ayman Bushnak  32 , Pietro Perotti  33 , Michaela Plath  34 , Alberto Paderno  35 , Noa Stempler  36 , Maria Kouri  37 , Vincent Grégoire  38 , Silke Tribius  39 , Susanne Singer  1   40 ; EORTC Quality of Life Group and the EORTC Head and Neck Group
Affiliations
Multicenter Study

Toxicities in long-term survivors of head and neck cancer-A multi-national cross-sectional analysis

Katherine J Taylor et al. Int J Cancer. .

Abstract

Head and neck cancer (HNC) patients may experience toxicities as a result of their treatment modality. While acute toxicities have been well documented, the prevalence of toxicities at long-term follow-up of HNC survivors is less clear. As part of a multi-national, cross-sectional study, HNC survivors at least 5 years post-diagnosis were invited to undergo a toxicity examination. Using the Common Terminology Criteria for Adverse Events (version 5), 33 toxicities were assessed. From 2019 to 2021, 1094 survivors from 26 sites in 11 countries completed the assessment. Eighty-seven percent were from Europe, and most were survivors of oropharynx (35%), oral cavity (21%), or larynx cancer (19%). The majority had been diagnosed at stage III or IV (62%), and the median time since diagnosis was 8 years (range 5-36). Most had been treated with surgery and radiotherapy with or without chemotherapy (38%). Six percent had no toxicities, and 26% had only mild toxicities. 68% had at least one moderate or severe late toxicity. Overall, the most frequent late toxicities at any grade were dry mouth (67%), soft tissue fibrosis (52%), dysphagia (51%), and voice alterations (39%). Fistulae, neck and face edema, and osteonecrosis of the jaws were present in very few survivors. Our study shows that the majority of HNC survivors experience moderate or severe late toxicities, but that the problems are concentrated in a small group of specific toxicities. Understanding the problems experienced in the long term can help better inform newly diagnosed patients as well as inform survivorship follow-up initiatives.

Keywords: CTCAE; dysphagia; head and neck cancer; survivor; toxicity; xerostomia.

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Conflict of interest statement

S. Singer has received consulting fees from Lilly that were outside of this study. A. Fabian has received honoraria from Merck Sharp and Dohme outside the field of this work. M. Pinto has received consulting fees from Meeting & Words S.r.l. and Hinovia S.r.l., a speaker fee from Becton Dickinson Italia S.p.A, and has participated as a co‐investigator in a study funded by Amgen, all of which are outside of this study. All other authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow of survivors enrolled in the EORTC 1629 study.
FIGURE 2
FIGURE 2
Severity distribution of investigated toxicities (1 of 2). Total n for each toxicity is 1094. Grades are according to the Common Terminology Criteria for Adverse Events (CTCAE; Version 5).
FIGURE 3
FIGURE 3
Severity distribution of investigated toxicities (2 of 2). Total n for each toxicity is 1094. Grades are according to the Common Terminology Criteria for Adverse Events (CTCAE; Version 5).
See this image and copyright information in PMC

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