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Oral Toxicity Management in Head and Neck Cancer Patients Treated with Chemotherapy and Radiation: Xerostomia and Trismus (Part

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Oral Toxicity Management in Head and Neck Cancer Patients Treated with Chemotherapy and Radiation: Xerostomia and Trismus (Part Critical Reviews in Oncology/Hematology 102 (2016) 47–54 Contents lists available at ScienceDirect Critical Reviews in Oncology/Hematology jo urnal homepage: www.elsevier.com/locate/critrevonc Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (Part 2). Literature review and consensus statement a a b a Michela Buglione , Roberta Cavagnini , Federico Di Rosario , Marta Maddalo , c c b d e Lucia Vassalli , Salvatore Grisanti , Stefano Salgarello , Ester Orlandi , Paolo Bossi , b b c f g Alessandra Majorana , Giorgio Gastaldi , Alfredo Berruti , Fabio Trippa , Pietro Nicolai , h i,∗ j,k l Andrei Barasch , Elvio G. Russi , Judith Raber-Durlacher , Barbara Murphy , a Stefano M. Magrini a Radiation Oncology Department, Spedali Civili Hospital, Brescia University, Italy b Department of Oral Diagnosis, Oral Medicine & Oral Pathology, Spedali Civili Hospital, Brescia University, Italy c Medical Oncology Department, Spedali Civili Hospital, Brescia University, Italy d Radio–Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy e Head and Neck Medical Oncology Unit, Fondazione, IRCCS Istituto Nazionale Tumori, Milan, Italy f Radiation Oncology Department, Azienda Ospedaliera ‘S. Maria’, TERNI, Italy g ENT Clinic and Head and Neck Department Spedali Civili Hospital, Brescia University, Italy h Department of General Dental Sciences, University of Alabama at Birmingham, USA i Radiation Oncology Department AO. S. Croce e Carle, Cuneo, Italy j Department of Oral and Maxillofacial Surgery, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands k Department of Medical Dental Interaction, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands l Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, TN, USA Contents 1. Introduction . 48 2. Material and methods . 48 3. Results. .49 4. Discussion . 49 4.1. Statements about xerostomia . 49 4.1.1. Xerostomia general statement . 49 4.1.2. Xerostomia-assessment scales . 49 4.1.3. Pretreatment. .49 4.1.4. During treatment . 49 4.1.5. After treatment/follow up . 51 4.2. Statements about trismus . 51 4.2.1. Trismus general statements . 51 4.2.2. During treatment . 51 4.2.3. After treatment/follow up . 52 5. Conclusions . 52 Conflict of interest . 52 Aknowledgments . 52 References . 52 Biographies . 54 ∗ Corresponding author. E-mail addresses: [email protected] (M. Buglione), [email protected] (R. Cavagnini), [email protected] (F. Di Rosario), [email protected] (M. Maddalo), [email protected] (L. Vassalli), [email protected] (S. Grisanti), [email protected] (S. Salgarello), [email protected] (E. Orlandi), [email protected] (P. Bossi), [email protected] (A. Majorana), [email protected] (G. Gastaldi), [email protected] (A. Berruti), [email protected] (F. Trippa), [email protected] (P. Nicolai), [email protected] (A. Barasch), [email protected] (E.G. Russi), [email protected] (J. Raber-Durlacher), [email protected] (B. Murphy), [email protected] (S.M. Magrini). http://dx.doi.org/10.1016/j.critrevonc.2016.03.012 1040-8428/© 2016 Published by Elsevier Ireland Ltd. 48 M. Buglione et al. / Critical Reviews in Oncology/Hematology 102 (2016) 47–54 a r a t i c l e i n f o b s t r a c t Article history: Radiotherapy alone or in combination with chemotherapy and/or surgery is a well-known radical treat- Received 2 May 2015 ment for head and neck cancer patients. Nevertheless acute side effects (such as moist desquamation, skin Accepted 9 March 2016 erythema, loss of taste, mucositis etc.) and in particular late toxicities (osteoradionecrosis, xerostomia, trismus, radiation caries etc.) are often debilitating and underestimated. Keywords: A multidisciplinary group of head and neck cancer specialists from Italy met in Milan with the aim of Head and neck cancer reaching a consensus on a clinical definition and management of these toxicities. Xerostomia The Delphi Appropriateness method was used for this consensus and external experts evaluated the Trismus Radiotherapy conclusions. The paper contains 20 clusters of statements about the clinical definition and management Chemotherapy of stomatological issues that reached consensus, and offers a review of the literature about these topics. Radio-induced xerostomia The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecrosis Radio-induced trismus (10 clusters of statements), whereas this second part deals with trismus and xerostomia (10 clusters of statements). © 2016 Published by Elsevier Ireland Ltd. 1. Introduction A task force of Radiation Oncologists (ROs), Medical Oncolo- gists (MOs), Oral Care Physicians (OCPs), Radiologists (Rs), and Radiotherapy (RT) with/without chemotherapy (CT) and/or Nurses (Ns) met in Milan with the aim of reaching a consensus on surgery is an established form of therapy for the curative treat- the supportive management of HNCPs’ oral radio/chemo-induced ment or palliation of head and neck cancer patients (HNCPs). In pathologies. recent years, better RT target definitions and healthy tissue avoid- This paper reports and discusses the statements regarding ance criteria have evolved, aimed at better loco-regional disease xerostomia and trismus that achieved consensus, whereas the control and higher survival rates (Parliament et al., 2005; Dirix and statements concerning dental pathologies and osteo-radionecroses Nuyts, 2010; Retel et al., 2011; Vissink et al., 2003a). RT delivery were reported in Part 1. techniques were also ameliorated thanks to the introduction of The consensus was focused particularly on those statements intensity modulated radiation therapy (IMRT). The resulting sharp with limited evidence. dose gradients and the possibility of simultaneously delivering dif- The results of the literature review and the statements that ferent fractional doses in the tumour and the surrounding healthy obtained a consensus have been reported and discussed in this tissues allowed the radiobiological effects to be more effectively paper. modulated. Acute and late adverse events (AEs) occurring after radiotherapy 2. Material and methods (±chemotherapy and/or surgery) have been studied with increas- ing interest, since it has been realized that their occurrence may The Delphi Appropriateness method was used for this Consen- hamper the good clinical results obtained. The different types of sus (Loblaw et al., 2012). treatment-related functional sequels can be grouped according to The panel, a group of 37 multidisciplinary experts (ROs, MOs, the anatomic and functional structures that, when damaged by OCPs, Rs, Ns), met in Milan on February 17–18, 2013 and appointed radiation, give rise to some specific clinical dysfunctions such as a facilitator board of 12 expert members, from different clinical dysphagia, xerostomia, and trismus. settings (6 ROs, 4 OCPs, 2 MOs). The facilitator board performed a Thus, numerous studies have tried to identify the systematic review of the literature on xerostomia and trismus in Dysphagia/Aspiration-Related Structures (DARSs) (Eisbruch Radio/Chemo-treated (RCT) HNCPs. et al., 2004) (e.g. the pharyngeal constrictors, tongue base, and The MEDLINE database was searched for English-language stud- larynx), Altered-Mastication-Related Structures or (AMRSs) (Teguh ies published from 1992 to March 2013 containing the key words: et al., 2008; Johnson et al., 2010; Van der Molen et al., 2011, 2013) head and neck; xerostomia; hyposalivation; dry mouth; trismus; (e.g. the masseter, pterygoid muscles and the temporal mandibular CT; and RT. joints, and the oral cavity), and Xerostomia-Related Structures or Potentially relevant abstracts presented at annual meetings of XRSs (Van de Water et al., 2009; Jellema et al., 2005) (e.g. the major the American Society of Clinical Oncology and the European Society and minor salivary glands) in recent years. of Medical Oncology were examined. The study selection included While health-related quality of life (HRQoL) after RT ± CT and or the following: surgery may be ameliorated with the new techniques (Pow et al., (a) Observational and prospective studies about assessment 2006; Nutting et al., 2011; Bhide et al., 2009; Caudell et al.,.
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