Long-term toxicity among head and neck cancer patients—A systematic review

The treatment regime for head and neck cancer (HNC) includes surgery, radiotherapy and chemotherapy. Treatment modalities are used alone or in combination. Long-term survivors of HNC may experience a range of therapy-dependent effects. Although research has been done on the acute and medium-term problems that occur for this patient group, the toxicities that persist long-term or present very late are less known. To review what is known about the occurrence of toxicities among former HNC patients who have survived at least 5 years. PubMed was searched for relevant articles published in English or German that used the Common Terminology Criteria for Adverse Events (CTCAE) to report on one or more of 11 preselected toxicities. Of 42 articles identified, the full text of 40 could be obtained. Three relevant articles were identified; all of which included nasopharynx patients who had received radiotherapy or chemotherapy or a combination of both. The long-term toxicities identified concerned hearing impairment, dry mouth, dysphagia, trismus, neuropathy, fibrosis, and pain. No information on the oral health of the survivors was found. Only one study reported detailed results, with dry mouth, hearing loss, and dysphagia being particularly prevalent. One study reported that 49% of long-term survivors had at least one grade 3 toxicity, of which approximately one third concerned hearing problems. Only a few studies aimed primarily at assessing the longterm toxicities in this survivor group are available but they are necessary to understand how to best support this patient group.