Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

660 Head and Neck Cancer

■Role of chemotherapy alone generally is limited for palliation in

unresectable tumor. Radiation also often plays a role in palliation

of unreseectable tumor, as may other modalities.

■For recurrent cancer in previously irradiated areas: if resectable,

intraoperative radiation therapy (IORT) is being used in a number of

centers with some encouraging results. If unresectable, then pallia-

tive approaches Early disease (T1 N0)-designed to minimize long-

term side effects. For example, EBRT for larynx and BOT, but surgical

resection for lateral tongue Management of neck when apparently

N0: dependent on management of primary site

■Selective neck dissection may be indicated when Rx of primary is

surgical

■Clinical followup without treatment indicated for T1-2 larynx EBRT

to both neck as well as primary often indicated if EBRT is most appro-

priate for primary.

■Advanced resectable disease: organ preservation approaches often

best initial choice; combined treatment often necessary

■Recurrent disease: IORT may be useful when surgically resectable;

otherwise palliative chemotherapy and pain management likely best

options

Side Effects & Complications

■Radiation:

➣dry mouth (xerostomia) is permanent and always occurs. some-

times mildly improved with the use of artifical saliva wetting

agents and/or with pilocarpine altered taste-degree of recovery

variable

➣transient mucositis and skin reaction: recovers in 4–8 wks

➣dysphagia, dependent on primary site, may be severe enough

to require nasogastric (or percutaneous gastrostomy) tube for

weeks, months, or permanently

■Chemotherapy:

➣cisplatin: peripheral neuropathy, ototoxicity, renal toxicity, nau-

sea on day of administration

➣5-fluorouracil: marrow toxicity, mucositis

➣carboplatin: marrow toxicity

■Surgery:

➣dependent on site and extent, & underlying medical health

➣requiring speech/swallowing therapy: may include dysarthria,

dysphagia, need for soft diet, aphonia following total laryngec-

tomy usually managed successfully with Blom-Singer device