Chapter 084. Head and Neck Cancer (Part 6) Chemoprevention β-Carotene and cis-retinoic acid can lead to the regression of leukoplakia. However, cis-retinoic acid does not reduce the incidence of second primaries Treatment Complications Complications from treatment of head and neck cancer are usually correlated to the extent of surgery and exposure of normal tissue structures to radiation. Currently, the extent of surgery has been limited or completely replaced by chemotherapy and radiation therapy as the primary approach. Acute complications of radiation include mucositis and dysphagia. Long-term complications include xerostomia, loss of taste, decreased tongue mobility, second malignancies, dysphagia, and neck fibrosis. The complications of chemotherapy vary with the regimen used but usually include myelosuppression, mucositis, nausea and vomiting, and nephrotoxicity (with cisplatin). The mucosal side effects of therapy can lead to malnutrition and dehydration. Many centers address issues of dentition before starting treatment, and some place feeding tubes to assure control of hydration and nutrition intake. About 50% of patients develop hypothyroidism from the treatment; thus, thyroid function should be monitored. Salivary Gland Tumors Most benign salivary gland tumors are treated with surgical excision, and patients with invasive salivary gland tumors are treated with surgery and radiation therapy. Neutron radiation may be particularly effective. These tumors may recur regionally; adenoidcystic carcinoma has a tendency to recur along the nerve tracks. Distant metastases may occur as late as 10–20 years after the initial diagnosis. For metastatic disease, therapy is given with palliative intent, usually chemotherapy with doxorubicin and/or cisplatin. Further Readings Adelstein DJ et al: An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 21:92, 2003 [PMID: 12506176] Bernier J et al: Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945, 2004 [PMID: 15128894] Bonner JA et al: Radiotherapy plus cetuximab for squamous- cell carcinoma of the head and neck. N Engl J Med 354:567, 2006 [PMID: 16467544] Brockstein B, Vokes EE: Concurrent chemoradiotherapy for head and neck cancer. Semin Oncol 31:786, 2004 [PMID: 15599856] Cohen EE et al: The expanding role of systemic therapy in head and neck cancer. J Clin Oncol 22:1743, 2004 [PMID: 15117998] Forastiere AA et al: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091, 2003 [PMID: 14645636] Pfister DG et al: American Society of Clinical Oncology clinical practice guideline for the use of larynx- preservation strategies in the treatment of laryngeal cancer. J Clin Oncol 24:3693, 2006 [PMID: 16832122] Seiwert TY et al: The chemoradiation para digm in head and neck cancer. Nat Clin Pract Oncol 4:145, 2007 Slebos RJ et al: Gene expression differences associated with human papillomavirus status in head and neck squamous cell carcinoma. Clin Cancer Res 12:701, 2006 [PMID: 16467079] Vokes E et al: Weekly carboplatin and paclitaxel followed by concomitant TFHX chemoradiotherapy: Curative and organ preserving therapy for advanced head and neck cancer. J Clin Oncol 21:320, 2003 [PMID: 12525525] . Chapter 084. Head and Neck Cancer (Part 6) Chemoprevention β-Carotene and cis-retinoic acid can lead to the regression of leukoplakia cell head and neck cancer. J Clin Oncol 21:92, 2003 [PMID: 12506176] Bernier J et al: Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. . squamous- cell carcinoma of the head and neck. N Engl J Med 354:567, 2006 [PMID: 16467544] Brockstein B, Vokes EE: Concurrent chemoradiotherapy for head and neck cancer. Semin Oncol 31:786, 2004