Radiation Side Effects: The Top 2

CURE, Fall 2005, Volume 4, Issue 3

The top 2 side effects of using radiation to treat head and neck cancers.

Dry Mouth: The salivary glands produce saliva, which is necessary for moistening food for swallowing, helping prevent tooth decay, lubricating the tongue and throat for speech and controlling bacteria. But for patients receiving radiation, the sensitivity of the salivary glands leads to low saliva production and the development of dry mouth (xerostomia), the severity of which depends on how much of the salivary gland is radiated.

Prior to radiation, Ethyol may be administered to protect the salivary glands. In addition, new radiation techniques, such as intensity-modulated radiation therapy, don’t allow radiation to the salivary gland. Still experimental at this point is moving the major salivary glands out of the radiation field.

If preventive methods don’t work and dry mouth occurs, medications are available to increase saliva production, including Salagen (pilocarpine) and Evoxac (cevimeline). For patients with temporary or partial salivary gland damage, nicotinic acid tablets and pilocarpine may be helpful.

Patients with dry mouth must practice good oral care and consider using toothpaste with fluoride and prescription mouth rinses, such as Peridex (chlorhexidine).

When managing the symptoms of dry mouth, the following may be helpful:

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Use artificial saliva substitutes, which come in the form of a gel, tablet or spray.

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Carry a bottle of water and take frequent sips.

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Drink fluids while chewing. Also consider adding gravy and sauces to dry food.

Mouth Sores: Oral mucositis results from inflammation of the tissue lining the nose and throat. Because the mucosa acts as a barrier to bacteria, individuals with oral mucositis not only have difficulty tasting, eating and drinking, but also are susceptible to infections.

Nearly all patients receiving radiation to the head and neck will experience mucositis, which typically appears two to three weeks after therapy begins. Examine the mouth at least once daily and report changes to a doctor or nurse.

In December 2004, the Food and Drug Administration approved Kepivance (palifermin) for severe oral mucositis in patients with blood cancers undergoing bone marrow transplant. The safety and efficacy of the drug is being investigated in patients with solid tumors, including head and neck cancer.

FGF-20 (fibroblast growth factor-20) has shown promise for mucositis intervention. Favorable results of a phase I trial with FGF-20 were reported in late 2004. A single dose of the drug was given to patients who received high-dose chemotherapy before stem cell transplant. Of the 22 patients, only four developed severe mucositis. A larger phase II trial is currently under way.

A new agent called Gelclair (bioadherent oral gel) forms a protective barrier, hydrating and coating the oral mucosa without numbing or drying. The drug can provide pain relief for up to seven hours in mild to moderate mucositis and up to two hours in severe mucositis.

When managing the symptoms of oral mucositis, the following may be helpful:

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Use a soft toothbrush or swab to clean the teeth.

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Use a baking soda rinse instead of mouthwashes that contain alcohol.

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Avoid acidic or spicy foods and foods with sharp edges, such as chips.