Late Adverse Events of Radiotherapy with Concomitant Cisplatin and the Response to Them

Abstract

Dysphagia is a late adverse event of radiotherapy with concomitant Cisplatin (CDDP-RT), and patients with advanced laryngeal cancer who undergo CDDP-RT have an impaired swallowing-related quality of life. Dysphagia induced by CDDP-RT has two major causative factors: delayed or untimely swallowing reflexes caused by xerostomia or oral or oropharyngeal mucosal sensory disturbance and a decrease in laryngeal perception, laryngeal elevation disorder, inadequate relaxation of the cricopharyngeal region, and other problems with the swallowing function due to the effects of RT on the larynx, pharyngeal contractile muscles, and other parts of the neck. Oral healthcare and dysphagia rehabilitation are considered essential for patients requiring CDDP-RT, and such a support system needs to be established at the facility in question. Future clinical trials (JCOG1912) will help clarify whether or not reducing the dose in the prophylactic irradiation area can mitigate late adverse events while maintaining treatment efficacy. Induction chemotherapy may be able to reduce the extent of irradiation of the tumor area and the area of prophylactic irradiation. However, this has not yet been proven, and further studies in larger cohorts are needed.