Friday, October 29, 2010

Radiation for Throat Cancer - Side Effects

Throat cancer is a very challanging diagnosis for the patient and for the doctor.  Depending on the site and stage of cancer, treatment can consist of surgery, radiation, chemotherapy, and any combination of the three treatments.   All treatments have pros and cons, and this post will focus on some of the cons of radiation therapy. 

As you can see in the picture above, radiation leads to loss of mucus glands within the throat, leading to a condition known as "laryngitis sicca", or dry larynx.  The throat becomes highly susceptible to stasis of secretions, crusting, and inflammation.  The sensation of the larynx and throat also becomes compromised, probably through loss of small blood vessels feeding the nerves of the throat.  Therefore, these mucus crusts are easily aspirated into the airway, leading to pneumonia.  Many years after radiation therapy it is not uncommon for the patient to decompensate and need a feeding tube for nutrition.  In many cases the patient may have done well for 5, 10, or even 15 years after treatment. 

In the patient above's case, he had throat cancer treated 15 years prior with radiation therapy.  He was swallowing and doing well until he underwent abdominal surgery and remained intubated for 5 hours.  Following surgery he began aspirating on foods and liquids, and he developed recurrent aspiration pneumonias.  Ultimately he required placement of a feeding tube, underwent intensive swallowing therapy, but never regained the ability to swallow. 

Unfortunately, this is not an isolated case.  I have at least 10 patients in my practice suffering from sequelae of radiation therapy and most cases started at least 5 years after treatment.  Most patients are unaware of the long-term consequences of treatment.  Given these devastating effects, every option should be presented to the patient and surgery should be strongly considered in cases of resectable and non-disfiguring disease.


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