THE SIDE EFFECTS OF RADIOTHERAPY IN THE PATIENT WITH ENT CANCER

Objectives: Our aim was to demonstrate the occurrence of post-radiotherapy side effects- even in the case of using intensively modulated therapy (IMRT) in patients with ENT cancer as its are: radiomucositis, dental caries, osteoradionecrosis, the increase in the size of the existing periapical lesions before radiotherapy, dysphagia, dysgeusia. Materials and methods: Our study included 35 cancer patients age between 32-81 years old with ENT cancer- neoplasm of larynx, oropharynx, oral cavity, nasopharynx, hypopharynx, sinuses; under treatment at the Regional Institute of Oncology, Iasi. They were examinated by one dental generalist, two endodontist, one radiologist, one doctor specialized in radiotherapy and an ENT doctor before and after radiotherapy. We used as irradiation dose between 50-70 Gy. Results: All patients suffered from various forms of cancer; the majority (40%) presented a neoplasm of the larynx, 8 patients (22,9%) presented a neoplasm of oropharynx, 6 patients (17,1%) presented a neoplasm of the oral cavity. Other forms of neoplasm found were nasopharynx, hypopharynx and respectively sinus neoplasm (1 case). The vast majority of the patients presented radiomucositis grade 2 (34,3%) and 3 (45,7%). The distribution of the localization of periapical lesions changed before and after radiotherapy. Osteoradionecrosis was initially diagnosed in 3 of the 35 patients (8,6%); after radiotherapy osteoradionecrosis was diagnosed in 6 patients (17,1%). We did not identify a statistically significant relationship between the dose of radiation administered and the degree of radiomucositis. Disscusions: Our retrospective study reported a frequency of 40% cancer of the larynx, 22,9% cancer of the oropharynx and 17,1% neoplasm of the oral cavity, followed by cancer of the nasopharynx, hypopharynx and sinus neoplasm out of a total of 35 patients taken into account. Taking into account the fact that the patients received an irradiation dose between 70 Gy (65,7%)- 66 Gy (22,9%), the degree of radiomucositis was mainly 2 (34,3%) or 3 (45,7%). We observed an increase in the diameter of the periapical lesions after radiotherapy associated with the dose of radiation administered. Areas with osteoradionecrosis revealed the same tendency of increase in their comparative analysis after the applied irradiation doses. Conclusions: The management of the side effects of radiotherapy can be managed favorably for the oncological patient through a close collaboration between the general dentist, ENT and the radiotherapist.