Wielding a double-edged sword in head and neck cancers—diagnosis, risk factors and mitigation strategies of radiation-induced head and neck sarcomas: a narrative review

Background: The risk factors for head and neck cancers (HNC) vary in different parts of the world. Objectives: To identify the risk factors for HNC and the correlation between these factors and the involved anatomical sites. Methods: We retrieved and analyzed health records of patients that met the inclusion criteria for HNC managed at our facility in a 10-year period using the International Classification of Diseases (ICD) version 10. Results: We studied 122 patients with a male to female ratio of 2.1:1 aged 13 years to 85 years (mean = 51 years). Alcohol ( P = .02), cigarette smoking ( P = .01), and cooking wood smoke ( P = .01) were associated with advanced tumor stage. Conclusions: The strongest risk factors for HNC are alcohol, tobacco, HIV, agricultural chemicals, and cooking wood fumes in both sexes in their sixth and seventh decades.

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Gabapentin for the treatment of pain related to radiation-induced mucositis in patients with head and neck cancers treated with intensity modulated radiation therapy (IMRT)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.16513 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 16513-16513 ◽

Cited By ~ 1

Author(s):

V. Bar Ad ◽

S. Both ◽

P. Dutta ◽

H. Quon

Keyword(s):

Radiation Therapy ◽

Retrospective Study ◽

Head And Neck ◽

Pain Control ◽

Radiation Treatment ◽

Pain Medication ◽

Head And Neck Cancers ◽

Median Dose ◽

Concomitant Boost ◽

Radiation Induced

16513 Background: Gabapentin has been reported to effectively treat multiple neuropathic pain syndromes. This retrospective study evaluates the efficacy of gabapentin for the treatment of pain related to radiation induced mucositis, in patients with head and neck cancers, treated with radiation therapy (RT). Methods: This retrospective study includes 30 pts with head and neck cancers, treated with RT, without concomitant or induction chemotherapy. IMRT planning was performed using a concomitant boost technique with a median dose of 54 Gy, 63 Gy, and 66 Gy delivered to the low risk clinical tumor volume (CTV), high risk CTV and boost target volume, respectively, using 30- 34 fractions. The dose of gabapentin was gradually increased starting on the second week of RT from 600 mg/day to the dose of 2700 mg/d over the course of one week. Narcotic pain medication (Roxicodone) was prescribed as needed. Results: 26 (86%) pts required no pain medication during the first two weeks of RT, despite the presence of grade 1 and/or 2 mucositis in 24 of them. During the third and fourth weeks of RT, 28 (93%) pts were treated with a median dose of 2700 mg/day of gabapentin, with only 3 (10%) pts requiring low dose narcotic pain medication, 15–30 mg/day of Roxicodone, added to gabapentin for adequate pain control, despite grade 2 or higher mucositis in 22 pts. During weeks 5 and 6, 28 (93%) pts continued to be treated with a median dose of 2700 mg/day of gabapentin with only 10 (35%) pts requiring 15–40 mg/day of Roxicodone, in addition to gabapentin for pain control, despite the presence of grade 2 or higher mucositis in 23 pts. Only 3% of the pts in this group had delay in RT delivery. Gabapentin was well tolerated with only 13% of pts experiencing mild side effects (somnolence, nausea, or vomiting), which were managed with reducing the dose or changing the dosing schedule. Conclusions: Gabapentin is effective and well-tolerated for the treatment of mucositis-induced pain related to radiation treatment in patients with head and neck cancers, treated with IMRT. We further demonstrate that the use of gabapentin at doses of 2700 mg per day can reduce or eliminate the need for narcotic pain medication. No significant financial relationships to disclose.

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