Radiotherapy in Head and Neck Cancer

Complication of radiotherapy:


  1. Skin – erythema, desquamation
  2. Mucosa – mucositis, dry mucosa
  3. Candidiasis
  4. Loss of appetite, nausea, vomitting ( Radiation sickness )
  5. Laryngeal edema
  6. Haematopoietic suppression


  1. Skin – atrophy, fibrosis of subcutaneous tissue
  2. Xerostomia
  3. Eye – retinopathy, cataract
  4. Teeth – decay, osteoradionecrosis
  5. Trismus ( fibrosis of TMJ and muscles of mastication)
  6. Endocrine deficit – thyroid, pituitary
  7. Transverse myelitis
  8. Radiation induced malignancy – thyroid cancer, osteosarcoma

Why patients undergoing Radiotherapy need to have Hemoglobin level above 10g/dl? 

  • Low Hb —> low oxygen carrying capacity —> low oxygen —> less radiation-induced cytotoxic free radicals to kill the tumour cells
  • Free radicals formation: O2  ——> O+ + O+

H2O ——> O+ + OH-

Is inappropiately high Hb good for radiotherapy?

  • No. Increased blood viscosity —-> reduces tumour cell perfusion —–> less free radicals to kill the tumour cells


Definition of Leukoplakia:

  • Premalignant condition
  • Characterised by a white patch or plaque that cannot be characterized clinically or histologically as any other disease. (WHO Definition)
Picture from:
Picture from:

How does Verrucous Carcinoma differ from SCC?

Verrucous Carcinoma: “Ackerman’s tumor.”  – 1st described by Ackerman

  • Uncommon variant of SCC, locally aggressive, clinically exophytic, low-grade, slow-growing, well-differentiated squamous cell carcinoma with minimal metastatic potential.
  • Risk factors: tobacco chewing,  oral snuff  “Snuff dipper’s cancer”, smoking, alcohol, betel nut chewing
  • Good prognosis. Local recurrence is not uncommon, but metastasis to distant parts of the body is rare.
  • Painless, thick white plaque resembling a cauliflower (warty lesion)
  • Commonest site: Oral cavity
  • Treatment: Wide local excision or radiotherapy