Dysphagia in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus

• Six clusters of statements had consensus from a multidisciplinary international expert panel on the management of dysphagia in head and neck cancer patients (HNCPs).
• Before chemo-radiotherapy: general statements and risk factors.
• During chemo-radiotherapy: statements about diagnosis of swallowing dysfunction of HNCPs.
• Statements about the radiotherapic precautions to be adopted in order to reduce their risk of radio-induced dysphagia in HNCPs.
• Statements about preventative and therapeutic exercises to be adopted.

BackgroundHead and neck cancer (HNC) and its therapy are associated with acute and late swallowing dysfunction. Consensus guidelines regarding evaluation and management are lacking. To address this gap, a multidisciplinary team of experts (oncologists, practitioners, deglutologists, etc.) met in Milan 17–18 February 2013 with the aim of reaching a consensus on the management of swallowing difficulties in HNC patients treated with radiotherapy with or without systemic therapies (such as chemotherapy and targeted agents). The consensus was focused particularly on those statements with limited evidence.The results of the literature review and the statements that obtained a consensus are reported and discussed in this paper.Materials and methodsThe Delphi Appropriateness Method was used for this consensus. External expert reviewers then evaluated the conclusions carefully according to their area of expertise.ResultsThis paper contains 6 clusters of statements about the management of swallowing problems in radio-treated HNC patients and a review of the recent literature on these topics.ConclusionsDysphagia assessment and its management are difficult and require a multi-team cooperation (ENT specialists, radiation and medical oncologists, deglutologists, etc.).