A MEDLINE search early in 2015 revealed more than 250,000 papers on head and neck cancer; over 100,000 on oral cancer; and over 60,000 on mouth cancer. Not all publications contain robust evidence. We endeavour to encapsulate the most important of the latest information and advances now employed in practice, in a form comprehensible to healthcare workers, patients and their carers. This series offers the primary care dental team in particular, an overview of the aetiopathogenesis, prevention, diagnosis and multidisciplinary care of mouth cancer, the functional and psychosocial implications, and minimization of the impact on the quality of life of patient and family.
Clinical Relevance: This article offers the dental team an overview of the use of radiotherapy, and its effects on the mouth and other tissues.
Article
Radiotherapy (RT) uses high-energy rays to destroy cancer cells, while trying to minimize harm to normal cells. X-rays were the first form of photon radiation to be used to treat cancer. The higher the energy of the x-ray beam, the deeper x-rays penetrate the target. The daily radiation dose must be enough to destroy cancer cells while minimizing damage to normal tissues: typically 2 Gy is delivered daily to a 64–70 Gy total dose (Gray [Gy] = energy absorption of 1 joule/kg [1 Gy = 100 rads]).
Radiotherapy alone is used to treat some types of mouth and oropharyngeal cancers. RT is an extremely effective treatment for oral squamous cell carcinoma (OSCC), sometimes as a primary modality or as an adjuvant following surgery. RT may be used as the sole treatment modality for primary oral cancers without obvious lymph node involvement, for base of tongue cancers and also for inoperable tumours. Even if surgery is the main treatment, radiotherapy may still be recommended after surgery to ablate any residual cancer cells, lowering the risk of recurrences. Radiotherapy complicates any further surgery because, in particular, the radiation endarteritis impedes tissue healing, predisposing to osteoradionecrosis. Radiotherapy may also be used palliatively to shrink a tumour or stop bleeding from it. It can also relieve symptoms if a cancer has metastasized elsewhere.
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