Complications
Chemotherapy causes immunosuppression. Some practitioners may use cytoproliferative agents to increase white blood cell counts to counter this effect.
Massive hemorrhage may result from tumor erosion into a vessel or the trachea. This may also occur as a consequence of surgery and prior radiation therapy.
Radiation therapy causes widespread fibrosis of all tissues in the treatment field. This may cause long-term problems with wound healing and tissue integrity. Predictors for severe acute toxicity are female sex, lower performance status, higher BMI, and more advanced disease; predictors for late toxicity are female sex and weight loss during radiation therapy.[74]
Cisplatin may cause permanent damage to the inner ear hair cells.
Cisplatin is known to cause renal failure and cystitis.
Dysphagia can be a consequence of laryngeal cancer, persisting during and after treatment, or a consequence of treatment. Surgery to remove all or part of the larynx may significantly alter the native anatomy involved in swallowing. Radiation therapy causes scarring and fibrosis, and leads to similar problems with swallowing.
By nature of the location of the cancer, voice changes or aphonia may occur as a consequence of the disease or the treatment. Voice complications after treatment for laryngeal cancer are almost universal. Both surgery and radiation may change the laryngeal architecture, causing voice changes of variable duration. Total laryngectomy will lead to aphonia unless the patient undergoes an additional procedure to enable tracheo-esophageal speech.
Overall, studies have indicated that voice and speech degenerate during chemoradiotherapy, improve again 1-2 months after treatment, and exceed pretreatment levels after 1 year or longer. However, voice and speech measures do not show normal values before or after treatment. Given the large time range of posttreatment data, missing baseline assessments, and the inclusion of non-laryngeal sites of disease and radiation in some studies, there is an urgent need for structured standardized multidimensional speech and voice assessment protocols in patients with advanced head and neck cancer treated with chemoradiotherapy.[75]
Total laryngectomy leaves a patient with a tracheostoma as the definitive airway. Bypassing the upper airway significantly decreases the patient's ability to smell. Consequently, the ability to appreciate combined taste and olfactory sensations is also altered.
Cisplatin may cause peripheral nerve damage.
Radiation therapy is a risk factor for developing an esophageal stricture. Total laryngectomy may lead to stricture at the site of pharyngeal closure. This is exacerbated by postoperative radiation therapy. Manifests as difficulty swallowing, and may be treated successfully in some patients with esophageal dilation.
Patients undergoing partial or total laryngectomy are at risk of fistulous communication between the pharynx and the soft tissues of the neck. Aggressive local wound care is sufficient in many, but some require additional reconstructive surgery to correct the problem. The risk of fistula formation is much higher in patients who have undergone radiation to the neck before surgery. Choice of surgical technique and correction of malnutrition helps to prevent fistula formation.
Radiation therapy may have short- and long-term effects on mucosa and salivary glands, such as mucositis and xerostomia.[76] Predictors for severe acute toxicity are female sex, lower performance status, higher BMI, and more advanced disease; predictors for late toxicity are female sex and weight loss during radiation therapy.[74]
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