Normal tissue complications and protection in head and neck cancer patients

It has been long recognized that radiotherapy, surgery, and chemotherapy for head and neck (H&N) cancer cause a wide range of acute and late morbidities. These effects impact general and H&N-specific symptoms, quality of life, and critical functions. The increasing use of altered fractionation and chemoradiation has led to a substantial increase in both acute and late toxicity. Countering this is the growing use of intensity-modulated radiation which has lowered dry mouth-related issues and targeted agents which are associated with less complex/lower burden toxicity profiles. In this chapter, we discuss issues in toxicity measures and reporting methods. We also discuss the management of mucositis, swallowing disorders, and osteonecrosis.