David I. Rosenthal, MD
Last Modified: November 1, 2001
Dear OncoLink "Ask the Experts,"
My father-in-law, age 87, recently had surgery to remove squamous cancer in his neck (just below jaw line). He is scheduled to begin radiation tomorrow but is now hesitant to undergo this treatment. His oncologist has told us that he has an 80% chance of survival following the surgery, and a nearly 100% survival-chance w/the radiation. However, with the radiation is likely to cause xerostomia and other side effects. At his age, my father-in-law believes that he does not want his quality-of-life further impaired (he is actually quite healthy and active and does not want to suffer through excessive dry mouth). He is now wondering weather the extra 20% is worth the discomfort and possibly permanent side effects of the radiation treatments. Can you help me understand better what he faces in both scenarioswith and without radiation?
David I. Rosenthal, MD, Director for Head and Neck Radiation Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:
It is a tough decision to make. There are never any guarantees about survival with any cancer treatment. After head and neck surgery for squamous cancer, we know certain tumor and pathology findings suggest a higher than desired risk for relapse. The consequences of relapse are often devastating, life-threatening or can be fatal. In certain circumstances, postoperative radiation can be used to substantially reduce the risks for the tumor coming back at the original site and surrounding the lymph nodes.
The trade off is a price in terms of acute and chronic toxicities and side effects, including xerostomia (dry mouth). There are some drugs that can be used to help prevent xerostomia. Amifostine (a radiation protector) may reduce the chances of developing this problem. If dry mouth develops, a medication called Salagen may help some patients increase salivation. These medications can help some people with this problem, but you need to ask his physician if he is a candidate for these treatments. As with any medication, there can be specific contraindications in any individual case.