Supportive Therapy in OncologySupportive Therapy in OncologyПоддерживающая терапия в онкологии3034-24733034-3178Publishing House ABV Press7910.17650/3034-2473-2026-3-1-43-50REVIEWSОБЗОРНЫЕ СТАТЬИReview ArticleManagement of patients with head and neck cancer undergoing radiation or chemoradiation therapy: from prevention to monitoringВедение пациентов со злокачественными новообразованиями головы и шеи, проходящих курс лучевой или химиолучевой терапии: от профилактики до мониторингаhttps://orcid.org/0000-0002-6835-5567AlievaSevil B.АлиеваСевил Багатуровна
Russian Federation
drsevil@mail.ruhttps://orcid.org/0000-0003-4944-4035ChernykhMarina V.ЧерныхМ. В.
Russian Federation
drsevil@mail.ruhttps://orcid.org/0000-0003-0183-4827ZaderenkoIgor A.ЗадеренкоИ. А.
Russian Federation
drsevil@mail.ruhttps://orcid.org/0000-0001-8983-4500KaledinRuslan R.КалединР. Р.
Russian Federation
drsevil@mail.ruhttps://orcid.org/0000-0001-5231-9927FedoseenkoDmitriy I.ФедосеенкоД. И.
Russian Federation
drsevil@mail.ruN.N. Blokhin National Medical Research Cancer Center of Oncology, Ministry of Health of the Russian FederationФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России2606202631435008042026Copyright ©; 2026, ABV-PressCopyright ©; 2026, АБВ-пресс2026ABV-PressАБВ-прессhttps://stio.abvpress.ru/jour/about/editorialPolicieshttps://stio.abvpress.ru/jour/article/view/79

Radiation therapy is a widely used treatment for head and neck cancer, used alone or in combination with chemotherapy or surgery. Despite its effectiveness, radiation therapy is often associated with undesirable side effects. Some oral complications develop soon after the start of treatment, while others may appear months or even years after completion of therapy. This article presents integrated approaches to managing patients with head and neck tumors that improve treatment outcomes and patient quality of life. Integrative, symptom-based approaches may improve patient outcomes; however, data on their use and impact in real-world clinical practice are still limited.

This article presents preventive and therapeutic measures and provides treatment recommendations.

Лучевая терапия – широко используемый метод лечения рака области головы и шеи, который может применяться как самостоятельно, так и в комбинации с химиотерапией или хирургическим лечением. Несмотря на эффективность, лучевая терапия часто сопровождается нежелательными побочными реакциями. Некоторые осложнения со стороны полости рта развиваются вскоре после начала лечения, тогда как другие могут появиться через месяцы или даже годы после завершения терапии. В статье представлены комплексные подходы к ведению пациентов с опухолями головы и шеи, которые способствуют улучшению результатов лечения и качества жизни пациентов. Интегративные подходы, основанные на симптомах, помогают облегчить прохождение курса лечения пациентов, однако данные об их применении и влиянии в реальной клинической практике пока ограничены.

В статье представлены профилактические и лечебные мероприятия и даны рекомендации по лечению.

radiation mucositisradiation dermatitislaser therapydysphagiaлучевой мукозитлучевой дерматитлазерная терапиядисфагияBergamaschi L., Vincini M.G., Zaffaroni M. et al. Management of radiation-induced oral mucositis in head and neck cancer patients: a real-life survey among 25 Italian radiation oncology centers. Support Care Cancer 2023;32(1):38. DOI: 10.1007/s00520-023-08185-5Cheng J., Dong J., Fang Y. et al. Radiation-induced skin injury: a review of pathophysiology, assessment, management, and re-irradiation protocols. Front Oncol 2026;15:1736717. DOI: 10.3389/fonc.2025.1736717Snider J.W. 3rd, Paine C.C. 2nd. Sticky stuff: xerostomia in patients undergoing head and neck radiotherapy – prevalence, prevention, and palliative care. Ann Palliat Med 2020;9(3):1340–50. DOI: 10.21037/apm.2020.02.36Govender R., Gilbody N., Simson G. et al. Post-radiotherapy dysphagia in head and neck cancer: current management by Speech-Language Pathologists. Curr Treat Options Oncol 2024;25(6):703–18. DOI: 10.1007/s11864-024-01198-0Fesinmeyer M.D., Mehta V., Blough D. et al. Effect of radiotherapy interruptions on survival in Medicare enrollees with local and regional head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010;78(3):675–81. DOI: 10.1016/j.ijrobp.2009.08.004Reber E., Gomes F., Vasiloglou M.F. et al. Nutritional risk screening and assessment. J Clin Med 2019;8(7):1065. DOI: 10.3390/jcm8071065Govender R., Wang J., Marston L. et al. Swallowing prehabilitation for people with head and neck cancer: a pilot cluster-randomised feasibility trial of the SIP SMART intervention. BMJ Open 2025;15(9):e103559. DOI: 10.1136/bmjopen-2025-103559Li Y., Zheng H., Bi S. et al. Precision rehabilitation for swallowing dysfunction after radiotherapy in head and neck cancer: current evidence, key controversies, and future perspectives. Front Oncol 2026;16:1732142. DOI: 10.3389/fonc.2026.1732142Vester S., Muhr A., Meier J. et al. Prehabilitation of dysphagia in the therapy of head and neck cancer – a systematic review of the literature and evidence evaluation. Front Oncol 2023;13:1273430. DOI: 10.3389/fonc.2023.1273430Common Terminology Criteria for Adverse Events (CTCAE): Version 4.0 / U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. Published: May 28, 2009 (v4.03: June 14, 2010). URL: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm (дата обращения: 24.04.2026).Elad S., Cheng K.K.F., Lalla R.V. et al. Mucositis Guidelines Leadership Group of the MASCC/ISOO. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2020:126(19):4423–31. Erratum in: Cancer 2021;127(19):3700. DOI: 10.1002/cncr.33549. DOI: 10.1002/cncr.33100Xia J., Tao X., Hu Q. et al. Expert consensus on the prevention and treatment of radiochemotherapy-induced oral mucositis. Int J Oral Sci 2025;17:54. DOI: 10.1038/s41368-025-00382-8Lodi G., Franchini R., Warnakulasuriya S. et al. Interventions for treating oral leukoplakia to prevent oral cancer. Cochrane Database Syst Rev 2016;7(7): CD001829. DOI: 10.1002/14651858.CD001829.pub4Stempniewicz A., Ceranowicz P., Warzecha Z. Potential therapeutic effects of gut hormones, ghrelin and obestatin in oral mucositis. Int J Mol Sci 2019;20(7):1534. DOI: 10.3390/ijms20071534Ferreira B., da Motta Silveira F.M., de Orange F.A. Low-level laser therapy prevents severe oral mucositis in patients submitted to hematopoietic stem cell transplantation: a randomized clinical trial. Support Care Cancer 2016;24(3):1035–42. DOI: 10.1007/s00520-015-2881-8Hu K.S., Shah P.H., Nguyen M.C. et al. Safety and efficacy of an LED-based intraoral device for daily photobiomodulation therapy prior to radiation treatment in reducing severity of oral mucositis in head and neck cancer patients: abstract 13. 2026 Multidisciplinary Head and Neck Cancers Symposium (February 19–21, 2026), Oral Scientific Sessions. Int J Radiat Oncol Biol Phys 2026;00:9.Shrateh O.N., Habib A., Shamsi H.U.R. et al. Treatment options for radiation-induced xerostomia in patients with head and neck cancer: a systematic review and meta-analysis. Br J Oral Maxillofa Surg 2026;64(1)624–32. DOI: 10.1016/j.bjoms.2025.10.003Forde E., Van den Berghe L., Buijs M. et al. Practical recommendations for the management of radiodermatitis: on behalf of the ESTRO RTT committee. Radiat Oncol 2025;20:46. DOI: 10.1186/s13014-025-02624-9Huang C.J., Hou M.F., Luo K.H. et al. RTOG, CTCAE and WHO criteria for acute radiation dermatitis correlate with cutaneous blood flow measurements. Breast 2015;24(3):230–6. DOI: 10.1016/j.breast.2015.01.008Nathan C.O., Asarkar A. Current management of xerostomia in head and neck cancer patients. Am J Otolaryngol 2023;44(4):103867. DOI: 10.1016/j.amjoto.2023.103867Koukourakis M.I., Danielidis V. Preventing radiation induced xerostomia. Cancer Treat Rev 2005;31(7):546–54. DOI: 10.1016/j.ctrv.2005.07.006Kahn S.T., Johnstone P.A. Management of xerostomia related to radiotherapy for head and neck cancer. Oncology (Williston Park) 2005;19(14):1827–32; discussion 1832–4, 1837–9. PMID: 16506635.Pow E.H.N., Kwong D.L.W., McMillan A.S. et al. Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: Initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys 2006;66(4)981–991. DOI: 10.1016/j.ijrobp.2006.06.013Wang X., Eisbruch A. IMRT for head and neck cancer: reducing xerostomia and dysphagia. J Radiat Res 2016;57(Suppl. 1):i69–i75. DOI: 10.1093/jrr/rrw047Buentzel J., Glatzel M., Frohlich D. Late toxicities due to multimodal treatment of head and neck cancer. Int J Radiat Oncol Biol Phys 2004;60(1).Holländer-Mieritz C., Johansen J., Johansen C. et al. Comparing the patients’ subjective experiences of acute side effects during radiotherapy for head and neck cancer with four different patient-reported outcomes questionnaires. Acta Oncol 2019;58(5):603–9. DOI: 10.1080/0284186X.2018.1563713Di Maio M., Basch E., Denis F. et al. The role of patient-reported outcome measures in the continuum of cancer clinical care: ESMO Clinical Practice Guideline. Ann Oncol 2022;33(9):878–92. DOI: 10.1016/j.annonc.2022.04.007Sin S.Y., Chua M.L.K., Wong S.M.M. et al. An evaluation of concordance between head and neck advanced practice radiation therapist and radiation oncologists in toxicity assessment for nasopharyngeal carcinoma patients. Tech Innov Patient Support Radiat Oncol 2021;19:52–6. DOI: 10.1016/j.tipsro.2021.08.001Sakai Y., Katsura K., Kanemitsu Y. et al. Patient-reported oral adverse events during cancer chemotherapy: longitudinal evaluation using patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE) and concordance with clinician assessments. Support Care Cancer 2025;33(12):1059. DOI: 10.1007/s00520-025-10126-3Salama V., Youssef S., Xu T. et al. Temporal characterization of longitudinal sequelae including acute pain, physiologic status, and toxicity kinetics in head and neck cancer patients receiving radiotherapy: A prospective electronic health record embedded registry study. Acut Pain 2022. DOI: 10.1101/2022.05.05.22274717Falchook A.D., Green R., Knowles M.E. et al. Comparison of patient- and practitioner-reported toxic effects associated with chemoradiotherapy for head and neck cancer. JAMA Otolaryngol Head Neck Surg 2016;142(6):517–23. DOI: 10.1001/jamaoto.2016.0656Sandler K.A., Mitchell S.A., Basch E. et al. Content validity of anatomic site-specific Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) Item sets for assessment of acute symptomatic toxicities in radiation oncology. Int J Radiat Oncol Biol Phys 2018;102(1):44–52. DOI: 10.1016/j.ijrobp.2018.04.048Underwood J., McCloskey S., Raldow A. et al. Developing a mobile Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events Administration System to capture postradiation toxicity in oncology: usability and feasibility study. JMIR Form Res 2022;6(4):e27775. DOI: 10.2196/27775van Aken E.S.M., Devnani B., Castelo-Branco L. et al. ESMO-ESTRO framework for assessing the interactions and safety of combining radiotherapy with targeted cancer therapies or immunotherapy. Radiotherapy and Oncology 2025;208:110910. DOI: 10.1016/j.radonc.2025.110910