Individuals who have been treated with radiation for head and neck cancer are at an increased risk for Radiation Fibrosis Syndrome (RFS). The syndrome can develop at any point following a course of radiation, which means symptoms can begin long after treatment has been completed.
What is RFS and Why Does it Occur?
Radiation is designed to go after cancerous cells, but it can negatively impact non-cancerous cells. In the case of RFS, the non-cancerous cells can have alterations in the production of fibrin, a protein, and as the fibrin builds up, the tissue can become damaged or scarred.
While RSF is possible in anyone who has been treated with radiation, individuals treated with larger quantities of radiation are at an increased risk for developing RFS. As a result, "patients with head and neck cancer (HNC) may . . . have a higher risk for developing RFS due to the high doses of radiation they receive and the critical structures that are often included in the radiation treatment field," explains Michael D. Stubblefield, MD, in his article, "Radiation Fibrosis Syndrome: What It Is and How to Treat It." Individuals treated with radiation for Hodgkin lymphoma are also at risk for RFS due to the types of radiation used. "Patients treated with mantle field, periaortic, inverted-Y, or total nodal radiation therapies for Hodgkin lymphoma (HL), especially if given before the 1990's, are at a particular risk of developing RFS since much higher doses of radiation were generally used."
Like many medical conditions, RFS has a range of symptoms and can be difficult to diagnose. Part of the difficulty in diagnosis stems from the distance symptoms can appear after radiation. "This tends to cause much confusion for both patients and their physicians who often have difficulty believing that a new symptom they develop could be due to in whole or part to radiation they receive years or even decades ago," notes Stubblefield.
RFS Symptoms in Head and Neck Cancer
For those treated for head and neck cancer, RFS can cause complications with the mouth, face, and/or neck.
Trismus - difficulty opening one's mouth
Cervical dystonia - pain, tightness, and/or neck spasms
Facial lymphedema - swelling in the face
Difficulties with speech and swallowing
Physical Therapy as a Tool for RFS
Physical therapy can play an important role following the onset of RFS symptoms. The exact therapy will vary from individual to individual, and could include stretching and strengthening the mouth and/or neck, depending on where the complication is located.
For individuals who develop trismus, physical therapy can help to improve jaw and mouth function. In more complicated instances of the condition, there are jaw stretching devices that can be used to help combat difficulties with opening the mouth.
Memorial Sloan Kettering Cancer Center has complied a very helpful education guide on trismus. It offers four ways to prevent the condition through a combination of massage, jaw exercises, a focus on posture, and an emphasis on oral hygiene.