Nasopharyngeal carcinoma: current management, future directions and dental implications

Nasopharyngeal carcinoma (NPC) is a distinct cancer of the head and neck. Approximately 70% of patients with NPC present with locally advanced disease. Phase III clinical trials support combined chemotherapy and radiotherapy for the initial treatment of these patients. Current treatment approaches for metastatic disease are variable. Oral complications of therapy for NPC are very common. In order to support cancer therapy the dental provider must be aware of the diagnosis, prognosis and approach to treatment. Dental care requires that radiation fields be understood as well as the permanent changes that occur with high dose radiation therapy. Radiation causes changes in bone and soft tissue that may result in acute and chronic oral complications. The most common acute complications are mucositis, infection, xerostomia and taste changes. Mucositis is of increased severity and duration when chemotherapy is combined with radiation therapy. Chronic complications are due to late effects of radiation therapy including hyposalivation, infection, taste change, dysphagia and trismus. Treatment innovations with molecularly targeted therapies and immunotherapy are being assessed to improve treatment outcomes in NPC and will impact oral complications and oral care.