Introduction: Head and neck radiotherapy, although curative, is associated with significant toxicity affecting the oral cavity. This study aimed to evaluate the prevalence, severity, and weekly progression of acute oral complications in a Moroccan cohort. Materials and Methods: A prospective longitudinal observational study was conducted between June and December 2021. Twenty-one patients receiving a cumulative radiation dose of ≥ 60 Gy were followed on a weekly basis. Oral complications were assessed using the World Health Organization (WHO) scale for mucositis, the Seminars in Radiation Oncology (SRO) criteria for xerostomia, and the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0) for dysphagia, dysgeusia, and trismus. Results: By the third week of treatment, 100% of patients had developed mucositis, xerostomia, and dysphagia. Severe complications (Grade 3/4) became predominant by the sixth week, with mucositis observed in 71.5% of patients, xerostomia in 47.6%, and dysphagia in 61.9%. Trismus affected 52.4% of the study population. Temporary interruption of radiotherapy due to treatment-related toxicity occurred in 28.5% of patients. Conclusion: Acute oral complications appeared earlier and were more severe than those reported in international studies. This finding may be attributed to the absence of systematic pre-treatment dental management and preventive care protocols.
Cite this paper
Adnane, S. , Saber, E. and Haitami, S. (2026). Frequency and Evolution of Acute Oral Complications in Patients Undergoing Head and Neck Radiotherapy. Open Access Library Journal, 13, e15530. doi: http://dx.doi.org/10.4236/oalib.1115530.
Barsouk, A., Aluru, J.S., Rawla, P., Saginala, K. and Barsouk, A. (2023) Epidemiology, Risk Factors, and Prevention of Head and Neck Squamous Cell Carcinoma. <i>Medical</i> <i>Sciences</i>, 11, Article 42. <br>https://doi.org/10.3390/medsci11020042
Alterio, D., Marvaso, G., Ferrari, A., Volpe, S., Orecchia, R. and Jereczek-Fossa, B.A. (2019) Modern Radiotherapy for Head and Neck Cancer. <i>Seminars</i> <i>in</i> <i>Oncology</i>, 46, 233-245. <br>https://doi.org/10.1053/j.seminoncol.2019.07.002
Lohia, S., Rajapurkar, M., Nguyen, S.A., Sharma, A.K., Gillespie, M.B. and Day, T.A. (2014) A Comparison of Outcomes Using Intensity-Modulated Radiation Therapy and 3-Dimensional Conformal Radiation Therapy in Treatment of Oropharyngeal Cancer. <i>JAMA</i> <i>Otolaryngology</i>—<i>Head</i> <i>&</i> <i>Neck</i> <i>Surgery</i>, 140, 331-337. <br>https://doi.org/10.1001/jamaoto.2013.6777
Anderson, G., Ebadi, M., Vo, K., Novak, J., Govindarajan, A. and Amini, A. (2021) An Updated Review on Head and Neck Cancer Treatment with Radiation Therapy. <i>Cancers</i>, 13, Article 4912. <br>https://doi.org/10.3390/cancers13194912
Saxena, V., Shoukath, S., Tiwari, N., Kumari, S.M. and Bachani, K. (2025) Oral Health-Related Quality of Life among Head and Neck Cancer Patients: Integrating Public Health Dentists in Comprehensive Care. <i>World</i> <i>Journal</i> <i>of</i> <i>Dentistry</i>, 16, 767-774. <br>https://doi.org/10.5005/jp-journals-10015-2693
Moslemi, D., Nokhandani, A.M., Otaghsaraei, M.T., Moghadamnia, Y., Kazemi, S. and Moghadamnia, A.A. (2016) Management of Chemo/Radiation-Induced Oral Mucositis in Patients with Head and Neck Cancer: A Review of the Current Literature. <i>Radiotherapy</i> <i>and</i> <i>Oncology</i>, 120, 13-20. <br>https://doi.org/10.1016/j.radonc.2016.04.001
Chiu, Y., Tseng, W., Ko, J. and Wang, T. (2022) Radiation-Induced Swallowing Dysfunction in Patients with Head and Neck Cancer: A Literature Review. 121, 3-13. <br>https://doi.org/10.1016/j.jfma.2021.06.020
Morais, M.O., Martins, A.F.L., de Jesus, A.P.G., de Sousa Neto, S.S., da Costa, A.W.F., Pereira, C.H., <i>et al</i>. (2020) A Prospective Study on Oral Adverse Effects in Head and Neck Cancer Patients Submitted to a Preventive Oral Care Protocol. <i>Supportive</i> <i>Care</i> <i>in</i> <i>Cancer</i>, 28, 4263-4273. <br>https://doi.org/10.1007/s00520-019-05283-1
Palmieri, M., Sarmento, D.J.S., Falcão, A.P., Martins, V.A.O., Brandão, T.B., Morais-Faria, K., <i>et al</i>. (2021) Frequency and Evolution of Acute Oral Complications in Patients Undergoing Radiochemotherapy Treatment for Head and Neck Squamous Cell Carcinoma. <i>Ear</i>, <i>Nose</i> <i>&</i> <i>Throat</i> <i>Journal</i>, 100, 449S-455S. <br>https://doi.org/10.1177/0145561319879245
van der Laan, H.P., Bijl, H.P., Steenbakkers, R.J.H.M., van der Schaaf, A., Chouvalova, O., Vemer-van den Hoek, J.G.M., <i>et al</i>. (2015) Acute Symptoms during the Course of Head and Neck Radiotherapy or Chemoradiation Are Strong Predictors of Late Dysphagia. <i>Radiotherapy</i> <i>and</i> <i>Oncology</i>, 115, 56-62. <br>https://doi.org/10.1016/j.radonc.2015.01.019
Jensen, S.B., Pedersen, A.M.L., Vissink, A., Andersen, E., Brown, C.G., Davies, A.N., <i>et al</i>. (2010) A Systematic Review of Salivary Gland Hypofunction and Xerostomia Induced by Cancer Therapies: Prevalence, Severity and Impact on Quality of Life. <i>Supportive</i> <i>Care</i> <i>in</i> <i>Cancer</i>, 18, 1039-1060. <br>https://doi.org/10.1007/s00520-010-0827-8
Germano, F., Melone, P., Testi, D., Arcuri, L., Marmiroli, L., Petrone, A., <i>et al</i>. (2015) Oral Complications of Head and Neck Radiotherapy: Prevalence and Management. <i>Minerva </i><i>Stomatologica</i>, 64, 189-202.
Loh, S.Y., Mcleod, R.W.J. and Elhassan, H.A. (2017) Trismus Following Different Treatment Modalities for Head and Neck Cancer: A Systematic Review of Subjective Measures. <i>European</i> <i>Archives</i> <i>of</i> <i>Oto-Rhino-Laryngology</i>, 274, 2695-2707. <br>https://doi.org/10.1007/s00405-017-4519-6
Jeremic, G., Venkatesan, V., Hallock, A., Scott, D., Hammond, A., Read, N., <i>et al</i>. (2011) Trismus Following Treatment of Head and Neck Cancer. <i>Journal of Otolaryngology</i>, 40, 323-329.
Bensadoun, R., Riesenbeck, D., Lockhart, P.B., Elting, L.S., Spijkervet, F.K.L. and Brennan, M.T. (2010) A Systematic Review of Trismus Induced by Cancer Therapies in Head and Neck Cancer Patients. <i>Supportive</i> <i>Care</i> <i>in</i> <i>Cancer</i>, 18, 1033-1038. <br>https://doi.org/10.1007/s00520-010-0847-4
Kouri, M., Vadalouca, A., Kouloulias, V., Papadopoulou, E., Vardas, E., Kyrodimos, E., <i>et al</i>. (2021) Oral Complications of Head and Neck Cancer Therapy. <i>Forum</i> <i>of</i> <i>Clinical</i> <i>Oncology</i>, 12, 52-66. <br>https://doi.org/10.2478/fco-2019-0016
Moussa, C., Estrade, L., Glomet, J., Rochefort, G.Y., Denis, F. and Daou, M.H. (2025) The Impact of Preventive Protocols on Oral Health Outcomes in Cancer Patients Undergoing Chemotherapy or Radiotherapy: A Systematic Review and Meta-Analysis. <i>Diseases</i>, 13, Article 186. <br>https://doi.org/10.3390/diseases13060186
Klausner, G., Bensadoun, R.J., Champion, A., Benzaquen, D., Canova, C.H., Claren, A., <i>et al</i>. (2021) État de l’art de la photobiomodulation dans la prise en charge des effets secondaires de la radiothérapie: Indications et niveaux de preuve. <i>Cancer</i>/<i>Radiothérapie</i>, 25, 584-592. <br>https://doi.org/10.1016/j.canrad.2021.06.025
Cronshaw, M., Parker, S., Anagnostaki, E., Mylona, V., Lynch, E. and Grootveld, M. (2020) Photobiomodulation and Oral Mucositis: A Systematic Review. <i>Dentistr</i><i>y</i> <i>Journal</i>, 8, Article 87. <br>https://doi.org/10.3390/dj8030087
Galiano-Castillo, N., Liu, L., Lozano-Lozano, M., Tumilty, S., Cantarero-Villanueva, I. and Baxter, G.D. (2021) Acute and Cumulative Benefits of Photobiomodulation for Xerostomia: A Systematic Review and Meta-Analysis. <i>Oral</i> <i>Diseases</i>, 27, 1115-1126. <br>https://doi.org/10.1111/odi.13648
Louzeiro, G.C., Cherubini, K., de Figueiredo, M.A.Z. and Salum, F.G. (2020) Effect of Photobiomodulation on Salivary Flow and Composition, Xerostomia and Quality of Life of Patients during Head and Neck Radiotherapy in Short Term Follow-Up: A Randomized Controlled Clinical Trial. <i>Journal</i> <i>of</i> <i>Photochemistry</i> <i>and</i> <i>Photobiology</i> <i>B</i>: <i>Biology</i>, 209, Article ID: 111933. <br>https://doi.org/10.1016/j.jphotobiol.2020.111933