Familial Nasopharyngeal Carcinoma 6

Long-Term Complications in the Treatment 22of Nasopharyngeal CarcinomaSimon S. Lo, Jiade J. Lu, and Lin KongCONTENTS22.1 Introduction 27522.2 Xerostomia 27622.2.1 Pathogenesis of Radiation-InducedSalivary Hypofunction 27622.2.2 Clinical Manifestationsand Diagnosis 27622.2.3 Management of Radiation-InducedXerostomia 27822.2.3.1 Symptomatic Relief Using SalivaryReplacements 27822.2.3.2 Cytoprotectant 27822.2.3.3 Salivary-Sparing Radiotherapy 27822.2.3.4 Medical Treatment of Xerostomia 27922.2.3.5 Management of Infectionand Dental Caries 27922.3 Hearing Deficit 27922.3.1 Pathogenesis 28022.3.2 Clinical Manifestationand Diagnosis 28022.3.3 Management 28122.4 Soft Tissue Fibrosis 28122.4.1 Pathogenesis 28122.4.2 Clinical Manifestationand Diagnosis 28222.4.3 Management 28222.5 Cranial Neuropathy 28322.5.1 Pathogenesis 28322.5.2 Clinical Manifestations 284Simon S. Lo, MDDepartment of Radiation Medicine, Arthur G. James CancerHospital, Ohio State University Medical Center, 300 West 10thAvenue, Ste 088A, Columbus, OH 43210, USAJiade J. Lu., MD, MBADepartment of Radiation Oncology, National UniversityCancer Institute, National University Health System, NationalUniversity of Singapore, 5 Lower Kent Ridge Road, Singapore119074, Republic of SingaporeLin Kong, MDDepartment of Radiation Oncology, Fudan University, ShanghaiCancer Center, 270 Dong An Road, Shanghai 200032, P.R. China22.125.5.2.1 Latent Period of CNP 28522.5.3 Management 28522.6 Brainstem and Spinal Cord Injury(Encephalomyelopathy) 28522.6.1 Pathogenesis 28622.6.2 Clinical Manifestationand Diagnosis 28622.6.3 Management 28622.7 Temporal Lobe Necrosis 28722.7.1 Pathogenesis 28722.7.2 Clinical Manifestationand Diagnosis 28722.7.3 Management 28822.8 Neuroendocrine Deficits 28822.8.1 Pathogenesis 28822.8.2 Clinical Manifestationand Diagnosis 28922.8.3 Management 28922.9 Second Primary Tumor 28922.9.1 Pathogenesis 28922.9.2 Clinical Manifestationsand Diagnosis 29022.9.3 Management 29022.10 Summary 290References 291IntroductionRadiation therapy is the mainstay therapeutic modalityfor nasopharyngeal carcinoma (NPC). In the last twodecades, advances in the diagnostic and treatmenttechniques in cancer management have significantlyimproved prognosis of NPC, including the long-termlocal and regional disease control as well as patients’overall survival. With definitive radiation therapy forearly stage disease and combined chemoradiotherapyfor locoregionally advanced disease, the overall