Sir, I was interested to read an article regarding The oral management of patients who have received radiotherapy to the head and neck region (BDJ 2013; 214: 387–393). Radiotherapy is a common treatment modality for head and neck cancers and it is important for dental professionals to be able to recognise the many side effects of radiotherapy.1

Working as a dentist in a head and neck oncology department, I think it is also important that patients and healthcare professionals are not only reminded of the fact that cancer patients are generally at a greater risk of developing secondary primary malignancies, but are also aware of the rare but serious risk of developing a secondary malignancy as a result of radiotherapy treatment, due to the mutagenic effects it may cause.

Head and neck radiotherapy induced malignancies (RIM) tend to have a long latency period and can present as swellings or masses which may be mistaken for dental pathology. Research has shown that radiation-induced head and neck sarcomas tend to be detected quite late resulting in poor long term prognosis. They can then be even more challenging to treat especially as radical surgery is sometimes required in a pre-irradiated site and in close proximity to important structures.2 This reinforces the importance of cancer screening and early referrals when abnormalities are detected.

The incidence of RIM are only likely to increase due to progressive ageing of the population and the increased survival of head and neck cancer patients due to better treatment regimes.