Prevention and Management of Aspiration Pneumonitis in Patients Undergoing Radiotherapy for Head and Neck Malignancies

Aspiration pneumonia is a common complication in head and neck cancer patients undergoing chemoradiation therapy, associated with significant morbidity and mortality. Dysphagia is the primary precursor to aspiration events. Radiation dose to anatomical structures involved in swallowing is the critical link between radiotherapy and aspiration risk. Incidence rates of aspiration pneumonia vary by tumor site, with higher rates for hypopharyngeal and nasopharyngeal cancers. Acute aspiration pneumonia during treatment can lead to interruptions, negatively impacting tumor control. Chronic aspiration remains a long-term concern. Sparing at-risk organs using intensity-modulated radiotherapy shows promise for reducing dysphagia and potentially aspiration pneumonia. Additional prevention strategies include swallowing assessments, postural and dietary modifications, and multidisciplinary care. Diagnosis requires clinical suspicion, characteristic imaging, and microbiological studies. Treatment involves antibiotics, supportive measures, and coordination with pulmonary specialists. Radiation oncologists play critical roles in treatment planning, surveillance, diagnosis, patient education, and multidisciplinary collaboration.