FIGURE 1.

(A) Acute and late toxicity profile of local and systemic chemotherapy. (i) Sagittal view of a CT-scan shows the patient’s tumor (in blue). Local therapy (surgery and radiotherapy) and systemic treatment can result in acute side effects (occurring within the first 90 days of treatment) or chronic side effects (lasting beyond 90 days). Local side effects include dermatitis, mucositis, xerostomia (dry mouth), dysphagia (difficulty swallowing), bleeding, wound healing swelling, and fibrosis. (ii) Systemic side effects are related to the cytotoxic properties of chemotherapy. Increased rates of adverse events (occurring synergistically due to the combination of radiotherapy/chemotherapy) may lead to treatment interruptions, jeopardizing patient outcomes. (B) Kinetics of adverse events over time. The aim of de-escalation trials is to flatten the curve of adverse effects [whether acute (in red) or chronic (in blue)], thereby improving the quality of life of patients with HNSCC and cancer survivors.