ABSTRACT
Intensity-modulated radiotherapy (IMRT) has been a significant technological advance in the field of radiotherapy in recent years. IMRT allows sparing of normal tissue while delivering radical radiation doses to the target volumes. The role of IMRT for parotid salivary gland sparing in head and neck cancer is well established. The utility of IMRT for pharyngeal constrictor muscle and cochlear sparing requires investigation in clinical trials. The current evidence supporting the use of IMRT in various head and neck subsites has been summarized. Sparing of organs at risk allows for dose-escalation to the target volumes, taking advantage of the steep dose-response relationship for squamous cell carcinomas to improve treatment outcomes in advanced head and neck cancers. However, dose-escalation could result in increased radiation toxicity (acute and late), which has to be studied in detail. The future of IMRT in head and neck cancers lies in exploring the use of biological imaging for dose-escalation using targeted dose painting.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/radiotherapy , Clinical Trials as Topic , Cochlea/pathology , Cochlea/radiation effects , Dose-Response Relationship, Radiation , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/radiotherapy , Humans , Pharyngeal Muscles/pathology , Pharyngeal Muscles/radiation effects , Radiation Injuries/prevention & control , Radiation Monitoring , Radiation Oncology/methods , Radiation Oncology/trends , Radiotherapy Dosage , Radiotherapy, ConformalABSTRACT
Dez pacientes portadores de diverticulo de Zenker foram submetidos a diverticulopexia associada a miotomia do musculo cricofaringeo para tratamento dessa afeccao, entre o periodo de 1983 a 1992. A tecnica consiste na disseccao do diverticulo e ancoramento do mesmo a fascia pre-vertebral de modo a ficar invertido, o que impede o seu enchimento com a degluticao. A media de idade dos pacientes era de 78,8 anos e todos tinham o diagnostico de diverticulo confirmado pela historia clinica e pela radiografia contrastada do esofago. Os sintomas mais comuns eram disfagia e regurgitacao, que foram avaliados no pos-operatorio em todos os pacientes...