ABSTRACT
PURPOSE: The study aims to assess the feasibility of Tomotherapy-based image-guided radiotherapy (IGRT) to reduce the aspiration risk in patients with non-laryngeal and non-hypopharyngeal cancer. A retrospective review of 48 patients undergoing radiation for non-laryngeal and non-hypopharyngeal head and neck cancers was conducted. All patients had a modified barium swallow (MBS) prior to treatment, which was repeated one month following radiotherapy. Mean middle and inferior pharyngeal dose was recorded and correlated with the MBS results to determine aspiration risk. RESULTS: Mean pharyngeal dose was 23.2 Gy for the whole group. Two patients (4.2%) developed trace aspiration following radiotherapy which resolved with swallowing therapy. At a median follow-up of 19 months (1-48 months), all patients were able to resume normal oral feeding without aspiration. CONCLUSION AND CLINICAL RELEVANCE: IGRT may reduce the aspiration risk by decreasing the mean pharyngeal dose in the presence of large cervical lymph nodes. Further prospective studies with IGRT should be performed in patients with non-laryngeal and non-hypopharyngeal head and neck cancers to verify this hypothesis.
Subject(s)
Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/radiotherapy , Radiotherapy, Image-Guided/adverse effects , Adult , Aged , Aged, 80 and over , Barium Sulfate , Female , Humans , Male , Middle Aged , Neoplasm Staging , Radiotherapy Dosage , Retrospective StudiesABSTRACT
PURPOSE: To compare the dosimetry of tomotherapy and the conventional half-beam technique (HBT) or non-split beam technique (NSBT) for target coverage and radiation dose to the lacrimal glands and lens. PATIENTS AND METHODS: A retrospective review of 7 patients with Graves' ophthalmopathy who had radiotherapy because of disease progression on high steroid dose is reported: 3 patients were treated with tomotherapy and 4 patients with HBT. RESULTS: Compared to HBT, tomotherapy may provide better target coverage and significant reduction of radiation dose to the lacrimal glands and a higher dose to the lens. The NSBT improved target coverage but resulted in significantly higher doses to the lens and lacrimal glands. CONCLUSION: Tomotherapy may provide better coverage of the target volume and may be more effective in reducing severe exophthalmos compared to the conventional radiotherapy technique.
Subject(s)
Graves Ophthalmopathy/radiotherapy , Radiotherapy, Intensity-Modulated/instrumentation , Tomography, Spiral Computed/instrumentation , Adult , Anti-Inflammatory Agents/administration & dosage , Drug Resistance , Feasibility Studies , Female , Follow-Up Studies , Humans , Middle Aged , Prednisone/administration & dosage , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Retrospective Studies , Young AdultABSTRACT
UNLABELLED: Platinum-based chemotherapy has been reported to induce diabetes and hyperosmolar coma in nondiabetic patients. The aim of the present study was to determine whether the administration of chemoradiation for head and neck carcinoma alters glucose metabolism during and after treatment. PATIENTS AND METHODS: Weekly nonfasting serum glucose level was obtained during treatment of one hundred and six patients with locally advanced head and neck cancer who underwent chemoradiationt. RESULTS: For the 91 non-diabetic patients, mean serum glucose level measured 97.75 before and 102.1, 102, 104.1, 109.1, 109.7, 110.3, 109.8, 113.2, 107.7 and 104.3 mg/dl during weeks 1-10 of treatment respectively. Serum glucose level elevation reached statistical significance for weeks 5-8. CONCLUSION: Chemoradiation for head and neck cancer may produce severe glucose metabolism alteration during treatment.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Blood Glucose/metabolism , Head and Neck Neoplasms/blood , Head and Neck Neoplasms/therapy , Hyperglycemia/chemically induced , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Blood Glucose/drug effects , Blood Glucose/radiation effects , Cisplatin/administration & dosage , Cisplatin/adverse effects , Combined Modality Therapy , Female , Fluorouracil/administration & dosage , Fluorouracil/adverse effects , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Humans , Hyperglycemia/blood , Male , Middle Aged , Mucositis/blood , Mucositis/chemically induced , Radiotherapy/adverse effects , Retrospective StudiesABSTRACT
The effectiveness of the cough reflex in patients who aspirated following radiation for head and neck cancer was evaluated in 89 patients (49 chemoradiation, 33 postoperative radiation, and 7 radiation alone). All patients had modified barium swallow because of dysphagia. The cough reflex was graded as present and effective, ineffective, intermittently effective, or absent. All patients were cancer-free at the time of the swallowing study. The cough reflex was present and effective in 46 patients (52%), ineffective in 17 patients (19%), and absent in 26 patients (29%) on initial investigation. Among the 43 patients who had ineffective or absent cough reflex, their treatment was chemoradiation (26), postoperative radiation (13), and radiation alone (4). In 30 patients who had sequential modified barium swallow, the cough reflex was constantly effective, ineffective, or intermittently effective in 12 (40%), 13 (43%), and 5 (17%) patients, respectively. The cough reflex was frequently ineffective or absent in patients who aspirated following radiation for head and neck cancer. Cough may also be intermittently ineffective to protect the airways following radiation.
