Fabrication of customized tongue-displacing stents: considerations for use in patients receiving head and neck radiotherapy.

BACKGROUND: Conformal or intensity-modulated radiation therapy can be improved by using a customized tongue-displacing (CTD) stent. These stents are designed to either move healthy oral tissues out of the path of the radiation beam or stabilize mobile tissues to allow more precise field control. METHODS: The authors describe CTD stent construction for both tongue-deviating and tongue-depressing applications. RESULTS: CTD stents enable clinicians to achieve more predictable and consistent radiation dosimetry planning while sparing greater volumes of healthy tissue from damage. They have been well tolerated by patients. CONCLUSIONS: Use of CTD stents results in increased oral mucosal sparing, ensures reproducible immobilization and is incorporated readily into the clinical practice of radiation oncology. Practical Implications. Clinicians can reduce or avoid significant morbidity to healthy oral tissues by using CTD stents. This can lead to better outcomes and improved quality of life for patients receiving head and neck radiation therapy.

Radiation associated tumors following therapeutic cranial radiation.

BACKGROUND: A serious, albeit rare, sequel of therapeutic ionizing radiotherapy is delayed development of a new, histologically distinct neoplasm within the radiation field. METHODS: We identified 27 cases, from a 10-year period, of intracranial tumors arising after cranial irradiation. The original lesions for which cranial radiation was used for treatment included: tinea capitis (1), acute lymphoblastic leukemia (ALL; 5), sarcoma (1), scalp hemangioma (1), cranial nerve schwannoma (1) and primary (13) and metastatic (1) brain tumors, pituitary tumor (1), germinoma (1), pinealoma (1), and unknown histology (1). Dose of cranial irradiation ranged from 1800 to 6500 cGy, with a mean of 4596 cGy. Age at cranial irradiation ranged from 1 month to 43 years, with a mean of 13.4 years. RESULTS: Latency between radiotherapy and diagnosis of a radiation-induced neoplasm ranged from 4 to 47 years (mean 18.8 years). Radiation-induced tumors included: meningiomas (14), sarcomas (7), malignant astrocytomas (4), and medulloblastomas (2). Data were analyzed to evaluate possible correlations between gender, age at irradiation, dose of irradiation, latency, use of chemotherapy, and radiation-induced neoplasm histology. Significant correlations existed between age at cranial irradiation and development of either a benign neoplasm (mean age 8.5 years) versus a malignant neoplasm (mean age 20.3; P = 0.012), and development of either a meningioma (mean age 7.0 years) or a sarcoma (mean age 27.4 years; P = 0.0001). There was also a significant positive correlation between latency and development of either a meningioma (mean latency 21.8 years) or a sarcoma (mean latency 7.7 years; P = 0.001). The correlation between dose of cranial irradiation and development of either a meningioma (mean dose 4128 cGy) or a sarcoma (mean dose 5631 cGy) approached significance (P = 0.059). CONCLUSIONS: Our study is the first to show that younger patients had a longer latency period and were more likely to have lower-grade lesions (e.g. meningiomas) as a secondary neoplasm, while older patients had a shorter latency period and were more likely to have higher-grade lesions (e.g. sarcomas).

Cancer pain emergencies: is there a role for radiation therapy?

Emergent cancer pain is a difficult entity to manage. Radiation therapy potentially may be used for its treatment. Several key issues must be addressed in patients with emergent cancer pain before initiating radiation. These issues include whether the necessary diagnostic information is available, whether the tumor will respond rapidly to radiation, and whether there are additional patient factors that will affect treatment. If these questions have been addressed, it is more likely that a successful outcome will be obtained if radiation therapy is used for the management of emergent cancer pain.