ABSTRACT
Objetivos: Os objetivos deste estudo foram avaliar os aspectos dosimétricos do uso do estabilizador bucal em reduzir a dose de irradiação nos tecidos saudáveis em pacientes com câncer de boca e orofaringe submetidos à radioterapia conformada tridimensional (3D) e radioterapia de intensidade modulada do feixe (IMRT) e, analisar a incidência das complicações orais decorrente do tratamento e sua relação com as técnicas de irradiação. Materiais e Métodos: Um total de 53 pacientes com câncer de cavidade oral (n = 38) e orofaringe (n = 15), foram prospectivamente avaliados e alocados em três grupos: Grupo 1 (cavidade oral parte inferior, n = 29), Grupo 2 (cavidade oral parte superior, n = 9) e Grupo 3 (orofaringe, n= 15). Para o planejamento radioterápico e avaliação dosimétrica, o mesmo paciente foi submetido a dois exames de tomografias computadorizadas um com o uso do dispositivo e o outro sem. Todos os pacientes utilizaram o estabilizador bucal durante a radioterapia e foram acompanhados semanalmente em relação aos efeitos colaterais do tratamento. Resultados: Os planejamentos radioterápicos que usaram o estabilizador bucal tiveram menor dose de irradiação nas estruturas saudáveis quando comparado com os planejamentos sem o estabilizador bucal em todos os grupos, principalmente na técnica IMRT. As glândulas parótidas contralaterais e os ossos gnáticos foram as estruturas saudáveis mais poupadas da dose de irradiação. A mucosite foi a complicação oral mais frequente durante a RT...
Objetive: The aims of this study were to evaluate the dosimetric features of intraoral stent in reducing the radiation dose in healthy tissue in patients with oral and oropharyngeal cancer undergoing three-dimensional conformal radiotherapy (3D) or intensity-modulated radiotherapy (IMRT) and, to analyze the incidence of oral complications and its relation with radiation techniques. Materials and Methods: A total of fifty-three patients with oral cavity (n = 38) and oropharynx (n = 15) cancer were prospectively evaluated and allocated into three groups: Group 1 (tumor located in lower oral cavity, n = 29), Group 2 (tumor located in upper oral cavity, n = 9) and Group 3 (oropharynx, n = 15). For radiotherapy planning and dosimetric analysis, the same patient underwent two CT scans - one with the use of the stent and the other without it. All patients used the stent during radiotherapy and were followed-up on a weekly basis to verify possible side effects. Results: In all three groups, the radiotherapy planning with intraoral stent showed significant lower irradiation dose in healthy structures when compared to the planning without the stentthis was particularly clear with the use of the IMRT technique. The contralateral parotid gland and jawbones were the healthy tissues better preserved. The most frequent oral complications verified during RT were mucositis. Interestingly, oral ulcerations were seem, in Group 1, only on the floor of mouth, tongue and lower lip, not affecting the upper oral mucosa. In addition, 3D-treated patients experienced more severe acute dysphagia and dysgeusia than IMRT-treated patients...
Subject(s)
Humans , Radiometry , Mouth Neoplasms , Oropharyngeal Neoplasms , Radiotherapy, Conformal , Radiotherapy, Intensity-ModulatedABSTRACT
OBJECTIVE: To determine whether an intraoral stent may decrease radiation dose to health tissues during intensity-modulated radiotherapy (IMRT) and to evaluate the effect on mucositis. STUDY DESIGN: A total of 33 patients with tongue or floor of the mouth cancer were retrospectively evaluated and divided into 2 groups: group 1 (with stent, n = 19) and group 2 (without stent, n = 14). Data were collected on dosimetric and mucositis outcomes. RESULTS: The mean dose to the maxilla was significantly lower in group 1 (20.9 Gy) than in group 2 (35.8 Gy) (P = .05). The mean dose to the ipsilateral parotid was 35.0 Gy in group 1 vs 41.8 Gy in group 2 (P = .05). No difference was seen in the severity of mucositis between groups (P = .82). However, grade III mucositis was present in group 1 at 4 weeks after IMRT, 1 week after its occurrence in group 2. CONCLUSIONS: A stent was effective in decreasing doses to healthy structures and delaying the emergence of mucositis.
Subject(s)
Mouth Neoplasms/radiotherapy , Mucositis/etiology , Radiation Injuries/prevention & control , Radiation Protection/instrumentation , Radiotherapy, Intensity-Modulated , Stents , Adult , Aged , Aged, 80 and over , Dose-Response Relationship, Radiation , Female , Humans , Male , Maxilla/radiation effects , Middle Aged , Mouth Neoplasms/pathology , Neoplasm Staging , Parotid Gland/radiation effects , Radiation Dosage , Radiometry , Retrospective Studies , Severity of Illness Index , Tongue Neoplasms/pathology , Tongue Neoplasms/radiotherapyABSTRACT
BACKGROUND: The intraoral stent is a mouth-opening device which may be used during head and neck cancer radiotherapy with the intention of preventing unnecessary irradiation in normal adjacent tissue. The use of this device during intensity-modulated radiation therapy (IMRT) has not been reported in the literature. METHODS: A 30-year-old woman with squamous cell carcinoma of the tongue was submitted to a CT for IMRT treatment planning with and without the use of the intraoral stent. RESULTS: Dosimetric analysis showed that the irradiation dose to the maxilla, both parotid glands, and left submandibular gland decreased with the use of this device. CONCLUSION: This article shows that intraoral stents seem to be useful in decreasing the radiation dose to healthy structures, especially in bone structures and salivary glands during radiotherapy, and emphasizes the importance of a multidisciplinary team during oncological therapy.
