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Head & Neck Cancer - Coggle Diagram
Head & Neck Cancer
Treatment Plan Consideration
staging of the cancer
extent of primary tumour, especially useful if
postoperative radiotherapy is later recommended
note any palpable lymph nodes recorded with a measurement of their size and position, if presence
complex anatomical and functional deficits of organs in head and neck region
cormobidity along with the disease
caridovascular disease
respiratory disease
patient factor
age
patient's personal reference
aim of radiotherapy treatment
radical
70 Gy for 35 fractions in 7 weeks
palliative
60 Gy for 30 fractions in 6 weeks
Treatment Options
3D-Conformal Radiotherapy (3D-CRT)
conform PTV by aid of multileaf collimator (MLC)
Intensity Modulated Radiotherapy (IMRT)
deliver highly conformal sculpted radiation dose to a very complex structure
improved sparing of adjoining critical structures like salivary glands, spinal cord, eyes, brainstem and larynx
better therapeutic gain than 3D-CRT
less normal tissue irradiation on the distal side of tumour as well as proximal side
surgery
only suits for patients which are fit for operation
often comes with neo-adjuvant and adjuvant radiotherapy
concurrent chemo-radiotherapy
Concomitant chemotherapy is given simultaneously with radiation therapy to improve local and distant control
tomotherapy
proton therapy
lower opioid pain requirement at the completion of radiation
lower rate of gastrostomy tube dependance compared to IMRT
lower mean dose to oral cavity, esophagus, larynx and parotid gland
Treatment Complications
acute side effects
occur in the period of 90 days after beginning of radiotherapy
Acute toxic effects to skin & mucous membrane
dysphagia & fatigue
late/chronic side effects
often happen after 90 days from beginning radiotherapy
xerostomia
chronic mucositis
chronic skin toxicity
IMRT has less toxicites compared to conventional RT
recovery of saliva secretions with IMRT is better
IMRT has significantly lower incidence of Grade 3 or
greater xerostomia, acute toxic effects to skin and mucous membranes .
Alternative Treatment
hyperbaric oxygen therapy
reduce the severity of radiation-induced injury by promoting wound healing
increase partial fibroblasts, improving collagen synthesis, and also to improve angiogenesis
faster wound healing of radiation-injured tissues, which is seen to reflect in function
able to preserving salivary gland function
improves overall survival of dental implants in irradiated mandibles
significant improvement in swallowing, subjective increase in salivary quantity, and improved taste