Download - ILL EFFECTS OF RADIOTHERAPY IN THE MANAGEMENT OF ORAL CANCER by Dr kashif ali Assistant professor
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ILL EFFECTS OF RADIOTHERAPY IN THE MANAGEMENT OF ORAL CANCER
byDr kashif ali
Assistant professor
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ORAL CANCER
Approximately 90% of oral cancer is SCC
Particularly common in developing world
Multifactorial etiology life styleHabits and
dietOthers
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Other1%
Leukemias5%Lymphomas
9%
Salivary gland tumours
7%
Squamous cell carcinomas
78%
Head & Neck Cancer Diagnosis
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Squamous Cell Carcinoma
• 90% of all oral cancers• 50% 5-year survival• can occur in: • tongue• skin• throat• soft palate
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Treatment plan is based on:
• anatomical considerations
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Treatment plan is based on:
Staging of disease using TNM classification
Eg. T3N2M0 laryngeal carcinoma
T = Tumour sizeN = Nodal statusM = Metastases
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Treatment Options
Primary surgery Primary Radiotherapy
+/- +/-
Adjuvant Radiotherapy
Surgery for Salvage
+/-+/-
Concurrent Chemotherapy
Concurrent Chemotherapy
OR
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Aims of radiotherapy
Radical radiotherapy --- curative intent
Palliative radiotherapy --To control symptoms
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Radiation Therapy
External beam–most common–largest fields
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Radiation Therapy
Brachytherapy–interstitial implantation of
radioisotope-filled needles
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Radiation Therapy
Au grain or Iridium Implants
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Radiation
• How much?
• Where?
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How much radiation?
1 “rad” = 1 centiGray (cGy)
200 cGy per day 5 days per week 1000 cGy per week
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How much radiation?
Total dose ranges from 6000 cGy – 7000 cGy
6 – 7 WEEKS of treatment
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ORAL CANCERTREATMENT MODALTIES
Ablative Surgery Surgery and / or radiotherapy Radiotherapy and Chemotherapy
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ORAL CANCERRADIOTHERAPY
Advantages Normal Anatomy and function Is maintained GA not needed Can be used to debulk inaccessible
lesions
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ORAL CANCERRADIOTHERAPY
Conventionally upto 60 Gys dose is given
Post radiotherapy complaints increase tremendously when the radiation dose is increased
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ORAL CANCERRADIOTHERAPY
ill effects Oral mucositis Xerostomia Loss of tasteOsteoradionecrosis
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Oral mucosaSeen in 1-2 weeksErythema with sever mucositis With or without ulcerationPain and disphagiaLoss of test- test bud atrophyDelayed healing Pale and less vascular mucosaRadiotherapy induced Submucous
fibrosis
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ORAL CANCERRADIOTHERAPY
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Salivary glands
1st week of radiotherapyXerostomia Difficulty in swallowing Nasua Rampant cariesPeriodontitisRecovery 3 to 4 months
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Management
Sipped of water Salivary substitute Mucous based sprays -saliva orthane
sprayCellulose --- glandosane, glycerin Pilocarpine hydrocloride 5mg QIDCevimelive hydroloride 30mg TDSStimulation of exocrine gland
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Skin
Erythema 3rd weekDose greater than 50 gy Healing 7 to 10 days
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Bone
OsteoradionecrosisIs devitilization of bone after
cancericidal dose of radiationEndarteritis Bone turn over become slow,
remolding dose not occur leads to exposed bone
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ORAL CANCERRADIOTHERAPY
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ORAL CANCERRADIOTHERAPY
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ORAL CANCERRADIOTHERAPY
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ORAL CANCERRADIOTHERAPY
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Other effects
Alteration of floraInc anaerobic speciesInc fungi , Candida Nystatin0.1% chlorexidine
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Late effects of radiation
Eyes Cataract 10 gyBlindness 50 gySpinal cord Paraplegia dose Inc 45gyCarotid artery stenosis
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ORAL CANCERRADIOTHERAPY
Conclusion Surgery is the first choice Surgery may be followed by
Radiotherapy or Chemotherapy if required
Where bone is involved, Radiotherapy / Chemotherapy do not work
Radiotherapy / Chemotherapy alone only work as palliative therapy
Radiotherapy must be done under the supervision of experienced oncologist
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ORAL CANCERRADIOTHERAPY
THANK YOU
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Evaluation of dentition before radiotherapy
Most feared side effect is ORN Factor determine the fate of teeth1. Condition of residual dentition-- ?2. Pt awareness – past care pt with good oral hygiene , the
clinician must retain as many of teeth as possible
Neglected oral health --ext
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Factor determine the fate of teeth
3 Immediacy of radiotherapy
4 Radiation location Pre radiation ext considered 1- 2 week
delay radiation5 Radiation doseInc 50 GY--- ext indicated Less than 50 – conservative
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Preparation of dentition for radiotherapy
Pre radiation Restorations Topical fluoride applicationOral hygiene measures and
instructionsPrevention of mechanical trauma Encourage to stop habitts
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Preparation of dentition for radiotherapy cont
Per radiation Rinse mouth with saline at least 10 times
daily Chlorhaxidine mouth wash 2 times Dental evaluation twice a week during
radiotherapy If overgrowth of candida than nystatin /
clotimazole Exercise – maintain mouth opening Weight loss should be checked NG tubes
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Post radiationRegular follow up every 3- 4 weekTopical fluoride
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Method of preparing preirradiation extraction
atraumatic extraction Interval B/w preirradiation ext and
beginning of radiotherapy 7-14 days 3 weeks if possible
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Impacted 3rd molar removal before radiotherapy
Partially erupted Complete embedded
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Carious teeth after radiotherapy
Treatment accordingly Composite , amalgamNecrotic pulp __ RCTIf RCT is difficult – amputation above
the gingiva left at place
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Tooth ext after radiotherapy
4 month gap HBO before and after ext 20- 30 dives
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Denture after radiation
Yes Soft liners