Functional Preservation and Quality of Life in Head and Neck Radiotherapy (eBook)

Foreword 6
Preface 7
Contents 9
Epidemiology and Treatment Outcome 12
1 Oral Cavity Cancer 13
1.1 Epidemiology and Treatment Outcome 13
References 23
2 Oropharynx: Epidemiology and Treatment Outcome 25
2.1 Introduction 26
2.2 Epidemiology 26
2.3 Staging 27
2.4 Treatment by Stages 28
2.5 Radiation Therapy Technique: Three-Dimensional Conformal Radiation Therapy vs. Intensity-Modulated Radiotherapy 31
2.6 Treatment-Related Toxicities 32
2.7 Conclusion 36
References 36
3 Hypopharynx 40
3.1 Introduction 40
3.2 Epidemiology and Etiology 41
3.3 Staging 41
3.4 Patterns of Spread 42
3.5 Clinical Presentation 42
3.6 Treatment Strategies 42
3.7 Quality of Life 44
3.8 Conclusion 48
References 48
4 Laryngeal Cancer: Epidemiology and Treatment Outcomes 51
4.1 Anatomy 51
4.2 Epidemiology and Risk Factors 52
4.3 Diagnostic Evaluation 52
4.4 Staging 52
4.5 Selection of Treatment Modality for Glottic Carcinoma 52
4.6 Selection of Treatment Modality for Supraglottic Carcinoma 54
4.7 Results of Treatment 55
References 62
5 Nasopharynx 65
5.1 Epidemiology 65
5.2 Current Treatment Recommendations 67
5.3 Treatment Outcome 69
5.4 Final Remarks 78
References 78
6 Paranasal Sinus and Nasal Cavity 82
6.1 Epidemiology 83
6.2 Diagnosis and Staging 83
6.3 Treatment 83
6.4 Follow-Up 91
6.5 Treatment of Recurrence 91
6.6 Cancer of the Nasal Vestibule 91
References 92
7 Salivary Glands and Quality of Life 95
7.1 Introduction 95
7.2 Epidemiology and Treatment Outcome 96
7.3 The Role of Radiotherapy 98
7.4 Factors In. uencing QOL in Salivary Gland Tumors 98
7.5 Radiation Techniques to Reduce the Complication Risks 102
7.6 Conclusion 104
References 105
8 Head and Neck Sarcomas and Lymphomas 108
8.1 Introduction 109
8.2 Evaluation and Diagnosis 109
8.3 Treatment of Sarcoma 111
8.4 Treatment of Lymphomas of the Head and Neck 117
References 118
9 Thyroid Cancer 121
9.1 Incidence 121
9.2 Types of Thyroid Cancer 122
9.3 Diagnosis 122
9.4 Management 124
References 128
10 Cervical Lymph Node Metastases from Unknown Primary Tumors 129
10.1 Introduction 129
10.2 Incidence 130
10.3 Diagnostic Workup 130
10.4 Treatment 131
10.5 Follow-Up 133
10.6 Prognostic Factors 133
10.7 Patterns of Failure 134
10.8 Morbidity 135
10.9 Conclusions and Future Directions 135
References 135
Treatment Techniques with Potential Impact on QOL 137
11 Dysphagia-Related Quality of Life of Patients 138
11.1 Introduction 139
11.2 Patients and Methods 139
11.3 Results 142
11.4 Discussion 142
11.5 Conclusions 145
References 146
12 Improving the Quality of Life of Patients 148
12.1 Introduction 148
12.2 Evolution of Highly Conformal RT: From 2D to 3D and to Intensity-Modulated Radiotherapy and Tomotherapy 149
12.3 IMRT: General Aspects 149
12.4 IMRT for Head and Neck Cancer 149
12.5 Reducing Xerostomia by Highly Conformal Radiotherapy 150
12.6 Efforts to Reduce Dysphagia Related to Chemo-RT of Head and Neck Cancer 152
12.7 Using IMRT to Reduce the Doses to the Swallowing Structures 153
12.8 Effects of Highly Conformal RT on Broad Aspects of QOL 154
References 155
13 Advantages of Proton Beam Therapy 157
13.1 History of Proton Beam Therapy 158
13.2 Rationale of using Proton Beam Therapy for Head and Neck Cancers 158
13.3 Intensity-Modulated Radiation Therapy vs. Intensity-Modulated Proton Therapy 158
13.4 Proton Beam Therapy for Sinonasal Malignancies 159
13.5 Proton Beam Therapy for Nasopharyngeal Carcinoma 160
13.7 Cost-Effectiveness of Proton Beam Therapy 162
13.8 Future Directions 162
References 162
14 Target Definition and Delineation 164
14.1 Introduction 165
14.2 Selection and Delineation of Nodal CTV 165
14.3 Delineation of Primary Tumor GTV with Multimodality Imaging 171
14.4 Selection and Delineation of the Primary Tumor CTV 173
14.5 Conclusion 173
References 174
15 Advanced Techniques 176
15.1 Introduction 177
15.2 Patient Motion in Head and Neck IMRT 177
15.3 Some Means to Control for Intrafraction Patient Motion in Head and Neck IMRT 177
15.4 Possible Consequences of Not Controlling for Inter- and Intrafraction Patient Motion Using Tracking in Head and Neck IMRT 178
15.5 Optical Tracking in Head and Neck IMRT 180
15.6 Summary 182
References 182
16 Adaptive Image-Guided Radiotherapy 184
16.1 Introduction 184
16.2 In-Room Image-Guidance Technologies for ART 185
16.3 Impact of Anatomical Changes During Treatment 186
16.4 Adaptation Strategies 188
References 190
17 Improving Form and Function 192
17.1 Introduction 192
17.2 Oral Cavity 193
17.3 Oropharynx 195
17.4 Larynx and Hypopharynx 197
17.5 Paranasal Sinuses and Skull Base 198
17.6 Neck 199
17.7 Conclusions 200
References 200
18 The Contribution of Chemotherapy 203
18.1 Introduction 203
18.2 Chemotherapy in Multimodality Treatment 204
18.3 Organ Preservation Considerations 204
18.4 The Emerging Role of Cetuximab 206
18.5 Treatment-Related Toxicities 207
18.6 Conclusions 211
References 212
19 Contributions of Targeted Agents 215
19.1 Introduction 215
19.2 Molecular Targeting Agents in HNSCC 216
19.3 Promising Molecular Targets 218
19.4 Toxicity, Morbidity, and Quality of Life with Molecular Targeting Agents 219
References 222
Toxicity, Quality of Life, Prevention, Rehabilitation, Supportive Care 224
20 Late Radiation-Induced Side Effects 225
20.1 Introduction 225
20.2 Assessment of Radiation-Induced Side E. ects 226
20.3 The Impact of Radiation-Induced Toxicity on Quality of Life 227
20.4 Xerostomia 228
20.6 Summary and Conclusion 235
References 235
21 Head and Neck Cancer Quality of Life Instruments 240
21.1 Introduction 240
21.2 Definition of QOL 241
21.3 Available Tools for Measurement of QOL 241
21.4 Challenges in HNC QOL Assessment and Interpretation 243
21.5 Choosing Measures and Assessment Schedules 244
21.6 Summary 245
References 245
22 Measuring and Reporting Toxicity 247
22.1 Introduction 247
22.2 Methods for Measurement of Side E. ects 248
22.3 Comparison of Morbidity Measures 250
22.4 Reporting Toxicity 251
22.5 Conclusion 252
References 252
23 Effects of Radiotherapy on Swallowing Function: Evaluation, Treatment, and Patient-Reported Outcomes 255
23.1 Patient-Reported Outcomes 256
23.2 Swallowing Dysfunction of Radiotherapy 256
23.3 Dysphagia-Specific Quality of Life Measures 257
23.4 Impact of Age on Swallowing Outcomes 258
23.5 Swallowing Evaluation for Patients with Head and Neck Cancer 258
23.6 Swallowing Evaluation and Treatment during Radiotherapy 260
23.7 Recommendations for Improving Comfort During Oral Intake 261
23.8 Evaluation and Treatment of Postradiotherapy Dysphagia 261
23.9 Use of Patient-Reported Outcomes in Clinical Practice 262
23.10 Conclusions 262
References 263
24 Dental Prophylaxis and Care 265
24.1 Pretreatment Oral Evaluation 266
24.2 Oral Care During and After Treatment 268
References 272
25 Smoking Cessation 273
25.1 Health Consequences of Smoking 273
25.2 Evidence-Based Treatment Overview 274
25.3 Motivational Interventions 279
25.4 Benefits of Smoking Cessation 279
25.5 Summary 280
References 280
26 Supportive Therapy Including Nutrition 282
26.1 Introduction 283
26.2 Mucositis 283
26.3 Prevention and Treatment of Oral or Pharyngeal Mucositis 283
26.4 Pain 286
26.5 Taste Alterations 286
26.6 Tobacco 286
26.7 Candidiasis 287
26.8 Skin Toxicity 288
26.9 Nutrition 289
26.10 Conclusion 291
References 291
27 Communication and Palliative Care 294
27.1 Introduction 294
27.2 The Palliative Care Comprehensive Assessment 295
27.3 Maintaining Hope While Negotiating Goals of Care 295
27.4 Dealing with Emotion 300
27.5 Summary 300
References 301
28 Organized Head and Neck Cancer Care 302
28.1 Introduction 302
28.2 Step 1: Recognize Challenges of HNC Treatment 303
28.3 Step 2: Form a Multidisciplinary Team 303
28.4 Step 3: Identify Barriers to Team Performance 303
28.5 Step 4: Define Patient-Centered Treatment Goals 304
28.6 Step 5: Provide Patient Navigation Assistance 304
28.7 Step 6: Describe the Nurse Coordinator Role 304
28.8 Step 7: Coordinate the Plan of Care 306
28.10 Conclusion 310
Subject Index 312
List of Contributors 316