Intensity Modulated Radiation Therapy
Doctors at NYU Langone usually use intensity modulated radiation therapy to manage laryngeal cancer. With this approach, a machine called a linear accelerator rotates around you as you lie on a treatment table. The machine delivers radiation beams from various directions. These beams are divided into many small, computer-controlled doses of different strengths.
Tailored to the size, shape, and location of the laryngeal tumor, these minibeams deliver high doses of radiation to the cancer and avoid nearby healthy structures. Treatment is delivered in fractionstypically once daily, five days a week, for six to seven weeks.
Daily use of a special scan, called a cone-beam CT, ensures that the radiation therapy is delivered as planned. During treatment, the tumor shrinks and you may lose weight, changing the shape of the body. As a result, a radiation oncologist may reposition you on the treatment table and adjust the radiation beams to match the precise location of the tumor.
Treatment Of Onj Usually Includes Treating The Infection And Good Dental Hygiene
Treatment of ONJ may include the following:
- Removing the infected tissue, which may include bone. Laser surgery may be used.
- Smoothing sharp edges of exposed bone.
- Using antibiotics to fight infection.
- Using medicated mouth rinses.
- Using pain medicine.
During treatment for ONJ, you should continue to brush and floss after meals to keep your mouth very clean. It is best to avoid tobacco use while ONJ is healing.
You and your doctor can decide whether you should stop using medicines that cause ONJ, based on the effect it would have on your general health.
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What Laryngeal Surgery Procedures Are Available
Surgery removes cancer. The goal of laryngeal cancer surgery is to remove the tumor while preserving your function. The surgeon may need to remove part or all of the larynx. Surgical procedures include:
- Cordectomy: Removes part or all of a vocal cord, usually through the mouth
- Supraglottic laryngectomy: Removes the supraglottis, either through the neck or through the mouth
- Hemilaryngectomy: Removes half the larynx, preserving your voice.
- Partial laryngectomy: Removes part of the larynx so you retain your ability to talk.
- Total laryngectomy: Removes the entire larynx, through the neck
- Thyroidectomy: Removes all or part of the thyroid gland.
- Laser surgery: Removes a tumor in a bloodless procedure using a laser beam.
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Management Of Supraglottic Larynx Cancers / Back To Top
Early cancers of the supraglottic larynx may be treated either with surgery or radiation therapy with a high likelihood of success. Moderately advanced cancers are usually treated with radiation therapy, and very advanced cancers are generally treated with surgery followed by radiation therapy. Unfortunately, surgery often involves removal of the larynx . The volume of the tumor calculated on CT scan or MR images before treatment is related to the chance of successful treatment with radiation therapy, and thus, currently, radiographic volume is used to determine treatment at the University of Florida. Patients who have higher volume lesions who would like to avoid laryngectomy are treated with radiation therapy and concomitant cisplatin chemotherapy. CT scan may also be used to follow up patients after treatment to detect early recurrences and facilitate successful surgical salvage.
Preventing And Controlling Oral Complications Can Help You Continue Cancer Treatment And Have A Better Quality Of Life
Sometimes treatment doses need to be decreased or treatment stopped because of oral complications. Preventive care before cancer treatment begins and treating problems as soon as they appear may make oral complications less severe. When there are fewer complications, cancer treatment may work better and you may have a better quality of life.
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Radiation Therapy For Laryngeal Cancer
Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is usually used to treat laryngeal cancer. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.
Radiation therapy is often combined with chemotherapy to treat laryngeal cancer. This is called chemoradiation. The 2 treatments are given during the same time period.
Radiation therapy is given for different reasons. You may have radiation therapy or chemoradiation:
- as a primary treatment for early stage laryngeal cancer or if you are not healthy enough to have surgery
- as a primary treatment, along with chemotherapy , to treat large tumours or tumours that have spread to nearby lymph nodes
- to destroy cancer cells left behind after surgery, with or without chemotherapy, to reduce the risk that the cancer will come back
- after surgery if the tumour is hard to remove, cant be completely removed or has spread to nearby tissues or lymph nodes
- to relieve pain or control the symptoms of advanced laryngeal cancer
People who have radiation therapy to treat laryngeal cancer need an immobilization mask. The mask is worn when planning treatment and during all radiation treatments. It helps you stay in the same position each time radiation is given.
Management Of Oropharynx Cancers / Back To Top
Carcinomas arising in the oropharynx, which includes the tonsils, base of the tongue, and soft palate, are usually treated with primary radiation therapy. Patients with advanced neck disease sometimes undergo a neck dissection after the radiation therapy. Patients with early cancers that may be treated with surgery alone are sometimes good candidates for Transoral Robotic Surgery , or a CO2 laser with a neck dissection. However, radiation following surgery is often required. High risk human papilloma virus positive oropharyngeal cancers are increasing in frequency and have an improved prognosis compared with HR-HPV negative cancers.
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What Other Tests Help Diagnose Laryngeal Cancer
Other diagnostic tests include:
- Imaging scans:CT or MRI scans provide detailed images of the body. A chest X-ray can see if cancer has spread to the lungs.
- Laryngoscopy: Your provider uses a thin, lighted tube called an endoscope to examine your larynx.
- PET scan: During a PET scan, a provider injects a small, safe dose of a radioactive substance into your vein. The substance highlights abnormal areas. A PET scanner machine creates 3D pictures from the energy the substance gives off.
- Biopsy: During a biopsy, your provider removes a small piece of any abnormal tissue in the larynx to examine under a microscope.
What Is The Larynx
The larynx is in your throat. Its also known as the voice box. The larynx helps us speak, breathe and swallow. Our vocal cords are part of the larynx.
The larynx is mostly made up of cartilage, a flexible tissue that makes a supportive framework. The larynx has three parts:
- Supraglottis : More than one in three laryngeal cancers start here.
- Glottis : More than half of laryngeal cancers start here, where the vocal cords are.
- Subglottis : About 5% of laryngeal cancers 1 in 20 start here.
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Dental Treatments May Be Put Off Until The Patient’s Immune System Returns To Normal
Regular dental treatments, including cleaning and polishing, should wait until the transplant patient’s immune system returns to normal. The immune system can take 6 to 12 months to recover after high-dose chemotherapy and stem cell transplant. During this time, the risk of oral complications is high. If dental treatments are needed, antibiotics and supportive care are given.
Studies On Proton Therapy In Head & Neck Cancer
Our team has identified these studies as examples of the clinical benefits of proton therapy in head and neck cancer.
Intensity Modulated Proton Therapy Versus Intensity Modulated Photon Radiation Therapy for Oropharyngeal Cancer: First Comparative Results of Patient-Reported Outcomes
This retrospective study of 81 patients treated with chemotherapy and radiation for oropharyngeal cancer compared patients reported outcomes between those treated with IMRT versus proton therapy. Patient- reported outcomes assess common symptoms of head and neck radiotherapy such as problems with taste, dry mouth, swallowing or chewing difficulties, lack of appetite, and fatigue. Both groups started with similar baseline symptoms. The average patient- reported symptom burden was statistically lower among those treated with proton therapy compared to IMRT during the first three months after treatment. These data suggest patients may report fewer and/or less intense symptoms during the recovery phase following treatment.
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What Are Possible Side Effects Of Radiation Therapy
The side effects depend on the site and extent of the head and neck cancer and whether it is done in conjunction with chemotherapy. In general, radiation therapy of the head and neck does not cause nausea, but a few patients do experience nausea during treatment. Many effective antiemetics can relieve this symptom if it should occur. Chemotherapy will cause its own side effects which will be discussed with the medical oncologist.
Generally, the side effects of radiation therapy become apparent abouttwo weeks into the treatment course, when a sore throat, loss of tastesensation, dryness of the mouth and dry skin reactions may occur. Sorethroat is the main side effect that makes the course of radiation therapydifficult.
If your sore throat is severe, you may be unable to take in enough food and liquids by mouth to maintain your weight or avoid dehydration. Your doctors will then insert a feeding tube temporarily into your stomach , which will allow you to maintain adequate nutrition without having to swallow all of the food that you need. Gastrostomy placement is usually an outpatient procedure. It is important, though, to continue swallowing even with a gastrostomy tube in place. Otherwise, your swallowing muscles may weaken this would cause permanent swallowing problems and make it difficult to stop using the gastrostomy tube even after the radiation treatment course is completed.
Side Effects Of Chemotherapy In Throat Cancer Patients
Chemotherapy drugs work by killing all cells that are dividing rapidly. This is exactly why chemotherapy drugs are effective against cancer cells. But due to the same nature of these drugs, they also end up destroying healthy cells such as cells present in the bone marrow , cells within the lining of the mouth and the intestines, and cells in the human hair follicles. Accordingly, people experience side effects , such as:
- Nausea and/or vomiting
- Loss of appetite and weight loss
- Mouth sores and ulcerations
- Diarrhoea and constipation, loose stools
- Immunosuppression or myelosuppression
- Problems with blood clotting or severe bleeding/bruising
- Persistent fatigue or shortness of breath
In addition to these risks, some chemotherapy drugs such as cisplatin, docetaxel, and paclitaxel can also cause nerve damage , which leads to numbness, tingling, or phantom pain felt in the hands and feet. The nerve damage caused by cisplatin can also magnify into hearing loss. Some of these side effects are temporary, but depending on the extent of damage, some may last for a very long time. It is important to consult a team of oncologists to understand the possible severity of side effects before a particular chemotherapy drug is accepted in treatment.
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Different Types Of Ebrt
There are also more advanced EBRT techniques that help doctors focus the radiation more precisely.
Three-dimensional conformal radiation therapy uses special computers to precisely map the location of the tumor. Several radiation beams are then shaped and aimed at the tumor from different directions, which makes it less likely to damage normal tissues.
Intensity modulated radiation therapy is a form of 3D-CRT. It uses a computer-driven machine that actually moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the tumor from several angles, the intensity of the beams can be adjusted to limit the dose reaching nearby normal tissues. This may let the doctor deliver a higher dose to the tumor.
Proton beam radiation therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which go through the patient and release radiation both before and after they hit the tumor, protons only travel a certain distance, so the tissues behind the tumor are exposed to very little radiation. Even the tissues in front of the tumor see less radiation than the tumor itself. This means that proton beam radiation can deliver radiation to the cancer while doing less damage to nearby normal tissues. Because there are so many critical structures close by, proton beam radiation can be used to treat certain tumors of the oral cavity or oropharynx. Proton therapy can be a safe option in certain cases when using x-rays is not.
Management Of Nasal Vestibule Cancers / Back To Top
Cancers arising in the nasal vestibule, just inside the opening of the nose, are relatively uncommon and are usually squamous cell carcinomas. They tend to behave like skin cancers and can be treated either with surgery or radiation therapy. The disadvantage of surgery for all but the earliest tumors is that the cosmetic result may be suboptimal, depending on how much of the nose must be removed, and a complex reconstructive procedure may be required. Radiation therapy alone is used to treat most of these cancers and usually consists of a combination of external beam irradiation and interstitial brachytherapy boosts. The chance of cure is essentially the same after either surgery or radiation therapy for all but the most advanced cancers. Very advanced cancers, which are more than 4 cm in diameter and invade bone, are probably best treated with a combination of surgery and radiation therapy because the chance of cure with radiation therapy alone in this instance is fairly low.
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If Youre Getting Radiation Therapy To The Head Or Neck
People who get radiation to the head and neck might have side effects such as:
- Soreness in the mouth or throat
How to care for your mouth during treatment
If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat. Here are some tips that may help you manage mouth problems:
- Avoid spicy and rough foods, such as raw vegetables, dry crackers, and nuts.
- Dont eat or drink very hot or very cold foods or beverages.
- Dont smoke, chew tobacco, or drink alcohol these can make mouth sores worse.
- Stay away from sugary snacks.
- Ask your cancer care team to recommend a good mouthwash. The alcohol in some mouthwashes can dry and irritate mouth tissues.
- Rinse your mouth with warm salt and soda water every 1 to 2 hours as needed.
- Sip cool drinks often throughout the day.
- Eat sugar-free candy or chew gum to help keep your mouth moist.
- Moisten food with gravies and sauces to make it easier to eat.
- Ask your cancer care team about medicines to help treat mouth sores and control pain while eating.
If these measures are not enough, ask your cancer care team for advice. Mouth dryness may be a problem even after treatment is over. If so, talk to your team about what you can do.
How to care for your teeth during treatment
Radiation treatment to your head and neck can increase your chances of getting cavities. This is especially true if you have dry mouth as a result of treatment.
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Management Of Neck Node Metasteses / Back To Top
Head and neck cancers frequently spread to lymph nodes in the neck. The treatment of the neck nodes is determined in conjunction with the treatment of the primary cancer in the mouth or throat. In general, relatively early stage neck metastasis are removed in conjunction with the tumor if the first step in treatment is to be an operation. On the other hand, if the primary cancer is best managed with radiation therapy, the neck nodes are treated with irradiation as well, and if they resolve completely at the end of treatment, surgery is not necessary. On the other hand, if neck nodes remain at the end of radiation therapy, it is safest to proceed with an operation to remove them. This operation is referred to as a neck dissection. Large lymph nodes, particularly those that do not go away completely after radiation therapy, are best treated with a combination of radiation and a neck dissection. A computed tomography or PET-CT scan is used following radiation therapy to determine the probability of remaining cancer and the need for surgery.
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Pharyngeal And Laryngeal Cancer
Duke specialists detect and treat throat cancer , voice box cancer , and cancer of the tonsils. We use sophisticated surgical techniques to remove tumors, and we do everything possible to preserve your ability to speak and function normally. If you’ve been diagnosed with the type of human papillomavirus that increases your risk for throat cancer, we work closely with you to tailor treatment to your specific situation. Our goal is to detect cancer early, personalize your treatment options, and increase your chances for a positive outcome.
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If Youre Getting Radiation Therapy To The Brain
People with brain tumors often get stereotactic radiosurgery if the cancer is in only one or a few sites in the brain. Side effects depend on where the radiation is aimed. Some side effects might show up quickly, but others might not show up until 1 to 2 years after treatment. Talk with your radiation oncologist about what to watch for and when to call your doctor.
If the cancer is in many areas, sometimes the whole brain is treated with radiation. The side effects of whole brain radiation therapy may not be noticeable until a few weeks after treatment begins.
Radiation to the brain can cause these short-term side effects:
- Trouble with memory and speech
Some of these side effects can happen because radiation has caused the brain to swell. Medicines are usually given to prevent brain swelling, but its important to let your cancer care team know about headaches or any other symptoms. Treatment can affect each person differently, and you may not have these particular side effects.
Radiation to the brain can also have side effects that show up later usually from 6 months to many years after treatment ends. These delayed effects can include serious problems such as memory loss, stroke-like symptoms, and poor brain function. You may also have an increased risk of having another tumor in the area, although this is not common.
Talk with your cancer care team about what to expect from your specific treatment plan.
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