Download ILL EFFECTS OF RADIOTHERAPY IN THE MANAGEMENT OF

ILL EFFECTS OF RADIOTHERAPY
IN THE MANAGEMENT OF ORAL
CANCER
by
Dr kashif ali
Assistant professor
ORAL CANCER
Approximately 90% of oral
cancer is SCC
 Particularly
common
in
developing world
 Multifactorial etiology
life style
Habits and diet
Others

Head & Neck Cancer
Diagnosis
Salivary gland
tumours
7%
Lymphomas
9%
Squamous cell
carcinomas
78%
Leukemias
5%
Other
1%
Squamous Cell Carcinoma
• 90% of all oral cancers
• 50% 5-year survival
• can occur in:
• tongue
• skin
• throat
• soft palate
Treatment plan is based on:
• anatomical considerations
Treatment plan is based on:
Staging of disease using TNM classification
T = Tumour size
N = Nodal status
M = Metastases
Eg. T3N2M0 laryngeal carcinoma
Treatment Options
Primary surgery
+/Adjuvant
Radiotherapy
+/Concurrent
Chemotherapy
OR
Primary Radiotherapy
+/Concurrent
Chemotherapy
+/Surgery for Salvage
Aims of radiotherapy
Radical radiotherapy -- curative intent
 Palliative radiotherapy
--To control
symptoms

Radiation Therapy
External beam
–most common
–largest fields
Radiation Therapy
Brachytherapy
–interstitial implantation of
radioisotope-filled needles
Radiation Therapy
Au grain or Iridium Implants
Radiation
• How much?
• Where?
How much radiation?
1 “rad” = 1 centiGray (cGy)
200 cGy per day
5 days per week
1000 cGy per week
How much radiation?
Total dose ranges from
6000 cGy – 7000 cGy
6 – 7 WEEKS of treatment
ORAL CANCER
TREATMENT MODALTIES
Ablative Surgery
 Surgery and / or radiotherapy
 Radiotherapy and Chemotherapy

ORAL CANCER
RADIOTHERAPY
Advantages



Normal Anatomy and function
Is maintained
GA not needed
Can be used to debulk inaccessible lesions
ORAL CANCER
RADIOTHERAPY
Conventionally upto 60 Gys dose is given
 Post radiotherapy complaints increase
tremendously when the radiation dose is
increased

ORAL CANCER
RADIOTHERAPY

ill effects
 Oral
mucositis
 Xerostomia
 Loss of taste
 Osteoradionecrosis
Oral mucosa
Seen in 1-2 weeks
 Erythema with sever mucositis
With or without ulceration
 Pain and disphagia
 Loss of test- test bud atrophy
 Delayed healing
 Pale and less vascular mucosa
 Radiotherapy induced Submucous fibrosis

ORAL CANCER
RADIOTHERAPY
Salivary glands
1st week of radiotherapy
 Xerostomia
 Difficulty in swallowing
 Nasua
 Rampant caries
 Periodontitis
 Recovery 3 to 4 months

Management
Sipped of water
 Salivary substitute
Mucous based sprays -saliva orthane spray
Cellulose --- glandosane, glycerin
Pilocarpine hydrocloride 5mg QID
Cevimelive hydroloride 30mg TDS
Stimulation of exocrine gland

Skin
Erythema
 3rd week
 Dose greater than 50 gy
 Healing 7 to 10 days

Bone
Osteoradionecrosis
 Is devitilization of bone after cancericidal
dose of radiation
 Endarteritis
 Bone turn over become slow, remolding
dose not occur leads to exposed bone

ORAL CANCER
RADIOTHERAPY
ORAL CANCER
RADIOTHERAPY
ORAL CANCER
RADIOTHERAPY
ORAL CANCER
RADIOTHERAPY
Other effects
Alteration of flora
 Inc anaerobic species
 Inc fungi , Candida
Nystatin
0.1% chlorexidine

Late effects of radiation
Eyes
Cataract 10 gy
Blindness 50 gy
 Spinal cord
Paraplegia dose Inc 45gy
 Carotid artery stenosis

ORAL CANCER
RADIOTHERAPY
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
ORAL CANCER
RADIOTHERAPY
THANK YOU
Evaluation of dentition before
radiotherapy


1.
2.


Most feared side effect is ORN
Factor determine the fate of teeth
Condition of residual dentition-- ?
Pt awareness – past care
pt with good oral hygiene , the clinician
must retain as many of teeth as possible
Neglected oral health --ext
Factor determine the fate of teeth
3 Immediacy of radiotherapy
4 Radiation location
Pre radiation ext considered 1- 2 week delay
radiation
5 Radiation dose
Inc 50 GY--- ext indicated
Less than 50 – conservative
Preparation of dentition for
radiotherapy
Pre radiation
Restorations
Topical fluoride application
Oral hygiene measures and instructions
Prevention of mechanical trauma
Encourage to stop habitts

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





Post radiation
 Regular follow up every 3- 4 week
 Topical fluoride

Method of preparing preirradiation
extraction
atraumatic extraction
 Interval B/w preirradiation ext and
beginning of radiotherapy
7-14 days
3 weeks if possible

Impacted 3rd molar removal before
radiotherapy
Partially erupted
 Complete embedded

Carious teeth after radiotherapy
Treatment accordingly
 Composite , amalgam
 Necrotic pulp __ RCT
 If RCT is difficult – amputation above the
gingiva left at place

Tooth ext after radiotherapy
4 month gap
 HBO before and after ext
 20- 30 dives

Denture after radiation
Yes
 Soft liners
