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ILL EFFECTS OF RADIOTHERAPY IN THE MANAGEMENT OF ORAL CANCER

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.

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ILL EFFECTS OF RADIOTHERAPY IN THE MANAGEMENT OF ORAL CANCER

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  1. ILL EFFECTS OF RADIOTHERAPY IN THE MANAGEMENT OF ORAL CANCER by Dr kashif ali Assistant professor

  2. ORAL CANCER • Approximately 90% of oral cancer is SCC • Particularly common in developing world • Multifactorial etiology life style Habits and diet Others

  3. Head & Neck Cancer Diagnosis

  4. Squamous Cell Carcinoma • 90% of all oral cancers • 50% 5-year survival • can occur in: • tongue • skin • throat • soft palate

  5. Treatment plan is based on: • anatomical considerations

  6. Treatment plan is based on: Staging of disease using TNM classification Eg. T3N2M0 laryngeal carcinoma

  7. Treatment Options OR +/- +/- +/- +/-

  8. Aims of radiotherapy • Radical radiotherapy --- curative intent • Palliative radiotherapy --To control symptoms

  9. Radiation Therapy External beam • most common • largest fields

  10. Radiation Therapy • Brachytherapy • interstitial implantation of • radioisotope-filled needles

  11. Radiation Therapy Au grain or Iridium Implants

  12. Radiation • How much? • Where?

  13. How much radiation? 1 “rad” = 1 centiGray (cGy) 200 cGy per day 5 days per week 1000 cGy per week

  14. How much radiation? Total dose ranges from 6000 cGy – 7000 cGy 6 – 7 WEEKS of treatment

  15. ORAL CANCERTREATMENT MODALTIES • Ablative Surgery • Surgery and / or radiotherapy • Radiotherapy and Chemotherapy

  16. ORAL CANCERRADIOTHERAPY Advantages • Normal Anatomy and function Is maintained • GA not needed • Can be used to debulk inaccessible lesions

  17. ORAL CANCERRADIOTHERAPY • Conventionally upto 60 Gys dose is given • Post radiotherapy complaints increase tremendously when the radiation dose is increased

  18. ORAL CANCERRADIOTHERAPY • ill effects • Oral mucositis • Xerostomia • Loss of taste • Osteoradionecrosis

  19. 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

  20. ORAL CANCERRADIOTHERAPY

  21. Salivary glands • 1st week of radiotherapy • Xerostomia • Difficulty in swallowing • Nasua • Rampant caries • Periodontitis • Recovery 3 to 4 months

  22. 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

  23. Skin • Erythema • 3rd week • Dose greater than 50 gy • Healing 7 to 10 days

  24. 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

  25. ORAL CANCERRADIOTHERAPY

  26. ORAL CANCERRADIOTHERAPY

  27. ORAL CANCERRADIOTHERAPY

  28. ORAL CANCERRADIOTHERAPY

  29. Other effects • Alteration of flora • Inc anaerobic species • Inc fungi , Candida Nystatin 0.1% chlorexidine

  30. Late effects of radiation • Eyes Cataract 10 gy Blindness 50 gy • Spinal cord Paraplegia dose Inc 45gy • Carotid artery stenosis

  31. 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

  32. ORAL CANCERRADIOTHERAPY THANK YOU

  33. Evaluation of dentition before radiotherapy • 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

  34. 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

  35. Preparation of dentition for radiotherapy • Pre radiation Restorations Topical fluoride application Oral hygiene measures and instructions Prevention of mechanical trauma Encourage to stop habitts

  36. 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

  37. Post radiation • Regular follow up every 3- 4 week • Topical fluoride

  38. Method of preparing preirradiation extraction • atraumatic extraction • Interval B/w preirradiation ext and beginning of radiotherapy 7-14 days 3 weeks if possible

  39. Impacted 3rd molar removal before radiotherapy • Partially erupted • Complete embedded

  40. Carious teeth after radiotherapy • Treatment accordingly • Composite , amalgam • Necrotic pulp __ RCT • If RCT is difficult – amputation above the gingiva left at place

  41. Tooth ext after radiotherapy • 4 month gap • HBO before and after ext • 20- 30 dives

  42. Denture after radiation • Yes • Soft liners

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