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The Toxicity of Radiotherapy for Head and Neck Tumours
NESEJTOVÁ, Šárka
Abstract The fundamental theoretical findings Head and neck tumours make up approximately 2-3% of all malignancies in our country. There is 4 times higher occurance at men population than women one. It is just smoking which belongs to important susceptible risk factors. The main therapeutic methods are operation, radiotherapy, chemotherapy, biotherapy and their combinations which carry, however, the risk of higher toxicity. The radiotherapy aim is to add the required dosage of ionizing radiation to target volume while maximally protecting treated organs. In order to decrease side effects the bearable radiation procedures are being developed which are trying to improve dosage distribution in target volume and decrease a dosage on surrounding good tissues. The level of treatment toxicity is one of the indicators for treatment effect evaluation. Basically we distinguish acute and chronic toxicity. The most often acute side effects of radiation of head and neck tumours are radiodermatitis, mucositis, xerostomia and dysphagia. Late toxicity is typically resulting in skin and mucous membrane atrophy, pharynx fibrosis and chronic decrease of salivation. Aim The aim of my thesis is to find out whether radiotherapy toxicity with my monitered sample is comparable with expert sources and whether its occurance is influenced by smoking. I have also done research if there is a difference between operated and non-operated patients with the level of side effects of radiation because the multimodal treatment is connected with a higher risk of toxicity. Research procedures My thesis is a theoretical research nature. In order to verify my hypothesis I have used the method of quantitative research with retrospective data collection from medical file archive of the Oncological department in the hospital České Budějovice a.s. In my selective sample I filed the patients who were being treated during 2009 - 2011 at the radiotherapeutical department of Hospital České Budějovice a.s. regardless age, sex, smokers or nonsmokers with an early degree of disease according to TNM classification. I have chosen the patients having neoplasm of larynx, oropharynx, tongue, hypopharynx or oral cavity as they are found at head and neck areas most often. The sample included both patients who had undergone only radiotherapy treatment and also those who had undergone adjuvant cancer therapy after a surgery. The common feature was a degree of side effect radiation and its dependance on smoking. The toxicity degree was evaluated by RTOG scoring for acute toxicity. Results In total I have evaluated 48 patients who met the criteria mentioned above. The Hample was made up of 88% men and 12% women . The average age of patients at the beginning of radiotherapy was 63,5. The most significant part were the ill with larynx tumours who made up 69% of all irradiated, the least occurance count hypopharynx /only 2%/. Smokers represent 29%, nonsmokers 11%, other patients were ex-smokers. 48% of patients were irradiated conventionally, 52% via an IMRT method. 31% of patients underwent adjuvant radiotherapy after surgery, the others only radiation. The most often side effect radiation occurred on skin, mucous membrane, pharynx, less occurance on salivary glands. Conclusion Ionizing radiation damage both malignant and good cells so we have to always consider damaging a good tissue while doing radiation. The sample of acute toxicity occurance seems to lower compared to an expert Study. A higher rate of acute side effects at smokers was not proved, however, the monitored sample shows a significant minority of nonsmokers so comparison does not have to be quite relevant. The nonoperated sample showed fewer side effects at early stage compared to the operated. It was not possible to statistically evaluate late toxicity.
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