[Head and neck intensity-modulated radiation therapy: Normal tissues dose constraints. Pharyngeal constrictor muscles and larynx].
Radio-induced pharyngolaryngeal chronic disorders may challenge the quality of life of head and neck cancer long survivors. Many anatomic structures have been identified as potentially impaired by irradiation and responsible for laryngeal edema, dysphonia and dysphagia. Some dose constraints might be plausible such as keeping the mean dose to the pharyngeal constrictor muscles under 50 to 55Gy, the mean dose to the supra-glottic larynx under 40 to 45Gy and, if feasible, the mean dose to the glottic larynx under 20Gy. A reduction of the dose delivered to the muscles of the floor of the mouth and the cervical esophagus would be beneficial as well. Nevertheless, the publications available do not provide an extensive enough level of proof. One should consider limiting as low as possible the dose delivered to these structures without compromising the quality of irradiation of the target tumor volumes.
Service de radiothérapie, IUCT-Oncopôle, institut Claudius-Régaud, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France. Electronic address: Graff-Cailleaud.Pierre@iuct-oncopole.fr.
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Graff
Service d'oncoréhabilitation, IUCT-Oncopôle, CHU de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
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Woisard
Service de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
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Racadot
Service de radiothérapie, centre Antoine-Lacassagne, 133, avenue de Valombrose, 06189 Nice, France.
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Thariat
Service de radiothérapie, centre Jean-Bernard, clinique Victor-Hugo, 18, rue Victor-Hugo, 72000 Le Mans, France.
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Pointreau
D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D004307:Dose-Response Relationship, Radiation; D055154:Dysphonia / Q000209:etiology / Q000517:prevention & control; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D007819:Laryngeal Edema / Q000209:etiology / Q000517:prevention & control; D007830:Larynx / Q000528:radiation effects; D058958:Organs at Risk; D010609:Pharyngeal Muscles / Q000528:radiation effects; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated
Dose; Dysphagia; Dysphagie; Dysphonia; Dysphonie; Laryngeal edema; Larynx; Pharynx; Radio-induced toxicity; Radiotherapy; Radiothérapie; Tolerance; Tolérance; Toxicité radio-induite; Œdème laryngé