Acute and late toxicities following intensity-modulated and image-guided radiotherapy for 27 patients with locally advanced laryngeal cancer.

<p>Acute and late toxicities following intensity-modulated and image-guided radiotherapy for 27 patients with locally advanced laryngeal cancer.</p

Treatment toxicity and patient outcome.

<p>Treatment toxicity and patient outcome.</p

Treatment toxicity reported in studies using IMRT and chemotherapy for the treatment of locally advanced rectal cancer.

<p>Treatment toxicity reported in studies using IMRT and chemotherapy for the treatment of locally advanced rectal cancer.</p

Illustration of the potential of Tomotherapy to spare the pharyngeal muscles in a patient with locally advanced base of tongue cancer and right neck nodal metastases treated with definitive concurrent chemoradiation.

<p>Despite the proximity of the gross tumor and neck nodes treated to 70 Gy, mean pharyngeal muscle radiation dose was 22.5 Gy. A split field intensity-modulated radiotherapy technique to shield the larynx and pharyngeal muscles would have underdosed the right neck nodes and gross tumor. The patient is in clinical remission two years following treatment and has no difficulty with swallowing except for xerostomia as the parotid gland could not be spared.</p

Dose distribution in Gray (Gy) to the larynx and other head and neck organs.

<p>TMJ: Temporo-mandibular joint.</p

Patient characteristics.

<p>IGRT: Image-guided radiotherapy; IMRT: Intensity-modulated radiotherapy.</p

Dose distribution to target volume and to critical organs at risk for complications following image-guided radiotherapy for head and neck cancer.

<p>PTV1: target volume receiving 66 to 70 Gy; PTV2: target volume receiving 59.6 to 63 Gy; PTV3: target volume receiving 54 to 56 Gy; Gy: gray.</p

Mean pharyngeal dose (Gy) correlation with dysphagia severity or aspiration reported in the literature.

<p>NA: not assessed; QOL: quality of life.</p

Illustrating the potential of Tomotherapy to spare the pharyngeal muscles in a patient who had postoperative chemoradiation for locally advanced base of tongue and bilateral neck metastases.

<p>Even though the right neck was dissected and required radiation of the surgical bed and scars to 63 Gy, the pharyngeal muscles can still be spared from excessive radiation dose. The midline laryngeal block with the split field intensity-modulated radiotherapy technique would have had underdosed the surgical scar and area of the surgical bed located in close proximity to the larynx and the gross lymph nodes on the left side. The patient is in remission 13 month after treatment.</p

Illustration of the effectiveness of Tomotherapy to deliver high radiation dose to the gross tumor and cervical lymph nodes while sparing adjacent normal structures.

<p>The patient had locally advanced base of the tongue cancer (T4) associated with massive cervical metastases (N3) and lung metastases at diagnosis. Following induction chemotherapy which resulted in resolution of the lung metastases, he had concurrent chemoradiation for local control and achieved a complete response of the gross tumor and lymph nodes on post-treatment PET-CT. The lung metastases recurred after treatment and were treated with adjuvant chemotherapy and consolidation stereotactic body radiotherapy. The patient is currently on remission two years after the treatment with no long-term complications except for xerostomia because of low radiation dose to the normal organs. The parotid glands could not be spared because of the close proximity to the gross lymph nodes and areas at high risk for disease.Red line: gross tumor and cervical lymph nodes treated to 70 Gy; green line: area at high risk for disease treated to 63 Gy; pink line: mandibular dose (mean: 56 Gy), gray line: pharyngeal muscles dose (mean: 33.6 Gy); gray-blue line: laryngeal dose (mean: 22.5 Gy); navy blue line: spinal cord dose (max: 39.4 Gy); light blue line: right cochlea dose: (mean: 4.5 Gy); light brown line: left cochlea dose: (mean: 5.3 Gy).</p