IMRT was able to reduce the V50(Gy) of the DARS.Dysphagia/Aspiration Related Structures (DARS) include: pharyngeal constrictor muscles, supraglottic and glottic larynx.A clear definition of different structures (and an evaluation of their involvement) could influence differently acute and late settings of toxicities. Prospective swallowing assessment with videofluoroscopy, endoscopy, and CT. Another interesting finding was that the middle pharyngeal constrictor was related to acute dysphagia, while the superior pharyngeal constrictor influenced late dysphagia. Michigan 2004 PMID 15590174 - "Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT?" (Eisbruch A, Int J Radiat Oncol Biol Phys. Conclusion: Dose-effect between dose and swallowing complaints observed.For each additional 10 Gy after 55 Gy, probability of dysphagia increases by 19% 70 Gy probability 40%, 50 Gy probability 20%, 22 Gy probability 2%. Superior constrictor: (figure 8: A) Arises from the pterygoid hamulus, pterygomandibular raphe, posterior end of mylohyoid line of mandible. The phases and mechanisms of deglutition (swallowing). Outcome: steep dose-effect relationship between mean dose to constrictor muscles and severe dysphagia. The attachments, innervation, function and intervening spaces of the pharyngeal constrictors.Mean F/U 1.5 years IMRT and 4 years 3D-CRT Erasmus University Medical Center 2007 (Netherlands)(2000-2005) PMID 17714815 - "Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship." (Levendag PC, Radiother Oncol. Conclusion: Aspiration and stricture common side effects dose limits established for larynx and inferior pharyngeal constrictors.No stricture if mean inferior pharyngeal constrictor dose <54 Gy smoking correlated significantly. No aspiration if mean larynx dose <48 Gy or mean inferior pharyngeal constrictor dose <54 Gy. Outcome: Clinically significant aspiration 32% and stricture 37%.96 patients with H&N cancers, 85% definitive RT vs 15% postop RT. The superior pharyngeal constrictor muscle is one of three pharyngeal constrictor muscles whose main function is to facilitate the process of deglutition. Harvard 2008 (2004-2006) PMID 18468812 - "Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy." (Caglar HB, Int J Radiat Oncol Biol Phys.Conclusion: Dose to larynx and pharyngeal constrictors predicted long-term swallowing complications.Predictors for pharyngoesophageal stricture: superior pharyngeal constrictor V65 >33%, middle pharyngeal constrictor V65 > 75% There are multiple physiologic variants of the pharyngeal constrictor muscles.Dose volume constraints for anterior oral cavity (V30 41 Gy, larynx V60 >24%, inferior pharyngeal constrictor V60 >12%.MDACC 2012 PMID 20646872 - "Candidate dosimetric predictors of long-term swallowing dysfunction after oropharyngeal intensity-modulated radiotherapy." (Schwartz DL, Int J Radiat Oncol Biol Phys.Front Page: Radiation Oncology | RTOG Trials | Randomized Trials.
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