Radiotherapy and Chemotherapy In Head And Neck Cancers

THE CELL CYCLE AND RADIOTHERAPY/ CHEMOTHERAPY:

The cell-cycle has the following phases

Go: Resting phase
G1: Growth phase
S: Synthesis phase
G2: Phase of growth and preparation for mitosis
M: Phase of mitosis.

Radiotherapy tends to affect the G2 and M phases, while CHEMOTHERAPY affects G1, S, G2 and M phases.

What is Radiotherapy?

Radiotherapy, also known as radiation therapy, is a treatment modality that uses high-energy radiation to kill cancer cells.

Overview of the principles of radiotherapy in the management of head and neck cancers:

Types of Radiotherapy

Here are the types of Radiotherapy:

1. External Beam Radiation Therapy (EBRT)

Delivers radiation from outside the body.
2. Internal Radiation Therapy (Brachytherapy)

Places radioactive material directly inside or near the tumor.
3. Stereotactic Body Radiation Therapy (SBRT)

Delivers high doses of radiation to small tumors.
4. Intensity-Modulated Radiation Therapy (IMRT)

Uses advanced technology to deliver precise doses of radiation.

Modes of Delivery of Radiotherapy

1. Conventional Fractionation: Delivers radiation in daily fractions, 5 days a week.

2. Hyperfractionation: Delivers smaller doses of radiation more frequently.

3. Accelerated Fractionation: Delivers radiation in larger doses, fewer times a week.

Cell Cycle and Mechanism of Action of Radiation Therapy

1. Cell Cycle: Radiation affects cells in the G2 and M phases of the cell cycle.

2. DNA Damage: Radiation causes DNA damage, leading to cell death.

3. Apoptosis: Radiation induces apoptosis, or programmed cell death.

Side Effects of Head and Neck Radiation Therapy

1. Xerostomia: Dry mouth due to salivary gland damage.

2. Dysphagia: Difficulty swallowing due to esophageal damage.

3. Mucositis: Inflammation of the mucous membranes.

4. Dermatitis: Skin reactions, including redness and itching.

5. Hearing Loss: Radiation-induced hearing loss.

Management of Side Effects of Radiotherapy

1. Xerostomia: Salivary gland substitutes, fluoride treatments, and saliva-stimulating medications.

2. Dysphagia: Dietary modifications, swallowing exercises, and feeding tubes.

3. Mucositis: Topical anesthetics, pain management, and mucosal protectants.

4. Dermatitis: Topical creams, skin care, and wound management.

5. Hearing Loss: Hearing aids, cochlear implants, and auditory rehabilitation.

What is Chemotherapy?

Chemotherapy is a treatment modality that uses chemical agents to kill cancer cells.

Overview of the principles of chemotherapy in the management of head and neck cancers:

Types of Chemotherapy

Here are the types of Radiotherapy:

1. Cytotoxic Chemotherapy

Kills cancer cells by interfering with cell division.
2. Targeted Chemotherapy

Targets specific molecular pathways involved in cancer growth.
3. Immunotherapy

Stimulates the immune system to recognize and attack cancer cells.

Modes of Delivery of Chemotherapy

1. Intravenous (IV) Chemotherapy: Delivered through a vein.

2. Oral Chemotherapy: Taken by mouth.

3. Intra-arterial Chemotherapy: Delivered directly into an artery that supplies the tumor.

4. Intraperitoneal Chemotherapy: Delivered into the abdominal cavity.

Cell Cycle and Mechanism of Action of Chemotherapy

1. Cell Cycle: Chemotherapy affects cells in the G1, S, G2, and M phases of the cell cycle

2. DNA Damage: Chemotherapy causes DNA damage, leading to cell death.

3. Apoptosis: Chemotherapy induces apoptosis, or programmed cell death.

Side Effects of Head and Neck Chemotherapy

1. Mucositis: Inflammation of the mucous membranes.

2. Dysphagia: Difficulty swallowing.

3. Xerostomia: Dry mouth.

4. Nausea and Vomiting: Gastrointestinal side effects.

5. Fatigue: Generalized weakness and fatigue

6. Hair Loss: Alopecia.

7. Hearing Loss: Ototoxicity.

Management of Side Effects of Chemotherapy

1. Mucositis: Topical anesthetics, pain management, and mucosal protectants.

2. Dysphagia: Dietary modifications, swallowing exercises, and feeding tubes.

3. Xerostomia: Salivary gland substitutes, fluoride treatments, and saliva-stimulating medications.

4. Nausea and Vomiting: Antiemetics, dietary modifications, and hydration.

5. Fatigue: Energy conservation, exercise, and psychosocial support.

6. Hair Loss: Scalp cooling, wigs, and hairpieces.

7. Hearing Loss: Hearing aids, cochlear implants, and auditory rehabilitation.

Note: The management of side effects should be individualized and guided by a multidisciplinary team of healthcare professionals.

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