Radiotherapy Planning

Gustatory disturbances occur in patients with head and neck cancer who undergo radiotherapy not directed to the oral cavity

INTRODUCTION

Even the most modern radiation techniques still result in some degree of toxicity to adjacent normal tissues. Consequently, the radiotherapy treatment in head and neck neoplasms potentially leads to gustatory dysfunction even in cases when the treatment area is outside or adjacent to the oral cavity. In this study we quantitatively and qualitatively assessed gustatory function in patients with head and neck cancers who underwent radiotherapy inside and outside of the oral cavity.

METHODS

Fifty-six patients with head and neck cancer responded to a specific questionnaire and had their gustatory function tested before, immediately after, and at 3 and 6 months following radiotherapy treatment. The irradiation field did not include the oral cavity in 29 patients and included it in 27 patients.

RESULTS

All patients suffered a severe loss of taste immediately after radiotherapy. The identification of sweet and bitter tastes decreased in both groups, but the sour decrement was exclusive to those who had the oral cavity irradiated. Fourteen percent of patients complained of qualitative changes of taste, namely taste distortions. No impact of xerostomia on the taste measures was apparent.

CONCLUSION

We found that patients with head and neck neoplasms submitted to radiotherapy have disturbed taste even when irradiation does not include the oral cavity. This deficit is worse immediately after the end of radiotherapy. Our findings do not support the hypothesis that decreased salivary flow is the major cause for radiation-induced changes in taste function.

The impact of training and professional collaboration on the interobserver variation of lung cancer delineations: a multi-institutional study

BACKGROUND

To assess the impact of training and interprofessional collaboration on the interobserver variation in the delineation of the lung gross tumor volume (GTVp) and lymph node (GTVln).

MATERIAL AND METHODS

Eight target volume delineations courses were organized between 2008 and 2013. Specialists and trainees in radiation oncology were asked to delineate the GTVp and GTVln on four representative CT images of a patient diagnosed with lung cancer individually prior each course (baseline), together as group (interprofessional collaboration) and post-training. The mean delineated volume and local standard deviation (local SD) between the contours for each course group were calculated and compared with the expert delineations.

RESULTS

A total 410 delineations were evaluated. The average local SD was lowest for the interprofessional collaboration (GTVp = 0.194 cm, GTVln = 0.371 cm) followed by the post-training (GTVp = 0.244 cm, GTVln = 0.607 cm) and baseline delineations (GTVp = 0.274 cm, GTVln: 0.718 cm). The mean delineated volume was smallest for the interprofessional (GTVp = 4.93 cm³, GTVln = 4.34 cm³) followed by the post-training (GTVp = 5.68 cm³, GTVln = 5.47 cm³) and baseline delineations (GTVp = 6.65 cm³, GTVln = 6.93 cm³). All delineations were larger than the expert for both GTVp and GTVln (p < .001).

CONCLUSION

Our findings indicate that image interpretational differences can lead to large interobserver variation particularly when delineating the GTVln. Interprofessional collaboration was found to have the greatest impact on reducing interobserver variation in the delineation of the GTVln. This highlights the need to develop a clinical workflow so as to ensure that difficult cases are reviewed routinely by a second radiation oncologist or radiologist so as to minimize the risk of geographical tumor miss and unnecessary irradiation to normal tissue.

External beam radiotherapy in thyroid carcinoma: clinical review and recommendations of the AIRO "Radioterapia Metabolica" Group

The therapeutic approach to thyroid carcinoma usually involves surgery as initial treatment. The use of external beam radiotherapy (EBRT) is limited to high-risk patients and depends on clinical stage and histologic type. Different behavior patterns and degrees of aggressiveness of thyroid carcinomas require different management for differentiated, medullary, and anaplastic carcinoma. However, the role of EBRT is an issue of debate. Most clinical studies are retrospective and based on single-institution experiences. In this article, we review the main literature and give recommendations for the use of EBRT in thyroid carcinoma on behalf of the "Radioterapia Metabolica" Group of the Italian Radiation Oncology Association.