Guidelines for Complications of Cancer Treatment Vol VIII Part B

has been on techniques like IMRT, IGRT, 3DCRT whichoffer the ability to spare the major salivary glands. Thereis evidence to suggest that when carefully executed theyresult in significant subjective and objectiveimprovement in xerostomia (LOE 3). It maybe possibleto reduce the incidence of permanent xerostomia withthe use of these techniques. However, care should betaken that the target be covered adequately.O’Sullivan et al., used ipsilateral radiotherapy portalsto treat cancers of the tonsil. In their study of 228 patients,after a mean follow-up of 7 years, the three year acturialcontrol rate was 77%, while the cause-specific survivalwas 76%. With careful selection of patients and attentionto planning it was possible to deliver adequate doses tothe target volume and at the same time protect adjacentcritical structures.Eisbruch and colleagues, Chao et al., have evaluatedprospectively the role of IMRT in being able to save theparotid glands. Various objective and subjective criteriahave been used for the evaluation. The investigatorsconcluded that it was possible to significantly reducethe dose to the salivary glands with the use of IMRT,with no adverse effect on tumor control. Though patientshad xerostomia during therapy, the spared salivary glandsshowed recovery with time.Though most of the results of these techniques is from wellconductedprospective, non-randomized series they prove thatit is possible to effectively spare the salivary glands and preventthe ensuing sequelae without compromising tumor control.This has a definite impact on outcome and quality of life ofpatients with head and neck cancers being treated onaggressive, multimodality regimes.172