Radiation Dose–Volume Effects in the Larynx and Pharynx

IJROBP Volume 76, Issue 3, Supplement, Pages S64-S69 (1 March 2010)
 

Larynx 

Radiotherapy affects voice quality in locally advanced HN cancer but less so in early-stage larynx cancer. An interesting conclusion follows this observation: clinically significant vocal dysfunction requires both the larynx and surrounding supralaryngeal structures to be affected. The surrounding tissues might be indirectly affected by a reduction in salivary function or directly by effects on the intrinsic musculature and soft tissue. From the published data, it seems reasonable to suggest limiting the mean noninvolved larynx dose to 40–45 Gy and limiting the maximal dose to <63–66 Gy, if possible, according to the tumor extent.

Dysphagia 

Recommended dose–volume limits 

The limited available data have suggested that minimizing the volume of the pharyngeal constrictors and larynx receiving ≥60 Gy and reducing, when possible, the volume receiving ≥50 Gy is associated with reduced dysphagia/aspiration. In several cases, such sparing can be achieved without compromising target doses. A separate question is whether such sparing is safe clinically, taking into account the uncertainties in target delineation. This issue was beyond the scope of this report.