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Laryngorhinootologie 2011; 90(11): 657-662
DOI: 10.1055/s-0031-1291303
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Schluckstörungen nach Kopf-Hals-Tumortherapie und die Möglichkeiten der IMRT

Treatment Related Swallowing Dysfunction and the Potentialities of IMRT
S. Dietzsch
1   Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Leipzig AöR
,
R. Melzer
1   Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Leipzig AöR
,
A. Boehm
2   Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig AöR
,
U. Wolf
1   Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Leipzig AöR
,
R. Kortmann
1   Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Leipzig AöR
,
M. Fuchs
3   Sektion Phoniatrie und Audiologie, Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig AöR
› Author Affiliations
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Publication History

Publication Date:
14 November 2011 (online)

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Zusammenfassung

Die Behandlungsergebnisse bei fortgeschrittenen Kopf-Halstumoren konnten durch modifizierte Fraktionierungsschemata oder Kombination mit einer Chemotherapie signifikant verbessert werden. Allerdings zeigt sich auch eine gestiegene Spättoxizität. Schluckstörungen spielen dabei eine wichtige Rolle, da sie die Lebensqualität der Patienten besonders beeinträchtigen und lebensbedrohliche Folgen haben können. Erste Untersuchungen konnten einen Zusammenhang zwischen der Dosisbelastung an bestimmten schluckrelevanten Strukturen und dem Risiko einer Dysphagie aufweisen, wobei sich die Mm. constrictores pharyngis sowie der supraglottische und glottische Larynx als wichtige Strukturen abzeichnen. Eine gezielte Schonung bei der IMRT-Optimierung sollte, soweit die Tumorlokalisation es zulässt, angestrebt werden. Allerdings stehen prospektive Untersuchungen unter Verwendung standardisierter Protokolle der Dysphagiediagnostik zur Validierung anzustrebender Dosisgrenzwerte noch aus. Außerdem kann die Schonung mittels IMRT nur als ein Ansatzpunkt angesehen werden, und ein Erfolg ist nur durch weitere interdisziplinäre Forschung mit HNO/MKG-Chirurgie, Phoniatrie und Logopädie zu erreichen.

Abstract

Treatment Related Swallowing Dysfunction and the Potentialities of IMRT

Altered fractionated radiotherapy and concurrent chemoradiation could improve local control and survival for patients with locally advanced head and neck cancer. However, intensified treatment seems to increase late toxicity. Late swallowing dysfunction is common and has a large impact on quality of life and can get life-threatening character. Recent studies could show interrelations between the radiation dose to certain anatomical structures involved in the swallowing process and the risk of swallowing dysfunction. Important structures seem to be the pharyngeal constrictors and the supraglottic and glottic larynx. Further prospective clinical validations using standardized diagnostic protocols for dysphagia are necessary to establish dose constraints to anatomical structures involved in swallowing.

Schlüsselwörter

Kopf-Halstumoren - Radiotherapie - Spättoxizität - Schluckstörung - Dysphagie - IMRT

Key words

head neck cancer - radiotherapy - late toxicity - swallowing dysfunction - dysphagia - IMRT
 

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