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Brain, Head and Neck

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Delineating Organs at Risk in Radiation Therapy

Abstract

The brain is contained within the skull and is enveloped by membranes called meninx, dura mater, arachnoid membrane, and pia mater. Extensions of the dura mater stabilize the position of the brain, forming structures such as the falx cerebri, tentorium cerebelli, cerebellar falx, and sella diaphragm. Cerebrospinal fluid (CSF), or liquor, produced in the choroid plexuses, protects the delicate nerve structures, sustains the brain, and conveys nutritive and chemical substances and waste products. It flows continuously from ventricles of the central canal of the spinal cord into the subarachnoid space. Diffusion through the arachnoid granulations in the upper sagittal sinus conveys the CSF to the venous bloodstream. In this complex system, the hematoencephalic barrier keeps neural tissue isolated from the general bloodstream.

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References

  1. Martini FH, Timmons MJ, Tallitsch RB (2010) Anatomia umana, Edises pp 387–415

    Google Scholar 

  2. Rabin BM, Meyer JR, Berlin JW et al (1996) Radiation-induced changes in the central nervous system and head and neck. RadioGraphics 16:1055–1072

    CAS  PubMed  Google Scholar 

  3. Kim JH, Brown SL, Jenrow KA et al (2008) Mechanism of radiation-induced toxicity and implications for future clinical trials. J Neuroncol 87:279–286

    CAS  Google Scholar 

  4. Mayo C, Yorke E, Merchant TE (2010) Radiationassociated brainstem injury. Int J Radiat Oncol Biol Phys 76(3 Suppl):S36–S41

    PubMed  PubMed Central  Google Scholar 

  5. Miglior M, Bagolini B, Boles Carenini B et al (1989) Oftalmologia Clinica. Second Edition. Monduzzi, pp 5–13

    Google Scholar 

  6. Jeganathan VSE, Wirth A, MacManus MP (2011) Ocular risks from orbital and periorbital radiation therapy: a critical review. Int J Radiat Oncol Biol Phys 79:650–659

    PubMed  Google Scholar 

  7. Marchand V, Dendale R (2010) Normal tissue tolerance to external beam radiation therapy: Eye structures. Cancer Radiothér 14:277–283

    CAS  PubMed  Google Scholar 

  8. Gordon KB, Char DH, Sagerman RH (1995) Late effects of radiation on the eye and ocular adnexa. Int J Radiat Oncol Biol Phys 31:1123–1139

    CAS  PubMed  Google Scholar 

  9. Cattaneo L (1972) Annotazioni di anatomia dell’uomo. Monduzzi, Vol. 2, pp 278–280

    Google Scholar 

  10. Lessell S (2004) Friendly fire: Neurogenic visual loss from radiation therapy. J Neuroophthalmol 24:243–250

    PubMed  Google Scholar 

  11. Danesh-Meyer HV (2008) Radiation-induced optic neuropathy. J Clin Neurosci 15:95–100

    PubMed  Google Scholar 

  12. Mayo C, Martel MK, Marks LB et al (2010) Radiation dose-volume effects of optic nerves and chiasm. Int J Radiat Oncol Biol Phys 76(3 Suppl):S28–S35

    PubMed  Google Scholar 

  13. Jereczek-Fossa BA, Zarowski A, Milani F et al (2003) Radiotherapy-induced ear toxicity. Cancer Treat Rev 29:417–430

    PubMed  Google Scholar 

  14. Bhide SA, Harrington KJ, Nutting CM (2007) Otological toxicity after postoperative radiotherapy for parotid tumours. Clin Oncol (R Coll Radiol) 19:77–82

    CAS  Google Scholar 

  15. Bhandare N, Jackson A, Eisbruch A et al (2010) Radiation therapy and hearing loss. Int J Radiat Oncol Biol Phys 76(3 Suppl)S50–S57

    PubMed  PubMed Central  Google Scholar 

  16. Balboni GC, Bastianini A, Brizzi E et al (1991) Anatomia Umana. Third Edition. Edi Ermes, Vol. 2, pp 64–74

    Google Scholar 

  17. Leslie M, Dische S (1991) Parotid gland function following accelerated and conventionally fractionated radiotherapy. Radiother Oncol 22:133–139

    CAS  PubMed  Google Scholar 

  18. Chambers MS, Garden AS, Kies MS (2004) Radiation-induced xerostomia in patients with head and neck cancer: Pathogenesis, impact on quality of life and management. Head Neck 26(9):796–807

    PubMed  Google Scholar 

  19. Dirix P, Nuyts S, Van den Bogaert W (2006) Radiation-induced xerostomia in patients with head neck cancer: a literature review. Cancer 107(11):2525–2534

    PubMed  Google Scholar 

  20. Deasy JO, Moiseenko V, Lawrence Marks D (2010) Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys 76(3 Suppl): S58–S63

    PubMed  PubMed Central  Google Scholar 

  21. Balboni GC, Bastianini A, Brizzi E et al (1991) Anatomia Umana. Third Edition. Edi Ermes, Vol. 2, pp 83–87

    Google Scholar 

  22. Eisbruch A, Lyden T, Bradford CR et al (2002) Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 53:23–28

    PubMed  Google Scholar 

  23. Langmore SE, Krisciunas GP (2010) Dysphagia after radiotherapy for head and neck cancer: etiology, clinical presentation, and efficacy of current treatments. Perspect Swallow Swallow Disord (Dysphagia) 19(2):32–38

    Google Scholar 

  24. Russi EG, Corvò R, Merlotti A et al (2012) Swallowing dysfunction in head and neck cancer patients treated by radiotherapy: Review and recommendations of the supportive task group of the Italian Association of Radiation Oncology. Cancer Treat Rev 38(8):1033–49

    PubMed  Google Scholar 

  25. Gramley F, Lorenzen J, Koellensperger E et al (2010) Atrial fibrosis and atrial fibrillation: the role of the TGF-b1 signaling pathway. Int J Cardiol 143(3):405–413

    PubMed  Google Scholar 

  26. Haydont V, Riser BL, Aigueperse J, Vozenin-Brotons M-C (2008) Specific signals involved in the long-term maintenance of radiation-induced fibrogenic differentiation: a role for CCN2 and low concentration of TGF-b1. Am J Physiol Cell Physiol 294(6):C1332–1341

    CAS  PubMed  Google Scholar 

  27. Langendijk JA, Doornaert P, Rietveld DHF et al (2009) A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer. Radiother Oncol 90(2):189–195

    PubMed  Google Scholar 

  28. Eisbruch A (2004) Dysphagia and aspiration following chemo-irradiation of head and neck cancer: major obstacles to intensification of therapy. Ann Oncol 15:363–364

    PubMed  Google Scholar 

  29. Levandag PC, Teguh DN, Voet P et al (2007) Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: A dose-effect relationship. Radiother Oncol 85:64–73

    Google Scholar 

  30. Eisbruch A, Schwartz M, Rasch C et al (2004) Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys 60:1425–1439

    PubMed  Google Scholar 

  31. Dornfeld K, Simmons JR, Karnell L et al (2007) Radiation doses to structures within and adjacent to the larynx are correlated with long-term diet and speechrelated quality of life. Int J Radiat Oncol Biol Phys 68:750–757

    PubMed  Google Scholar 

  32. Jensen K, Lambertsen K, Grau C (2007) Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: Frequency, intensity, and correlation with dose and volume parameters. Radiother Oncol 85:74–82

    PubMed  Google Scholar 

  33. Fua TF, Corry J, Milner AD et al (2007) Intensitymodulated radiotherapy for nasopharyngeal carcinoma: Clinical correlation of dose to the pharyngoesophageal axis and dysphagia. Int J Radiat Oncol Biol Phys 67:976–981

    PubMed  Google Scholar 

  34. Rancati T, Schwarz M, Allen AM et al (2010) QUANTEC: organ-specific paper. Radiation dose-volume effects in the larynx and pharynx. Int J Radiat Oncol Biol Phys 76(3 Suppl):S64–S69

    PubMed  PubMed Central  Google Scholar 

  35. Balboni GC, Bastianini A, Brizzi E et al (1991) Anatomia Umana. Third Edition. Edi Ermes, Vol. 2, pp 292–310

    Google Scholar 

  36. Fung K, Yoo J, Leeper HA et al (2001) Vocal function following radiation for non-laryngeal versus laryngeal tumors of the head neck. Laryngoscope 111:1920–1924

    CAS  PubMed  Google Scholar 

  37. Rancati T, Schwartz M, Allen AM et al (2010) Radiation dose-volume effect in larynx and pharynx. Int J Rad Oncol Biol Phys 76(3 Suppl):S64–S69

    Google Scholar 

  38. Balboni GC, Bastianini A, Brizzi E et al (1991) Anatomia Umana. Third Edition. Edi Ermes, Vol. 1, pp 93–96

    Google Scholar 

  39. Harris M (1992) The conservative management of osteoradionecrosis of the mandible with ultrasound therapy. Br J Oral Maxillofac Surg 30:313–318

    CAS  PubMed  Google Scholar 

  40. Marx RE (1983) A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg 41:351–357

    CAS  PubMed  Google Scholar 

  41. Ben-David MA, Diamante M, Radawski JD et al (2007) Lack of osteoradionecrosis of the mandible after intensity-modulated radiotherapy for head and neck cancer: likely contributions of both dental care and improved dose distributions. Int J Radiat Oncol Biol Phys 68:396–402

    PubMed  PubMed Central  Google Scholar 

  42. Meyer I (1970) Infectious diseases of the jaws. J Oral Surg 28:17–26

    CAS  PubMed  Google Scholar 

  43. Marx RE (1983) Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 41:283–288

    CAS  PubMed  Google Scholar 

  44. Chrcanovic BR, Reher P, Sousa AA, Harris M (2010) Osteoradionecrosis of the jaws. A current overview. Part 1: Physiopathology and risk and predisposing factors. Oral Maxillofac Surg 14:3–16

    PubMed  Google Scholar 

  45. Silvestre-Rangil J, Silvestre FJ (2011) Clinico-therapeutic management of osteoradionecrosis: a literature review and update. Med Oral Patol Oral Cir Bucal 16:e900–e904

    PubMed  Google Scholar 

  46. Oh HK, Chambers MS, Martin JW Et al (2009) Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis. J Oral Maxillofac Surg 67:1378–1386

    PubMed  Google Scholar 

  47. Jereczek-Fossa BA, Orecchia R (2002) Radiotherapy-induced mandibular bone complications. Cancer Treat Rev 28:65–74

    PubMed  Google Scholar 

  48. Bagan JV, Jiménez Y, Hernández S et al (2009) Osteonecrosis of the jaws by intravenous bisphosphonates and osteoradionecrosis: a comparative study. Med Oral Patol Oral Cir Bucal 14:e616–e619

    PubMed  Google Scholar 

  49. Lee IJ, Koom WS, Lee CG Et a l (2009) Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys 75(3 Suppl):1084–1091

    PubMed  Google Scholar 

  50. Lyons A, Ghazali N (2008) Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg 46:653–660

    PubMed  Google Scholar 

  51. Marx RE, Johnson RP (1987) Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol 64:379–390

    CAS  PubMed  Google Scholar 

  52. Mendenhall WM (2004) Mandibular osteoradionecrosis. J Clin Oncol 22:4867–4868

    PubMed  Google Scholar 

  53. Wahl MJ (2006) Osteoradionecrosis prevention myths Int J Radiat Oncol Biol Phys 64:661–669

    PubMed  Google Scholar 

  54. Dijkstra PU, Kalk WW, Roodenburg JL (2004) Trismus in head and neck oncology: a systematic review. Oral Oncol 40:879–889

    CAS  PubMed  Google Scholar 

  55. Teguh DN, Levendag PC, Voet P et al (2008) Trismus in patients with oropharyngeal cancer: relationship with dose in structures of mastication apparatus. Head Neck 30:622–630

    PubMed  Google Scholar 

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Cefaro, G.A., Genovesi, D., Perez, C.A. (2013). Brain, Head and Neck. In: Delineating Organs at Risk in Radiation Therapy. Springer, Milano. https://doi.org/10.1007/978-88-470-5257-4_2

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  • DOI: https://doi.org/10.1007/978-88-470-5257-4_2

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