Intensity-modulated radiation therapy (IMRT) is presently the recommended technique for the treatment of locally advanced head and neck carcinomas. Proton therapy would allow to reduce the volume of irradiated normal tissue and, thus, to decrease the risk of late dysphagia, xerostomia, dysgeusia and hypothyroidism. An exhaustive research was performed with the search engine PubMed by focusing on the papers about the physical difficulties that slow down use of proton therapy for head and neck carcinomas. Range uncertainties in proton therapy (±3 %) paradoxically limit the use of the steep dose gradient in distality. Calibration uncertainties can be important in the treatment of head and neck cancer in the presence of materials of uncertain stoichiometric composition (such as with metal implants, dental filling, etc.) and complex heterogeneities. Dental management for example may be different with IMRT or proton therapy. Some uncertainties can be somewhat minimized at the time of optimization. Inter- and intrafractional variations and uncertainties in Hounsfield units/stopping power can be integrated in a robust optimization process. Additional changes in patient's anatomy (tumour shrinkage, changes in skin folds in the beam patch, large weight loss or gain) require rescanning. Dosimetric and small clinical studies comparing photon and proton therapy have well shown the interest of proton therapy for head and neck cancers. Intensity-modulated proton therapy is a promising treatment as it can reduce the substantial toxicity burden of patients with head and neck squamous cell carcinoma compared to IMRT. Robust optimization will allow to perform an optimal treatment and to use proton therapy in current clinical practice.

• MeSH
• biofyzika záření * MeSH
• celková dávka radioterapie MeSH
• dlaždicobuněčné karcinomy hlavy a krku radioterapie   MeSH
• dysgeuzie etiologie   prevence a kontrola   MeSH
• hypotyreóza etiologie   prevence a kontrola   MeSH
• kritické orgány MeSH
• lidé MeSH
• nádory hlavy a krku radioterapie   MeSH
• nejistota MeSH
• plánování radioterapie pomocí počítače MeSH
• poruchy polykání etiologie   prevence a kontrola   MeSH
• protonová terapie * MeSH
• radiační onkologie * MeSH
• radiační poranění etiologie   prevence a kontrola   MeSH
• radioterapie řízená obrazem MeSH
• radioterapie s modulovanou intenzitou škodlivé účinky   MeSH
• teoretické modely MeSH
• translační biomedicínský výzkum * MeSH
• xerostomie etiologie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Timing of radiotherapy for low-grade gliomas is still controversial due to concerns of possible adverse late effects. Prevention of possible late cognitive sequelae by hippocampal avoidance has shown promise in phase II trials. A patient with progressive low-grade glioma with gradual dedifferentiation into anaplastic astrocytoma is presented along with description of radiotherapy planning process attempting to spare the hippocampus. To our knowledge, this is the first described case using volumetric modulated arc technique to spare hippocampus during transformed low-grade glioma radiotherapy. Using modern intensity-modulated radiotherapy systems it is possible to selectively spare hippocampus together with other standard organs at risk. For selected patients, an attempt to spare hippocampus can be considered as long as other dose characteristics are not significantly compromised compared to standard treatment plan created without any effort to avoid hippocampus.

• MeSH
• adjuvantní radioterapie metody   MeSH
• antitumorózní látky alkylující terapeutické užití   MeSH
• astrocytom patologie   MeSH
• celková dávka radioterapie MeSH
• čelní lalok patologie   MeSH
• chronické poškození mozku prevence a kontrola   MeSH
• dakarbazin analogy a deriváty   terapeutické užití   MeSH
• dediferenciace buněk MeSH
• gliom farmakoterapie   radioterapie   chirurgie   MeSH
• hipokampus účinky záření   MeSH
• kombinovaná terapie MeSH
• kraniální ozáření škodlivé účinky   metody   MeSH
• léčba šetřící orgány metody   MeSH
• lidé MeSH
• lokální recidiva nádoru farmakoterapie   radioterapie   MeSH
• mladý dospělý MeSH
• plánování radioterapie pomocí počítače MeSH
• progrese nemoci MeSH
• radioterapie s modulovanou intenzitou škodlivé účinky   metody   MeSH
• supratentoriální nádory farmakoterapie   radioterapie   chirurgie   MeSH
• tumor burden MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH