Parotid sparing irradiation for the head and neck cancers

Several authors have shown that xerostomia restricts nutritional intake and limits the ability of patients to maintain normal weight. When both parotids are irradiated, patients never fully regain their normal weight, however if one parotid is irradiated the patients are able to fully recover their weight with in the year. There are certain sites in the head and neck where small and lateralized cancers with diminished risk of contralateral neck metastases can be treated with parotid sparing techniques, i.e., oral cavity, retromolar trigone, anterior tonsillar pillar, tonsillar fossa, and true vocal cord. In these sites it is appropriate to spare the opposite parotid and closely observe the un-irradiated neck. Based on Dr. O' Sullivans long term follow up of patients with cancers of the oral cavity and tonsil, we are encouraged that patients can be irradiated with homo-lateral parotid techniques with out jeopardizing loco-regional control. Hazuka et al and Maesa et al suggested that three dimensional treatment planning may allow the use of parotid sparing techniques in patients who otherwise would not have been considered candidates using conventional radiotherapy techniques.