IMRT was able to reduce the V50(Gy) of the DARS.Dysphagia/Aspiration Related Structures (DARS) include: pharyngeal constrictor muscles, supraglottic and glottic larynx.Prospective swallowing assessment with videofluoroscopy, endoscopy, and CT. Michigan 2004 PMID 15590174 - "Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT?" (Eisbruch A, Int J Radiat Oncol Biol Phys. Conclusion: Dose-effect between dose and swallowing complaints observed.For each additional 10 Gy after 55 Gy, probability of dysphagia increases by 19% 70 Gy probability 40%, 50 Gy probability 20%, 22 Gy probability 2%. Outcome: steep dose-effect relationship between mean dose to constrictor muscles and severe dysphagia.Mean F/U 1.5 years IMRT and 4 years 3D-CRT Its primary action is constricting of the pharynx (in coordination with the superior pharyngeal constrictor and the inferior pharyngeal constrictor muscles) to deliver a bolus of food into the esophagus. The middle pharyngeal constrictor muscle is one of the pharyngeal constrictor muscles. Erasmus University Medical Center 2007 (Netherlands)(2000-2005) PMID 17714815 - "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." (Levendag PC, Radiother Oncol. Citation, DOI, disclosures and article data.Conclusion: Aspiration and stricture common side effects dose limits established for larynx and inferior pharyngeal constrictors.No stricture if mean inferior pharyngeal constrictor dose <54 Gy smoking correlated significantly. No aspiration if mean larynx dose <48 Gy or mean inferior pharyngeal constrictor dose <54 Gy. Outcome: Clinically significant aspiration 32% and stricture 37%. 96 patients with H&N cancers, 85% definitive RT vs 15% postop RT. Harvard 2008 (2004-2006) PMID 18468812 - "Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy." (Caglar HB, Int J Radiat Oncol Biol Phys.Conclusion: Dose to larynx and pharyngeal constrictors predicted long-term swallowing complications.Predictors for pharyngoesophageal stricture: superior pharyngeal constrictor V65 >33%, middle pharyngeal constrictor V65 > 75%.Dose volume constraints for anterior oral cavity (V30 41 Gy, larynx V60 >24%, inferior pharyngeal constrictor V60 >12%.MDACC 2012 PMID 20646872 - "Candidate dosimetric predictors of long-term swallowing dysfunction after oropharyngeal intensity-modulated radiotherapy." (Schwartz DL, Int J Radiat Oncol Biol Phys.
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