NUTRITION DURING HEAD AND NECK RADIATION

1. NUTRITION DURING HEAD & NECK RADIATION
ICRO,VISAKHAPATNAM
17TH AUAGUST 2019
DR KANHU CHARAN PATRO
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4. NUTRITION NUTRITION NUTRITION
VERY IMPORTANT DURING RADIATION
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5. BEFORE RADIATION ASSESSMENT
DURING RADIATION MANAGEMENT
POST RADIATION SURVILLENCE
ALL ARE IMPORTANT GUIDENCE
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7. MCOSITIS,DYSPHAGIA AND ASPIRATION
XEROSTOMIA,DYSGUESIA IN ADDITION
CHEMO VOMITING AND NAUSEATING SENSATION
ADDING FACTORS DUE TO TUMORIZATION
CTREAT PROBLEM FOR NUTRITION
THESE ALL HAPPENS DURING RADIATION
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9. CAUSES OF MALNUTRITION
• Radiation therapy
– Oral Mucositis,
– Stomatitis,
– Xerostomia,
– Dysphagia,
– Dysgeusia.
• Chemotherapy - enhances the side effects of radiation
therapy, and also cause s nausea, vomiting and decreased
desire to eat
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11. CONCURRENT CHEMO
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13. ASK THE PATIENT TO DRINK WATER
COUGHING IS A SIGN TO SUFFER [5]
COUGHING IS A SIGN OF ASPIRATION
NEEDS THE FEEDING TUBE INSERTION [6]
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14. Assessment
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17. EVERYDAY WEIGHT MEASUREMENT
IT IS THE ONE STEP NUTRITION MANAGEMENT
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19. TRY TO MAINTAIN A DIET CHART
IT SHOULD BE IN YOUR RADIATION CART
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21. PATIENTS NEED HIGH PROTEIN DIET
NO NEED TO RESTRICT FAT & CARBOHYDRATE
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23. EGG, NUTS, PANEER, CHICKEN AND MUTTON
THESE ARE THE HIGH PROTEIN NUTRITION
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24. HIGH PROTEIN DIET
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25. THE ROLE OF GLUTAMINE IS NOT FOR SURE
SOME STUDIES SHOWED MUCOSITIS CURE [11]
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27. MULTIVITAMIN AND MINERALS
NOT RECOMMENDED MORE THAN ALLOWANCES
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30. WHEN MUCOSITIS HINDERS THE FLOW
TO DRINK BEST USE A STRAW
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32. PROTEIN NEED IS ONE GM PER KG PER DAY
ENERGY IS 30 CALORIE PER KG PER DAY
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34. THERE ARE VARIOUS ASSESSMENT TOOLS
ANY ONE IS OK FOR TO KEEP YOU COOL
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36. TRY TO AVOID PARENTRAL NUTRITION
NOTHING CAN REPLACE ENTERAL NUTRITION
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38. ANOTHER FACTOR IS ORAL CANDIDACIES
NEEDS ANTIFUNGAL TO ERADICATE THIS CRISIS
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41. PERIODIC GARGLING IS REQUIRED FOR HYGIENE
TRY MAGIC MOUTH WASH AND BENZYDAMINE
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43. SODA SALT GARGLE DISSOLVES THE STICKY SUBSTANCE
TOPICAL ANESTHETICS HAS ITS OWN IMPORTANCE
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HYPONATREMIA IS SECONDARY TO POOR NUTRITION
ALTERED SENSORIUM LEADS TO ASPIRATION

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51. OAR AND TARGET HINDERS NUTRITION
EXTRA CARE IMPROVES NUTRITION
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52. MEDIAL BORDER AT MEDIAL OF CAROTID
NODAL CONTOURING ARTICLES ARE THE GUIDE
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54. UPPER BORDER AT C1 TRANSVERSE IN L2 NODE
UNLESS YOU ARE TREATING RP NODE
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56. WHEN ADDRESSING RETROPHARYNGEAL NODE
DO NOT INCLUDE MEDIAL RETROPHARYNGEAL NODE
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59. BOT, SUPRAGLOTTIS AND CONSTRICTORS
THEY ARE SWALLOWING ELEVATORS
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61. OC ,VC AND PC
PLEASE COUNT ON CC
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64. IF YOU WANT TO IMPROVE NUTRITON
TRY TO IMPROVE PLAN OPTIMIZATION
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65. TRY TO COLLAPSE THE BRIDGE OVER VC & PC
IMPORTANT DURING NON LARYNGOPHARYNX
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66. GREEN-95% DISTRIBUTION
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67. GREEN-95%,BLUE -70% DISTRIBUTION
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68. STILL THERE IS A VALUE OF MIDLINE BLOCK
IN 2D PLANNING TRY TO USE THAT BLOCK
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70. POSTCRICOID STENOSIS
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71. PLANNING FOR NON ORAL CAVITY
AVOID LOW DOSE SPILLAGE OVER ORAL CAVITY
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72. PAROTID IS NOT THE ONLY MOIST TARGET
OTHER MOIST STRICTURES ARE NOT TO FORGET
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76. 899
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77. PREVENT LOW DOSE FALL OVER ORAL CAVITY
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79. WE SHOULD NOT BE HAPPY WITH IMRT
HOPE WE WILL PRACTICE “DO IMRT”
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80. DARS STUDY-ONGOING
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81. DO-IMRT-[Dysphagia Optimized IMRT]
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ST.IMRT
VS
DO-IMRT

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86. TAKE CARE OF THE NUTRITION DURING RADIATION
WEIGHT LOSS NEEDS ADAPTIVE RADIATION
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87. LOOSE ORFIT
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88. SWALLOWING EXERCISES DURING AND AFTER RADIATION
YOU TUBE DEMO GIVES BETTER VISUALIZATION
MENDELSHON, MASAKO AND SHAKER MANEUVERS
THESE EXERCISES INCREASE NUTRITION TURNOVERS
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https://www.youtube.com/watch?v=H4S1Afq4fps

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MENDELSOHN MANEUVER

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SHAKER MANEUVER

93. IMPORTANT POST RT SURVILLENCE
CORRECT THE FLUID AND ELECTROLYTE IMBALANCE
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94. XEROSTOMIA AND POST CRICOID STENOSIS
THESE ARE THE IMPORTANT LATE CRISIS
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95. POSTCRICOID STENOSIS
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98. ARTIFICAL SALIVA, PILOCARPINE AND STIMULATION
SOME PATIENTS NEED ENDODAILATATION
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European Society for Clinical Nutrition and
Metabolism (ESPEN)

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107. SUMMARY
• Counseling
– Assessment
• TOOLS
– Management
– Rehabilitation
• METICULOUS TARGET DELINEATION
• METICULOUS PLANNING
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108. • AROI
• ICRO
• ORGANIZERS
• PATIENT AUDIENCE
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