Nutrition is very important during radiation therapy for head and neck cancers. Regular assessment and careful management are needed to address issues like mucositis, dysphagia, xerostomia, and other side effects that can impact nutrition. High protein and calorie-dense foods, swallowing exercises, and mitigating factors that hinders eating are some of the strategies discussed to help maintain nutrition during treatment.

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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