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Application des innovations technologiques de la radiothérapie au traitement des cancers ORL : résultats cliniques de la radiothérapie conformationnelle avec modulation d'intensité : applications de l'imagerie embarquée en radiothérapie ORL

Abstract : Numerous and exciting technological innovations were recently developed in radiotherapy. We aimed to assess benefits in two specific fields. 1) Clinical results of Intensity Modulated Radiotherapy (IMRT) applied to the treatment of Head and Neck (H&N) patients. The first study was a long-term monocentric prospective registration of all H&N patients treated with IMRT in our institution. Locoregional control was excellent and toxicities limited. Recurrences were in-field. Dosimetric recommendations (parotids mean dose) were established. The second study assessed the impact of IMRT on health-related quality of life for H&N patients through a multicentric matched-pair comparison with conventional radiotherapy. Outstanding benefits were observed particularly in the fields of salivary dysfunction and oral discomfort. 2) Contribution of Image Guided Radiotherapy (IGRT) in the management of H&N patients treated with IMRT. The first study was a monitoring of delivered dose, using 3D dose recalculation from Megavoltage Cone-Beam CT (CBCT), as a quality assurance measure of a panel of H&N IMRT patients aligned with IGRT. Dosimetric consequences of anatomical changes were assessed. Contribution of color-coded MVCBCT dose-difference maps was studied. The aim of the second study was to quantify the inherent relative mobility between anatomic regions of the H&N area and to assess the dosimetric impact of several different matching procedures. Recommendations for the use of CBCT images in a daily practice were established.
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https://hal.univ-lorraine.fr/tel-01746233
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Pierre Graff-Cailleaud. Application des innovations technologiques de la radiothérapie au traitement des cancers ORL : résultats cliniques de la radiothérapie conformationnelle avec modulation d'intensité : applications de l'imagerie embarquée en radiothérapie ORL. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2011. Français. ⟨NNT : 2011NAN10073⟩. ⟨tel-01746233⟩

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