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Split Dose Radiotherapy

Paul W. Scanlon, MD
JAMA. 1972;220(3):400-401. doi:10.1001/jama.1972.03200030058016.
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Treatment reactions seen in the course of and after radiotherapy for malignant lesions of the head and neck are among the severest and physically most distressing encountered by the radiotherapist. One of the severest reactions, radioepithelitis or skin reaction, was obviated with the advent of supervoltage equipment, particularly cobalt teletherapy in the mid 1950's. There have been other notable advances toward improved treatment planning and administration. Still, the average patient undergoing modern high-dose fractionated radiotherapy to the upper respiratory and digestive tracts is subject to a most distressing array of treatment side effects.

Depending on the size of the treatment portals and the area of mucous membrane encompassed within the treatment area, radiomucositis, essentially a process of cellular death and denudation of the germinative layer of the mucous membranes, ensues about two weeks after radiation is initiated. Initially this radiomucositis is painful only on swallowing or mastication, but later, at


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