IMPORTANCE Whole-brain radiation therapy (WBRT) delivers a substantial radiation dose to the parotid glands, but the parotid glands are not delineated for avoidance and xerostomia has never been reported as an adverse effect. Minimizing the toxic effects in patients receiving palliative treatments, such as WBRT, is crucial. OBJECTIVE To assess whether xerostomia is a toxic effect of WBRT.

Several treatment- and disease-specific factors were found to be associated with an NMSI. Overall, our results suggest that complexity (eg, head and neck, image-guided intensity-modulated radiotherapy, and daily imaging) might be a contributing factor for an NMSI. This promotes an idea of developing a more dedicated and robust quality assurance system for complex cases and highlights the importance of a strong reporting system to support a safety culture.

PurposeThis study aimed to compare the swallowing function in patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma treated with de-intensified chemoradiation therapy (6 weeks, 60 Gy) versus those receiving standard-of-care chemoradiation therapy (7 weeks, 70 Gy).Methods and materialsA retrospective review was conducted of 78 patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma with modified barium swallow studies pretreatment and 6 to 8 weeks posttreatment. The swallowing function was objectively scored for penetration, aspiration, and pharyngeal residue. Forty patients received de-intensified chemoradiation therapy (60 Gy image guided radiation therapy with weekly cisplatin 30 mg/m2) and 38 patients received standard-of-care chemoradiation therapy (70 Gy image guided radiation therapy with chemotherapy of the medical oncologist's choosing). Univariate and multivariate analyses were performed to detect differences between the cohorts with regard to laryngeal penetration, aspiration, and pharyngeal residue. A multivariate logistic regression was used to determine the overall effect of treatment on the swallowing function. Patient-reported swallowing outcomes in de-intensified cohort were assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Module for Head and Neck Cancer and the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events questionnaires.ResultsPatients treated with de-intensified chemoradiation therapy were associated with a suggestion of lower risk of developing overall swallowing dysfunction (odds ratio [OR], 0.62; P = .07), laryngeal penetration (OR, 0.63; P = .12), and pharyngeal residue (OR, 0.61; P = .08). The mean pre- and 2-year post-European Organisation for Research and Treatment of Cancer Quality of Life scores pertaining to swallowing (1-4 scale, higher worse) in the de-intensified cohort were 1.4 and 1.2 for liquids; 1.2 and 1.1 for purees; 1.5 and 1.7 for solids, 1.0 and 1.3 for choked when swallowing; and 9.0 and 10.8 for composite score, respectively. The mean pre- and 2-year post-Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events swallowing difficulty scores (1-5 scale, with higher scores being worse) were 1.5 and 1.8, respectively.ConclusionsCompared with 7 weeks of 70 Gy, 6 weeks of 60 Gy de-intensified chemoradiation therapy appears to better preserve the baseline swallowing function (per objective modified barium swallow assessment). Patients treated with de-intensified chemoradiation therapy reported minimal changes in swallowing function.

70.3%(P>0.05). In Per1 and Per3 protein positive groups, PFS in 1 year, 2 years and 3 years were 96.6%, 69% and 55.2%, respectively; in negative groups, PFS in 1 year, 2 years and 3 years were 71%, 32.3% and 16.1%(P<0.05).PFS in Per2 positive group in 1 year, 2 years and 3 years were 96.3%, 77.8% and 59.2%, respectively; negative group in 1 year, 2 years and 3 years were 72.7%, 33.3% and 24.2% (P<0.05); RFS in Per1 and Per3 negative groups in 1 year, 2 years and 3 years were 77.4%, 45.2% and 35.5%, respectively; positive group in 1 year, 2 years and 3 years were 96.6%, 82.8% and 67.7% (P<0.05). RFS in Per2 protein negative group in 1 year, 2 years and 3 years were 81.8%, 48.4.% and 36.3%, respectively; positive group in 1 year, 2 years and 3 years were 96.3%, 81.5% and 66.7% (P<0.05). Conclusion: Per1, Per2 and Per3 genes may play a critical role in the occurrence and development of HNSCC,compared with negative Per1 and Per3 protein expression, patients with positive Per1 and Per3 protein expression may have longer OS and show the trend of extended PFS and RFS.