Beyond mean pharyngeal constrictor dose for beam path toxicity in non-target swallowing muscles: Dose–volume correlates of chronic radiation-associated dysphagia (RAD) after oropharyngeal intensity modulated radiotherapy

Dale, Timothy M.; Hutcheson, Katherine A.; Mohamed, A.S.R.; Lewin, Jan S.; Gunn, G. Brandon; Rao, Arvind; Kalpathy–Cramer, Jayashree; Frank, Steven J.; Garden, Adam S.; Messer, Jay A.; Warren, Benjamin W.; Lai, Stephen Y.; Beadle, Beth M.; Morrison, William H.; Phan, Jack; Skinner, Heath D.; Gross, Neil D.; Ferrarotto, Renata; Weber, Randal S.; Rosenthal, David I.; Fuller, Clifton D.

doi:10.1016/j.radonc.2016.01.019

Cited by 90 publications

(46 citation statements)

References 81 publications

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“…Pharyngeal constrictors and the larynx were first identified by multiple investigators as primary dysphagia-aspiration-related organs (DARS) [95]. Beyond the classic DARS, emerging work suggests relevance of dose/volume distributions to submental musculature (i.e., geniohyoid, mylohyoid) that are critical to elevate the hyolaryngeal complex and assist with cervical esophageal opening [96,97]. Reporting normal tissue complications probabilities as a function of DARS, Eisbruch et al gave solid ground for efforts to reduce dysphagia in the IMRT era [95,98,99].…”

Section: Dysphagiamentioning

confidence: 99%

Treatment of late sequelae after radiotherapy for head and neck cancer

Strojan

Hutcheson

Eisbruch

et al. 2017

Cancer Treatment Reviews

254

171

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Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.

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Section: Dysphagiamentioning

confidence: 99%

Treatment of late sequelae after radiotherapy for head and neck cancer

Strojan

Hutcheson

Eisbruch

et al. 2017

Cancer Treatment Reviews

254

171

View full text Add to dashboard Cite

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“…The second set of limitations are inherent to models themselves, either due to patient case mix or statistical methods employed. For example a recent publication showed that late dysphagia was related to a different set of muscle dose constraints than in the models used here [9,10], which could be related to the inclusion of only oropharyngeal cancer and the use of a recursive partitioning approach in this latter publication [21]. Indeed the majority of NTCP models investigated in the present study are based on logistic regression, which makes assumptions with regards to dose-toxicity relationship that are valid only for a subset of toxicities, e.g.…”

Section: Discussionmentioning

confidence: 99%

Toward a model-based patient selection strategy for proton therapy: External validation of photon-derived normal tissue complication probability models in a head and neck proton therapy cohort

Blanchard

Wong

Gunn

et al. 2016

Radiotherapy and Oncology

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Objective To externally validate head and neck cancer (HNC) photon-derived normal tissue complication probability (NTCP) models in patients treated with proton beam therapy (PBT). Methods This prospective cohort consisted of HNC patients treated with PBT at a single institution. NTCP models were selected based on the availability of data for validation and evaluated using the leave-one-out cross-validated area under the curve (AUC) for the receiver operating characteristics curve. Results 192 patients were included. The most prevalent tumor site was oropharynx (n=86, 45%), followed by sinonasal (n=28), nasopharyngeal (n=27) or parotid (n=27) tumors. Apart from the prediction of acute mucositis (reduction of AUC of 0.17), the models overall performed well. The validation (PBT) AUC and the published AUC were respectively 0.90 versus 0.88 for feeding tube 6 months post-PBT; 0.70 versus 0.80 for physician rated dysphagia 6 months post-PBT; 0.70 versus 0.80 for dry mouth 6 months post-PBT; and 0.73 versus 0.85 for hypothyroidism 12 months post-PBT. Conclusion While the drop in NTCP model performance was expected in PBT patients, the models showed robustness and remained valid. Further work is warranted, but these results support the validity of the model-based approach for treatment selection for HNC patients.

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“…Radiotherapy induces treatment related toxicities correlated to the RT dose delivered to normal tissues ( 12 , 13 ). Moreover, concomitant systemic treatment significantly increases the acute and late toxicity ( 6 , 14 ).…”

Section: Changes In Primary (Chemo)radiotherapymentioning

confidence: 99%

Toxicity Reduction in the Treatment of HPV Positive Oropharyngeal Cancer: Emerging Combined Modality Approaches

2018

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Human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPC) is a distinct clinical entity within the head and neck cancers, with a unique epidemiology and, in general, a favorable prognosis. Because of this favorable prognosis, researchers have considered de-intensifying the current standard treatment of HPV+ OPC in order to reduce acute and late treatment related toxicity without compromising outcome. Current ongoing trials can be divided in three main categories: de-intensification of the chemotherapy by replacing concomitant platinum-based chemotherapy with the EGFR-inhibitor cetuximab, or de-intensification of the radiation dose of either the primary radiotherapy of selected, good-responding patients after induction chemotherapy or of the adjuvant radiotherapy based on pathology features after primary surgery. Despite the good prognosis of the majority of HPV+ OPC patients, a proportion of them still have poor prognosis. This unmet need has led clinical research on new treatment strategies focused on influencing the unique micro-environment of HPV+ OPC with for example immunotherapy. This article summarizes the current understanding regarding the optimal treatment of non-metastatic HPV+ OPC. Ongoing and published clinical trials regarding de-intensification strategies, immunotherapy and proton therapy are described focusing on the rationale and underlying evidence of these emerging treatment strategies. Nevertheless, until the results of the ongoing trials are known, the treatment of HPV+ OPC in clinical practice should remain identical to the treatment of HPV negative OPC.

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Beyond mean pharyngeal constrictor dose for beam path toxicity in non-target swallowing muscles: Dose–volume correlates of chronic radiation-associated dysphagia (RAD) after oropharyngeal intensity modulated radiotherapy

Cited by 90 publications

References 81 publications

Treatment of late sequelae after radiotherapy for head and neck cancer

Treatment of late sequelae after radiotherapy for head and neck cancer

Toward a model-based patient selection strategy for proton therapy: External validation of photon-derived normal tissue complication probability models in a head and neck proton therapy cohort

Toxicity Reduction in the Treatment of HPV Positive Oropharyngeal Cancer: Emerging Combined Modality Approaches

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