Changes in Patient-reported Swallow Function in the Long Term After Chemoradiotherapy for Oropharyngeal Carcinoma

Martin, A.; Murray, Louise; Sethugavalar, B.; Buchan, C.; Williams, Gillian F.; Şen, Mehmet; Prestwich, R.J.D.

doi:10.1016/j.clon.2018.06.013

Cited by 13 publications

(6 citation statements)

References 26 publications

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“…Advanced T classification and baseline dysfunction were associated with increased gastrostomy placement and dependence rates. A more recent study (treatment window 2010-2012) by Martin et al 26 reported a rate of enteral feeding support during treatment of 79%. The rates reported by both studies are higher compared with our historical patient cohort, suggesting that our gastrostomy placement rates are not disproportionately high.…”

Section: Discussionmentioning

confidence: 99%

Swallowing Function in Survivors of Oropharyngeal Cancer Is Associated With Advanced T Classification

Harms

Kansara

Stach

et al. 2019

Ann Otol Rhinol Laryngol

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Objectives: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing in the United States. The aim of this study was to characterize the functional status of OPSCC survivors to identify predictors of swallowing dysfunction in this patient population. Methods: OPSCC survivors (n = 81) treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2005 and 2015 with at least 2 years of clinical follow-up were reviewed. Functional status was ascertained using (1) gastrostomy and tracheostomy placement and retention, (2) gastrostomy use at last follow-up, (3) patient-reported diet, and (4) modified barium swallow. Results: Median follow-up duration was 5.6 years; 67% of patients had ≥10-pack-year tobacco exposure; 96% of tumors for which p16 data were available were p16 positive. At last follow-up, 82% of patients reported a regular diet, and only 9 patients required gastrostomy use. Gastrostomy use at last follow-up was higher in patients with T3 and T4 tumors compared with those with T1 and T2 tumors ( P = .01). The relationship between T classification and gastrostomy use persisted even when the analysis was limited to p16+ tumors and p16+ tumors with ≥10-pack-year history of tobacco exposure. Conclusions: Advanced T classification at presentation is a critical predictor of gastrostomy use in long-term OPSCC survivors irrespective of p16 status or tobacco exposure history. Level of Evidence: 2b

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Section: Discussionmentioning

confidence: 99%

Swallowing Function in Survivors of Oropharyngeal Cancer Is Associated With Advanced T Classification

Harms

Kansara

Stach

et al. 2019

Ann Otol Rhinol Laryngol

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“…In line with previous literature, we found that nearly half of HNC patients report persistent dysphagia. 19,20,21,22 Dysphagia is less common in patients treated only surgically than in those who have received (chemo)RT. 19 Irradiation causes soft tissue deformities such as upper sphincter stricture, mucosal injuries, damage to connective tissue, and xerostomia, all of which impair bolus movement during swallowing.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia, hypothyroidism, and osteoradionecrosis after radiation therapy for head and neck cancer

Ranta

Kytö

Nissi

et al. 2021

Laryngoscope Investig Oto

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Objectives:To analyze the long-term side effects of radiation therapy (RT) for head and neck cancer (HNC).Methods: Retrospective chart analysis of all 688 HNC patients treated during 2010-2015 at Turku University Hospital, Finland. All patients who survived for more than a year after RT/chemoRT were included (n = 233). Intensity modulated RT (IMRT) with standard fractionation was applied in each case.Results: One hundred and six patients (45%) reported persisting dysphagia, for which neck RT increased risk. Definitive neck RT to high-risk volume did not increase late toxicity risks compared to elective neck RT. Radiation-induced hypothyroidism (29%, n = 67) was more common among younger patients and females. Osteoradionecrosis (12%, n = 29) was more common in the oral cavity cancer group (20.7%, n = 92) compared to all other subsites.Conclusions: Late toxicities of RT for HNC are common. Age, gender, tumor subsite, and neck RT affect susceptibility to long-term side effects.

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“…A lower post-treatment MDADI score means a decrease of QoL resulting from dysphagia 20 , 22 and a change of 10 points or greater means a clinically significant deterioration in QoL. 23 , 24 …”

Section: Methodsmentioning

confidence: 99%

Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric

Lim

Lee

Zakeri

et al. 2021

Technol Cancer Res Treat

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Purpose/Objective(s): The additional personnel and imaging procedures required for Adaptive Radiation Therapy (ART) pose a challenge for a broad implementation. We hypothesize that a change in transit fluence during the treatment course is correlated with the change of quality of life and thus can be used as a replanning trigger. Materials/Methods: Twenty-one head and neck cancer (HNC) patients filled out an MD Anderson Dysphagia Inventory (MDADI) questionnaire, before-and-after the radiotherapy treatment course. The transit fluence was measured by the Watchdog (WD) in-vivo portal dosimetry system. The patients were monitored with daily WD and weekly CBCTs. The region of interest (ROI) of each patient was defined as the outer contour of the patient between approximate spine levels C1 to C4, essentially the neck and mandible inside the beam’s eye view. The nth day integrated transit fluence change, Δϕn, and the volume change, ΔVROI, of the ROI of each patient was calculated from the corresponding WD and CBCT measurements. The correlation between MDADI scores and age, gender, planning mean dose to salivary glands <Dsg>, weight change ΔW, ΔVROI, and Δϕn, were analyzed using the ranked-Pearson correlation. Results: No statistically significant correlation was found for age, gender and ΔW. <Dsg> was found to have clinically important correlation with functional MDADI (ρ = −0.39, P = 0.081). ΔVROI was found to have statistically significant correlation of 0.44, 0.47 and 0.44 with global, physical and functional MDADI ( P-value < 0.05). Δϕn was found to have statistically significant ranked-correlation (−0.46, −0.46 and −0.45) with physical, functional and total MDADI ( P-value < 0.05). Conclusion: A transit fluence based decision support metric (DSM) is statistically correlated with the dysphagia risk. It can not only be used as an early signal in assisting clinicians in the ART patient selection for replanning, but also lowers the resource barrier of ART implementation.

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Changes in Patient-reported Swallow Function in the Long Term After Chemoradiotherapy for Oropharyngeal Carcinoma

Cited by 13 publications

References 26 publications

Swallowing Function in Survivors of Oropharyngeal Cancer Is Associated With Advanced T Classification

Swallowing Function in Survivors of Oropharyngeal Cancer Is Associated With Advanced T Classification

Dysphagia, hypothyroidism, and osteoradionecrosis after radiation therapy for head and neck cancer

Can the Risk of Dysphagia in Head and Neck Radiation Therapy Be Predicted by an Automated Transit Fluence Monitoring Process During Treatment? A First Comparative Study of Patient Reported Quality of Life and the Fluence-Based Decision Support Metric

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