Impact of radiation dose on patient-reported acute taste alteration in a prospective observational study cohort in head and neck squamous cell cancer (HNSCC)

Abstract

Purpose Taste alteration (TA) is a frequent acute side effect of radiation treatment in HNSCC patients. Principal aim of our study was to investigate dosimetric parameters in relation to patient-assessed taste impairment in a prospective cohort treated with intensity-modulated radiotherapy. Methods All patients with locally advanced HNSCC and amenable to radical treatment were included. Chemotherapy-induced taste alteration scale (CITAS), EORTC QLQ-C30 and QLQ-HN43 questionnaires at baseline (T0), 3 weeks (T1) and 3 months (T2) after radiotherapy conclusion were used to assess taste impairment. Base of tongue, submandibular glands (SG), parotid glands (PG) and taste buds, along with anterior and medium third of the tongue, were considered as organs at risk and thus delineated according to consensus guidelines. The mean dose to the above-mentioned structures was correlated with patient-reported outcomes. Results Between September 2019 and November 2020, 33 patients were recruited, 31 of which analyzed. 71% had oropharyngeal carcinoma, mostly HPV-related (60%). All were treated with tomotherapy. 77.4% had concurrent cisplatin. Mean scores of general taste alterations, global health status and dry mouth and sticky saliva were assessed. The mean doses to the anterior third, medium third and base of the tongue were 23.85, 35.50 and 47.67 Gy, respectively. Taste buds received 32.72 Gy; right and left parotid 25 and 23 Gy; right and left submandibular glands 47.8 and 39.4 Gy. At univariate analysis, dysgeusia correlated with SG mean dose (95% CI 0–0.02 p = 0.05) and PG mean dose (95% CI 0–0.02 p = 0.05); dry mouth with mean dose to anterior (95% CI 0.03–1.47 p = 0.04) and medium third (95% CI 0.02–0.93 p = 0.04) of the tongue, to taste buds (95% CI 0.06–0.96 p = 0.03) and to SGs (95% CI 0.06–0.63 p = 0.02); pain mouth with mean dose to taste buds (95% CI 0–0.02 p = 0.04), to SGs (95% CI 0–0.03 p = 0.03) and to base tongue (95% CI 0–0.02 p = 0.02). Conclusions Our analysis supports the influence of dose distribution on the development of TA in HNSCC patients. The contribution of dose to taste buds and tongue subvolumes remains unclear and worthy of further investigation.

Unravelling Quality of Life for Head and Neck Cancer Patients after VMAT Radiation Therapy: Insights from Toxicity, Dosimetry and Symptoms Correlation

“…However, our analysis delved deeper into the significance of symptoms by conducting Spearman’s correlation coefficient analysis for the time points immediately after the completion of treatment and the one 3 months after it ( Table 1 and Table 2 respectively). We found moderate statistical significance between certain symptoms (such as pain, swallowing difficulty, and dry mouth) and dosimetric data at the Organs at Risk (OARs) similarly to other research teams [ 24 , 25 ]. Conversely, symptoms like appetite loss, sticky mouth, and sensory problems showed low statistical correlation with dosimetric data.…”

“…The sample size during participant recruitment indeed constitutes a factor that could affect the generalizability of the results and thus is a major concern in the majority of studies focusing on clinical regimes. While similar numbers of patients have been previously employed in analogous studies [ 24 , 34 ], the possibility of enlarging the sample size in future research endeavors is under consideration. Additionally, the fact that QoL questionnaires are relying on self-reported data introduces the possibility of bias in symptoms severity on behalf of the patient.…”

Taste and Smell Alterations (TSAs) in Cancer Patients

“…An interesting review [ 72 ] indicates that olfactory perception of foods among head-and-neck-cancer patients is more frequent than changes in taste perception, as are changes in texture, temperature, and other oral sensations, such as hotness and cold. In these patients, smell is less affected by RT than taste, and can recover within 6 to 9 months after RT [ 73 ]. Another aspect of TSA is related to paraneoplastic syndrome, which includes tumor-induced alterations in the production of hormones, growth factors, and antigen–antibody complexes.…”

Impact of fosaprepitant in the prevention of nausea and emesis in head and neck cancer patients undergoing cisplatin-based chemoradiation: a pilot prospective study and a review of literature

“…Indeed nausea may be significantly influenced by the occurrence of dysgeusia. In this regard, some authors have investigated the use of chemotherapy-induced taste alteration scale (CiTAS) to prospectively evaluate this adverse event [ 39 ]. Of note, a recovery for discomfort, phantogeusia–parageusia and general taste impairment at 6 months was observed by Martini and colleagues [ 39 ].…”