Patterns of dysphagia and acute toxicities in patients with head and neck cancer undergoing helical IMRT±concurrent chemotherapy

Moroney, Laura B.; Helios, Jennifer; Ward, Elizabeth C.; Crombie, Jane; Wockner, Leesa; Burns, Clare L.; Spurgin, Ann‐Louise; Blake, Claire; Kenny, Lizbeth; Hughes, Brett

doi:10.1016/j.oraloncology.2016.11.009

Cited by 46 publications

(40 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When grading outcomes such as oncologic treatment toxicity, whether in the context of designing a clinical trial or in routine clinical practice, both the timing of assessment(s) and type of information provided by a particular metric or diagnostic test acquired must be carefully weighed (6). Alteration of eating and swallowing in the acute phase of radiotherapy can be a manifestation of many issues including mucositis, thick secretions, and dysgeusia (7). Surgery has its own acute impact on swallowing, largely dependent on the extent and location of tumor in addition to the surgical approach (8–11).…”

Section: Introductionmentioning

confidence: 99%

Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades

et al. 2017

View full text Add to dashboard Cite

Clinician-reported toxicity grading through common terminology criteria for adverse events (CTCAE) stages dysphagia based on symptoms, diet, and tube dependence. The new dynamic imaging grade of swallowing toxicity (DIGEST) tool offers a similarly scaled five-point ordinal summary grade of pharyngeal swallowing as determined through results of a modified barium swallow (MBS) study. This study aims to inform clinicians on the similarities and differences between dysphagia severity according to clinical CTCAE and MBS-derived DIGEST grading. A cross-sectional sample of 95 MBS studies was randomly selected from a prospectively-acquired MBS database among patients treated with organ preservation strategies for head and neck cancer. MBS DIGEST and clinical CTCAE dysphagia grades were compared. DIGEST and CTCAE dysphagia grades had "fair" agreement per weighted κ of 0.358 (95% CI .231-.485). Using a threshold of DIGEST ≥ 3 as reference, CTCAE had an overall sensitivity of 0.50, specificity of 0.84, and area under the curve (AUC) of 0.67 to identify severe MBS-detected dysphagia. At less than 6 months, sensitivity was 0.72, specificity was 0.76, and AUC was 0.75 while at greater than 6 months, sensitivity was 0.22, specificity was 0.90, and AUC was 0.56 for CTCAE to detect dysphagia as determined by DIGEST. Classification of pharyngeal dysphagia on MBS using DIGEST augments our understanding of dysphagia severity according to the clinically-derived CTCAE while maintaining the simplicity of an ordinal scale. DIGEST likely complements CTCAE toxicity grading through improved specificity for physiologic dysphagia in the acute phase and improved sensitivity for dysphagia in the late-phase.

show abstract

Section: Introductionmentioning

confidence: 99%

Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Treatments for head and neck cancer (HNSCC), including surgery, radiotherapy and chemotherapy have a number of side effects, which can impact on nutritional intake (Talwar and Findlay, 2012), with multi-modality therapy having higher toxicity (Moroney et al , 2017). As a consequence, many patients experience significant weight loss and develop malnutrition during the course of treatment (Hebuterne et al , 2014).…”

mentioning

confidence: 99%

Randomised controlled trial of early prophylactic feeding vs standard care in patients with head and neck cancer

et al. 2017

View full text Add to dashboard Cite

Background:Weight loss remains significant in patients with head and neck cancer, despite prophylactic gastrostomy and intensive dietary counseling. The aim of this study was to improve outcomes utilising an early nutrition intervention.Methods:Patients with head and neck cancer at a tertiary hospital in Australia referred for prophylactic gastrostomy prior to curative intent treatment were eligible for this single centre randomised controlled trial. Exclusions included severe malnutrition or dysphagia. Patients were assigned following computer-generated randomisation sequence with allocation concealment to either intervention or standard care. The intervention group commenced supplementary tube feeding immediately following tube placement. Primary outcome measure was percentage weight loss at three months post treatment.Results:Recruitment completed June 2015 with 70 patients randomised to standard care (66 complete cases) and 61 to intervention (56 complete cases). Following intention-to-treat analysis, linear regression found no effect of the intervention on weight loss (10.9±6.6% standard care vs 10.8±5.6% intervention, P=0.930) and this remained non-significant on multivariable analysis (P=0.624). No other differences were found for quality of life or clinical outcomes. No serious adverse events were reported.Conclusions:The early intervention did not improve outcomes, but poor adherence to nutrition recommendations impacted on potential outcomes.

show abstract

“…39 For the current study, data were analyzed for the subset of patients with oropharyngeal SCC and planned for helical IMRT with concurrent chemotherapy who had been prospectively recruited between September 2013 and November 2014. 39 For the current study, data were analyzed for the subset of patients with oropharyngeal SCC and planned for helical IMRT with concurrent chemotherapy who had been prospectively recruited between September 2013 and November 2014.…”

Section: Participantsmentioning

confidence: 99%

“…This work has led to the development of parotid-sparing IMRT and swallow-sparing IMRT techniques. 39 More evidence is needed regarding outcomes for patients with oropharyngeal SCC undergoing helical IMRT to determine whether more conformal treatment approaches minimize toxicity and optimize functional outcomes for these patients. 29 Theoretical helical IMRT planning and dosimetry studies describe the potential for improved normal tissue sparing through steep dose gradients in different directions, greater homogeneity of dose control, and increased precision of dose distributions while achieving better target coverage.…”

Section: Introductionmentioning

confidence: 99%

“…As a patient group at high risk for toxicities, particularly dysphagia due to the proximity of the tumor and treatment field to the swallowing apparatus, this information is necessary to inform when and to what extent patients with oropharyngeal SCC undergoing helical IMRT require speech pathology services during treatment. 39 More evidence is needed regarding outcomes for patients with oropharyngeal SCC undergoing helical IMRT to determine whether more conformal treatment approaches minimize toxicity and optimize functional outcomes for these patients. Thus, the purpose of this study was to prospectively evaluate the extent, severity, and pattern of presentation, peak incidence, early recovery of dysphagia, and a range of acute toxicities in a prospective cohort of patients with oropharyngeal SCC undergoing helical IMRT with concurrent chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Helical intensity‐modulated radiotherapy with concurrent chemotherapy for oropharyngeal squamous cell carcinoma: A prospective investigation of acute swallowing and toxicity patterns

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

Patterns of dysphagia and acute toxicities in patients with head and neck cancer undergoing helical IMRT±concurrent chemotherapy

Cited by 46 publications

References 43 publications

Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades

Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades

Randomised controlled trial of early prophylactic feeding vs standard care in patients with head and neck cancer

Helical intensity‐modulated radiotherapy with concurrent chemotherapy for oropharyngeal squamous cell carcinoma: A prospective investigation of acute swallowing and toxicity patterns

Contact Info

Product

Resources

About