Predicting Dysphagia in Patients With Head and Neck Carcinomas Treated with Radiation Therapy Using Validated Swallowing Metrics

Shukla, Rakendu; Dyer, Brandon A.; Evangelista, Lisa; Bewley, Arnaud F.; Farwell, D. Gregory; Kuhn, Maggie A.; Belafsky, Peter C.; Daly, Megan E.; Rao, Shyam

doi:10.1016/j.ijrobp.2017.06.1490

Cited by 6 publications

(3 citation statements)

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“…The degree of swallow dysfunction reported here replicates those published by Shukla et al 40 Their study, like this one, found the majority of patients had early stage (T1 or T2) oropharyngeal primaries, followed by oral cavity tumors. A higher proportion of their participants underwent surgery (62% compared to 47.5%); however, the relationship between timing of radiation, tumor location, and swallowing function was not expanded upon.…”

Section: Discussionsupporting

confidence: 91%

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

et al. 2021

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Background The relationship between swallowing outcomes and radiotherapy dose to dysphagia and aspiration‐related structures (DARS) may be different following definitive versus postoperative radiotherapy (PORT) for mucosal head and neck cancer (HNC) and has not been well‐studied. Method Patient‐ and clinician‐reported swallowing measures were prospectively collected at six time points from baseline to 24 months postradiotherapy HNC. Radiotherapy plans were retrospectively analyzed to assess dose delivered to DARS. The association between swallowing outcomes and participant demographics, tumor characteristics, and radiotherapy dose in definitive and postoperative treatment cohorts was assessed. Results Ninety‐three participants who received radiotherapy for HNC were included in the analysis (n = 49 definitive radiotherapy for laryngeal/pharyngeal primary tumors and n = 44 postoperative PORT for predominantly oral cavity/salivary gland tumors). Participants undergoing PORT had lower doses to DARS than those undergoing definitive RT. High dose to the pharyngeal constrictors and base of tongue for definitive RT and the esophageal inlet, supraglottic larynx and cervical esophagus for the PORT group were associated with worse swallowing function. Conclusion Radiation dose to DARS is associated with post‐treatment swallowing outcomes. These dose/outcome relationships may vary between the definitive and postoperative settings.

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Section: Discussionsupporting

confidence: 91%

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

et al. 2021

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“…The FOIS is a 7 level scale where 1 represents complete enteral nutrition, 2 and 3 represent some dependence on enteral nutrition with varied levels of oral intake, 4,5 and 6 indicate modified oral intake, and Level 7 represents a normal diet and fluids. Though initially validated in the stroke population, the FOIS is increasingly used in HNC studies investigating dysphagia allowing for comparison across studies (Shukla et al, 2017). Baseline dysphagia was defined as a FOIS score £5 at week 1 of treatment or if unavailable, at combined head and neck clinic.…”

Section: Methodsmentioning

confidence: 99%

“…3) a functional measure of dysphagia using the FOIS (Crary et al, 2005) The FOIS is a 7-level scale where 7 represents a normal diet, 6, 5, and 4 indicate modified oral intake of varying levels, 3 and 2 reflect consistent and inconsistent oral intake with enteral nutrition and 1 represents complete enteral nutrition. The FOIS was chosen as it is quick, it is used clinically across the study hospital and state thus allowing efficient clinical handover between clinics and sites if required, and is increasingly used in HNC studies investigating dysphagia, including those conducted by the research team allowing for comparison across studies (Moroney, Helios, Ward, Crombie, Burns, et al, 2018 = Chapter 4;Moroney, Helios, Ward, Crombie, Pelecanos, et al, 2018 = Chapter 3;Moroney et al, 2017 = Chapter 2;Shukla et al, 2017); 4) diet and fluid texture; and 5) both the speech pathologist and patient reported whether they felt a SP review was required during their treatment. At this timepoint, a primary endpoint of "<10% patients identified by the speech pathologist to have dysphagia requiring SP management" was set by the authors as the study criteria to validate The Pathway's dysphagia screening was correctly identifying any patients in need.…”

Section: Methodsmentioning

confidence: 99%

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

Moroney¹

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The management of head and neck cancer (HNC) using radiotherapy +/-chemotherapy (C)RT is associated with significant morbidity, due to key structures required for speech, swallowing, respiration, and voice falling within the treatment field. Common sequelae of non-surgical treatment include a wide range of toxicities, though dysphagia (swallowing difficulty) is particularly prominent. Dysphagia may be a short-term acute toxicity, or persist long-term, and can have a significant negative impact on quality of life. With recent advancements in technology, new conformal radiotherapy techniques such as helical intensity modulated radiotherapy (H-IMRT) have been introduced into clinical practice. Such techniques offer potential to limit the radiation exposure to non-cancerous normal tissues, and potentially reduce associated treatment toxicities -whilst maintaining cure rates. However as yet, there is limited literature documenting the incidence, severity, and pattern of treatment related toxicities, including dysphagia, associated with H-IMRT +/-chemotherapy, to support if such improvements for the patient are realised. Understanding how patients are impacted by new treatment approaches is crucial information for speech pathology services, that manage the dysphagia and related toxicities of patients. Therefore, the overall objective of this thesis was to evaluate the incidence and severity of dysphagia and related toxicities of patients undergoing H-IMRT +/-chemotherapy to inform speech pathology management practices. A secondary objective was to use this information to develop, and then evaluate a new clinical pathway of care. These objectives were addressed in a series of 4 studies.Study 1 (Chapter 2) prospectively examined the range of dysphagia and related toxicities from baseline to 12 weeks post H-IMRT +/-chemotherapy for a heterogeneous cohort of patients with mixed tumour sites and stages. A high proportion of patients were found to continue to experience grade 2-3 toxicity that peaked in the final week of treatment. Symptoms consistently improved thereafter, with the majority better than baseline by 12 weeks post-treatment.Concurrent chemotherapy at least doubled the odds of experiencing most symptoms. The findings of Chapter 2 confirmed that despite advancements in radiotherapy technique, patients iv The findings, clinical implications, limitations, and future areas of research are discussed in Chapter 6 of this thesis. In conclusion, this thesis provides information detailing the incidence, severity, and temporal pattern of dysphagia and related toxicities experienced by patients with HNC undergoing H-IMRT +/-chemotherapy to optimise supportive care and enhance patient education. These findings can be used to inform the timing and intensity of patient centred speech pathology service delivery models that meet the specific needs of patient subgroups and can form the basis of future guidelines for speech pathology support. v

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Radiotherapy for cutaneous head and neck cancer and parotid tumours: a prospective investigation of treatment-related acute swallowing and toxicity patterns

Moroney

Helios

Ward

et al. 2018

Support Care Cancer

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Patients in these subgroups of HNC experienced minimal treatment-related toxicity during radiotherapy. As such, the need for supportive symptom management by SP is low. Models that involve interdisciplinary surveillance of symptoms with referral to SP only when required may be best suited for these individuals to ensure issues are identified whilst minimising patient burden created by unnecessary routine SP appointments.

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Predicting Dysphagia in Patients With Head and Neck Carcinomas Treated with Radiation Therapy Using Validated Swallowing Metrics

Cited by 6 publications

References 0 publications

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

Radiotherapy for cutaneous head and neck cancer and parotid tumours: a prospective investigation of treatment-related acute swallowing and toxicity patterns

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