Prospective Evaluation of Taste Function in Patients With Head and Neck Cancer Receiving Intensity-Modulated Radiotherapy

Abstract

IMPORTANCEThe majority of the patients with head and neck cancer (HNC) experience taste dysfunction (TD) during or after radiotherapy (RT). However, prospectively collected data for taste dysfunction have been limited, especially in the era of intensity-modulated RT (IMRT). OBJECTIVE To evaluate the taste function in patients with HNC receiving IMRT by investigating the association between time course and recovery of TD in both acute and late phases. DESIGN, SETTING, AND PARTICIPANTS From August 2017 to November 2020, patients treated at the Chang Gung Memorial Hospital with curative or postoperative IMRT for HNC were enrolled in this prospective cohort study. The data analysis was performed from March 2021 to January 2022. EXPOSURES IMRT with and without concurrent chemotherapy. MAIN OUTCOMES AND MEASURES Taste function was measured using the whole-mouth solution method for 4 tastes (salt, sweet, sour, and bitter). Subjective evaluations (National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.03] and Subjective Total Taste Acuity scale) were used. Patient self-reported quality of life was evaluated using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N35). RESULTS A total of 87 patients (78 [90%] men and 9 [10%] women; mean [range] age, 58 years) were enrolled. Overall TD rates were 79 of 86 (91.9%), 63 of 83 (75.9%), 27 of 81 (33.3%), 5 of 56 (8.9%), and 2 of 30 (6.7%) during RT, and 1 week, 3 months, 6 months, and 1 year after RT, respectively. Positive correlation occurred between objectively measured taste loss for the 4 taste qualities and subjective perception of taste loss. Only oral cavity mean dose 4000 cGy or greater predicted TD 3 months after RT. The mean oral cavity doses to the predicted 15% (D 15 ), 25% (D 25 ), and 50% (D 50 ) probabilities were 25, 38, and 60 Gy at 3 months and 57, 60, and 64 Gy at 6 months, respectively. CONCLUSIONS AND RELEVANCEIn this cohort study, most patients still experienced TD during and at 3 months after RT. Only a few patients experienced long-term TD. A high oral cavity dose was associated with TD in patients with HNC receiving IMRT. Reducing oral cavity dose may promote early recovery of taste function after IMRT.

Mean Oral Cavity Organ-at-Risk Dose Predicts Opioid Use and Hospitalization during Radiotherapy for Patients with Head and Neck Tumors

“…In the study by Chen et al, the whole-mouth solution method for four tastes (salt, sweet, sour, and bitter) was used to objectively measure taste function in patients with head and neck cancer treated with IMRT or volumetric modulated arc therapy (VMAT) [32]. Patients were excluded if they had received previous RT to head and neck regions and/or had abnormal taste function prior to RT.…”

Acute Taste Dysfunction in Oropharyngeal Cancer Patients after Transoral Robotic Surgery

“…Treatment‐related TDs are usually attributed to cytotoxic damage of taste receptor cells from CT and RT 7,33,41–48 . Persistent TDs in HNC have a dose‐dependent relationship with RT, with oral cavity doses ≥40–50 Gy conferring a higher risk of symptoms and worse TI 12,49–51 . Furthermore, the lingual branch of GN is also vulnerable to surgical injury during tonsillectomy due to inconsistent protection in the palatine fossa 22,24,25,52 .…”

“…7,33,[41][42][43][44][45][46][47][48] Persistent TDs in HNC have a dosedependent relationship with RT, with oral cavity doses ≥40-50 Gy conferring a higher risk of symptoms and worse TI. 12,[49][50][51] Furthermore, the lingual branch of GN is also vulnerable to surgical injury during tonsillectomy due to inconsistent protection in the palatine fossa. 22,24,25,52 There is likely a higher risk of GNI in oncologic resection given its location deep to the superior Laryngoscope 133: December 2023 Tharakan et al: Acute Taste Dysfunction after TORS pharyngeal constrictor muscle.…”

“…Like other studies, we found no association between age or tumor stage and taste outcomes after HNC treatment. 49 Rates of worsened taste had potentially clinically meaningful differences by sex, tonsil versus tongue base tumors, tumor pathology, or comorbidity burden, but the differences had wide confidence intervals, therefore definitive conclusions of the true size of these differences cannot be made. The imprecision of these estimates may be due to a small sample size and could be explored further in an appropriately powered study or meta-analysis.…”