A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy

Ursino, Stefano; D’Angelo, Elisa; Mazzola, Rosario; Merlotti, Anna; Morganti, Riccardo; Cristaudo, Agostino; Paiar, Fabiola; Musio, Daniela; Alterio, Daniela; Bacigalupo, Almalina; Russi, Elvio; Lohr, Frank

doi:10.1007/s00066-017-1160-7

Cited by 33 publications

(21 citation statements)

References 61 publications

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“…Advances in head and neck surgery have led from radical neck dissection to selective neck dissection in selected patients with squamous cell carcinoma of the oral cavity, pharynx and larynx [36]. In radiation oncology modern techniques such as IMRT or VMAT combined with image-guidance allow a higher precision in dose application and therefore individualized treatment approaches should be investigated [37][38][39][40]. The aim of the DIREKHT trial is to reduce late toxicity after postoperative radiotherapy without increasing locoregional failure.…”

Section: Discussionmentioning

confidence: 99%

Dose Reduction to the Swallowing Apparatus and the Salivary Glands by De-Intensification of Postoperative Radiotherapy in Patients with Head and Neck Cancer: First (Treatment Planning) Results of the Prospective Multicenter DIREKHT Trial

Haderlein

Speer

Ott

et al. 2020

Cancers

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Aim: Evaluating radiotherapy treatment plans of the prospective DIREKHT trial (ClinicalTrials.gov, NCT02528955) investigating de-intensification of radiotherapy in patients with head and neck cancer. Patients and Methods: The first 30 patients from the DIREKHT trial of the leading study centre were included in this analysis. Standard treatment plans and study treatment plans derived from the protocol were calculated for each patient. Sizes of planning target volumes (PTVs) and mean doses to organs at risk were compared using the Student’s t-test with paired samples. Results: Mean PTV3 including primary tumor region and ipsilateral elective neck up to a dose of 50 Gy in the study treatment plans was 662 mL (+/− 165 mL standard deviation (SD)) and therefore significantly smaller than those of the standard treatment plans (1166 mL (+/− 266 mL SD). In the medial and inferior constrictor muscles, cricopharyngeal muscle, glottic and supraglottic laryngeal areas, arytenoid cartilages, contralateral major salivary glands highly significant dose reductions (p < 0.0001) of more than 10 Gy were achieved in study treatment plan compared to standard treatment plan. Conclusion: De-intensification of radiotherapy led to smaller planning target volumes and clinical relevant dose reductions in the swallowing apparatus and in the contralateral salivary glands.

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Section: Discussionmentioning

confidence: 99%

Dose Reduction to the Swallowing Apparatus and the Salivary Glands by De-Intensification of Postoperative Radiotherapy in Patients with Head and Neck Cancer: First (Treatment Planning) Results of the Prospective Multicenter DIREKHT Trial

Haderlein

Speer

Ott

et al. 2020

Cancers

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“…To date, despite the rationale to use IMRT to reduce posttreatment dysphagia has been well acknowledged, this assumption is still to be confirmed due to the heterogeneity of the current clinical data. Nevertheless, a positive trend seems to emerge by the literature data reporting an overall lower pattern of aspiration after IMRT compared with 3DCRT (2.6-7% versus 7-78%, respectively) and is likely to increase as the radiation oncologist will be more and more encouraged to optimize plans to SWOARs in their clinical practice [59].…”

Section: Intensity and Modulated Radiotherapy (Imrt) As A Strategy Tomentioning

confidence: 99%

Radiation-Related Dysphagia: From Pathophysiology to Clinical Aspects

Ursino¹,

Cocuzza²,

Santopadre³

et al. 2020

Voice and Swallowing Disorders

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In Western countries, head and neck cancers (HNCs) account for about 5% of all tumors. Due to tumor locations at the aero-digestive crossroad, patients frequently suffer from swallowing dysfunction caused both by primary cancer (baseline dysphagia) and cancer therapies (treatment-related dysphagia). In this regard, radiation-induced dysphagia represents a real "Achille's heel" which historically occurs in more than 50% of patients and can lead to a malnutritional status and an increased risk of aspiration pneumonia. In fact radiotherapy, by restricting the driving pressure of the bolus through the pharynx and/or limiting the opening of the cricopharyngeal muscle, leads to a post-swallowing pharyngeal residue that may spill into the airway causing ab ingestis pneumonia. On the contrary, an organ preservation strategy should provide both the highest tumor control probability (TCP) and the minimum function impairment with the subsequent maximum therapeutic index gain. In this regard, intensity-modulated RT (IMRT) might reduce the probability of postradiation dysphagia by producing concave dose distributions with better avoidance of several critical structures, such as swallowing organs at risk (SWOARs), which might result in better functional outcomes. Similarly, a prompt swallowing rehabilitation provided before, during, and soon after radiotherapy plays an important role in improving oncologic swallowing outcomes.

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“…The irradiated dose and volume to these critical organs is a major determinant for RT toxicity as well as for irradiating adequate dose to target volume. Compared to 3D-CRT, the use of IMRT not only increased treatment outcomes but also reduced toxicity significantly [23][24][25]. Many expect further benefit from the use of proton therapy [26].…”

Section: Head and Neck Cancermentioning

confidence: 99%

Proton therapy: the current status of the clinical evidences

2019

Precis Future Med

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Proton therapy has the potential advantages of better conformal planning and higher biological effect than photon therapy (X-ray) for targeting tumor tissues. While the energy of a photon passes through the target, the energy of a proton is deposited at a certain depth, which in turn is negligible beyond this stopping point (i.e., the "Bragg peak"). In addition, the proton beam has a 10% higher biological effect in the same dose than the photon beam. Recent technological advances have led to wide use of proton therapy in clinical practice. To date, more than 170,000 patients have received proton therapy. Although clinical experience with proton therapy is increasing now, only approximately 1% of all radiation therapy recipients receive proton therapy and prospective randomized studies involving large sample populations remain very limited yet. The aim of this review is to describe the physical and biological properties of proton therapy and discusses the clinical evidence supporting proton therapy in various disease sites.

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A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy

Abstract: Despite several methodological limitations, reports from the current literature seem to suggest better swallowing outcomes with IMRT compared to 3DCRT. Further improvements are likely to result from the increased use of IMRT plans optimized for SWOAR sparing.

Cited by 33 publications

References 61 publications

Dose Reduction to the Swallowing Apparatus and the Salivary Glands by De-Intensification of Postoperative Radiotherapy in Patients with Head and Neck Cancer: First (Treatment Planning) Results of the Prospective Multicenter DIREKHT Trial

Dose Reduction to the Swallowing Apparatus and the Salivary Glands by De-Intensification of Postoperative Radiotherapy in Patients with Head and Neck Cancer: First (Treatment Planning) Results of the Prospective Multicenter DIREKHT Trial

Radiation-Related Dysphagia: From Pathophysiology to Clinical Aspects

Proton therapy: the current status of the clinical evidences

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