Dysphagia in head and neck cancer patients following intensity modulated radiotherapy (IMRT)

Abstract

BackgroundTo evaluate the objective and subjective long term swallowing function, and to relate dysphagia to the radiation dose delivered to the critical anatomical structures in head and neck cancer patients treated with intensity modulated radiation therapy (IMRT, +/- chemotherapy), using a midline protection contour (below hyoid, ~level of vertebra 2/3).Methods82 patients with stage III/IV squamous cell carcinoma of the larynx, oropharynx, or hypopharynx, who underwent successful definitive (n = 63, mean dose 68.9Gy) or postoperative (n = 19, mean dose 64.2Gy) simultaneous integrated boost (SIB) -IMRT either alone or in combination with chemotherapy (85%) with curative intent between January 2002 and November 2005, were evaluated retrospectively. 13/63 definitively irradiated patients (21%) presented with a total gross tumor volume (tGTV) >70cc (82-173cc; mean 106cc). In all patients, a laryngo-pharyngeal midline sparing contour outside of the PTV was drawn. Dysphagia was graded according subjective patient-reported and objective observer-assessed instruments. All patients were re-assessed 12 months later. Dose distribution to the swallowing structures was calculated.ResultsAt the re-assessment, 32-month mean post treatment follow-up (range 16-60), grade 3/4 objective toxicity was assessed in 10%. At the 32-month evaluation as well as at the last follow up assessment mean 50 months (16-85) post-treatment, persisting swallowing dysfunction grade 3 was subjectively and objectively observed in 1 patient (1%). The 5-year local control rate of the cohort was 75%; no medial marginal failures were observed.ConclusionsOur results show that sparing the swallowing structures by IMRT seems effective and relatively safe in terms of avoidance of persistent grade 3/4 late dysphagia and local disease control.

Dysphagia after definitive radiotherapy for head and neck cancer

“…Frequency and severity of swallowing problems can depend on different factors: (1) abuse of tobacco; (2) abuse of alcohol; (3) immunodepression; (4) tumour stage; (5) localization; and (6) RT (total radiation dose, fraction size, and target volumes) that may induce oedema and fibrosis of several normal structures, such as the pharyngeal musculature [19]. Late dysphagia has led some authors to consider the relationship between swallowing-related structures such as pharyngeal constrictor muscles, larynx and oesophagus and factors affecting patients, tumours and treatments [3,19,25].…”

Commissioning an in‐room mobile CT for adaptive proton therapy with a compact proton system

“…However, larger criterion of 3%, 3 mm was assessed because clinically we utilize a 3% + 3 mm as our range uncertainty for proton plans. Also, this criterion for gamma analysis is utilized for IMRT QA and gives some clinical reference regarding the acceptability of comparing two different dose planes 13, 14, 15, 16. Plans were evaluated at treatment isocenter in the coronal, sagittal, and transverse planes.…”

Intensity Modulated Radiation Therapy (IMRT) in the Treatment of Squamous Carcinoma of the Oropharynx: An Overview

“…Eight studies [27,[31][32][33][34][35][36][37], summarised in Table 3, have assessed swallowing after IMRT for patients with tumours of the oropharynx. The studies used questionnaires with or without video-fluoroscopy to assess the swallowing dysfunction.…”