Intensity-Modulated Chemoradiotherapy Aiming to Reduce Dysphagia in Patients With Oropharyngeal Cancer: Clinical and Functional Results

Feng, Felix Y.; Kim, Hyungjin Myra; Lyden, Teresa; Haxer, Marc J.; Worden, Francis P.; Feng, Mary; Moyer, Jeffrey S.; Prince, Mark E.; Carey, Thomas E.; Wolf, Gregory T.; Bradford, Carol R.; Chepeha, Douglas B.; Eisbruch, Avraham

doi:10.1200/jco.2009.24.6199

Cited by 313 publications

(345 citation statements)

References 45 publications

Supporting

Mentioning

309

Contrasting

Unclassified

Order By: Relevance

“…As already mentioned in the introduction, comparing these findings with similar literature is not straight forward, since only a few authors investigated data prospectively, both pre-and posttreatment, and included objective and subjective measures [6,24]. Feng et al published 2 prospective studies that included patients with oropharyngeal and/or nasopharyngeal cancer, and found significant correlations between dysphagia endpoints (i.e.…”

Section: Discussionmentioning

confidence: 95%

Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose–effect relationships for swallowing and mastication structures

Molen

Heemsbergen

Jong

et al. 2013

Radiotherapy and Oncology

108

View full text Add to dashboard Cite

General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication. Material and Methods:Assessment of 55 patients before, 10-weeks (N=49) and 1-year post-treatment (N=37). Calculation of dose-volume parameters for swallowing (inferior (IC), middle (MC), and superior constrictors (SC)), and mastication structures (e.g. masseter). Investigation of relationships between dose-parameters and endpoints for swallowing problems (videofluoroscopy-based laryngeal Penetration-Aspiration Scale (PAS), and study-specific structured questionnaire) and limited mouth-opening (measurements and questionnaire), taking into account baseline scores. Results:At 10-weeks, volume of IC receiving ≥60Gy (V60) and mean dose IC were significant predictors for PAS. One-year post-treatment, reported problems with swallowing solids were significantly related to masseter dose-parameters (mean, V20, V40 and V60) and an inverse relationship (lower dose related to a higher probability) was observed for V60 of the IC. Dose-parameters of masseter and pterygoid muscles were significant predictors of trismus at 10-weeks (mean, V20, and V40). At 1-year, doseparameters of all mastication structures were strong predictors for subjective mouth-opening problems (mean, max, V20, V40, and V60). Conclusions:Dose-effect relationships exist for dysphagia and trismus. Therefore treatment plans should be optimized to avoid these side effects.

show abstract

Section: Discussionmentioning

confidence: 95%

Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose–effect relationships for swallowing and mastication structures

Molen

Heemsbergen

Jong

et al. 2013

Radiotherapy and Oncology

108

View full text Add to dashboard Cite

show abstract

“…Feng et al reported the feasibility of safely sparing the non-involved pharyngeal constrictor muscles in a prospective series of 73 patients and found excellent disease control and long-term swallowing outcomes, with only one patient requiring supplemental enteral feeding at 12 months. 16 Ninety-four percent of patients were eating a regular diet (grade 0-1 dysphagia) at 12 months. Although target delineation has become more complex, the three-dimensional dose gradients afforded by IMRT have allowed for greater conformality to target volumes and reduced doses to organs at risk.…”

Section: Discussionmentioning

confidence: 99%

“…The latter hypothesis has been founded in the observation that long-term swallowing dysfunction is independently associated with the mean dose to the pharyngeal constrictor muscles and larynx, as well as the volume of structures receiving between 50-70 Gy. [16][17][18][19] Multiple randomized trials are currently investigating the use of transoral surgery +/− adjuvant therapy in the setting of de-intensifying treatment for HPV-positive disease (ECOG 3311, ADEPT), as well as in the setting of multimodality treatment intensification for HPVnegative disease (RTOG 1221).…”

Section: Discussionmentioning

confidence: 99%

A Multi-institution Pooled Analysis of G-Tube Dependence in Patients With Oropharyngeal Cancer Treated With Definitive IMRT

Setton

Lee

Huang

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

“…High doses of radiation to these organs can cause dry mouth (xerostomia) and difficulty swallowing (dysphagia) 2, 3, 4, 5, 6. Sparing a patient's salivary glands and larynx has been shown to reduce symptoms and increase patient quality of life 2, 7, 8, 9. The QUANTEC review of dose–volume effects on salivary function by Deasy et al concluded that for IMRT plans the mean dose to each parotid gland should be kept as low as possible 3.…”

Section: Introductionmentioning

confidence: 99%

Assessment of PlanIQ Feasibility DVH for head and neck treatment planning

Fried

Chera

Das

2017

J Applied Clin Med Phys

View full text Add to dashboard Cite

IntroductionDesigning a radiation plan that optimally delivers both target coverage and normal tissue sparing is challenging. There are limited tools to determine what is dosimetrically achievable and frequently the experience of the planner/physician is relied upon to make these determinations. PlanIQ software provides a tool that uses target and organ at risk (OAR) geometry to indicate the difficulty of achieving different points for organ dose–volume histograms (DVH). We hypothesized that PlanIQ Feasibility DVH may aid planners in reducing dose to OARs.Methods and materialsClinically delivered head and neck treatments (clinical plan) were re‐planned (re‐plan) putting high emphasis on maximally sparing the contralateral parotid gland, contralateral submandibular gland, and larynx while maintaining routine clinical dosimetric objectives. The planner was blinded to the results of the clinically delivered plan as well as the Feasibility DVHs from PlanIQ. The re‐plan treatments were designed using 3‐arc VMAT in Raystation (RaySearch Laboratories, Sweden). The planner was then given the results from the PlanIQ Feasibility DVH analysis and developed an additional plan incorporating this information using 4‐arc VMAT (IQ plan). The DVHs across the three treatment plans were compared with what was deemed “impossible” by PlanIQ's Feasibility DVH (Impossible DVH). The impossible DVH (red) is defined as the DVH generated using the minimal dose that any voxel outside the targets must receive given 100% target coverage.ResultsThe re‐plans performed blinded to PlanIQ Feasibilty DVH achieved superior sparing of aforementioned OARs compared to the clinically delivered plans and resulted in discrepancies from the impossible DVHs by an average of 200–700 cGy. Using the PlanIQ Feasibility DVH led to additional OAR sparing compared to both the re‐plans and clinical plans and reduced the discrepancies from the impossible DVHs to an average of approximately 100 cGy. The dose reduction from clinical to re‐plan and re‐plan to IQ plan were significantly different even when taking into account multiple hypothesis testing for both the contralateral parotid and the larynx (P < 0.004 for all comparisons). No significant differences were observed between the three plans for the contralateral parotid when considering multiple hypothesis testing.ConclusionsClinical treatment plans and blinded re‐plans were found to suboptimally spare OARs. PlanIQ could aid planners in generating treatment plans that push the limits of OAR sparing while maintaining routine clinical target coverage goals.

show abstract

Intensity-Modulated Chemoradiotherapy Aiming to Reduce Dysphagia in Patients With Oropharyngeal Cancer: Clinical and Functional Results

Cited by 313 publications

References 45 publications

Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose–effect relationships for swallowing and mastication structures

Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose–effect relationships for swallowing and mastication structures

A Multi-institution Pooled Analysis of G-Tube Dependence in Patients With Oropharyngeal Cancer Treated With Definitive IMRT

Assessment of PlanIQ Feasibility DVH for head and neck treatment planning

Contact Info

Product

Resources

About