Pattern of dysphagia after swallowing-sparing intensity-modulated radiotherapy (IMRT) of head and neck cancers: results of a mono-institutional prospective study

Ursino, Stefano; Cocuzza, P.; Seccia, Veronica; Delishaj, D.; Cristaudo, Agostino; Pasqualetti, Francesco; Giusti, Patrizia; Santopadre, Stefania; Morganti, Riccardo; Fiorica, Francesco; Paiar, Fabiola; Fattori, Bruno

doi:10.1007/s00066-018-1328-9

Cited by 9 publications

(8 citation statements)

References 40 publications

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“…It investigates de‐escalation of adjuvant radiotherapy in a defined low‐risk head and neck patient population 39 . Another retrospective study has shown that the preservation of functionally important structures by special intensity‐modulated radiation therapy techniques is possible and even reduces the rate of aspiration 40 . Whether de‐escalation is possible in the head and neck region could depend on tumor and lymph node volume 41 …”

Section: Discussionmentioning

confidence: 99%

Secondary Tracheoesophageal Puncture After Laryngectomy Increases Complications With Shunt and Voice Prosthesis

et al. 2020

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Objectives/Hypothesis: To evaluate the demographics, clinical features, management, and prognostic indicators of tracheoesophageal puncture complications in patients undergoing placement of voice prosthesis following cancer treatment. Study Design: Retrospective analysis. Methods: A retrospective analysis was conducted of cases from a tertiary referral center diagnosed between 1996 and 2015. Multivariate logistic regression was used to determine factors associated with tracheoesophageal puncture (TEP) and voice prostheses-complication-free survival (TEP/VP-CFS). Results: One hundred fourteen cases were identified. Most patients were males (92.9%) with pT3 (26.8%) or pT4 (58.1%) N+ (53.6%) tumors. All patients received laryngectomy as the primary treatment, with 75% of patients receiving adjuvant radiation therapy or chemoradiotherapy. Complications with TEP were common (65.2%). The most frequent problem was salivary leakage (50.0%), which at the same time was the most common reason for changing the prosthesis. On univariate regression analysis, prosthesis placement time after adjuvant radiotherapy (hazard ratio [HR]: 4.17, 95% confidence interval [CI]: 2-8.69), secondary prosthesis placement after primary surgery (HR: 3.97, 95% CI: 1.99-7.9), and laryngectomy with flap reconstruction (HR: 1.96, 95% CI: 0.99-3.89) were significant prognosticators for complications. Multivariate regression analysis revealed secondary prosthesis placement after adjuvant radiotherapy (HR: 3.66, 95% CI: 1.39-9.68) or after primary surgery (HR: 2.57, 95% CI: 0.92-7.2) to be the strongest predictors of reduced TEP/VP-CFS. Conclusions: Secondary prosthesis placement after primary surgery, placement after previous irradiation, and laryngectomy with flap reconstruction are predictors of poor TEP/VP-CFS. Planned adjuvant radiotherapy is not a contraindication for TEP with prosthetic placement, but it is very important to place the prosthesis during the primary surgery or at least before scheduled radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Secondary Tracheoesophageal Puncture After Laryngectomy Increases Complications With Shunt and Voice Prosthesis

et al. 2020

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“…Our previously published results [7] showed a significant worsening of VF-assessed swallowing function for S (p = 0.039) rather than L bolus (no statistically significant variations) reporting an overall pattern of post-swallowing P/A of 31% and 30% at 6 and 12 months after treatment. Specifically, P was found in 6 patients (17%) and A (14%) in 5 patients (14%) at 6 months, and in 6 patients (20%) and 3 patients (10%) at 12 months after treatment, respectively.…”

Section: Discussionmentioning

confidence: 54%

“…We recently reported our prospective longitudinal study on nasopharyngeal and oropharyngeal cancers to assess the impact of RT or RTCT on swallowing function through an objective instrumental assessment from before treatment to 6 and 12 months after treatment using SWOARs-sparing IMRT (primary endpoint). We proved that better swallowing outcomes can be achieved with respect to standard approaches [7]. However, at present, it is unknown which SWOARs mostly contribute to RID so the prediction of its occurrence as well as its correlation with specific RT dose features is lacking.…”

Section: Introductionmentioning

confidence: 77%

“…Of the 38 eligible patients, 36 and 30 patients underwent VF at 6 and 12 months, respectively. The summaries of baseline patient and tumor characteristics and treatment details are reported elsewhere [7]. Among the 38 evaluable patients, 7 (18%) experienced a locoregional recurrence (6 local and 1 both local and regional), of whom 5 underwent subsequent metastatic progression (4 lung and 1 bone metastasis).…”

Section: Resultsmentioning

confidence: 99%

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Incorporating dose–volume histogram parameters of swallowing organs at risk in a videofluoroscopy-based predictive model of radiation-induced dysphagia after head and neck cancer intensity-modulated radiation therapy

Ursino

Giuliano²,

Martino³

et al. 2020

Strahlenther Onkol

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Purpose To develop a videofluoroscopy-based predictive model of radiation-induced dysphagia (RID) by incorporating DVH parameters of swallowing organs at risk (SWOARs) in a machine learning analysis. Methods Videofluoroscopy (VF) was performed to assess the penetration-aspiration score (P/A) at baseline and at 6 and 12 months after RT. An RID predictive model was developed using dose to nine SWOARs and P/A-VF data at 6 and 12 months after treatment. A total of 72 dosimetric features for each patient were extracted from DVH and analyzed with linear support vector machine classification (SVC), logistic regression classification (LRC), and random forest classification (RFC). Results 38 patients were evaluable. The relevance of SWOARs DVH features emerged both at 6 months (AUC 0.82 with SVC; 0.80 with LRC; and 0.83 with RFC) and at 12 months (AUC 0.85 with SVC; 0.82 with LRC; and 0.94 with RFC). The SWOARs and the corresponding features with the highest relevance at 6 months resulted as the base of tongue (V65 and Dmean), the superior (Dmean) and medium constrictor muscle (V45, V55; V65; Dmp; Dmean; Dmax and Dmin), and the parotid glands (Dmean and Dmp). On the contrary, the features with the highest relevance at 12 months were the medium (V55; Dmin and Dmean) and inferior constrictor muscles (V55, V65 Dmin and Dmax), the glottis (V55 and Dmax), the cricopharyngeal muscle (Dmax), and the cervical esophagus (Dmax). Conclusion We trained and cross-validated an RID predictive model with high discriminative ability at both 6 and 12 months after RT. We expect to improve the predictive power of this model by enlarging the number of training datasets.

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“…These findings, despite on a smaller sample size, were confirmed by the University of Pisa mono-institutional prospective experience [62], in which 38 patients affected by naso and oropharynx cancers submitted to SWOARs-IMRT+CT were studied by combining FEES and VFS both at baseline and at 6 and 12 months. An overall moderate/severe dysphagia, based on the amount of pharyngeal residue (P-score) at FEES, accounted for 47 and 37% at 6 and 12 months for solid consistencies.…”

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

confidence: 71%

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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Pattern of dysphagia after swallowing-sparing intensity-modulated radiotherapy (IMRT) of head and neck cancers: results of a mono-institutional prospective study

Abstract: Promising results using a SWOARs-sparing IMRT technique are reported. Therefore, treatment plans should be optimized for reducing doses to these structures.

Cited by 9 publications

References 40 publications

Secondary Tracheoesophageal Puncture After Laryngectomy Increases Complications With Shunt and Voice Prosthesis

Secondary Tracheoesophageal Puncture After Laryngectomy Increases Complications With Shunt and Voice Prosthesis

Incorporating dose–volume histogram parameters of swallowing organs at risk in a videofluoroscopy-based predictive model of radiation-induced dysphagia after head and neck cancer intensity-modulated radiation therapy

Radiation-Related Dysphagia: From Pathophysiology to Clinical Aspects

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