Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma

Abstract

Objective To determine the factors associated with longitudinal patient-reported dysphagia as measured by the MD Anderson Dysphagia Inventory (MDADI) in locoregionally advanced oropharyngeal carcinoma (OPC) survivors treated with split-field intensity modulated radiotherapy (IMRT). Methods A retrospective analysis combined data from three single-institution clinical trials for stage III/IV head and neck carcinoma. According to trial protocols, patients had prospectively-collected MDADI at baseline, 6, 12, and 24 months after treatment. OPC patients with baseline and at least one post-treatment MDADI were included. Longitudinal analysis was completed with multivariate linear mixed effects modeling. Results 116 patients met inclusion criteria. Mean baseline MDADI composite was 88.3, dropping to 73.8 at 6 months, and rising to 78.6 and 83.3 by 12 and 24 months, respectively (compared to baseline, all p<0.0001). Tumor stage and smoking status were significant predictors of longitudinal MDADI composite scores. Patients with T1, T2, and T3 tumors had 15.9 (p=0.0001), 10.9 (p=0.0049), and 7.5 (p=0.0615), respectively, higher mean MDADI composite than those with T4 tumors, and current smokers had a 9.4 (p=0.0007) lower mean MDADI composite than never smokers. Conclusion Patients report clinically-meaningful dysphagia early after split-field IMRT for locoregionally advanced OPC that remains apparent 6 months after treatment. MDADI scores recover slowly thereafter, but remain depressed at 24 months compared to baseline. Higher tumor stage and smoking status are important markers of patient-reported function through the course of treatment, suggesting these are important groups for heightened surveillance and more intensive interventions to optimize swallowing outcomes.

Predictors of Patient-Reported Dysphagia Following IMRT Plus Chemotherapy in Oropharyngeal Cancer

“…Unlike other Authors, we found no significant association between swallowing dysfunction and other factors such as age, and advanced T and N stage [1,[45][46][47][48][49], probably because of differences Radiochemotherapy and no chemoradiotherapy in OPC in patients' characteristics and treatment. We found a different association between HPV and MDADI-CS in the two T stage groups: in the T1-2 subset HPV-negative and -positive patients had similar MDADI -CS distribution, whereas in the T3-4 subset HPV-negative patients had significantly lower MDADI-CS.…”

“…This was likely due to the short duration of enteral feeding, although a trend of better scores was found on a univariable analysis among patients without enteral nutrition. Differently, in a large retrospective cross-sectional study by baseline, suggesting only partial recovery of perceived swallowing function [49]. In a second recent paper by Goepfert et al, which aimed at characterizing long-term MDADI results following IMRT for patients with "low-intermediate risk" OPC included in current trials (e.g., ECOG 3311, NRG HN002, CRUK PATHOS), a poor MDADI CS (<60) was reported in 4%, 11%, 15%, and 9% of patients at baseline and 6, 12, and 24 months, respectively [16].…”

“…Moreover, we did not study the potential role of smoking status, due to the absence of complete data. Interestingly, in the paper by Goepfert et al, current smokers had a 9.4-fold lower mean MDADI over time than never smokers [49].…”

Very late xerostomia, dysphagia, and neck fibrosis after head and neck radiotherapy

“…[3][4][5] Long-term HNC survivors especially are significantly affected by late toxicities 6,7 ; yet the data on very late toxicity (VLT) (≥3 years after radiotherapy) remains sparse. [12][13][14][15] Multiple studies, for example, have shown that xerostomia is a chronic condition, highly prevalent at 6 months after IMRT and notably affecting QOL. 9 Nonetheless, the impact of these late toxicities on QOL remains substantial.…”

“…9 Nonetheless, the impact of these late toxicities on QOL remains substantial. [12][13][14][15] Multiple studies, for example, have shown that xerostomia is a chronic condition, highly prevalent at 6 months after IMRT and notably affecting QOL. [16][17][18] Also, dysphagia has been found to be one of the most commonly reported late side effects after radiotherapy, 16,18 with 45% of patients reporting it 2 years after IMRT.…”