Radiation-Induced trismus in head and neck cancer patients

Kent, M. Louise; Brennan, Michael T.; Noll, Jenene; Fox, Philip C.; Burri, Stuart H.; Hunter, J.C.; Lockhart, Peter B.

doi:10.1007/s00520-007-0345-5

Cited by 158 publications

(93 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As correlations for a given structure may indirectly represent correlations for an adjacent muscle due to this dose “spill-over”, multimetric modeling was utilized. Indeed higher dose correlations were found for the MI and MPI on univariate analysis consistent with prior studies identifying the M and P muscles [2,4,6]. …”

Section: Discussionsupporting

confidence: 88%

“…The overall rate of trismus in our series (11%) was low compared to other published series [2]. Severe trismus (Grade 2 or 3) occurred in only eight of the 46 patients with trismus.…”

Section: Discussioncontrasting

confidence: 68%

“…The consequent impact on oral nutrition, impairment of speech, oral hygiene, and general discomfort, can result in significant morbidity [1,2]. While radiation therapy has been reported to induce chronic trismus with a late onset, an understanding of the dose-volume parameters causing radiation-induced trismus is limited.…”

mentioning

confidence: 99%

“…While radiation therapy has been reported to induce chronic trismus with a late onset, an understanding of the dose-volume parameters causing radiation-induced trismus is limited. Previous studies report incidence rates between 5% and 50% in patients treated with head and neck radiotherapy [2,3]. Muscle damage and fibrosis have been proposed as causes for this late toxicity of radiation [4–6].…”

mentioning

confidence: 99%

See 3 more Smart Citations

Dose-volume factors correlating with trismus following chemoradiation for head and neck cancer

et al. 2015

View full text Add to dashboard Cite

Background To investigate the dose-volume factors in mastication muscles that are implicated as possible causes of trismus in patients following treatment with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy for head and neck cancers. Material and methods All evaluable patients treated at our institution between January 2004 and April 2009 with chemotherapy and IMRT for squamous cell cancers of the oropharynx, nasopharynx, hypopharynx or larynx were included in this analysis (N = 421). Trismus was assessed using CTCAE 4.0. Bi-lateral masseter, temporalis, lateral pterygoid and medial pterygoid muscles were delineated on axial computed tomography (CT) treatment planning images, and dose-volume parameters were extracted to investigate univariate and multimetric correlations. Results Forty-six patients (10.9%) were observed to have chronic trismus of grade 1 or greater. From analysis of baseline patient characteristics, toxicity correlated with primary site and patient age. From dose-volume analysis, the steepest dose thresholds and highest correlations were seen for mean dose to ipsilateral masseter (Spearman’s rank correlation coefficient Rs = 0.25) and medial pterygoid (Rs = 0.23) muscles. Lyman-Kutcher-Burman modeling showed highest correlations for the same muscles. The best correlation for multimetric logistic regression modeling was with V68Gy to the ipsilateral medial pterygoid (Rs = 0.29). Conclusion Chemoradiation-induced trismus remains a problem particularly for patients with oropharyngeal carcinoma. Strong dose-volume correlations support the hypothesis that limiting dose to the ipsilateral masseter muscle and, in particular, the medial pterygoid muscle may reduce the likelihood of trismus.

show abstract

Section: Discussionsupporting

confidence: 88%

“…The overall rate of trismus in our series (11%) was low compared to other published series [2]. Severe trismus (Grade 2 or 3) occurred in only eight of the 46 patients with trismus.…”

Section: Discussioncontrasting

confidence: 68%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Dose-volume factors correlating with trismus following chemoradiation for head and neck cancer

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Trismus is has been noted to be exceedingly common both post conventional radiotherapy and IMRT to head and neck cancer, with one study suggesting a rate of 45% [28]. The rate of trismus in this series is low at 15% and may reflect the pro-active approach in its prevention.…”

Section: Discussionmentioning

confidence: 68%

Intensity modulated radiotherapy (IMRT) in the management of locally advanced oropharyngeal squamous cell carcinomata (SCC): disease control and functional outcome using the therapy outcome measure (TOM) score - report from a single U.K. institution

et al. 2010

View full text Add to dashboard Cite

IntroductionThis paper evaluates tumour control and toxicity especially in relation to swallowing dysfunction in those patients with locally advanced oropharyngeal squamous cell carcinoma who have undergone either primary chemo-radiation or post-operative parotid sparing IMRT. The TOM scoring system was used to assess dysphagia.MethodsAll patients with locally advanced (stage 3/4) squamous cell oropharyngeal cancer and who required either primary or post-operative RT were identified. Toxicity was recorded prospectively. The TOM score (0-5 where 5 indicates that the patient is able to eat a normal diet and 0-2 varying degrees of enteral feeding dependency), weights and trismus was recorded immediately prior to and following radiotherapy.Results24 patients were identified between 1/2003 and 11/2007. Median weight loss during radiotherapy was 9 kg. All but one patient had a gastrostomy (RIG) tube inserted prophylactically. With a mean follow-up of 37.1 months, 62.5% of pts had a TOM score of 5, 12.5% scored 3, 8% scored and 17% scored 0-2.. For those patients whose swallowing function did recover, it took on average 8.7 months. 15% patients experienced trismus secondary to radiotherapy. 2 year overall survival was 92% and disease specific survival 96%.ConclusionExcellent disease control with intensified schedules of radiotherapy with IMRT has been achieved in this patient population. Intermediate toxicity is significant but with longer follow-up, dysphagia continues to improve with 75% of patients not requiring any form of enteral or oral supplementation.

show abstract

Complications That Affect Postlaryngectomy Voice Restoration

Starmer¹,

Ishman²,

Flint³

et al. 2009

Arch Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

Radiation-Induced trismus in head and neck cancer patients

Abstract: Curative doses of RT for head and neck cancer result in trismus in a high percentage of patients, independent of other treatment modalities. Trismus has a negative impact on quality of life in this population.

Cited by 158 publications

References 18 publications

Dose-volume factors correlating with trismus following chemoradiation for head and neck cancer

Dose-volume factors correlating with trismus following chemoradiation for head and neck cancer

Intensity modulated radiotherapy (IMRT) in the management of locally advanced oropharyngeal squamous cell carcinomata (SCC): disease control and functional outcome using the therapy outcome measure (TOM) score - report from a single U.K. institution

Complications That Affect Postlaryngectomy Voice Restoration

Contact Info

Product

Resources

About