Swallowing outcomes following Intensity Modulated Radiation Therapy (IMRT) for head &amp; neck cancer – A systematic review

Roe, Justin; Carding, Paul; Dwivedi, Raghav C.; Kazi, Rehan; Rhys‐Evans, Peter; Harrington, Kevin; Nutting, Christopher M.

doi:10.1016/j.oraloncology.2010.07.012

Cited by 88 publications

(82 citation statements)

References 49 publications

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“…This method was pioneered by Ogilvie et al [50] and more recently utilised by Crowther et al [51] to provide a visual display of synthesised evidence, where lack of homogeneity between studies has precluded the traditional use of a forest plot. The average TREND score was 13.8 (range, [10][11][12][13][14][15][16][17][18]. Despite the variable scorings, studies were deemed to have sufficiently comparable quality in their methodology and reported findings, hence none warranted exclusion from the final cohort.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…Whilst acute toxicities, including oedema, mucositis, pain and altered/thickened salivary flow, impair the swallowing mechanism in the short-term [1][2][3][4], radiation-induced tissue fibrosis and chronic oxidative stress perpetuate impairment to the deglutition musculature long after treatment has been completed [5][6][7]. These long-term swallowing complications can contribute to significant survivorship burden for HNC patients [8][9][10], resulting in detrimental impacts on psychosocial aspects of and participation in everyday life [11,12] and ultimately reduced quality of life [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…Whilst a number of excellent systematic and critical reviews have already been published which discuss what is known about the characteristics of dysphagia following (C)RT for HNC and the clinical and functional implications for this population [3,12,[23][24][25][26][27]] no review to date has explicitly focused on the patterns of key physiologic or PHYSIOLOGICAL SWALLOWING DEFICITS FOLLOWING (C)RT FOR HNC 5 anatomical disorders underlying these difficulties and compared their reported prevalence.…”

Section: Introductionmentioning

confidence: 99%

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Physiological Changes to the Swallowing Mechanism Following (Chemo)radiotherapy for Head and Neck Cancer: A Systematic Review

et al. 2013

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Emerging research suggests that preventative swallowing rehabilitation, undertaken pre-or during (chemo)radiotherapy ([C]RT), can significantly improve early swallowing outcomes for head and neck cancer (HNC) patients. However, these treatment protocols are highly variable. Determining specific physiological swallowing parameters which are most likely to be impacted post-(C)RT would assist in refining clear targets for preventative rehabilitation.Therefore, this systematic review (1) examined the frequency and prevalence of physiological swallowing deficits observed post-(C)RT for HNC, and (2) determined the patterns of prevalence of these key physiological deficits over time post-treatment. Online databases were searched for relevant papers published between January 1998 and March 2013. In total, 153 papers were identified and appraised for methodological quality and suitability based on exclusionary criteria. Ultimately, nineteen publications met the study's inclusion criteria.Collation of reported prevalence of physiological swallowing deficits revealed reduced laryngeal excursion, base of tongue (BOT) dysfunction, reduced pharyngeal contraction and impaired epiglottic movement as most frequently reported. BOT dysfunction and impaired epiglottic movement showed a collective prevalence of over 75% in the majority of patient cohorts, whilst reduced laryngeal elevation and pharyngeal contraction had a prevalence of over 50%. Sub-analysis suggested a trend that the prevalence of key deficits is dynamic although persistent over time. These findings can be used by clinicians to inform preventative intervention, and support the use of specific, evidence-based therapy tasks explicitly selected to target the highly prevalent deficits post-(C)RT for HNC.

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Section: Methodological Qualitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Physiological Changes to the Swallowing Mechanism Following (Chemo)radiotherapy for Head and Neck Cancer: A Systematic Review

et al. 2013

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“…IntensityModulated Radiation Therapy (IMRT) is one of the approaches reducing side effects by limiting the RT doses to structures vital for function. Several studies have shown that IMRT in head and neck cancer treatment reduces overall adverse effects such as xerostomia and dysphagia, and thus improves quality of life, even when chemotherapy is added to IMRT (chemo-IMRT) [1][2][3][4][5]. It appears possible to limit the dose to the musculature involved in swallowing and mastication without compromising radiation to the tumor site(s) [2,3,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Three important swallowing muscles are the inferior, middle, and superior constrictors, innervated by the vagal nerve [7,8]. Disruption of normal swallowing function (dysphagia), may lead to (silent) aspiration, laryngeal penetration, more than normal residue after the swallow and/or reflux [1,[7][8][9][10][11][12]. The structures involved in mastication are the pterygoid, masseter, and temporalis muscles, and the mandibular condyle [13].…”

Section: Introductionmentioning

confidence: 99%

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

112

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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.

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Modern Image-Guided Intensity-Modulated Radiotherapy for Oropharynx Cancer and Severe Late Toxic Effects

Ward

Ross

Koyfman

et al. 2016

JAMA Otolaryngol Head Neck Surg

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Swallowing outcomes following Intensity Modulated Radiation Therapy (IMRT) for head & neck cancer – A systematic review

Cited by 88 publications

References 49 publications

Physiological Changes to the Swallowing Mechanism Following (Chemo)radiotherapy for Head and Neck Cancer: A Systematic Review

Physiological Changes to the Swallowing Mechanism Following (Chemo)radiotherapy for Head and Neck Cancer: A Systematic Review

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

Modern Image-Guided Intensity-Modulated Radiotherapy for Oropharynx Cancer and Severe Late Toxic Effects

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