Dysphagia
Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: A dose-effect relationship

https://doi.org/10.1016/j.radonc.2007.07.009Get rights and content

Abstract

Purpose/Objective

To assess the relationship between the radiation therapy (RT) dose received by the muscular components of the swallowing (sw) apparatus and – dysphagia related – quality of life (QoL) in oropharyngeal cancer.

Materials/Methods

Between 2000 and 2005, 81 patients with SCC of the oropharynx were treated by 3DCRT or IMRT, with or without concomitant chemotherapy (CHT); 43 out of these 81 patients were boosted by brachytherapy (BT). Charts of 81 patients were reviewed with regard to late dysphagia complaints; 23% experienced severe dysphagia. Seventeen patients expired. Fifty-six out of 64 (88%) responded to quality of life (QoL) questionnaires; that is, the Performance Status Scales of List, EORTC H&N35, and the M.D. Anderson Dysphagia Inventory.

The superior (scm), middle (mcm), and inferior constrictor muscle (icm), the cricopharyngeus muscle and the inlet of the esophagus, are considered of paramount importance for swallowing. The mean dose was calculated in the muscular structures. Univariate analysis and multivariate analysis were performed using the proportional odds model.

Results

Mean follow-up was 18 months (range 2–34) for IMRT, and 46 months for 3DCRT (range 2–72). At 3-years, a LRC of 84%, DFS of 78% and OS of 77% were observed. A significant correlation was observed between the mean dose in the scm and mcm, and severe dysphagia complaints (univariate analysis). A steep dose–effect relationship, with an increase of the probability of dysphagia of 19% with every additional 10 Gy, was established. In the multivariate analysis, BT (dose) was the only significant factor.

Conclusion

A dose–effect relationship between dose and swallowing complaints was observed. One way to improve the QoL is to constrain the dose to be received by the swallowing muscles.

Section snippets

Materials and methods

This study is based on a cohort of 81 patients diagnosed with squamous cell carcinoma (SCC) of the oropharynx, treated with curative intent between 2000 and 2005 in a single institution by highly conformal radiation therapy techniques (Table 1). That is, 46 patients by 3DCRT and 35 patients by IMRT. The treatment of preference for Tonsillar Fossa/Soft Palate tumors, T1-T3 disease, or Base of Tongue tumors (T1-4 disease), consisted at the time of a first series of 46 Gy (2 Gy per fraction, 6

Prevalence of dysphagia

Eighty-one patients with SCC of the TF/SP and BOT were analyzed for dysphagia (Table 1). Advanced staged disease is present in 75% (14/56) of patients (Table 2). The IMRT series of patients investigated has a mean follow up of 18 months (range 2–34) for IMRT as opposed to 46 months (range 2–72) for 3DCRT. Overall, the LRFS, DFS and OS at 3 years were 84%, 78% and 77%, respectively (Fig. 3). Chart review revealed nineteen out of 81 patients (23 percent) experienced moderate to severe (RTOG grade

Discussion

It is evident from the current literature that the intensification of therapy for head and neck cancer in general, either by altered fractionation RT schemes (e.g. in case of accelerated RT) and/or by the addition of concomitant chemotherapy, results in improved local-regional tumor control [7], [11], [18]. Unfortunately, as shown by meta-analysis, the late sequelae also increase. Dysphagia is obviously correlated with the functionality of the swallowing mechanism. The functionality is based on

Conclusions

We identified a subset of patients with oropharyngeal cancers with inability to swallow normally. Patients had been treated with highly conformal RT techniques, that is 3DCRT, IMRT and combinations of these with BT as a boost. Some of these patients were treated with concomitant chemotherapy as well. The dysphagia encountered in these patients is obviously multi-factorial. We were particularly interested in this paper whether the complaints were site and/or dose related. Patients were studied

References (22)

  • A.Y. Chen et al.

    The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M.D. Anderson dysphagia inventory

    Arch Otolaryngol Head Neck Surg

    (2001)
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