DysphagiaDysphagia 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
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
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