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Jovanovic N, Palma DA, Warner A, Mitchell S, Doyle PC, Theurer JA. Sarcopenia as a Predictor of Feeding Tube Placement in Individuals with Oropharyngeal Cancer. Adv Radiat Oncol 2024; 9:101484. [PMID: 38681896 PMCID: PMC11043844 DOI: 10.1016/j.adro.2024.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/14/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose In oropharyngeal squamous cell carcinoma (OPSCC), systemic loss of skeletal muscle mass (SMM), or sarcopenia, is a strong prognostic predictor of survival outcomes. However, the relationship between sarcopenia and nutrition-related outcomes is not well understood. This investigation evaluated the prognostic significance of sarcopenia for feeding tube (FT) placement in a cohort of OPSCC patients. Methods and Materials A retrospective cohort study was conducted with data collected from 194 OPSCC patients treated with definitive radiation therapy (RT) or chemoradiation therapy (CRT). Sarcopenia was assessed from computed tomography imaging at the level of the third cervical (C3) and fourth thoracic (T4) vertebrae. The prognostic nature of pretreatment sarcopenia and its relationship with FT placement was explored using logistic regression. Results The median age of patients included was 61.0 years, and the majority were male (83%). In this patient cohort, 87.6% underwent concurrent CRT, and 30.9% received a FT over the course of treatment. Sarcopenia was identified at baseline in 72.7% of patients based on C3 SMM measurements and in 41.7% based on measures at the level of T4. Based on measures at both C3 and T4, those with sarcopenia were significantly more likely to receive a FT and had significantly worse freedom from FT placement compared with patients without sarcopenia. Sarcopenia assessed at T4 was a significant predictor of FT placement. Conclusions SMM measured at T4 may represent a novel and practical biomarker for sarcopenia detection that is associated with the need for FT placement. These findings suggest that the detection of baseline sarcopenia could guide decision-making related to the need for nutritional support in OPSCC patients undergoing RT/CRT.
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Affiliation(s)
| | - David A. Palma
- Department of Radiation Oncology, London Health Science Centre, London, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Science Centre, London, Canada
| | - Sylvia Mitchell
- Department of Radiation Oncology, London Health Science Centre, London, Canada
| | - Philip C. Doyle
- Department of Otolaryngology – Head and Neck Surgery, Division of Laryngology, Stanford University School of Medicine, Stanford, California
| | - Julie A. Theurer
- Health and Rehabilitation Sciences, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
- Department of Otolaryngology – Head and Neck Surgery, London Health Science Centre, London, Canada
- School of Communication Sciences and Disorders, Elborn College, Western University, London, Canada
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2
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Kalavacherla S, Bernard B, Kim SS, Dornisch A, Blumenfeld L, Linnemeyer-Risser K, Sanghvi P, Guo T. Early Improved Functional Outcomes in Head and Neck Cancer Patients with Primary Tumor Detection. Laryngoscope 2024; 134:701-707. [PMID: 37462352 PMCID: PMC10874284 DOI: 10.1002/lary.30903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES We characterize functional outcomes in head and neck cancer of unknown primary (CUP) based on primary site identification. METHODS In this retrospective study, CUP cases were categorized as known primaries (KP) if a tumor was localized after diagnostic workup or persisting unknown primaries (UP). Age, sex, HPV status, diagnostic methods, and treatments regimens were collected. Pretreatment and short-term posttreatment (3-6 months after completion of treatment) weights, PHQ-9, Eating Assessment Tool (EAT-10), and Voice Handicap Index (VHI-10) scores were compared between UP and KP. RESULTS Among 67 CUP patients, 35 (52.2%) had identified primaries (91.4% oropharyngeal and 8.6% nasopharyngeal). KP patients were younger (58 vs. 64, p = 0.04) and more likely to be HPV-positive (88.6% vs. 50%, p = 0.002). Overall detection rates were 16.7% for PET/CT, 34.7% for direct laryngoscopy, and 46.6% for transoral robotic oropharyngectomy. Diagnostic workup was not significantly different between groups. Patients with KP received smaller intermediate radiation dose volumes (436.5 vs. 278.9 cc, p = 0.03) and lower doses to the cricopharyngeal muscle (41.6 vs. 24.6 Gy, p = 0.03).Pretreatment weights, PHQ-9, EAT-10, and VHI-10 scores did not differ between groups. However, posttreatment, UP had greater relative weight loss (-14.1% vs. -7.6%, p = 0.032), higher EAT-10 scores (12.5 vs. 3, p = 0.004), and higher PHQ-9 scores (6 vs. 1.4, p = 0.017). Specifically, UP reported more stressful swallowing, difficulty swallowing solids and pills, and swallowing affecting public eating. CONCLUSION KP patients experienced less weight loss, depression, and reduced swallowing dysfunction, highlighting an early functional benefit of primary tumor identification likely driven by reduced radiation treatment volumes. LEVEL OF EVIDENCE 4 Laryngoscope, 134:701-707, 2024.
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Affiliation(s)
- Sandhya Kalavacherla
- School of Medicine, University of California San Diego, La Jolla, California, U.S.A
| | - Benjamin Bernard
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Sangwoo S Kim
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, U.S.A
| | - Anna Dornisch
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, U.S.A
| | - Liza Blumenfeld
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, U.S.A
- Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California, San Diego, California, U.S.A
| | - Kristen Linnemeyer-Risser
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, U.S.A
- Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California, San Diego, California, U.S.A
| | - Parag Sanghvi
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, U.S.A
- Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California, San Diego, California, U.S.A
| | - Theresa Guo
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, U.S.A
- Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California, San Diego, California, U.S.A
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3
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Schar MS, Omari TI, Woods CM, Footner LR, Marshall N, Cock C, Thompson A, Nguyen T, Athanasiadis T, Ooi EH. Pharyngeal tongue base augmentation for dysphagia therapy: A prospective case series in patients post head and neck cancer treatment. Head Neck 2022; 44:1871-1884. [PMID: 35665556 DOI: 10.1002/hed.27104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/03/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dysphagia post head and neck cancer (HNC) multimodality treatment is attributed to reduced pharyngeal strength. We hypothesized that pharyngeal tongue base augmentation for dysphagia (PAD therapy) would increase pharyngeal pressures during swallowing thereby improving swallow symptoms. METHODS Adults with moderate-severe dysphagia post-HNC treatment had PAD therapy using a temporary filler (hyaluronic acid [HA]), with follow-up long-lasting lipofilling. Swallowing preprocedure and postprocedure was assessed with the Sydney Swallow Questionnaire (SSQ), High-Resolution Pharyngeal Manometry (HRPM), and Videofluoroscopic Swallowing Study (VFSS). Statistical comparison utilized paired tests. RESULTS Six participants (all male; median age 64 years [IQR 56, 71]) underwent PAD therapy at a median of 47 [IQR 8, 95] months post-treatment. SSQ scores reduced from baseline (mean 1069 [95%CI 703, 1434]) to post-HA (mean 579 [76, 1081], p > 0.05), and post-lipofilling (491 [95%CI 913, 789], p = 0.003, n = 4). Individual participants demonstrated reduced Swallow Risk Index, Bolus Presence Time, and increased Upper Esophageal Sphincter opening, but mesopharyngeal contractile pressures were unchanged. VFSS measures of aspiration, residue, and severity were unchanged. CONCLUSIONS Novel PAD therapy is safe and improves dysphagia symptoms. Biomechanical swallowing changes are suggestive of more efficacious bolus propulsion with conservative filler volume, but this was unable to resolve residue or aspiration measures.
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Affiliation(s)
- Mistyka S Schar
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Taher I Omari
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Charmaine M Woods
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lauren R Footner
- Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nicholas Marshall
- Department of Plastics & Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Charles Cock
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Alison Thompson
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Thi Nguyen
- South Australian Medical Imaging, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Theodore Athanasiadis
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Eng H Ooi
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
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4
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Liou HH, Tsai SW, Hsieh MHC, Chen YJ, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Hung DSY. Evaluation of Objective and Subjective Swallowing Outcomes in Patients with Dysphagia Treated for Head and Neck Cancer. J Clin Med 2022; 11:jcm11030692. [PMID: 35160142 PMCID: PMC8836568 DOI: 10.3390/jcm11030692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
We evaluated objective and subjective swallowing function outcomes in patients with dysphagia treated for head and neck cancer (HNC) and identified risk factors for poor swallowing outcomes. Patients undergoing videofluoroscopic swallowing studies (VFSS) between January 2016 and March 2021 were divided into four groups according to primary tumor sites; post-treatment dysphagia was assessed. The penetration–aspiration scale (PAS) and bolus residue scale (BRS) were used to objectively assess swallowing function through VFSS. The Functional Oral Intake Scale (FOIS) was used for subjective analyses of swallowing statuses. To account for potential confounding, important covariates were adjusted for in logistic regression models. Oropharyngeal tumors were significantly more likely to have poor PAS and BRS scores than oral cavity tumors, and the patients with nasopharyngeal tumors were significantly less likely to have poor FOIS scores. Old age, having multiple HNCs, and a history of radiotherapy were associated with an increased odds of poor PAS scores (for all types of swallows), poor BRS scores (for semiliquid and solid swallows), and poor FOIS scores, respectively. This indicates using only subjective assessments may not allow for accurate evaluations of swallowing function in patients treated for HNC. Using both objective and subjective assessments may allow for comprehensive evaluations.
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Affiliation(s)
- Hsin-Hao Liou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Yi-Jen Chen
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Cheng-Chih Huang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Chun-Yen Ou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Chan-Chi Chang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Wei-Ting Lee
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - Sen-Tien Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
| | - David Shang-Yu Hung
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (H.-H.L.); (S.-W.T.); (Y.-J.C.); (J.-R.H.); (C.-C.H.); (C.-Y.O.); (C.-C.C.); (W.-T.L.); (S.-T.T.)
- Correspondence:
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5
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Martino R, Fitch MI, Fuller CD, Hope A, Krisciunas G, Langmore SE, Lazarus C, Macdonald CL, McCulloch T, Mills G, Palma DA, Pytynia K, Ringash J, Sultanem K, Theurer J, Thorpe KE, Hutcheson K. The PRO-ACTIVE trial protocol: a randomized study comparing the effectiveness of PROphylACTic swallow InterVEntion for patients receiving radiotherapy for head and neck cancer. BMC Cancer 2021; 21:1100. [PMID: 34645411 PMCID: PMC8513207 DOI: 10.1186/s12885-021-08826-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Swallowing therapy is commonly provided as a treatment to lessen the risk or severity of dysphagia secondary to radiotherapy (RT) for head and neck cancer (HNC); however, best practice is not yet established. This trial will compare the effectiveness of prophylactic (high and low intensity) versus reactive interventions for swallowing in patients with HNC undergoing RT. METHODS This multi-site, international randomized clinical trial (RCT) will include 952 adult patients receiving radiotherapy for HNC and who are at high risk for post-RT dysphagia. Participants will be randomized to receive one of three interventions for swallowing during RT: RE-ACTIVE, started promptly if/when dysphagia is identified; PRO-ACTIVE EAT, low intensity prophylactic intervention started before RT commences; or, PRO-ACTIVE EAT+EXERCISE, high intensity prophylactic intervention also started before RT commences. We hypothesize that the PRO-ACTIVE therapies are more effective than late RE-ACTIVE therapy; and, that the more intensive PRO-ACTIVE (EAT + EXERCISE) is superior to the low intensive PRO-ACTIVE (EAT). The primary endpoint of effectiveness is duration of feeding tube dependency one year post radiation therapy, selected as a pragmatic outcome valued equally by diverse stakeholders (e.g., patients, caregivers and clinicians). Secondary outcomes will include objective measures of swallow physiology and function, pneumonia and weight loss, along with various patient-reported swallowing-related outcomes, such as quality of life, symptom burden, and self-efficacy. DISCUSSION Dysphagia is a common and potentially life-threatening chronic toxicity of radiotherapy, and a priority issue for HNC survivors. Yet, the optimal timing and intensity of swallowing therapy provided by a speech-language pathologist is not known. With no clearly preferred strategy, current practice is fraught with substantial variation. The pragmatic PRO-ACTIVE trial aims to specifically address the decisional dilemma of when swallowing therapy should begin (i.e., before or after a swallowing problem develops). The critical impact of this dilemma is heightened by the growing number of young HNC patients in healthcare systems that need to allocate resources most effectively. The results of the PRO-ACTIVE trial will address the global uncertainty regarding best practice for dysphagia management in HNC patients receiving radiotherapy. TRIAL REGISTRATION The protocol is registered with the US Patient Centered Outcomes Research Institute, and the PRO-ACTIVE trial was prospectively registered at ClinicalTrials.gov , under the identifier NCT03455608 ; First posted: Mar 6, 2018; Last verified: Jun 17, 2021. Protocol Version: 1.3 (January 27, 2020).
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Affiliation(s)
- R Martino
- Department of Speech Language Pathology, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
- Rehabilitation Science Institute, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
- Department of Otolaryngology, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
| | - M I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - C D Fuller
- Division of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA
| | - A Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada
| | - G Krisciunas
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, USA
| | - S E Langmore
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, USA
| | - C Lazarus
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA
| | - C L Macdonald
- Qualitative Health Research Consultants, Madison, WI, USA
| | - T McCulloch
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, WI, U.S.A
| | - G Mills
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - D A Palma
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - K Pytynia
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA
| | - J Ringash
- Department of Otolaryngology, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada
| | - K Sultanem
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - J Theurer
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - K E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Canada
| | - K Hutcheson
- Division of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA.
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA.
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6
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Mehta MP, Prince R, Butt Z, Maxwell BE, Carnes BN, Patel UA, Stepan KO, Mittal BB, Samant S. Evaluating dysphagia and xerostomia outcomes following transoral robotic surgery for patients with oropharyngeal cancer. Head Neck 2021; 43:3955-3965. [PMID: 34617643 DOI: 10.1002/hed.26887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We assessed long-term patient-reported dysphagia and xerostomia outcomes following definitive surgical management with transoral robotic surgery (TORS) in patients with oropharyngeal cancer (OPC) via a cross-sectional survey study. METHODS Patients with OPC managed with primary oropharyngeal surgery as definitive treatment at least 1 year ago between 2015 and 2019 were identified. The M. D. Anderson Dysphagia Inventory (MDADI) and Xerostomia Inventory (XI) scores were compared across treatment types (i.e., no adjuvant therapy [TORS-A] vs. adjuvant radiotherapy [TORS+RT] vs. adjuvant chemoradiotherapy [TORS+CT/RT]). RESULTS The sample had 62 patients (10 TORS-A, 30 TORS+RT, 22 TORS+CT/RT). TORS-A had clinically and statistically significantly better MDADI scores than TORS+RT (p = 0.03) and TORS+CT/RT (p = 0.02), but TORS+RT and TORS+CT/RT were not significantly different. TORS-A had clinically and statistically significantly less XI than TORS+RT (p < 0.01) and TORS+CT/RT (p < 0.01). CONCLUSIONS Patients with OPC who have undergone TORS+RT or TORS+CT/RT following surgery face clinically worse dysphagia and xerostomia outcomes relative to patients who undergo TORS-A.
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Affiliation(s)
- Mitesh P Mehta
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rebecca Prince
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zeeshan Butt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bryce E Maxwell
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittni N Carnes
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Urjeet A Patel
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katelyn O Stepan
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bharat B Mittal
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandeep Samant
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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7
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Fitzgerald CWR, Long SM, McLean AT, Cracchiolo JR. Patient-reported outcomes in human papillomavirus-related oropharyngeal cancer. J Surg Oncol 2021; 124:967-976. [PMID: 34599762 DOI: 10.1002/jso.26690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022]
Abstract
This review explores how human papillomavirus-related oropharyngeal cancer affects health-related quality of life (HR-QoL) and the role patient-reported outcomes (PROs) can play in optimizing treatment. PRO measures (PROMs) are comprehensive, subjective assessments of patients' day-to-day HR-QoL. Developed through a scientifically robust, multistage process, PROMs offer insight into patients' symptoms, function, and satisfaction with care. The use of PROMs can increase symptom awareness, stimulate discussion, and enhance shared decision-making between patients and healthcare providers.
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Affiliation(s)
- Conall W R Fitzgerald
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell/Columbia, New York, New York, USA
| | - Andrew T McLean
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer R Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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8
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Barbon CEA, Yao CMKL, Alvarez CP, Goepfert RP, Fuller CD, Lai SY, Gross ND, Hutcheson KA. Dysphagia profiles after primary transoral robotic surgery or radiation for oropharyngeal cancer: A registry analysis. Head Neck 2021; 43:2883-2895. [PMID: 34080249 DOI: 10.1002/hed.26768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/06/2021] [Accepted: 05/19/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To describe the physiologic swallowing impairments (MBSImP™©) associated with safety/efficiency impairments (DIGESTsafety /DIGESTefficiency grades) at 3-6 months after transoral robotic surgery (TORS) or radiation therapy (RT). STUDY DESIGN Secondary analysis of registry data. SETTING Single, academic institution. METHODS Two hundred and fifty-seven patients with HPV+ oropharynx cancer were stratified by primary treatment (75 TORS, 182 RT). Modified barium swallow studies were analyzed at baseline and 3-6 months using MBSImP scores and DIGESTsafety /DIGESTefficiency grades. DIGESTsafety /DIGESTefficiency grades and MBSImP were compared groupwise and associations between DIGESTsafety /DIGESTefficiency grades and MBSImP were explored by ordinal logistic regression. Exploratory analyses were stratified by multimodality treatment. RESULTS Neither DIGESTsafety /DIGESTefficiency differed significantly between groups at baseline or 3-6 months. Laryngeal vestibule closure was impaired more frequently in the RT group (RT: 41% vs. TORS: 27%; p = 0.02) while the TORS group had significantly more pharyngeal contraction impairment (63%; p < 0.001) compared to RT at 3-6 months. CONCLUSION The results suggest a focal injury associated with DIGESTsafety /DIGESTefficiency post-TORS in contrast to a low-level diffuse physiologic impairment associated with post-RT dysphagia.
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Affiliation(s)
- Carly E A Barbon
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Christopher M K L Yao
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Clare P Alvarez
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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9
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Dysphagia, trismus and speech impairment following radiation-based treatment for advanced stage oropharyngeal carcinoma: a one-year prospective evaluation. Eur Arch Otorhinolaryngol 2021; 279:1003-1027. [PMID: 34043065 DOI: 10.1007/s00405-021-06870-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/04/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective was to assess swallowing, mouth opening and speech function during the first year after radiation-based treatment (RT(+)) after introduction of a dedicated preventive rehabilitation program for stage III-IV oropharyngeal carcinoma (OPC). METHODS Swallowing, mouth opening and speech function were collected before and at six- and twelve-month follow-up after RT(+) for OPC as part of ongoing prospective assessments by speech-language pathologists . RESULTS Objective and patient-perceived function deteriorated until 6 months and improved until 12 months after treatment, but did not return to baseline levels with 25%, 20% and 58% of the patients with objective dysphagia, trismus and speech problems, respectively. Feeding tube dependency and pneumonia prevalence was low. CONCLUSION Despite successful implementation, a substantial proportion of patients still experience functional limitations after RT(+) for OPC, suggesting room for improvement of the current rehabilitation program. Pretreatment sarcopenia seems associated with worse functional outcomes and might be a relevant new target for rehabilitation strategies.
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10
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Ottenstein L, Cornett H, Switchenko JM, Nathan M, Thomas S, Gillespie AI, McColloch N, Barrett T, Studer MB, Brinkman M, Kaka AS, Boyce BJ, Ferris RL, Aiken AH, El-Deiry M, Beitler JJ, Patel MR. Characterizing postoperative physiologic swallow function following transoral robotic surgery for early stage tonsil, base of tongue, and unknown primary human papillomavirus-associated squamous cell carcinoma. Head Neck 2021; 43:1629-1640. [PMID: 33547716 PMCID: PMC8046724 DOI: 10.1002/hed.26632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Data objectively evaluating acute post-transoral robotic surgery (TORS) swallow function are limited. Our goal was to characterize and identify clinical variables that may impact swallow function components 3 weeks post-TORS. METHODS Retrospective cohort study. Pre/postoperative use of the Modified Barium Swallow Impairment Profile (MBSImP) and Penetration-Aspiration Scale (PAS) was completed on 125 of 139 TORS patients (2016-2019) with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scores were retrospectively calculated. Uni/multivariate analysis was performed. RESULTS Dysfunctional pre-TORS DIGEST scores were predictive of post-TORS dysphagia (p = 0.015). Pre-TORS MBSImP deficits in pharyngeal stripping wave, swallow initiation, and clearing pharyngeal residue correlated with airway invasion post-TORS based on PAS scores (p = 0.012, 0.027, 0.048, respectively). Multivariate analysis of DIGEST safety scores declined with older age (p = 0.044). Odds ratios (ORs) for objective swallow function components after TORS were better for unknown primary and tonsil primaries compared to base of tongue (BOT) (OR 0.35-0.91). CONCLUSIONS Preoperative impairments in specific MBSImP components, older patients, and BOT primaries may predict more extensive recovery in swallow function after TORS.
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Affiliation(s)
- Lauren Ottenstein
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hannah Cornett
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jeffrey M. Switchenko
- Department of Biostatistics & Bioinformatics, Winship Cancer Institute, Atlanta, Georgia, USA
| | - Meghana Nathan
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Susan Thomas
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amanda I. Gillespie
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy McColloch
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Meghan Brinkman
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Azeem S. Kaka
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Atlanta, Georgia, USA
| | - Brian J. Boyce
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Atlanta, Georgia, USA
| | - Robert L. Ferris
- Department of Otolaryngology – Head & Neck Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ashley H. Aiken
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mark El-Deiry
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Atlanta, Georgia, USA
| | - Jonathan J. Beitler
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Atlanta, Georgia, USA
- Department of Radiation Oncology, Winship Cancer Institute, Atlanta, Georgia, USA
| | - Mihir R. Patel
- Department of Otolaryngology – Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Winship Cancer Institute, Atlanta, Georgia, USA
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11
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Tadavarthi Y, Hosseini P, Reyes SE, Focht Garand KL, Pisegna JM, Pearson WG. Pilot Study of Quantitative Methods for Differentiating Pharyngeal Swallowing Mechanics by Dysphagia Etiology. Dysphagia 2021; 36:231-241. [PMID: 32410203 PMCID: PMC7666098 DOI: 10.1007/s00455-020-10123-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
Quantitative analysis of modified barium swallow (MBS) imaging is useful to determine the impact of various disease states on pharyngeal swallowing mechanics. In this retrospective proof of concept study, kinematic analysis and computational analysis of swallowing mechanics (CASM) were used to demonstrate how these methods differentiate swallowing dysfunction by dysphagia etiology. Ten subjects were randomly selected from four cohorts of dysphagic patients including COPD, head and neck cancer (HNC), motor neuron disease, and stroke. Each subject was age- and gender-matched with healthy, non-dysphagic controls. MBS videos of 5 ml thin and 5 ml thick bolus trials from each subject were used. A MATLAB tracker tool was adapted and updated to collect and compile data for each video (n = 160). For kinematic measurements, a MANOVA was performed with post-hoc analyses to determine group differences. For CASM measurements, a morphometric canonical variate analysis with post hoc analysis was performed to determine group differences. Kinematic analyses indicated statistically significant differences between HNC cohort and controls in distance measurements for hyolaryngeal approximation (p = .001), laryngeal elevation (p = 0.0001), pharyngeal shortening (p = 0.0002), and stage transition duration timing (p = 0.002). Timing differences were noted between the stroke cohort and controls for pharyngeal transit time (p = 0.007). Multivariate morphometric canonical variate analysis showed significant differences between etiology groups (p < 0.0001) with eigenvectors indicating differing patterns of swallowing mechanics. This study demonstrated that swallowing mechanics among cohorts of dysphagic patients can be differentiated using kinematics and CASM, providing different but complementary quantitative methods for investigating the impact of various disease states on swallowing function.
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Affiliation(s)
| | - Pouria Hosseini
- Medical College of Georgia (MCG), Augusta University, Augusta, Georgia
| | - Stephanie E Reyes
- College of Allied Health Sciences, Augusta University, Augusta, Georgia
- Department of Otolaryngology, MCG, Augusta University, Augusta, Georgia
| | - Kendrea L Focht Garand
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile, AL, USA
| | - Jessica M Pisegna
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, MA, USA
| | - William G Pearson
- Department of Cellular Biology and Anatomy, MCG, Augusta University, Augusta, Georgia.
- Department of Otolaryngology, MCG, Augusta University, Augusta, Georgia.
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12
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Alterio D, Gugliandolo SG, Augugliaro M, Marvaso G, Gandini S, Bellerba F, Russell‐Edu SW, De Simone I, Cinquini M, Starzyńska A, Zaffaroni M, Bacigalupo A, Fanetti G, Durante S, Dicuonzo S, Orecchia R, Jereczek‐Fossa BA. IMRT versus 2D/3D conformal RT in oropharyngeal cancer: A review of the literature and meta‐analysis. Oral Dis 2020; 27:1644-1653. [DOI: 10.1111/odi.13599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/07/2020] [Accepted: 07/26/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Daniela Alterio
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
| | | | - Matteo Augugliaro
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
- Department of Oncology and Hemato‐Oncology University of Milan Milan Italy
| | - Giulia Marvaso
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
- Department of Oncology and Hemato‐Oncology University of Milan Milan Italy
| | - Sara Gandini
- Molecular and Pharmaco‐Epidemiology Unit Department of Experimental Oncology IEOEuropean Institute of Oncology IRCCS Milan Italy
| | - Federica Bellerba
- Molecular and Pharmaco‐Epidemiology Unit Department of Experimental Oncology IEOEuropean Institute of Oncology IRCCS Milan Italy
| | | | - Irene De Simone
- Planning and Design Unit Department of Oncology Pharmacological Research Institute IRCSS Mario Negri Milan Italy
| | - Michela Cinquini
- Methodology of Systematic reviews and Guidelines development Unit Department of Oncology Pharmacological Research Institute IRCSS Mario Negri Milan Italy
| | - Anna Starzyńska
- Department of Oral Surgery Medical University of Gdańsk Gdańsk Poland
| | - Mattia Zaffaroni
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
| | | | - Giuseppe Fanetti
- Department of Radiotherapy Oncology National Cancer Institute CRO Aviano Italy
| | - Stefano Durante
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
- Department of Oncology and Hemato‐Oncology University of Milan Milan Italy
| | - Samantha Dicuonzo
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
| | | | - Barbara Alicja Jereczek‐Fossa
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
- Department of Oncology and Hemato‐Oncology University of Milan Milan Italy
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13
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Jung K, Narwal M, Min SY, Keam B, Kang H. Squamous cell carcinoma of head and neck: what internists should know. Korean J Intern Med 2020; 35:1031-1044. [PMID: 32663913 PMCID: PMC7487309 DOI: 10.3904/kjim.2020.078] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
Squamous cell carcinoma of head and neck (SCCHN) is a group of cancer arising from mucosal surfaces of the head and neck. Optimal management of SCCHN requires a multidisciplinary team of surgical oncologists, radiation oncologists, medical oncologists, nutritionist, and speech-language pathologists, due to the complexity of anatomical structure and importance of functional outcome. Human papilloma virus (HPV)-related SCCHN represents a distinct subset from HPV negative SCCHN which is associated with carcinogen exposure such as cigarette smoking, betel nut use and alcohol. HPV related SCCHN responds better to concurrent chemoradiation and has better overall prognosis, compared to HPV negative SCCHN. Radiation therapy has been introduced to the treatment of SCCHN, administered concurrently with systemic chemotherapy for locoregional SCCHN, as well as a palliative measure for recurrent and/or metastatic (R/M) SCCHN. Recently, immune checkpoint inhibitors have been shown to improve overall survival in R/M-SCCHN and have been incorporated into the standard of care. Combination approaches with immune therapy and targeted therapy for biomarker enriched population based on genomics are being actively investigated and will shape the future of SCCHN treatment.
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Affiliation(s)
- Kyungsuk Jung
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Manpreet Narwal
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Seon Young Min
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyunseok Kang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Correspondence to Hyunseok Kang, M.D. Department of Medicine, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, USA Tel: +1-4158857356 Fax: +1-4153337984 E-mail:
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14
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da Silva GM, Portas J, López RVM, Côrrea DF, Arantes LMRB, Carvalho AL. Study of Dysphagia in Patients with Advanced Oropharyngeal
Cancer Subjected to an Organ Preservation Protocol Based on
Concomitant Radiotherapy and Chemotherapy. Asian Pac J Cancer Prev 2019; 20:977-982. [PMID: 30912631 PMCID: PMC6825780 DOI: 10.31557/apjcp.2019.20.3.977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Organ preservation protocol (based on chemo-radiotherapy) for oropharyngeal tumors include dysphagia as a possible sequel leading to function impairment and changes in patient’s quality of life. Objectives: The aim of this study is to assess dysphagia severity after treatment in advanced oropharyngeal cancer patients treated with concurrent chemo-radiation. Methods: This prospective cross-sectional study included 64 participants who had been disease free for at least six months after primary treatment. Dysphagia severity was assessed by fibre-optic endoscopic evaluation of swallowing (FEES) and the Dysphagia Outcome and Severity Scale (DOSS); the occurrence of penetration/aspiration during swallowing was also investigated. All participants also completed the M. D. Anderson Dysphagia Inventory (MDADI). The correlation of FEES results with clinical-demographic variables and MDADI scores was assessed. Descriptive analysis was performed, and qualitative variables were compared using either the chi-square or Fisher’s exact test. Results: FEES revealed silent aspiration in 18.8% of the patients. Approximately 6.3% of the patients exhibited severe dysphagia (scores 1-2 in DOSS). Dysphagia severity was significantly associated with the MDADI physical domain scores. The participants with scores 5-7 in DOSS (no or mild dysphagia) exhibited less limitations in the MDADI physical domain (p=0.015). Conclusions: Silent aspiration was detected in one of every five patients treated with concurrent chemo-radiotherapy; almost half of the patients exhibit at least moderate dysphagia. Assessment of the participant’s quality of life via the MDADI revealed an association between the physical domain scores and dysphagia severity.
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Affiliation(s)
| | - Juliana Portas
- Speech Language Pathology Department, Barretos Cancer Hospital, Barretos – SP, Brazil
| | | | | | | | - André Lopes Carvalho
- Head and Neck Surgery Department, Barretos Cancer Hospital, Barretos – SP, Brazil
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15
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Wong ATT, Lai SY, Gunn GB, Beadle BM, Fuller CD, Barrow MP, Hofstede TM, Chambers MS, Sturgis EM, Mohamed ASR, Lewin JS, Hutcheson KA. Symptom burden and dysphagia associated with osteoradionecrosis in long-term oropharynx cancer survivors: A cohort analysis. Oral Oncol 2017; 66:75-80. [PMID: 28249651 DOI: 10.1016/j.oraloncology.2017.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/04/2017] [Accepted: 01/07/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose is to examine the relationship between mandibular osteoradionecrosis (ORN) and chronic dysphagia in long-term oropharynx cancer (OPC) survivors, and to determine the perceived symptom burden associated with ORN. MATERIALS AND METHODS Medical records of 349 OPC patients treated with bilateral IMRT and systemic therapy were reviewed. ORN was graded using a published 4-point classification schema. Patients were considered to have chronic dysphagia if they had aspiration pneumonia, stricture or aspiration detected by fluoroscopy or endoscopy, and/or feeding tube dependence in long-term follow-up ⩾1year following radiotherapy. MD Anderson Symptom Inventory - Head and Neck Module (MDASI-HN) scores were analyzed in a nested cross-sectional survey sample of 118 patients. RESULTS 34 (9.7%, 95% CI: 6.8-13.3%) patients developed ORN and 45 (12.9%, 95% CI: 9.6-16.9%) patients developed chronic dysphagia. Prevalence of chronic dysphagia was significantly higher in ORN cases (12/34, 35%) compared to those who did not develop ORN (33/315, 11%, p<0.001). ORN grade was also significantly associated with prevalence of dysphagia (p<0.001); the majority of patients with grade 4 ORN requiring major surgery (6 patients, 75%) were found to have chronic dysphagia. Summary MDASI-HN symptom scores did not significantly differ by ORN grade. Significantly higher symptom burden was reported, however, among ORN cases compared to those without ORN for MDASI-HN swallowing (p=0.033), problems with teeth and/or gums (p=0.016) and change in activity (p=0.015) item scores. CONCLUSIONS ORN is associated with excess burden of chronic dysphagia and higher symptom severity related to swallowing, dentition and activity limitations.
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Affiliation(s)
- Angela T T Wong
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Martha P Barrow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Theresa M Hofstede
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark S Chambers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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16
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Dysphagia, Speech, Voice, and Trismus following Radiotherapy and/or Chemotherapy in Patients with Head and Neck Carcinoma: Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6086894. [PMID: 27722170 PMCID: PMC5045989 DOI: 10.1155/2016/6086894] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/01/2016] [Indexed: 01/19/2023]
Abstract
Introduction. Patients with head and neck cancer suffer from various impairments due to the primary illness, as well as secondary consequences of the oncological treatment. This systematic review describes the effects of radiotherapy and/or chemotherapy on the functions of the upper aerodigestive tract in patients with head and neck cancer. Methods. A systematic literature search was performed by two independent reviewers using the electronic databases PubMed and Embase. All dates up to May 2016 were included. Results. Of the 947 abstracts, sixty articles met the inclusion criteria and described one or more aspects of the sequelae of radiotherapy and/or chemotherapy. Forty studies described swallowing-related problems, 24 described voice-related problems, seven described trismus, and 25 studies described general quality of life. Only 14 articles reported that speech pathologists conducted the interventions, of which only six articles described in detail what the interventions involved. Conclusion. In general, voice quality improved following intervention, whereas quality of life, dysphagia, and oral intake deteriorated during and after treatment. However, as a consequence of the diversity in treatment protocols and patient characteristics, the conclusions of most studies cannot be easily generalised. Further research on the effects of oncological interventions on the upper aerodigestive tract is needed.
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17
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Goepfert RP, Lewin JS, Barrow MP, Gunn GB, Fuller CD, Beadle BM, Garden AS, Rosenthal DI, Kies MS, Papadimitrakopoulou V, Lai SY, Gross ND, Schwartz DL, Hutcheson KA. Long-Term, Prospective Performance of the MD Anderson Dysphagia Inventory in "Low-Intermediate Risk" Oropharyngeal Carcinoma After Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 97:700-708. [PMID: 27485284 DOI: 10.1016/j.ijrobp.2016.06.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/24/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To characterize long-term MD Anderson Dysphagia Inventory (MDADI) results after primary intensity modulated radiation therapy (IMRT) for oropharyngeal carcinoma (OPC) among patients with "low-intermediate risk" OPC who would be eligible for current trials (eg, ECOG 3311, NRG HN002, CRUK PATHOS). METHODS AND MATERIALS A retrospective pooled analysis combined data from 3 single-institution clinical trials for advanced-stage head and neck carcinoma. Inclusion criteria were clinical stage III/IV OPC (T1-2/N1-2b, T3/N0-2b) treated with definitive split-field IMRT and prospectively collected MDADI at baseline and at least 1 posttreatment interval available in trial databases. Patients were sampled to represent likely human papillomavirus (HPV)-associated disease (HPV+/p16+ or <10 pack-years if HPV/p16 unknown). The MDADI composite scores were collected at baseline and 6, 12, and 24 months after treatment. Pairwise tests were Bonferroni corrected for multiple comparisons. RESULTS Forty-six patients were included. All received bilateral neck irradiation with a median dose of 70 Gy and systemic therapy (57% concurrent, 43% induction only). Overall the mean baseline MDADI composite score was 90.1, dropping to 74.6 at 6 months (P<.0001) and rising to 78.5 (P<.0001) and 83.1 (P=.002) by 12 and 24 months relative to baseline, respectively, representing a clinically meaningful drop in MDADI scores at 6 months that partially recovers by 24 months (6 vs 24 months, P=.05). Poor MDADI scores (composite <60) were reported in 4%, 11%, 15%, and 9% of patients at baseline and 6, 12, and 24 months, respectively. Fifteen percent of patients had a persistently depressed composite score by at least 20 points at the 24-month interval. CONCLUSION "Low-intermediate risk" patients with OPC treated with laryngeal/esophageal inlet dose-optimized split-field IMRT are highly likely to report recovery of acceptable swallowing function in long-term follow-up. Only 15% report poor swallowing function and/or persistently depressed MDADI at 12 months or more after IMRT. These data serve as a benchmark future trial design and endpoint interpretation.
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Affiliation(s)
- Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martha P Barrow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Merrill S Kies
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David L Schwartz
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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18
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Starmer HM, Quon H, Kumar R, Alcorn S, Murano E, Jones B, Humbert I. The Effect of Radiation Dose on Swallowing: Evaluation of Aspiration and Kinematics. Dysphagia 2015; 30:430-7. [PMID: 26025757 DOI: 10.1007/s00455-015-9618-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 04/15/2015] [Indexed: 01/18/2023]
Abstract
Radiation oncologists have focused on the pharyngeal constrictors as the primary muscles of concern for dysphagia. However, our prior investigations have demonstrated that radiation dose to the geniohyoid rather than the constrictor muscles was more closely related to penetration aspiration scores (PAS). We examined the relationship between (1) radiation dose and swallowing temporal kinematics, and (2) between PAS and swallowing kinematics in these patients. Videofluoroscopic swallowing studies of 41 patients following radiation therapy for oropharyngeal cancer were analyzed for thin liquid boluses. Timing measures included duration of laryngeal vestibule closure (DLVC), duration to maximum hyoid elevation (DTMHE), duration to cricopharyngeal opening (DTCPO), and pharyngeal transit time (PTT). PAS was extracted for each swallow and considered normal if ≤ 2. As minimum and mean dose to the geniohyoid increased, DTMHE, DTCPO, and PTT increased. Worse PA scores were most strongly correlated with radiation dose received by geniohyoid (r = 0.445, p < 0.0001). Mean DLVC varied according to PAS group (normal PAS mean = 0.67 s, abnormal PAS mean = 0.13 s; p < 0.001). Similarly, DTCPO was significantly different based upon PAS (normal PAS mean = 0.22 s, abnormal PAS mean = 0.37 s, p = 0.016). As PAS increased, DTPCO and PTT increased (r = 0.208, p = 0.04; r = 0.204, p = 0.043). A negative correlation was noted between PAS and DLVC (r = -0.375, p = 0.001). Higher doses of radiation to the geniohyoid muscles are associated with increased severity of dysphagia as measured through both kinematics and PAS. Consideration of dose to the geniohyoid should be considered when planning radiation.
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Affiliation(s)
- Heather M Starmer
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA,
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Kerr P, Myers CL, Butler J, Alessa M, Lambert P, Cooke AL. Prospective functional outcomes in sequential population based cohorts of stage III/ IV oropharyngeal carcinoma patients treated with 3D conformal vs. intensity modulated radiotherapy. J Otolaryngol Head Neck Surg 2015; 44:17. [PMID: 25964113 PMCID: PMC4436159 DOI: 10.1186/s40463-015-0068-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE To compare early (3 and 6 month) and later (12 and 24 month) functional outcomes of stage III and IV (M0) oropharyngeal squamous cancer patients treated in sequential cohorts with 3D conformal (3DCRT) or intensity modulated radiotherapy (IMRT). PATIENTS AND METHODS 200 patients in sequential population based cohorts of 83 and 117 patients treated at a single institution with 3DCRT and then IMRT respectively were prospectively assessed at pre-treatment and 3, 6, 12 and 24 months post treatment. A standard functional outcomes protocol including performance status (KPS, ECOG), 3 Performance Status scales for Head and Neck (PSS-HN), the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), Voice Handicap Index-10 (VHI-10) and self-rated xerostomia were applied. RESULTS Mean age at diagnosis was 59 years. The primary site was base of tongue in 77 and tonsil or soft palate in 123 patients. Median follow up was 2.5 years for the second cohort. Concomitant therapy was used in 159 (79.5%). Overall survival at 3 years was 75.6% and 71.5% for IMRT and 3DCRT cohorts respectively (not significant). A multiple imputation technique was used to estimate missing values in order to avoid a healthy patient bias. KPS and ECOG reached nadirs at 3 to 6 months but approached baseline values at 12 to 24 months and did not differ by treatment. The 3 PSS-HN scales, Eating in Public (p < 0.001), Understandability of Speech (p = 0.009) and Oral Diet Texture (p = 0.002) and all showed significantly better outcomes in favor of IMRT. The RBHOMS showed a difference in favor of IMRT which appeared during 3 to 6 months (p < 0.001). The VHI-10 also showed a difference in favor of IMRT (p = 0.015). Self-rated xerostomia did not differ at 3 and 6 months but was significantly better in favor of IMRT after 12 months p = 0.005 CONCLUSIONS: A prospectively administered functional outcomes protocol showed meaningful differences in favor of IMRT over 3DCRT early (3-6 months) and later (12-24 months) in the treatment of oropharyngeal carcinoma with equivalent survival. These data support the adoption of IMRT as the standard radiation treatment method for patients with stage III and IV (M0) oropharyngeal squamous carcinoma. KPS and ECOG may not be sensitive to oropharyngeal cancer patients' functional outcomes by treatment.
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Affiliation(s)
- Paul Kerr
- Department of Otolaryngology, Winnipeg, Manitoba, Canada.
| | | | - James Butler
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada. .,Department of Radiology, Winnipeg, Manitoba, Canada.
| | | | | | - Andrew L Cooke
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada. .,Department of Radiation Oncology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0 V9, Canada.
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