1
|
Tang A, Li J, Scheff N, Johnson JT, Contrera KJ, Nilsen ML. Quality of Life Outcomes for Parotid Malignancies. Laryngoscope 2024. [PMID: 38837232 DOI: 10.1002/lary.31554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND This study describes patient-reported outcome measures (PROMs) and associated factors in patients who underwent surgery for malignant parotid tumors (MPT). METHODS This is a retrospective study of all surgically treated MPT patients in a multidisciplinary head and neck cancer (HNC) survivorship clinic (2017-2023). PROMs included University of Washington Quality of Life Questionnaire (UW-QOL), Eating Assessment Tool (EAT-10), Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Neck Disability Index (NDI), and Insomnia Severity Index. Multivariable regression analysis was used to investigate clinical predictors associated with PROMs. RESULTS In 62 MPT patients, the prevalence of clinically relevant dysphagia symptoms (EAT-10), elevated symptoms of depression (PHQ-8), moderate/severe symptoms of anxiety (GAD-7), moderate/severe neck pain with activities of daily living (NDI), and moderate/severe symptoms of insomnia at last follow-up was 32.3%, 15.5%, 7.1%, 17.7%, and 7.2%, respectively. Nonparametric one-sided test revealed that patients treated with adjuvant CRT had significantly worse physical QOL, social-emotional QOL, and swallowing scores than patients treated with surgery alone (p = 0.01, p = 0.02, p = 0.03, respectively); that patients treated with surgery and adjuvant RT had significantly worse physical QOL and social-emotional QOL than patients treated with surgery alone (p < 0.01, p = 0.01, respectively) and that patients treated with surgery and adjuvant CRT had significantly worse swallowing and neck pain than patients treated with surgery and adjuvant RT (p = 0.03, p = 0.05, respectively). CONCLUSIONS In patients with surgically treated MPT, adjuvant CRT and RT were associated with worse PROMs. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
Collapse
Affiliation(s)
- Anthony Tang
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Jinhong Li
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, U.S.A
| | - Nicole Scheff
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Kevin J Contrera
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Marci L Nilsen
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, U.S.A
| |
Collapse
|
2
|
Brisson-McKenna M, Jefferson GD, Siddiqui SH, Adams S, Afanasieva Sonia S, Chérid A, Burns J, Di Gironimo C, Mady LJ. Swallowing Function After Treatment of Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:371-388. [PMID: 37030949 DOI: 10.1016/j.otc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Dysphagia is a common functional outcome following treatment of laryngeal cancer. Despite curative advances in both nonsurgical and surgical approaches, preserving and optimizing swallowing function is critical. Understanding the nature and severity of dysphagia depending on initial tumor staging and treatment modality and intensity is crucial. This chapter explores current evidence on the acute and chronic impacts of treatments for laryngeal cancer on swallow function, as well as the medical and nonmedical management of dysphagia in this population.
Collapse
Affiliation(s)
- Maude Brisson-McKenna
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada.
| | - Gina D Jefferson
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, 2500 N. State St.Jackson, MS 39216-4505, USA
| | - Sana H Siddiqui
- Head & Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Sarah Adams
- Voice and Swallowing Center, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Sofia Afanasieva Sonia
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Aïda Chérid
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Jesse Burns
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Carla Di Gironimo
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Leila J Mady
- Head & Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA; Cancer Risk and Control Program of Excellence, Sidney Kimmel Cancer Center, 233 S 10th Street, Philadelphia, PA 19107, USA
| |
Collapse
|
3
|
Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
Collapse
|
4
|
Lane C, Myers C, Jiang D, Cooke A, Kerr P. Selected functional outcomes in advanced oral cancer: Comparison of surgery alone versus surgery with postoperative radiotherapy. Head Neck 2021; 44:710-721. [PMID: 34939707 DOI: 10.1002/hed.26968] [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: 04/11/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Study objectives were to determine whether the addition of postoperative radiation (PORT) resulted in a decline in oral function relative to surgery alone and to describe the longitudinal course of oral function following treatment of advanced oral cancer. METHODS This was a 36-month retrospectively analyzed observational cohort study of patients with stage III-IV oral cancer. Prospectively collected, oral functional outcomes were acquired pretreatment and 3, 6, 12, 24, and 36 months post-treatment. RESULTS One hundred and eighteen patients were included. Forty-three patients treated with surgery alone were compared to 75 who received surgery with PORT. Mixed model analysis demonstrated the acute effect of PORT was associated with patient-rated xerostomia (p < 0.001) and the late or persistent effect was associated with decreased clinician-rated eating in public (p = 0.008), understandability of speech (p = 0.02), and normalcy of diet (p = 0.005) compared with surgery alone. There were no differences between surgery alone and PORT groups in clinician-rated feeding tube dependence or patient-rated speech handicap. CONCLUSIONS The use of PORT was associated with a demonstrable decline in oral function in four of six outcomes measures relative to surgery alone.
Collapse
Affiliation(s)
- Ciaran Lane
- Department of Otolaryngology - Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Candace Myers
- Section of Communication Disorders, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Deping Jiang
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Cooke
- Department of Radiation Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kerr
- Department of Otolaryngology - Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
5
|
Petersson K, Finizia C, Tuomi L. Predictors of severe dysphagia following radiotherapy for head and neck cancer. Laryngoscope Investig Otolaryngol 2021; 6:1395-1405. [PMID: 34938880 PMCID: PMC8665420 DOI: 10.1002/lio2.676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate if severe dysphagia following radiotherapy for head and neck cancer (HNC) could be predicted by patient and tumor characteristics, feeding tube use, weight factors, jaw opening function, and saliva secretion. METHODS Data was collected from 94 HNC patients 6 to 36 months post radiotherapy. Swallowing function was assessed by videofluroscopy (VFS). Severe dysphagia was defined by Penetration Aspiration Scale (PAS) as PAS≥5 or a total score ≤60 on the M. D. Anderson Dysphagia Inventory (MDADI). RESULTS Thirty-three patients (35%) had PAS ≥5 and 19 (20%) a MDADI ≤60, that is, presented with severe dysphagia. Univariable logistic regression analysis (UVA) gave that tumor of the tonsil, overweight at time of VFS and each unit increase in Body Mass Index (BMI) predicted less risk of PAS ≥5. Dependency of feeding tube at time of VFS and each month's continued use and weight loss ≥7.5% since treatment to time of VFS predicted increased risk of PAS ≥5. Predictive variables from the UVA of PAS ≥5 (tumor of the tonsil, overweight, and total duration of feeding tube), were analyzed by multivariate logistic regression analysis. All retained power as independent predictors. UVA for MDADI showed that use of feeding tube at time of VFS predicted MDADI ≤60 with the risk increasing each month. Each increasing unit of BMI decreased risk of MDADI ≤60. CONCLUSION Long time users of feeding tube and higher weight-loss are at risk of severe dysphagia. This makes collaboration between professionals working with dysphagia an important step in detecting severe dysphagia.Level of Evidence: 3.
Collapse
Affiliation(s)
- Kerstin Petersson
- Department of Otorhinolaryngology, Head and Neck SurgeryInstitute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of OtorhinolaryngologyRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck SurgeryInstitute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of OtorhinolaryngologyRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck SurgeryInstitute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of OtorhinolaryngologyRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| |
Collapse
|
6
|
de Carvalho MI, Gatti M, Guedes RLV, Froes RCF, Costa DR, da Silva Vitor J, da Silva Santos PS, Berretin-Felix G. Swallowing, nutritional status, and salivary flow in patients after head and neck cancer treatment, a pilot study. Sci Rep 2021; 11:20233. [PMID: 34642369 PMCID: PMC8511146 DOI: 10.1038/s41598-021-99208-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022] Open
Abstract
Determine the relationship between swallowing function, nutritional status, and salivary flow in patients after head and neck cancer treatment. This pilot study included 17 patients. Swallowing was assessed through videofluoroscopy and surface electromyography (sEMG), nutritional status through anthropometry and dietary assessment, and salivary flow both with and without mechanical stimulation. Test analysis showed that 66.7% of patients had functional limitations in swallowing in 58.3%, 66.7%, and 58.3% residue scale with an average of a line of barium on a structure for pudding, honey, and liquid consistencies, respectively. Laryngeal penetration was found in 8.3% during the swallowing of liquid. Surface electromyography (sEMG) showed above normal values for muscle activity time during the swallowing of pudding. Anthropometric assessment and muscle and adipose tissue indicated eutrophy. Salivary flow test with mechanical stimulus showed that 82.3% of patients' salivary production was well below the appropriate level. There was a significant correlation between muscle tissue reserve and muscle activity time during swallowing in the studied muscles (left masseter p = 0.003, right masseter p = 0.001, suprahyoid p = 0.001, orbicularis oris = 0.020), all in pudding consistency. This pilot study confirmed the relationship between swallowing and nutritional status for its participants, showing that appropriate protein intake influences muscle activity during swallowing in head and neck cancer survivors.
Collapse
Affiliation(s)
- Mariana Inri de Carvalho
- Department of Speech Therapy, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
| | - Marina Gatti
- Department of Speech Therapy, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Renata Ligia Vieira Guedes
- Department of Speech and Language Pathology, Faculdades Metropolitanas Unidas/FMU, São Paulo, SP, Brazil
| | | | - Danila Rodrigues Costa
- Department of Speech Therapy, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Jhonatan da Silva Vitor
- Department of Speech Therapy, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | | | - Giédre Berretin-Felix
- Department of Speech Therapy, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| |
Collapse
|
7
|
Mathew A, Tirkey AJ, Li H, Steffen A, Lockwood MB, Patil CL, Doorenbos AZ. Symptom Clusters in Head and Neck Cancer: A Systematic Review and Conceptual Model. Semin Oncol Nurs 2021; 37:151215. [PMID: 34483015 PMCID: PMC8492544 DOI: 10.1016/j.soncn.2021.151215] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The two approaches to symptom-cluster research include grouping symptoms and grouping patients. The objective of this systematic review was to examine the conceptual approaches and methodologies used in symptom-cluster research in patients with head and neck cancer. DATA SOURCES Articles were retrieved from electronic databases (CINAHL, MEDLINE via Ovid, APA PsycINFO, Scopus, Embase, and Cochrane Central Register of Controlled Trials-CENTRAL), five grey literature portals, and Google Scholar. Seventeen studies met the eligibility criteria. Eight studies grouped symptoms to identify symptom clusters, of which two used qualitative methods. The number of symptom clusters ranged from two to five, and the number of symptoms in a cluster ranged from 2 to 11. Nine studies grouped patients based on their experiences with multiple symptoms. Cluster analysis and factor analysis were most commonly used. Despite variable names and composition of symptom clusters, synthesis revealed three prominent symptom clusters: general, head and neck cancer-specific, and gastrointestinal. Being female and quality of life were significantly associated with high symptom group or cluster severity. Biological mechanisms were sparsely examined. CONCLUSION Symptom cluster research in head and neck cancer is emerging. Consensus on nomenclature of a symptom cluster will facilitate deduction of core clinically relevant symptom clusters in head and neck cancer. Further research is required on understanding patients' subjective experiences, identifying predictors and outcomes, and underlying mechanisms for symptom clusters. IMPLICATIONS FOR NURSING PRACTICE Identification of clinically relevant symptom clusters would enable targeted symptom assessment and management strategies, thus improving treatment efficiencies and patient outcomes.
Collapse
Affiliation(s)
- Asha Mathew
- College of Nursing, University of Illinois, Chicago; Christian Medical College, Vellore, India.
| | | | - Hongjin Li
- College of Nursing, University of Illinois, Chicago; Christian Medical College, Vellore, India
| | | | | | | | - Ardith Z Doorenbos
- College of Nursing, University of Illinois, Chicago; University of Illinois Cancer Center, Chicago
| |
Collapse
|
8
|
Chiu YH, Tseng WH, Ko JY, Wang TG. Radiation-induced swallowing dysfunction in patients with head and neck cancer: A literature review. J Formos Med Assoc 2021; 121:3-13. [PMID: 34246510 DOI: 10.1016/j.jfma.2021.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/28/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Swallowing dysfunction is a prevailing state following radiotherapy in patients with head and neck cancer. Following the advancement of cancer treatment in recent years, the survival rate of head and neck cancer has gradually increased. Simultaneously, patients with head and neck cancer suffer due to the long-duration and more prominent swallowing dysfunction states. Based on an extensive literature review, we aimed to explore the mechanisms, risk factors, and clinical evaluations of swallowing dysfunction and their related symptoms following radiotherapy. These include functional changes of the muscles, trismus, xerostomia, neuropathy, and lymphedema. When swallowing dysfunction occurs, patients usually seek medical help and are referred for rehabilitation therapy, such as muscle strengthening and tongue resistance exercise. Furthermore, clinicians should discuss with patients how and when to place the feeding tube. Only through detailed evaluation and management can swallowing dysfunction resolve and improve the quality of life of patients with head and neck cancer following radiotherapy.
Collapse
Affiliation(s)
- Yi-Hsiang Chiu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
9
|
Elhalawani H, Cardenas CE, Volpe S, Barua S, Stieb S, Rock CB, Lin T, Yang P, Wu H, Zaveri J, Elgohari B, Abdallah LE, Jethanandani A, Mohamed ASR, Court LE, Hutcheson KA, Brandon Gunn G, Rosenthal DI, Frank SJ, Garden AS, Rao A, Fuller CD. 18FDG positron emission tomography mining for metabolic imaging biomarkers of radiation-induced xerostomia in patients with oropharyngeal cancer. Clin Transl Radiat Oncol 2021; 29:93-101. [PMID: 34195391 PMCID: PMC8239739 DOI: 10.1016/j.ctro.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/11/2021] [Accepted: 05/30/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose Head and neck cancers radiotherapy (RT) is associated with inevitable injury to parotid glands and subsequent xerostomia. We investigated the utility of SUV derived from 18FDG-PET to develop metabolic imaging biomarkers (MIBs) of RT-related parotid injury. Methods Data for oropharyngeal cancer (OPC) patients treated with RT at our institution between 2005 and 2015 with available planning computed tomography (CT), dose grid, pre- & first post-RT 18FDG-PET-CT scans, and physician-reported xerostomia assessment at 3-6 months post-RT (Xero 3-6 ms) per CTCAE, was retrieved, following an IRB approval. A CT-CT deformable image co-registration followed by voxel-by-voxel resampling of pre & post-RT 18FDG activity and dose grid were performed. Ipsilateral (Ipsi) and contralateral (contra) parotid glands were sub-segmented based on the received dose in 5 Gy increments, i.e. 0-5 Gy, 5-10 Gy sub-volumes, etc. Median and dose-weighted SUV were extracted from whole parotid volumes and sub-volumes on pre- & post-RT PET scans, using in-house code that runs on MATLAB. Wilcoxon signed-rank and Kruskal-Wallis tests were used to test differences pre- and post-RT. Results 432 parotid glands, belonging to 108 OPC patients treated with RT, were sub-segmented & analyzed. Xero 3-6 ms was reported as: non-severe (78.7%) and severe (21.3%). SUV- median values were significantly reduced post-RT, irrespective of laterality (p = 0.02). A similar pattern was observed in parotid sub-volumes, especially ipsi parotid gland sub-volumes receiving doses 10-50 Gy (p < 0.05). Kruskal-Wallis test showed a significantly higher mean RT dose in the contra parotid in the patients with more severe Xero 3-6mo (p = 0.03). Multiple logistic regression showed a combined clinical-dosimetric-metabolic imaging model could predict the severity of Xero 3-6mo; AUC = 0.78 (95%CI: 0.66-0.85; p < 0.0001). Conclusion We sought to quantify pre- and post-RT 18FDG-PET metrics of parotid glands in patients with OPC. Temporal dynamics of PET-derived metrics can potentially serve as MIBs of RT-related xerostomia in concert with clinical and dosimetric variables.
Collapse
Affiliation(s)
- Hesham Elhalawani
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States
| | - Carlos E Cardenas
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Stefania Volpe
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Souptik Barua
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States.,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Sonja Stieb
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Calvin B Rock
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Radiation Oncology, University of Utah Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Timothy Lin
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pei Yang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, Xiangya Medical School, Central South University, Changsha, China
| | - Haijun Wu
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jhankruti Zaveri
- Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Baher Elgohari
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Clinical Oncology & Nuclear Oncology, Mansoura University, Mansoura, Egypt
| | - Lamiaa E Abdallah
- Department of Clinical Oncology & Nuclear Oncology, Ain Shams University, Cairo, Egypt
| | - Amit Jethanandani
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Laurence E Court
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - G Brandon Gunn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - David I Rosenthal
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Arvind Rao
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States.,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States.,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI, United States.,Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Clifton D Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
10
|
Gaito S, France A, Foden P, Abravan A, Burnet N, Garcez K, Kota VR, Lee LW, Price J, Sykes A, Thomson D, Smith E, Osorio EV, McPartlin A. A Predictive Model for Reactive Tube Feeding in Head and Neck Cancer Patients Undergoing Definitive (Chemo) Radiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:e433-e441. [PMID: 34090753 DOI: 10.1016/j.clon.2021.05.002] [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: 08/19/2020] [Revised: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
AIMS Careful management of a patient's nutritional status during and after treatment for head and neck squamous cell cancers (HNSCC) is crucial for optimal outcomes. The aim of this study was to develop a model for stratifying a patient's risk of requiring reactive enteral feeding through a nasogastric tube during radiotherapy for HNSCC, based on clinical and treatment-related factors. MATERIALS AND METHODS A cohort of consecutive patients treated with definitive (chemo)radiotherapy for HNSCC between January 2016 and January 2018 was identified in the institutional electronic database for retrospective analysis. Patients requiring enteral feeding pretreatment were excluded. Clinical and treatment data were obtained from prospectively recorded electronic clinical notes and planning software. RESULTS Baseline patient characteristics and tumour-related parameters were captured for 225 patients. Based on the results of the univariate analysis and using a stepwise backwards selection process, clinical and dosimetric variables were selected to optimise a clinically predictive multivariate model, fitted using logistic regression. The parameters found to affect the probability, P, of requiring a nasogastric feeding tube for >4 weeks in our clinical multivariate model were: tumour site, tumour stage (early T0/1/2 stage versus advanced T3/T4 stage), chemotherapy drug (none versus any drug) and mean dose to the contralateral parotid gland. A scoring model using the regression coefficients of the selected variables in the clinical multivariate model achieved an area under the curve (AUC) of 0.745 (95% confidence interval 0.678-0.812), indicating good discriminative performance. Internal validation of the model involved splitting the dataset 80:20 into training and test datasets 10 times and assessing differences in AUC of the model fitted to these. CONCLUSIONS We developed an easy-to-use prediction model based on both clinical and dosimetric parameters, which, once externally validated, can lead to more personalised treatment planning and inform clinical decision-making on the appropriateness of prophylactic versus reactive enteral feeding.
Collapse
Affiliation(s)
- S Gaito
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK; The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, UK; The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK.
| | - A France
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, UK
| | - P Foden
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, UK
| | - A Abravan
- The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK; The Christie NHS Foundation Trust, Department of Radiotherapy Related Research, Manchester, UK
| | - N Burnet
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK
| | - K Garcez
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK
| | - V R Kota
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK
| | - L W Lee
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK
| | - J Price
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK; The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK
| | - A Sykes
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK
| | - D Thomson
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK; The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK
| | - E Smith
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK; The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, UK; The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK
| | - E V Osorio
- The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK; The Christie NHS Foundation Trust, Department of Radiotherapy Related Research, Manchester, UK
| | - A McPartlin
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK; The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK
| |
Collapse
|
11
|
Mierzwa ML, Gharzai LA, Li P, Wilkie JR, Hawkins PG, Aryal MP, Lee C, Rosen B, Lyden T, Blakely A, Chapman CH, Thamarus J, Schonewolf C, Shah J, Eisbruch A, Schipper MJ, Cao Y. Early MRI Blood Volume Changes in Constrictor Muscles Correlate With Postradiation Dysphagia. Int J Radiat Oncol Biol Phys 2020; 110:566-573. [PMID: 33346093 DOI: 10.1016/j.ijrobp.2020.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/01/2020] [Accepted: 12/13/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Predicting individual patient sensitivity to radiation therapy (RT) for tumor control or normal tissue toxicity is necessary to individualize treatment planning. In head and neck cancer, radiation doses are limited by many nearby critical structures, including structures involved in swallowing. Previous efforts showed that imaging parameters correlate with RT dose; here, we investigate the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) blood volume (BV) changes in predicting dysphagia. METHODS AND MATERIALS This study included 32 patients with locally advanced oropharyngeal squamous cell carcinoma treated with definitive chemoradiation on an institutional protocol incorporating baseline and early midtreatment DCE-MRI. BV maps of the pharyngeal constrictor muscles (PCM) were created, and BV increases midtreatment were correlated with the following parameters at 3 and 12 months post-RT: RT dose, Dynamic Imaging Grade of Swallowing Toxicity swallow score, aspiration frequency, European Organisation for Research and Treatment of Cancer HN35 patient-reported outcomes, physician-reported dysphagia, and feeding tube (FT) dependence. RESULTS The mean BV to the PCMs increased from baseline to fraction 10, which was significant for the superior PCM (P = .006) and middle PCM (P < .001), with a trend in the inferior PCM where lower mean doses were seen (P = .077). The factors associated with FT dependence at 3 months included BV increases in the total PCM (correlation, 0.48; P = .006) and middle PCM (correlation, 0.50; P = .004). A post-RT increase in aspiration was associated with a BV increase in the superior PCM (correlation, 0.44; P = .013),and the increase in the total PCMs was marginally significant (correlation, 0.34; P = .06). The best-performing models of FT dependence (area under the receiver operating curve [AUC] = 0.84) and aspiration increases (AUC = 0.78) included BV increases as well as a mean RT dose to middle PCM. CONCLUSIONS Our results suggest that midtreatment BV increases derived from DCE-MRI are an early predictor of dysphagia. Further investigation of these promising imaging markers to assess individual patient sensitivity to treatment and the patient's subsequent risk of toxicities is warranted to improve personalization of RT planning.
Collapse
Affiliation(s)
- Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Pin Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Joel R Wilkie
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Madhava P Aryal
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Choonik Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Benjamin Rosen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Teresa Lyden
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan
| | - Anna Blakely
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan
| | - Christina H Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Thamarus
- Department of Speech and Language Pathology, Veterans Affairs Hospital, Ann Arbor, Michigan
| | - Caitlin Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
12
|
Hu J, Andablo-Reyes E, Mighell A, Pavitt S, Sarkar A. Dry mouth diagnosis and saliva substitutes-A review from a textural perspective. J Texture Stud 2020; 52:141-156. [PMID: 33274753 DOI: 10.1111/jtxs.12575] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
The aim of this review is to assess the objective and subjective diagnosis, as well as symptomatic topical treatment of dry mouth conditions with a clear focus on textural perspective. We critically examine both the current practices as well as outline emerging possibilities in dry mouth diagnosis and treatment, including a patent scan for saliva substitutes. For diagnosis, salivary flow rates and patient-completed questionnaires have proven to be useful tools in clinical practice. To date, objective measurements of changes in mechanical properties of saliva via rheological, adsorption, and tribological measurements and biochemical properties of saliva such as assessing protein, mucins (MUC5B) are seldom incorporated into clinical diagnostics; these robust diagnostic tools have been largely restricted to application in non-clinical settings. As for symptomatic treatments of dry mouth, four key agents including lubricating, thickening, adhesive, and moisturizing agents have been identified covering the overall landscape of commercial saliva substitutes. Although thickening agents such as modified celluloses, polysaccharide gum, polyethylene glycol, and so forth are most commonly employed saliva substitutes, they offer short-lived relief from dry mouth and generally do not provide boundary lubrication properties of real human saliva. Innovative technologies such as self-assembly, emulsion, liposomes, and microgels are emerging as novel saliva substitutes hold promise for alternative approaches for efficient moistening and lubrication of the oral mucosa. Their adoption into clinical practice will depend on their efficacies, duration of relief, and ease of application by the practitioners and patient compliance.
Collapse
Affiliation(s)
- Jing Hu
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, UK
| | - Efren Andablo-Reyes
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, UK
| | - Alan Mighell
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Sue Pavitt
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Anwesha Sarkar
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, UK
| |
Collapse
|
13
|
Simultaneous evaluation of symptoms, swallowing functions, and patient-reported swallowing difficulties and their correlations with ingestion status during definitive chemoradiotherapy for oropharyngeal and hypopharyngeal cancer. Support Care Cancer 2020; 29:955-964. [DOI: 10.1007/s00520-020-05570-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
|
14
|
Burghartz M, Taeger J, Metzger M, Scherzad A, Gehrke T, Ickrath P, Kolb E, Kleinsasser N, Hagen R, Hackenberg S. Investigation of Cellular Function and DNA Integrity during 2D in vitro Culture of Human Salivary Gland Epithelial Cells. Cells Tissues Organs 2020; 208:66-75. [PMID: 32023622 DOI: 10.1159/000505433] [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: 09/27/2019] [Accepted: 12/15/2019] [Indexed: 11/19/2022] Open
Abstract
In vitro culture of human salivary gland epithelial cells (SGEC) is still a challenge. A high quantity and quality of cells are needed for the cultivation of 3D matrices. Furthermore, it is known that DNA damage is supposed to be an important factor involved in carcinogenesis. This study investigates cellular function and DNA integrity of human SGEC during 3 passage steps in 2 groups (group 1: n = 10; group 2: n = 9). Cellular function was analyzed by immunofluorescence, transmission electron microscopy (TEM), and quantitative real-time polymerase chain reaction (qPCR). DNA integrity was tested via the comet assay. Immunohistochemistry and qPCR results showed stable α-amylase and pan-cytokeratin levels; TEM revealed functional cells; and no significant DNA damage could be detected in the comet assay during 3 culture steps. The study shows that not only at cellular but also at DNA level human SGEC can be safely quantified over 3 passages for preclinical tissue engineering without loss of differentiation and function.
Collapse
Affiliation(s)
- Marc Burghartz
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Johannes Taeger
- Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany,
| | - Marco Metzger
- Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Würzburg, Würzburg, Germany
| | - Agmal Scherzad
- Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Gehrke
- Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Pascal Ickrath
- Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Evelyn Kolb
- Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Norbert Kleinsasser
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University, Linz, Austria
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Stephan Hackenberg
- Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
15
|
Hayakawa T, Kawakami S, Soda I, Kainuma T, Nozawa M, Sekiguchi A, Miyamoto S, Yamashita T, Ishiyama H. Dosimetric factors associated with long-term patient-reported outcomes after definitive radiotherapy of patients with head and neck cancer. Radiat Oncol 2019; 14:221. [PMID: 31818301 PMCID: PMC6902539 DOI: 10.1186/s13014-019-1429-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022] Open
Abstract
Background The aim of this study was to explore the relationships between dosimetric parameters of organs at risk and patient-reported outcomes (PRO) after radiotherapy of patients with head and neck cancer. Methods PRO data of 53 patients with head and neck cancer treated with radiotherapy were prospectively collected. These data concerned health-related quality of life (HRQOL) and were collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and head and neck cancer module (QLQ-H&N35). Patients were divided into “severe-deterioration” and “mild-deterioration” groups on the basis of degree of deterioration HRQOL > 6 months after completing treatment. The relationships between HRQOL deteriorations and patient-related or dosimetry-related factors were evaluated. P < 0.0013 according to Bonferroni correction was considered to denote statistical significance. Results Regarding “trouble with social eating (HNSO)” and “coughing (HNCO),” there were significant differences between the severe-deterioration and mild-deterioration groups in mean dosages to the superior pharyngeal constrictor muscle (SPC) (HNSO: 62.5 Gy vs 54.2 Gy; p = 0.00029, and HNCO: 61.5 Gy vs 54.1 Gy; p = 0.0012) and parotid gland (HNSO: 24.1 Gy vs 20.5 Gy; p = 0.000056, and HNCO: 24.2 Gy vs 20.3 Gy; p = 0.00043). Regarding “nausea and vomiting,” there was a significant difference between the two groups in the mean dosage to the middle pharyngeal constrictor muscle (MPC: 61.9 Gy vs. 58.4Gy; P = 0.00059). Conclusions We found that dosages to the SPC and parotid gland were associated with severe deterioration in HRQOL attributable to difficulty in HNSO and HNCO, whereas dosage to the MPC was associated with severe deterioration attributable to nausea and vomiting.
Collapse
Affiliation(s)
- Toyokazu Hayakawa
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Japan
| | - Shogo Kawakami
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Japan
| | - Itaru Soda
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Japan
| | - Takuro Kainuma
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Japan
| | - Marika Nozawa
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Japan
| | - Akane Sekiguchi
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Japan
| | - Shunsuke Miyamoto
- Department of Otorhinolaryngology and Head and Neck Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Japan
| | - Taku Yamashita
- Department of Otorhinolaryngology and Head and Neck Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Japan
| | - Hiromichi Ishiyama
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Japan.
| |
Collapse
|
16
|
Hedström J, Tuomi L, Finizia C, Olsson C. Identifying organs at risk for radiation-induced late dysphagia in head and neck cancer patients. Clin Transl Radiat Oncol 2019; 19:87-95. [PMID: 31646203 PMCID: PMC6804434 DOI: 10.1016/j.ctro.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/02/2022] Open
Abstract
Background and purpose Dysphagia is a common, severe and dose-limiting toxicity after oncological treatment of head and neck cancer (HNC). This study aims to investigate relationships between radiation doses to structures involved in normal swallowing and patient-reported as well as clinically measured swallowing function in HNC patients after curative (chemo-) radiation therapy (RT) with focus on late effects. Materials and methods Patients (n = 90) with HNC curatively treated with RT ± chemotherapy in 2007-2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific symptom score was used to determine patient-reported dysphagia. The Penetration-Aspiration Scale (PAS) was applied to determine swallowing function by VFS (PAS ≥ 4/ ≥ 6 = moderate/severe dysphagia). Thirteen anatomical structures involved in normal swallowing were individually delineated on the patients' original planning CT scans and associated dose-volume histograms (DVHs) retrieved. Relationships between structure doses and late toxicity were investigated through univariable and multivariable logistic regression analysis (UVA/MVA) accounting for effects by relevant clinical factors. Results Median assessment time was 7 months post-RT (range: 5-34 months). Mean dose to the contralateral parotid gland and supraglottic larynx as well as maximum dose to the contralateral anterior digastric muscle predicted patient-reported dysphagia (AUC = 0.64-0.67). Mean dose to the pharyngeal constrictor muscle, the larynx, the supraglottic larynx and the epiglottis, as well as maximum dose to the contralateral submandibular gland predicted moderate and severe dysphagia by VFS (AUC = 0.71-0.80). Conclusion The patients in this cohort were consecutively identified pre-treatment, and were structurally approached and assessed for dysphagia after treatment at a specific time point. In addition to established dysphagia organs-at-risk (OARs), our data suggest that epiglottic and submandibular gland doses are important for swallowing function post-RT. Keeping DVH thresholds below V60 = 60% and V60 = 17%, respectively, may increase chances to reduce occurrence of severe late dysphagia. The results need to be externally validated in future studies.
Collapse
Key Words
- 3D-CRT, Three Dimensional Conformal Radiation Therapy
- AAA, Anisotropic Analytical Algorithm
- ACE-27, Adult Comorbidity Evaluation 27
- AUC, area under the Receiver Operating Characteristic (ROC) curve
- BMI, body mass index
- CI, confidence interval
- CT, computed tomography
- Cc, cubic centimeter
- DARS, dysphagia-aspiration-related structures
- DESdC, Drinking, Eating, Swallowing difficulties and Coughing when eating/drinking
- DVH, dose-volume histogram
- Deglutition disorders
- Dysphagia-aspiration-related structures
- EBRT, external beam radiation therapy
- EQD2, equivalent dose in 2Gy fractions
- Gy, Gray
- HNC, head and neck cancer
- Head and neck neoplasms
- ICRU, International Commission on Radiation Units and Measurements
- IMRT, intensity-modulated radiation therapy
- MVA, multivariable logistic regression
- N.A, non applicable
- OAR, organ-at-risk
- OR, odds ratio
- PAS, penetration-aspiration scale
- PCM, pharyngeal constrictor muscle
- PRO, patient-reported outcome
- QoL, quality of life
- ROC, Receiver Operating Characteristic curve
- RT, radiation therapy
- Radiation dose
- Radiation therapy
- SD, standard deviation
- SEM, standard error of the mean
- SLP, speech-language pathologist
- TNM, Tumor location, Nodular engagement, Metastasis
- UES, upper esophageal sphincter
- UVA, univariable logistic regression
- VFS, videofluoroscopy
- VMAT, volumetric-modulated radiation therapy
- Vx, the volume (%) of a structure receiving ≥xGy.
- ρ, Spearman’s Correlation Coefficient
Collapse
Affiliation(s)
- Johanna Hedström
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Anesthesia and Intensive Care, Area 2, 416 85 Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Otorhinolaryngology, 413 45 Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Otorhinolaryngology, 413 45 Gothenburg, Sweden
| | - Caroline Olsson
- Department of Radiation Physics, Institute of Clinical Sciences, the Sahlgrenska Academy Gothenburg University, 413 45 Gothenburg, Sweden.,Regional Cancer Center West, the Western Sweden Healthcare Region, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| |
Collapse
|
17
|
The prevalence of patient-reported dysphagia and oral complications in cancer patients. Support Care Cancer 2019; 28:1141-1150. [PMID: 31203510 DOI: 10.1007/s00520-019-04921-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/05/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Research investigating swallowing problems (dysphagia) and complications within the oral cavity in non-head and neck cancer patients is limited. The purpose of this study was to determine the prevalence of patient-reported dysphagia and oral complications in all cancer patients and to examine the relationships between cancer types, oral complications and dysphagia. METHODS A cross-sectional study was conducted at a specialist cancer centre in Australia. Data on patient-reported dysphagia and oral complications were collected using the Vanderbilt Head and Neck Symptom Survey (version 2.0) which was completed by participants in one of three settings: inpatients, ambulatory patients receiving chemotherapy, or ambulatory patients receiving radiotherapy. RESULTS Data were collected on 239 patients, receiving treatment for 14 cancer types. The proportion of patients who reported dysphagic symptoms were as follows: any dysphagia (54%); dysphagia for liquids (20%); and dysphagia for solids (46%). Significantly more head and neck patients and significantly fewer breast patients reported dysphagia, but there were no differences between other tumour types. Oral symptoms across all cancer types were reported at the following rates: taste changes (62%); xerostomia (56%); voice changes (37%); smell changes (35%); thick mucous (33%); difficulty with teeth/dentures (25%); mouth/throat pain (20%); and trismus (19%). CONCLUSIONS This is the first time comprehensive data on dysphagia and oral complications across all cancer patients have been collected. We have identified that dysphagic symptoms and oral complications-which have implications for quality of life and function-are common in all cancer patients, not just those with head and neck cancer.
Collapse
|
18
|
Barnhart MK, Cartmill B, Ward EC, Brown E, Sim J, Saade G, Rayner S, Robinson RA, Simms VA, Smee RI. Optimising Radiation Therapy Dose to the Swallowing Organs at Risk: An In Silico Study of feasibility for Patients with Oropharyngeal Tumours. Dysphagia 2019; 34:869-878. [PMID: 30741335 DOI: 10.1007/s00455-019-09983-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
Recent evidence suggests that reducing radiotherapy dose delivered to specific anatomical swallowing structures [Swallowing Organs at Risk (SWOARs)] may improve swallowing outcomes post-treatment for patients with head and neck cancer. However, for those patients with tumours of the oropharynx, which typically directly overlap the SWOARs, reducing dose to these structures may be unachievable without compromising on the treatment of the disease. To assess the feasibility of dose reduction in this cohort, standard IMRT plans (ST-IMRT) and plans with reduced dose to the SWOARs (SW-IMRT) were generated for 25 oropharyngeal cancer patients (Brouwer et al. in Radiother Oncol 117(1):83-90, https://doi.org/10.1016/j.radonc.2015.07.041 , 2015; Christianen et al. in Radiother Oncol 101(3):394-402, https://doi.org/10.1016/j.radonc.2011.05.015 , 2011). ST-IMRT and SW-IMRT plans were compared for: mean dose to the SWOARs, volume of pharynx and larynx receiving 50 Gy and 60 Gy (V50 and V60 respectively) and overlap between the tumour volume and the SWOARs. Additionally, two different SWOARs delineation guidelines (Brouwer et al. in Radiother Oncol 117(1):83-90, https://doi.org/10.1016/j.radonc.2015.07.041 , 2015; Christianen et al. in Radiother Oncol 101(3):394-402, https://doi.org/10.1016/j.radonc.2011.05.015 , 2011) were used to highlight differences in calculated volumes between existing contouring guidelines. Agreement in SWOARs volumes between the two guidelines was calculated using a concordance index (CI). Despite a large overlap between the tumour and SWOARs, significant (p < 0.05) reductions in mean dose to 4 of the 5 SWOARs, and V50/V60 for the pharynx and larynx were achieved with SW-IMRT plans. Low CIs per structure (0.15-0.45) were found between the two guidelines highlighting issues comparing data between studies when different guidelines have been used (Hawkins et al. in Semin Radiat Oncol 28(1):46-52, https://doi.org/10.1016/j.semradonc.2017.08.002 , 2018; Brodin et al. in Int J Radiat Oncol Biol Phys 100(2):391-407, https://doi.org/10.1016/j.ijrobp.2017.09.041 , 2018). This study found reducing dose to the SWOARs is a feasible practice for patients with oropharyngeal cancer. However, future prospective research is needed to determine if the extent of dose reduction achieved equates to clinical benefits.
Collapse
Affiliation(s)
- Molly K Barnhart
- Speech Pathology Department, Prince of Wales Hospital (POWH), Randwick, Sydney, NSW, 2031, Australia. .,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Bena Cartmill
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Buranda, QLD, 4102, Australia.,Speech Pathology, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Woolloongabba, QLD, 4102, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Buranda, QLD, 4102, Australia
| | - Elizabeth Brown
- Radiation Oncology, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Woolloongabba, QLD, 4102, Australia
| | - Jonathon Sim
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia
| | - George Saade
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia
| | - Sandra Rayner
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia
| | - Rachelle A Robinson
- Speech Pathology Department, Prince of Wales Hospital (POWH), Randwick, Sydney, NSW, 2031, Australia
| | - Virginia A Simms
- Speech Pathology Department, Prince of Wales Hospital (POWH), Randwick, Sydney, NSW, 2031, Australia
| | - Robert I Smee
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia.,The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia
| |
Collapse
|
19
|
External validation of a multifactorial normal tissue complication probability model for tube feeding dependence at 6 months after definitive radiotherapy for head and neck cancer. Radiother Oncol 2018; 129:403-408. [DOI: 10.1016/j.radonc.2018.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/12/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022]
|
20
|
Ozkaya Akagunduz O, Eyigor S, Kirakli E, Tavlayan E, Erdogan Cetin Z, Kara G, Esassolak M. Radiation-Associated Chronic Dysphagia Assessment by Flexible Endoscopic Evaluation of Swallowing (FEES) in Head and Neck Cancer Patients: Swallowing-Related Structures and Radiation Dose-Volume Effect. Ann Otol Rhinol Laryngol 2018; 128:73-84. [PMID: 30343589 DOI: 10.1177/0003489418804260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to restore dose-volume parameters of swallowing-related structures (SRSs) by evaluating long-term swallowing dysfunctions after radiotherapy (RT) in head and neck cancer patients (HNCPs). MATERIALS AND METHODS Head and neck cancer patients whose pharyngeal region was involved in RT portal and treated with definitive RT/chemoradiotherapy (CRT) were included in the analyses. Patients underwent objective swallowing assessment by flexible endoscopic evaluation of swallowing (FEES). Volumes of SRSs that received 55 Gy (V55) (mean dose [Dmean]) were evaluated according to the dose-volume histograms of each patient. For every SRS, optimal dose-volume cut-off values were determined by receiver operating characteristic curve analysis. RESULTS Fifty-five patients at a median 20 months (range, 12-26 months) after their treatments were evaluated. There was a strong negative correlation between FEES scores and dose-volume parameters of SRS ( r ⩽ -0.5, P < .0001). According to our results, middle pharyngeal constrictor (MPC) and inferior pharyngeal constrictor (IPC) had a Dmean > 57 Gy, base of tongue (BOT) Dmean > 50 Gy, supraglottic larynx (SGL) and glottic larynx (GL) Dmean > 55 Gy, and cervical esophagus (CE) Dmean > 45 Gy. MPC V55 > 70%, IPC V55 > 50%, BOT V55 > 65%, CE V55 > 40%, and SGL and GL V55 > 50% were significant predictors for dysphagia. CONCLUSION It was found that dysphagia correlates strongly with dose-volume parameters of SRSs. IPC, SGL, and CE were found to be structures significantly associated with dysphagia.
Collapse
Affiliation(s)
- Ozlem Ozkaya Akagunduz
- 1 Faculty of Medicine, Department of Radiation Oncology, Ege University, Ankara Street, Izmir, Turkey
| | - Sibel Eyigor
- 2 Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Ege University, Izmir, Turkey
| | - Esra Kirakli
- 3 Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Radiation Oncology Department, Izmir, Turkey
| | - Emin Tavlayan
- 1 Faculty of Medicine, Department of Radiation Oncology, Ege University, Ankara Street, Izmir, Turkey
| | | | - Gulsen Kara
- 1 Faculty of Medicine, Department of Radiation Oncology, Ege University, Ankara Street, Izmir, Turkey
| | - Mustafa Esassolak
- 1 Faculty of Medicine, Department of Radiation Oncology, Ege University, Ankara Street, Izmir, Turkey
| |
Collapse
|
21
|
Likhterov I, Ru M, Ganz C, Urken ML, Chai R, Okay D, Liu J, Stewart R, Culliney B, Palacios D, Lazarus CL. Objective and subjective hyposalivation after treatment for head and neck cancer: Long-term outcomes. Laryngoscope 2018; 128:2732-2739. [PMID: 30325025 DOI: 10.1002/lary.27224] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study examined saliva weight over time and its association with diet and patient-rated swallowing, dry mouth, sticky saliva, and dysgeusia quality of life in head and neck cancer (HNCA) patients treated with surgery plus adjuvant chemoradiotherapy (CRT), or primary CRT. STUDY DESIGN Prospective cohort study in an outpatient HNCA center setting. METHODS Patients were seen pretreatment, and 1, 3, 6, 12, 24, and 36 + months post-treatment. All had newly diagnosed oral, oropharynx, nasopharynx, larynx/hypopharynx cancer from 2010 to 2016 and were to undergo surgery + CRT or primary CRT. Stimulated saliva weight was assessed with the Saxon test. Diet, eating, dry mouth, and dysgeusia quality of life were assessed and correlated with saliva weight, treatment modality, and tumor site. RESULTS Saliva weight decreased the most within the first 3 months across treatment groups, except for the surgery + CRT group, which continued to decline. Similar trends were seen by tumor site. Performance Status Scale (PSS) Normalcy of Diet and all quality-of-life scores declined following treatment. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck-35 (EORTC QLQ-H&N35); Eating Assessment Tool (EAT-10); M. D. Anderson Dysphagia Inventory (MDADI) Composite, Global, and subdomain scores; and PSS Diet were significantly correlated with saliva weight. CONCLUSIONS Saliva weight worsened post-treatment across groups and tumor site, with improvement by 36 + months. Saliva weight correlated with diet, eating quality of life and perception of dysgeusia across time points. Despite dose-sparing intensity-modulated radiation therapy, newer technologies are needed to preserve saliva production and maintain higher quality of life. LEVEL OF EVIDENCE 2b Laryngoscope, 128:2732-2739, 2018.
Collapse
Affiliation(s)
- Ilya Likhterov
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery
| | - Meng Ru
- Department of Population Health Science and Policy
| | - Cindy Ganz
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery
| | - Raymond Chai
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery
| | - Devin Okay
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery
| | - Jerry Liu
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Robert Stewart
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Bruce Culliney
- Department of Radiation Oncology.,Department of Medical Oncology, Mount Sinai Health System, New York, New York, U.S.A
| | - Daisy Palacios
- Department of Radiation Oncology.,Department of Medical Oncology, Mount Sinai Health System, New York, New York, U.S.A
| | - Cathy L Lazarus
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery
| |
Collapse
|
22
|
Almståhl A, Skoogh Andersson J, Alstad T, Fagerberg-Mohlin B, Finizia C. Explorative study on quality of life in relation to salivary secretion rate in head and neck cancer patients treated with radiotherapy up to 2 years post treatment. Int J Dent Hyg 2018; 17:46-54. [PMID: 30113762 DOI: 10.1111/idh.12363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/16/2018] [Accepted: 08/08/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to analyse quality of life (QoL) pretreatment and up to 24 months post radiation therapy (RT) in patients with head and neck (H&N) cancer. METHODS Twenty-nine patients (19 men and 10 women) with a mean age of 59 ± 8 years were included. The stimulated salivary secretion was measured and the patients completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaires (EORTC QLQ-C30 and H&N35) and the Hospital Anxiety and Depression scale (HADS) pretreatment and at 6, 12 and 24 months post RT. RESULTS At all time-points after RT (6, 12, and 24 months), patients with hyposalivation (stimulated secretion rate ≤0.7 mL/min) reported clinically significant differences (> 10 points) regarding insomnia, swallowing, social eating, dry mouth, and sticky saliva. Statistically significant differences were found for emotional functioning and insomnia at 12 months (P < 0.05 for both) and for sticky saliva at both 12 and 24 months (P < 0.05 and P < 0.01). The number of clinically significant differences increased from 10 at both 6 and 12 months post-RT to 14 functioning/symptom scales and single items at the 24 months follow-up. At 24 months post RT, 21% of patients with hyposalivation had HADS scores suggesting anxiety problems compared to 7% for those with stimulated salivary secretion rates >0.7 mL/min. CONCLUSION Patients with hyposalivation showed deterioration in health related quality of life (QoL) at 24 months compared with 12 months post RT. Most pronounced were problems with insomnia, swallowing, social eating, dry mouth, and sticky saliva.
Collapse
Affiliation(s)
- Annica Almståhl
- Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jessica Skoogh Andersson
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Torgny Alstad
- Department of Oral Prosthetics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bodil Fagerberg-Mohlin
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
23
|
Barbe AG, Ludwar L, Scharfenberg I, Hellmich M, Dano R, Barbe MT, Noack MJ. Circadian rhythms and influencing factors of xerostomia among Parkinson’s disease patients. Oral Dis 2018; 25:282-289. [DOI: 10.1111/odi.12942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
| | - Lena Ludwar
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
| | - Isabel Scharfenberg
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology University of Cologne Köln Germany
| | - Richard Dano
- Department of Neurology University of Cologne Köln Germany
| | | | - Michael Johannes Noack
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
| |
Collapse
|
24
|
Peach MS, Trifiletti DM, Vachani C, Arnold-Korzeniowski K, Bach C, Hampshire M, Metz JM, Hill-Kayser CE. Patient-reported outcomes in head and neck cancer: prospective multi-institutional patient-reported toxicity. PATIENT-RELATED OUTCOME MEASURES 2018; 9:245-252. [PMID: 30100773 PMCID: PMC6067627 DOI: 10.2147/prom.s153919] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose Head and neck cancer is occurring in an increasingly younger patient population, with treatment toxicity that can cause significant morbidity. Using a patient guided, Internet-based survivorship care plan program, we obtained and looked at patterns of patient-reported outcomes data from survivors seeking information after treatment for head and neck cancer. Methods The Internet-based OncoLife and LIVESTRONG Care Plan programs were employed, which design unique survivorship care plans based on patient-reported data. Care plans created for survivors of head and neck cancer were used in this evaluation. Demographics, treatment modality, and toxicity were included in this evaluation. Toxicity was further analyzed, grouped into system-based subsets. Results A total of 602 care plans were created from self-identified head and neck cancer survivors, from which patient-reported outcome data were attained. A majority of patients were Caucasian (96.2%) with median age at diagnosis of 55 years, living in suburban locations (39.9%), with ~50% receiving care within 20 miles of their residence. There was an equal distribution of education levels from high school only to graduate school. The majority of patients received care through cancer centers (96.7%), with a split between academic and non-academic centers. Ninety-three percent of patients had radiation therapy as part of their treatment modality, with 70.3% having chemotherapy and 60.1% having surgery. The most common system toxicities affected the oropharynx, followed by epithelium (skin/hair/nail), and then general global health. Specifically, the most common side effects were difficulty swallowing (61.5%) and changes in skin color/texture (49.7%). One third of patients experienced hearing/tinnitus/vertigo, xerostomia, loss of tissue flexibility, or fatigue. Conclusion The current work demonstrates the ability to obtain patient-reported outcomes of head and neck cancer survivors through an Internet-based survivorship care plan program. For this group dysphagia and dermatitis were the most commonly reported toxicities, as was expected; however, global effects of therapy, such as fatigue, were also significant and should be addressed in future survivorship planning.
Collapse
Affiliation(s)
- M Sean Peach
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | | | - Carolyn Vachani
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | | | - Christina Bach
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | - Margaret Hampshire
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | - James M Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | | |
Collapse
|
25
|
Barnhart MK, Ward EC, Cartmill B, Nund R, Robinson RA, Chandler SJ, Smee RI. Content analysis of rehabilitation goals for patients following non-surgical head and neck cancer treatment. Support Care Cancer 2018; 27:639-647. [PMID: 30051201 DOI: 10.1007/s00520-018-4364-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/18/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Following head and neck cancer (HNC) treatment, individuals experience an array of side effects which can impact on physical, emotional, and practical aspects of their lives. Responsive, supportive rehabilitation services are therefore essential to address ongoing survivorship needs. This study examined the nature of patient-reported goals from acute to long-term post-treatment, to inform design/delivery of future rehabilitation services. METHODS Using a cross-sectional cohort design, 91 patients between 2 weeks and 5 years of post non-surgical HNC treatment (acute n = 29; sub-acute n = 28; long-term n = 34), provided their top four rehabilitation goals considering any aspect of their lives. Content analysis was used to categorise responses at each time point. RESULTS Three core categories of patient goals were identified relating to: (1) treatment side effects (TSE), (2) overall health (OH), and (3) living life (LL). TSE goals were a priority during the acute and sub-acute phases, with less focus long-term. LL goals were prevalent across all time points, though increased in the long-term. Approximately a third of all goals at each time point related to OH. CONCLUSIONS A variety of rehabilitation goals were identified, and the focus shifted over time. These data highlight the importance of changing the focus of rehabilitation as patients' priorities vary over time. Early multidisciplinary care from allied health services is crucial to provide support with managing side effects and returning to daily activities. In the long-term, greater input from services to address health, nutrition, leisure, and fitness goals may be more beneficial.
Collapse
Affiliation(s)
- Molly K Barnhart
- Speech Pathology Department, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, Sydney, NSW, 2031, Australia. .,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD, 4102, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD, 4102, Australia.,Speech Pathology, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Rebecca Nund
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD, 4102, Australia
| | - Rachelle A Robinson
- Speech Pathology Department, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, Sydney, NSW, 2031, Australia
| | - Sophie J Chandler
- Speech Pathology Department, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, Sydney, NSW, 2031, Australia
| | - Robert I Smee
- Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia.,The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia.,Tamworth Base Hospital, Tamworth, NSW, 2340, Australia
| |
Collapse
|
26
|
Orlandi E, Miceli R, Infante G, Mirabile A, Alterio D, Cossu Rocca M, Denaro N, Vigna-Taglianti R, Merlotti A, Schindler A, Pizzorni N, Fallai C, Licitra L, Bossi P. Predictors of Patient-Reported Dysphagia Following IMRT Plus Chemotherapy in Oropharyngeal Cancer. Dysphagia 2018; 34:52-62. [PMID: 29948260 DOI: 10.1007/s00455-018-9913-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
The aim of this cross-sectional study is to evaluate the factors associated with patient-reported dysphagia in patients affected by locally advanced oropharyngeal cancer (OPC) treated with definitive intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy (CHT), with or without induction CHT. We evaluated 148 OPC patients treated with IMRT and concurrent CHT, without evidence of disease and who had completed their treatment since at least 6 months. At their planned follow-up visit, patients underwent clinical evaluation and completed the M.D. Anderson dysphagia inventory (MDADI) questionnaire. The association between questionnaire composite score (MDADI-CS) and different patients' and tumor's characteristics and treatments (covariates) was investigated by univariable and multivariable analyses, the latter including only covariates significant at univariable analysis. With a median time from treatment end of 30 months [range 6-74 months, interquartile range (IQR) 16-50 months], the median (IQR) MDADI-CS was 72 (63-84). The majority of patients (82.4%) had a MDADI-CS ≥ 60. At multivariable analysis, female gender, human papilloma virus (HPV)-negative status, and moderate and severe clinician-rated xerostomia were significantly associated with lower MDADI-CS. Patient-perceived dysphagia was satisfactory or acceptable in the majority of patients. HPV status and xerostomia were confirmed as important predictive factors for swallowing dysfunction after radiochemotherapy. Data regarding female gender are new and deserve further investigation.
Collapse
Affiliation(s)
- Ester Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, MI, Italy.
| | - Rosalba Miceli
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriele Infante
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aurora Mirabile
- Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Daniela Alterio
- Department of Radiotherapy, Advanced Radiotherapy Center, European Institute of Oncology, Milan, Italy
| | - Maria Cossu Rocca
- Medical Oncology Division of Urogenital and Head and Neck Tumours, European Institute of Oncology, Milan, Italy
| | - Nerina Denaro
- Department of Oncology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | | | - Annamaria Merlotti
- Department of Radiation Oncology, Azienda Ospedaliera Santa Croce and Carle, Cuneo, Italy
| | - Antonio Schindler
- Phoniatric Unit, Department of Biomedical and Clinical Sciences, Ospedale Sacco, University of Milan, Milan, Italy
| | - Nicole Pizzorni
- Phoniatric Unit, Department of Biomedical and Clinical Sciences, Ospedale Sacco, University of Milan, Milan, Italy
| | - Carlo Fallai
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, MI, Italy
| | - Lisa Licitra
- Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Paolo Bossi
- Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| |
Collapse
|
27
|
Oral health and chemotherapy act as cofactors in malnutrition in the elderly with other cancers than head and neck malignancies. Clin Oral Investig 2018; 23:235-243. [DOI: 10.1007/s00784-018-2430-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
|
28
|
Treatment toxicities and their impact on oral intake following non-surgical management for head and neck cancer: a 3-year longitudinal study. Support Care Cancer 2018; 26:2341-2351. [DOI: 10.1007/s00520-018-4076-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/29/2018] [Indexed: 02/07/2023]
|
29
|
Wopken K, Bijl HP, Langendijk JA. Prognostic factors for tube feeding dependence after curative (chemo-) radiation in head and neck cancer: A systematic review of literature. Radiother Oncol 2018; 126:56-67. [DOI: 10.1016/j.radonc.2017.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 12/31/2022]
|
30
|
Ardito F, Pellegrino MR, Perrone D, Troiano G, Cocco A, Lo Muzio L. In vitro study on anti-cancer properties of genistein in tongue cancer. Onco Targets Ther 2017; 10:5405-5415. [PMID: 29180873 PMCID: PMC5692202 DOI: 10.2147/ott.s133632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Tongue cancer is an extremely aggressive disease and is characterized by a poor prognosis. It is a complex disease to treat and current therapies have produced mediocre results with many side effects. Some facts suggest that natural essences can support traditional cancer therapy by carrying out a synergistic function with chemotherapy. Therefore, we evaluated the antitumor effects of genistein on tongue carcinoma cells. Methods Genistein 20, 50 and 100 µM were used for 24, 48 and 72 hours on 3 tongue carcinoma cell lines. xCELLigence system was used to evaluate the effects on cell adhesion, proliferation and to calculate IC50 values. Both MTT assay and Trypan blue assay were used to evaluate alterations in cell viability, scratch assay for cell migration and Western blot analysis for expression of some proteins. Results Cell adhesion was inhibited especially between 20 and 50 µM of genistein treatment. Proliferation was reduced by 50% for treatments with 20 µM at 24 hours, with 20 or 50 µM at 48 and 50 µM at 72 hours (P<0.0001). Viability tests confirmed a proportional reduction in concentration of genistein and duration of treatments. Even cell migration was reduced significantly (P<0.001). Genistein down-regulates vitronectin, OCT4 and survivin. Conclusion This in vitro study clarifies the anti-tumor effect of genistein on tongue carcinoma. In vivo studies are needed to confirm these data and develop a suitable delivery system that is capable of acting directly on tumor.
Collapse
Affiliation(s)
- Fatima Ardito
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Mario R Pellegrino
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Donatella Perrone
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Armando Cocco
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| |
Collapse
|
31
|
Burghartz M, Lennartz S, Schweinlin M, Hagen R, Kleinsasser N, Hackenberg S, Steußloff G, Scherzad A, Radeloff K, Ginzkey C, Walles H, Metzger M. Development of Human Salivary Gland-Like Tissue In Vitro. Tissue Eng Part A 2017; 24:301-309. [PMID: 28783453 DOI: 10.1089/ten.tea.2016.0466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The loss of salivary gland function caused by radiation therapy of the head and neck is a serious condition and it affects a patient's quality of life. The current lack of effective therapies demands new options to be explored. This study tested whether human salivary gland epithelial cells (SGECs) could be successfully cultured on a decellularized porcine gut matrix (SIS-muc) in both mono- and coculture with microvascular endothelial cells (mvECs). By performing immunofluorescence imaging, transmission as well as scanning electron microscopy (SEM), quantitative polymerase chain reaction (qPCR), and an amylase enzyme assay, it was investigated as to what extent the three-dimensional (3D)-cultured cells could maintain their molecular differentiation and the production of working α-amylase (α-AMY) compared with two-dimensional (2D) culture. In both 3D mono- and coculture, SGECs were successfully cultured and formed acinar-like structures. Those findings were confirmed by SEM imaging. Immunofluorescence imaging revealed that 3D-cultured cells expressed α-AMY, Claudin-1 (CL-1), and water channel protein aquaporin-5 (AQP-5). Two-dimensional-cultured cells only were positive for α-AMY. Real time (RT)-qPCR analysis showed that α-AMY relative gene expression was higher in both 3D mono- and coculture than in 2D culture. In α-AMY enzyme assay, cocultured SGECs showed about 25 times increased enzyme activity compared with 2D-cultured cells. In conclusion, the SIS-muc combined with endothelial coculture seems a suitable culture setting for the tissue engineering of functional human salivary gland tissue.
Collapse
Affiliation(s)
- Marc Burghartz
- 1 Department of Otorhinolaryngology, Head and Neck Surgery , Klinikum Stuttgart, Stuttgart, Germany
| | - Simon Lennartz
- 2 Institute of Diagnostic and Interventional Radiology, University Hospital Cologne , Cologne, Germany
| | - Matthias Schweinlin
- 3 Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Würzburg , Würzburg, Germany
| | - Rudolf Hagen
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Norbert Kleinsasser
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Stephan Hackenberg
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Gudrun Steußloff
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Agmal Scherzad
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Kathrin Radeloff
- 4 University Department of Otorhinolaryngology , Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Universitiy Hospital Würzburg, Würzburg, Germany
| | - Christian Ginzkey
- 5 Department of Otorhinolaryngology, Head and Neck Surgery "Otto-Körner", University Hospital Rostock , Rostock, Germany
| | - Heike Walles
- 3 Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Würzburg , Würzburg, Germany
| | - Marco Metzger
- 3 Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Würzburg , Würzburg, Germany
| |
Collapse
|
32
|
Petkar I, Bhide S, Newbold K, Harrington K, Nutting C. Dysphagia-optimised Intensity-modulated Radiotherapy Techniques in Pharyngeal Cancers: Is Anyone Going to Swallow it? Clin Oncol (R Coll Radiol) 2017; 29:e110-e118. [PMID: 28242166 DOI: 10.1016/j.clon.2017.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
Dysphagia after primary chemoradiotherapy or radiation alone in pharyngeal cancers can have a devastating impact on a patient's physical, social and emotional state. Establishing and validating efficient dysphagia-optimised radiotherapy techniques is, therefore, of paramount importance in an era where health-related quality of life measures are increasingly influential determinants of curative management strategies, particularly as the incidence of good prognosis, human papillomavirus-driven pharyngeal cancer in younger patients continues to rise. The preferential sparing achievable with intensity-modulated radiotherapy (IMRT) of key swallowing structures implicated in post-radiation dysfunction, such as the pharyngeal constrictor muscles (PCM), has generated significant research into toxicity-mitigating strategies. The lack of randomised evidence, however, means that there remains uncertainty about the true clinical benefits of the dosimetric gains offered by technological advances in radiotherapy. As a result, we feel that IMRT techniques that spare PCM cannot be incorporated into routine practice. In this review, we discuss the swallowing structures responsible for functional impairment, analyse the studies that have explored the dose-response relationship between these critical structures and late dysphagia, and consider the merits of reported dysphagia-optimised IMRT (Do-IMRT) approaches, thus far. Finally, we discuss the dysphagia/aspiration-related structures (DARS) study (ISRCTN 25458988), which is the first phase III randomised controlled trial designed to investigate the impact of swallow-sparing strategies on improving long-term function. To maximise patient benefits, improvements in radiation delivery will need to integrate with novel treatment paradigms and comprehensive rehabilitation strategies to eventually provide a patient-centric, personalised treatment plan.
Collapse
Affiliation(s)
- I Petkar
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - S Bhide
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - K Newbold
- The Royal Marsden NHS Foundation Trust, London, UK
| | - K Harrington
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - C Nutting
- The Royal Marsden NHS Foundation Trust, London, UK
| |
Collapse
|
33
|
Gensheimer MF, Nyflot M, Laramore GE, Liao JJ, Parvathaneni U. Contribution of submandibular gland and swallowing structure sparing to post-radiation therapy PEG dependence in oropharynx cancer patients treated with split-neck IMRT technique. Radiat Oncol 2016; 11:151. [PMID: 27846899 PMCID: PMC5111199 DOI: 10.1186/s13014-016-0726-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/04/2016] [Indexed: 11/28/2022] Open
Abstract
Background Radiation therapy-related dysphagia is worsened by xerostomia. The submandibular glands (SMG) produce saliva rich in lubricating mucins, and sparing the SMG has been shown to reduce xerostomia. The goal of this study was to determine whether SMG sparing IMRT is associated with reduced post-treatment PEG dependence in locally advanced oropharynx cancer patients. Methods Patients treated with definitive radiation therapy for oropharynx cancer were included in this retrospective study. Those with disease recurrence were excluded. Salivary glands and swallowing-related organs at risk, including pharyngeal constrictors, were contoured. Primary endpoint was time from end of radiation treatment to freedom from gastrostomy (PEG) tube dependence. Cox proportional hazards regression and logistic regression were used to assess influence of normal tissue doses on swallowing related endpoints. Results Sixty-nine patients were included. All had stage III/IV disease and 97% received concurrent systemic therapy. Fifty-seven percent had contralateral SMG (cSMG) mean dose <50 Gy, a level shown to predict for xerostomia. Eighty four percent of patients had a PEG tube placed electively. On univariate analysis, the strongest predictor of time to freedom from PEG tube dependence was cSMG dose (HR 0.97 per Gy (95% CI 0.95–0.98), p < 0.0001). This relationship persisted on multivariate analysis (p = 0.052). The dose to superior and middle pharyngeal constrictor muscles, and larynx were also significant on univariate analysis. Patients with cSMG dose less than median (42 Gy, n = 34) had a significantly shorter time to freedom from PEG dependence: median 1.9 vs. 3.5 months, p < 0.0001. At 6 months, 3% of patients with cSMG dose < 42 Gy were PEG dependent compared to 31% with cSMG dose > 42 Gy (p = 0.002). Conclusions Patients treated with cSMG sparing radiotherapy had significantly shorter time to PEG tube removal after treatment, suggesting a clinically meaningful reduction in subacute dysphagia compared to non-cSMG sparing treatment.
Collapse
Affiliation(s)
| | - Matthew Nyflot
- Department of Radiation Oncology, University of Washington Medical Center, 1959 NE Pacific St Box 356043, Seattle, WA, 98195, USA
| | - George E Laramore
- Department of Radiation Oncology, University of Washington Medical Center, 1959 NE Pacific St Box 356043, Seattle, WA, 98195, USA
| | - Jay J Liao
- Department of Radiation Oncology, University of Washington Medical Center, 1959 NE Pacific St Box 356043, Seattle, WA, 98195, USA
| | - Upendra Parvathaneni
- Department of Radiation Oncology, University of Washington Medical Center, 1959 NE Pacific St Box 356043, Seattle, WA, 98195, USA.
| |
Collapse
|
34
|
Barbe AG, Bock N, Derman SHM, Felsch M, Timmermann L, Noack MJ. Self-assessment of oral health, dental health care and oral health-related quality of life among Parkinson's disease patients. Gerodontology 2016; 34:135-143. [DOI: 10.1111/ger.12237] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Anna Greta Barbe
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
| | - Nadine Bock
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
| | - Sonja Henny Maria Derman
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
| | - Moritz Felsch
- Institute of Medical Statistics, Informatics and Epidemiology; University of Cologne; Köln Germany
| | - Lars Timmermann
- Department of Neurology; University of Cologne; Köln Germany
| | - Michael Johannes Noack
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
| |
Collapse
|