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Kuhn MA, Gillespie MB, Ishman SL, Ishii LE, Brody R, Cohen E, Dhar SI, Hutcheson K, Jefferson G, Johnson F, Rameau A, Sher D, Starmer H, Strohl M, Ulmer K, Vaitaitis V, Begum S, Batjargal M, Dhepyasuwan N. Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2023; 168:571-592. [PMID: 36965195 DOI: 10.1002/ohn.302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/16/2023] [Accepted: 02/01/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer opportunities for quality improvement. Dysphagia in HNC was defined as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx. METHODS Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers managing dysphagia in adult HNC populations. The development group prioritized topics where there was significant practice variation and topics that would improve the quality of HNC patient care if consensus were possible. RESULTS The development group identified 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized definition for consensus; 12 statements were designated as no consensus. CONCLUSION Expert consensus was achieved for 48 statements pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to dysphagia in HNC patients.
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Affiliation(s)
- Maggie A Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stacey L Ishman
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa E Ishii
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University Medical Institute, Cockeysville, Maryland, USA
| | - Rebecca Brody
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, West Linn, Oregon, USA
| | - Ezra Cohen
- Moores Cancer Center at UC San Diego Health, La Jolla, California, USA
| | | | - Kate Hutcheson
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Center, Houston, Texas, USA
| | - Gina Jefferson
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Surgical Oncology/Microvascular Reconstruction, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Anais Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - David Sher
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Madeleine Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Karen Ulmer
- Milton J Dance, Jr Head and Neck Cancer at GBMC, Baltimore, Maryland, USA
| | - Vilija Vaitaitis
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Charleston, South Carolina, USA
| | - Sultana Begum
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Misheelt Batjargal
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Late-onset swallowing outcomes post-treatment for head and neck cancer in a UK-based population. J Laryngol Otol 2023; 137:293-300. [PMID: 35317872 PMCID: PMC9975761 DOI: 10.1017/s0022215122000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adverse swallowing outcomes following head and neck squamous cell carcinoma treatment in the context of late-onset post-radiotherapy changes can occur more than five years post-treatment. METHODS A retrospective study was conducted utilising patient records from March 2013 to April 2015. Patients were categorised into 'swallow dysfunction' and 'normal swallow' groups. Quality of life was investigated using the MD Anderson Dysphagia Inventory and EuroQol questionnaires. RESULTS Swallow dysfunction was seen in 77 (51 per cent) of 152 patients. Twenty-eight patients (36 per cent) in the swallow dysfunction group reported symptoms in year five. Swallow dysfunction was associated with stage IV head and neck squamous cell carcinoma (p < 0.001) and radiotherapy (p < 0.001). MD Anderson Dysphagia Inventory global scores showed significant differences between swallow dysfunction and normal swallow groups (p = 0.01), and radiotherapy and surgery groups (p = 0.03), but there were no significant differences between these groups in terms of MD Anderson Dysphagia Inventory composite or EuroQol five-dimensions instrument scores. CONCLUSION One-third of head and neck squamous cell carcinoma survivors with swallow dysfunction still show symptoms at more than five years post-surgery, a point at which they are typically discharged.
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Ursino S, Calistri E, De Felice F, Bonomo P, Desideri I, Franco P, Arcadipane F, Colosimo C, Mazzola R, Maddalo M, Gonnelli A, Malfatti G, Morganti R, Musio D, Paiar F. Patient-Reported Outcomes After Swallowing (SWOARs)-Sparing IMRT in Head and Neck Cancers: Primary Results from a Prospective Study Endorsed by the Head and Neck Study Group (HNSG) of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Dysphagia 2023; 38:159-170. [PMID: 35587295 PMCID: PMC9118191 DOI: 10.1007/s00455-022-10434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/25/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To prospectively investigate changes in M.D. Anderson Dysphagia Inventory (MDADI) scores in patients affected by naso- and oropharynx cancer after definitive radiochemotherapy (ChemoRT) using swallowing organs at risk (SWOARs)-sparing IMRT. METHODS MDADI questionnaires were collected at baseline and at 6 and 12 months after treatment. MDADI scores were categorized as follows: ≥ 80 "optimal," 80-60 "adequate," < 60 "poor" deglutition-related quality of life (QoL) group, and dichotomized as "optimal" vs "adequate/poor" for the analysis. A mean MDADI composite (MDADI-C) change of 10 points was considered as minimal clinically important difference (MCID). RESULTS Sixty-three patients were enrolled of which 47 were considered for the analysis. At baseline, 26 (55%) were "optimal" and 21 (45%) were "adequate/poor." The mean baseline MDADI-C score was 93.6 dropping to 81 at 6 months (p = 0.013) and slightly rising to 85.5 at 12 months (p = 0.321) for the "optimal" group. Indeed, the mean baseline MDADI-C score was 64.3 rising to 77.5 at 6 months (p = 0.006) and stabilizing at 76 at 12 months (p = 0.999) for the "adequate/poor" group. A statistically significant but not clinically relevant worsening of the MDADI-C score was reported for the "optimal" group, whereas both a statistically significant and clinically meaningful improvement of the MDADI-C score were reported for the "adequate/poor" group from before to post-treatment. CONCLUSION Our results suggest a doubly clinical benefit of dose optimization to SWOARs to minimize the RT sequalae in patients with a baseline "optimal" deglutition-related QoL and to recover from cancer dysphagia in those with a baseline "adequate/poor" deglutition-related QoL.
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Affiliation(s)
- Stefano Ursino
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy.
| | - Elisa Calistri
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
| | - Francesca De Felice
- Radiation Oncology Unit, University Hospital La Sapienza, Viale del Policlinico 155, 00161, Rome, Italy
| | - Pierluigi Bonomo
- Radiation Oncology Unit, University Hospital Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, University Hospital Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, University of Turin, Via Camillo Benso di Cavour 31, 10123, Turin, Italy
| | - Caterina Colosimo
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
- Radiation Oncology Unit, S.Luca Hospital, Via Guglielmo Lippi Francesconi 556, 55100, Lucca, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore-Don Calabria Hospital Cancer Care Center, Via Sempreboni 5, 37024, Verona, Italy
| | - Marta Maddalo
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Via del Medolo 2, 25123, Brescia, Italy
| | - Alessandra Gonnelli
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
| | - Giulia Malfatti
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, Via Roma 67, 56100, Pisa, Italy
| | - Daniela Musio
- Radiation Oncology Unit, University Hospital La Sapienza, Viale del Policlinico 155, 00161, Rome, Italy
| | - Fabiola Paiar
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
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ZHANG S, LIN B, ZHOU P, LIU S. Analysis of clinical efficacy and prognostic side effects of radiotherapy with Teggio capsule on 78 elderly patients with esophageal cancer. Minerva Med 2022; 113:758-759. [DOI: 10.23736/s0026-4806.20.06839-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Price JM, West CM, Dixon LM, Iyizoba-Ebozue Z, Garcez K, Lee L, McPartlin A, Slevin F, Sykes A, Prestwich RJD, Thomson DJ. Similar long-term swallowing outcomes for accelerated, mildly-hypofractionated radiotherapy compared to conventional fractionation in oropharynx cancer: a multi-centre study. Radiother Oncol 2022; 172:111-117. [PMID: 35595173 DOI: 10.1016/j.radonc.2022.05.013] [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: 02/09/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE There is renewed interest in hypofractionated radiotherapy, but limited data and a lack of consensus to support use for head and neck cancer. In this multicentre analysis we compared outcomes for patients with oropharynx squamous cell carcinoma (OPSCC) treated with conventional and accelerated, mildly hypofractionated radiotherapy without chemotherapy. MATERIALS AND METHODS A multi-centre, observational study of consecutive OPSCCs treated between 2015 and 2018. Patients underwent curative-intent radiotherapy (oropharynx and bilateral neck) using conventionally fractionated (70 Gy in 35 fractions over 7 weeks, n = 97) or accelerated, mildly hypofractionated (65-66 Gy in 30 fractions over 6 weeks, n = 136) radiotherapy without chemotherapy. Locoregional control (LRC) and overall survival (OS) were compared. Patients alive and cancer-free at a minimum of 2 years post-radiotherapy (n = 151, 65%) were sent an MD Anderson Dysphagia Inventory (MDADI) questionnaire to assess swallow function. RESULTS LRC and OS were similar across schedules (p = 0.78 and 0.95 respectively, log-rank test). Enteral feeding rates during radiotherapy appeared higher in the 7-week group though this did not reach statistical significance (59% vs 48%, p = 0.08). Feeding rates were similar at 1 year post radiotherapy for both groups (10% vs 6%, p = 0.27). 107 patients returned MDADI questionnaires (71%); there were no differences between the 6- and 7-week groups for median global (60.0 vs 60.0, p = 0.99) and composite (65.8 vs 64.2, p = 0.44) MDADI scores. CONCLUSION Patients with OPSCC treated with radiotherapy alone have similar swallowing outcomes, LRC and OS following accelerated, mild hypofractionation and standard fractionation schedules, supporting its use as a standard-of-care option for patients unsuitable for concurrent chemotherapy.
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Affiliation(s)
- J M Price
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - C M West
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - L M Dixon
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Z Iyizoba-Ebozue
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, United Kingdom
| | - K Garcez
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - L Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A McPartlin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - F Slevin
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, United Kingdom
| | - A Sykes
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R J D Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, United Kingdom
| | - D J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom.
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Vermaire JA, Raaijmakers CPJ, Monninkhof EM, Verdonck-de Leeuw IM, Terhaard CHJ, Speksnijder CM. Factors associated with swallowing dysfunction in patients with head and neck cancer. Oral Dis 2022. [PMID: 35298058 DOI: 10.1111/odi.14192] [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: 01/03/2022] [Revised: 03/03/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this prospective cohort study was to investigate swallowing function in relation to personal and clinical factors among patients with head and neck cancer (HNC) from diagnosis up to 2 years after treatment. METHODS The 100 mL water swallow test was measured before treatment, and 3, 6, 12, and 24 months after treatment. Linear mixed-effects model analysis was conducted to investigate changes over time and the association with personal (sex, age) and clinical (tumor site, tumor stage, treatment modality) factors. RESULTS Among 128 included patients, number of swallows increased from baseline to 3 months after treatment and decreased to baseline again at 6 months after treatment. The number of swallows was associated with age and treatment modality. CONCLUSIONS In patients with HNC, swallowing (dys)function changes over time with the worst score 3 months after treatment. A higher age and being treated with surgery are factors associated with swallowing dysfunction over time.
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Affiliation(s)
- Jorine A Vermaire
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis P J Raaijmakers
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Evelyn M Monninkhof
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Chris H J Terhaard
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Late radiation effects in survivors of head and neck cancer: State of the science. Crit Rev Oncol Hematol 2021; 162:103335. [PMID: 33992801 DOI: 10.1016/j.critrevonc.2021.103335] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/15/2023] Open
Abstract
Head and neck squamous cell carcinoma is one of the most common neoplasms. Radiotherapy (RT) plays an essential role in the management of such cases. Despite advances in the technique, hyposalivation, xerostomia, dysphagia, trismus, radiation caries, and osteoradionecrosis remain significant late complications of RT. The aim of this narrative review was to summarize and update the main findings related to late side effects of radiotherapy in survivors of head and neck cancer (HNC). Such effects limit the ability to speak, ingest food and medications, and breathe and also exert a negative impact on social well-being and quality of life. This review highlights research in the field for both researchers and clinicians, assisting in the prevention and management of these adverse conditions. The findings can contribute to improving preventive management and multidisciplinary interventions for HNC patients.
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Lee J, Kim WC, Yoon WS, Rim CH. Implications of Radiotherapy Utilization in Korea from 2010 to 2019. J Korean Med Sci 2021; 36:e117. [PMID: 33975394 PMCID: PMC8111041 DOI: 10.3346/jkms.2021.36.e117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study was to assess the rate of radiotherapy (RT) utilization according to the modality in South Korea to identify the implications of contemporary RT patterns. METHODS We collected information from claims and reimbursement records of the National Health Insurance Service from 2010 to 2019. We classified the location of each institution as capital (Seoul, Incheon, and Gyeonggi-do) and non-capital areas. RESULTS The rate of RT utilization in total cancer patients nationwide was 24.5% in 2010, which consistently has increased to 36.1% in 2019 (annual increase estimate [AIE], 4.5%). There was an abrupt increase in patients receiving intensity-modulated RT (IMRT), with an AIE of 33.5%, and a steady decline in patients receiving three-dimensional conformal RT (3DCRT), with an AIE of -7.1%. The commonest RT modality was IMRT (44.5%), followed by 3DCRT and stereotactic RT (SRT) (37.2% and 13.5%) in 2019. An increasing trend of advanced RT (such as IMRT and SRT) utilization was observed regardless of the region, although the AIE in the capital areas was slightly higher than that in non-capital areas. CONCLUSION The utilization of overall RT application and especially of advanced modalities remarkably increased from 2010 to 2019. We also found gaps in their AIEs between capital and non-capital areas. We should ensure that advanced RT is accessible to all cancer patients across South Korea.
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Affiliation(s)
- Jeongshim Lee
- Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea.
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[Functional outcome after transmandibular resection and primary chemoradiation in advanced oropharyngeal squamous cell carcinoma]. HNO 2021; 69:110-121. [PMID: 32929521 PMCID: PMC7862514 DOI: 10.1007/s00106-020-00930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ziel der Arbeit In dieser Studie wurden die funktionellen Ergebnisse nach transmandibulärer Resektion und Rekonstruktion mittels mikrovaskulär anastomosiertem Radialistransplantat (TMR+Tx) gegenüber einer primären Radiochemotherapie (pRCT) bei fortgeschrittenen orophayngealen Plattenepithelkarzinomen (OPSCC) verglichen. Methoden Es erfolgte ein Vergleich zwischen 50 OPSCC-Patienten mit TMR+Tx und 50 OPSCC-Patienten mit pRCT. Die Wasserschluckzeit war als primärer Endpunkt definiert. Der Saxon-Test, die maxillomandibuläre Distanz, der Mallampati-Score, der Quotient aus Körpergröße zu Gewicht, eine nasale Penetration, das Vorhandensein einer Ernährungssonde/Tracheostomie sowie 4 validierte Fragebögen (Visuelle Analogskala zur Mundtrockenheit, Sicca VAS; MD Anderson Dysphagia Inventory, MDADI; Voice Handicap Index, VHI; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Head and Neck Cancer – 35 Items, QLQ-H&N35) dienten als sonstige Endpunkte zur Beurteilung der Funktion und Lebensqualität. Ergebnisse Die Gesamtkohorte an operierten Patienten zeigte eine erhöhte Rate an nasaler Penetration (p < 0,0001), was mit einer verlängerten Wasserschluckzeit verbunden war (p < 0,05). Durch eine modifizierte Rekonstruktion des Weichgaumens wurde die nasale Penetration in der chirurgisch therapierten Gruppe im Vergleich zur klassischen Rekonstruktion signifikant reduziert (p = 0,0001). Patienten mit pRCT litten signifikant stärker an einer Xerostomie (Saxon-Test) als Patienten nach TMR+Tx und Adjuvanz (p = 0,001). In den Fragebögen zur Funktionalität und Lebensqualität zeigte sich kein Unterschied zwischen den Gruppen. Schussfolgerung Die TMR+Tx mit modifizierter Rekonstruktion und adjuvante Therapie zeigte gegenüber der pRCT vergleichbare funktionelle Ergebnisse.
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Im I, Carnaby GD, Takahashi N, Dungan S, Crary MA. Clinical Swallowing Profile Change in HNC Patients Treated with C/RT. Laryngoscope 2020; 131:E1873-E1880. [PMID: 33179771 DOI: 10.1002/lary.29266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To demonstrate utility of the Mann Assessment of Swallowing Ability-Cancer (MASA-C) to describe change in swallowing ability in a cohort of HNC patients from pre-C/RT to post-C/RT to follow up at 3 months post-C/RT. An exploratory analysis compared patients treated with radiotherapy (RT) only to patients treated with chemoradiation (CRT). STUDY DESIGN Prospective Cohort. METHODS The MASA-C and Functional Oral Intake Scale (FOIS) were completed on 85 HNC patients within the first 5 days of CRT initiation, at the completion of C/RT (6 weeks), and 3 months after completion of C/RT. MASA-C total scores and clinical profiles were used to describe change in swallowing performance at each time point. RESULTS MASA-C and FOIS scores were significantly lower at 6 weeks and 3 months compared to baseline. Patients treated with CRT demonstrated more frequent and more severe dysphagia. Post C/RT items demonstrating the most deterioration included taste, diet level, oral mucosa, saliva, weight loss, and pharyngeal functions. Significant recovery was observed between 6 weeks and 3 months on both the MASA-C and FOIS. MASA-C items revealing the greatest recovery included taste, diet level, oral mucosa, tongue movement, weight loss, oral transit, voice, and pharyngeal phase. Few significant differences were noted between RT and CRT cases at 3 months. CONCLUSIONS Swallowing functions deteriorate significantly following C/RT with incomplete recovery at 3 months. Few differences were noted between RT and CRT treated patients at 3 months. Clinical profiling with the MASA-C provides a standard, simple method to document swallow function change over time in these patients. LEVEL OF EVIDENCE 2 Laryngoscope, 131:E1873-E1880, 2021.
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Affiliation(s)
- Ikjae Im
- Department of Language and Rehabilitation Counseling, Catholic Kwandong University, Gangneung, Republic of Korea.,Center for Upper Aerodigestive Functions, University of Central Florida, Orlando, Florida, U.S.A
| | - Giselle D Carnaby
- Center for Upper Aerodigestive Functions, University of Central Florida, Orlando, Florida, U.S.A
| | - Noriaki Takahashi
- Center for Upper Aerodigestive Functions, University of Central Florida, Orlando, Florida, U.S.A.,Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Tokyo, Japan
| | - Sarah Dungan
- Center for Upper Aerodigestive Functions, University of Central Florida, Orlando, Florida, U.S.A
| | - Michael A Crary
- Center for Upper Aerodigestive Functions, University of Central Florida, Orlando, Florida, U.S.A
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Di Gravio EJ, Lang P, Kim HAJ, Chinnery T, Mundi N, MacNeil SD, Mendez A, Yoo J, Fung K, Mymryk JS, Barrett JW, Read N, Venkatesan V, Kuruvilla S, Mendez LC, Winquist E, Mitchell S, Mattonen SA, Nichols AC, Palma DA. Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution. Radiat Oncol 2020; 15:261. [PMID: 33168055 PMCID: PMC7654053 DOI: 10.1186/s13014-020-01705-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT. Methods Consecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria. Results A total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026). Conclusions Primary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.
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Affiliation(s)
- Eric J Di Gravio
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Pencilla Lang
- Department of Oncology, Western University, London, ON, Canada
| | - Hugh Andrew Jinwook Kim
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Tricia Chinnery
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Neil Mundi
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - Joe S Mymryk
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - John W Barrett
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Nancy Read
- Department of Oncology, Western University, London, ON, Canada
| | | | - Sara Kuruvilla
- Department of Oncology, Western University, London, ON, Canada
| | - Lucas C Mendez
- Department of Oncology, Western University, London, ON, Canada
| | - Eric Winquist
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - Sylvia Mitchell
- Department of Oncology, Western University, London, ON, Canada
| | - Sarah A Mattonen
- Department of Oncology, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,Department of Otolaryngology - Head and Neck Surgery, Victoria Hospital, London Health Science Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - David A Palma
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada. .,Department of Oncology, Western University, London, ON, Canada. .,Department of Otolaryngology - Head and Neck Surgery, Victoria Hospital, London Health Science Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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12
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Ursino S, Giuliano A, Martino FD, Cocuzza P, Molinari A, Stefanelli A, Giusti P, Aringhieri G, Morganti R, Neri E, Traino C, Paiar F. Incorporating dose-volume histogram parameters of swallowing organs at risk in a videofluoroscopy-based predictive model of radiation-induced dysphagia after head and neck cancer intensity-modulated radiation therapy. Strahlenther Onkol 2020; 197:209-218. [PMID: 33034672 PMCID: PMC7892680 DOI: 10.1007/s00066-020-01697-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022]
Abstract
Purpose To develop a videofluoroscopy-based predictive model of radiation-induced dysphagia (RID) by incorporating DVH parameters of swallowing organs at risk (SWOARs) in a machine learning analysis. Methods Videofluoroscopy (VF) was performed to assess the penetration-aspiration score (P/A) at baseline and at 6 and 12 months after RT. An RID predictive model was developed using dose to nine SWOARs and P/A-VF data at 6 and 12 months after treatment. A total of 72 dosimetric features for each patient were extracted from DVH and analyzed with linear support vector machine classification (SVC), logistic regression classification (LRC), and random forest classification (RFC). Results 38 patients were evaluable. The relevance of SWOARs DVH features emerged both at 6 months (AUC 0.82 with SVC; 0.80 with LRC; and 0.83 with RFC) and at 12 months (AUC 0.85 with SVC; 0.82 with LRC; and 0.94 with RFC). The SWOARs and the corresponding features with the highest relevance at 6 months resulted as the base of tongue (V65 and Dmean), the superior (Dmean) and medium constrictor muscle (V45, V55; V65; Dmp; Dmean; Dmax and Dmin), and the parotid glands (Dmean and Dmp). On the contrary, the features with the highest relevance at 12 months were the medium (V55; Dmin and Dmean) and inferior constrictor muscles (V55, V65 Dmin and Dmax), the glottis (V55 and Dmax), the cricopharyngeal muscle (Dmax), and the cervical esophagus (Dmax). Conclusion We trained and cross-validated an RID predictive model with high discriminative ability at both 6 and 12 months after RT. We expect to improve the predictive power of this model by enlarging the number of training datasets.
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Affiliation(s)
- Stefano Ursino
- Department of Radiation Oncology, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy.
| | - Alessia Giuliano
- Department of Physics, S. Luca Hospital, Via Guglielmo Lippi Francesconi 556, 55100, Lucca, Italy
| | - Fabio Di Martino
- Department of Physics, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy
| | - Paola Cocuzza
- Department of Radiation Oncology, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy
| | - Alessandro Molinari
- Department of Radiation Oncology, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy
- Department of Radiation Oncology, Ecomedica Institute of Clinical Research, Via Cherubini 2/4, 50053, Empoli, Italy
| | - Antonio Stefanelli
- Department of Radiation Oncology, University Hospital Cona, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Patrizia Giusti
- Department of Radiology, University Hospital S. Chiara/Cisanello, Via Roma 55/Via Paradisa 2, 56100, Pisa, Italy
| | - Giacomo Aringhieri
- Department of Radiology, University Hospital S. Chiara/Cisanello, Via Roma 55/Via Paradisa 2, 56100, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, Via Roma 55, 56100, Pisa, Italy
| | - Emanuele Neri
- Department of Radiology, University Hospital S. Chiara/Cisanello, Via Roma 55/Via Paradisa 2, 56100, Pisa, Italy
| | - Claudio Traino
- Department of Physics, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy
| | - Fabiola Paiar
- Department of Radiation Oncology, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy
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13
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Prospective observational study to estimate set-up errors and optimise PTV margins in patients undergoing IMRT for head and neck cancers from a Government cancer centre of Eastern India. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractBackground:The head and neck cancers as a whole are the most common cancers among males in India. Technological advancements have led to an improvement in radiation therapy (RT) techniques with subsequent reduction in normal tissue complications. To correct patient set-up errors, an off-line correction method like no action level (NAL) protocol may be used as a preferred protocol particularly for a busy department. The objectives of the study were to measure the translational set-up errors using kV cone-beam computed tomography (CBCT) in patients undergoing intensity modulated radiotherapy (IMRT) in head and neck cancers and also to optimise clinical target volume (CTV) to planning target volume (PTV) margin using NAL protocol.Material and methods:On the first 5 days of RT, patient’s position was verified by kV-CBCT and then weekly during the course of treatment. The comparison between the reference and kV-CBCT images was performed, and the shifts measured and recorded. The mean error from the initial five consecutive fractions was corrected on the sixth daily fraction. Displacements in all the directions were measured. The population systematic and random errors were determined and used to estimate PTV margins according to the van Herk formula.Results:A total of 322 images were analysed. Before correction, 15, 12 and 9% patients had systematic error ≥3 mm on X, Y and Z axes, but after correction this was reduced to 9, 0 and 0%. The total percentage of patients whose set-up margin was ≥5 mm before correction was 5, 6·25, 3·75%, but after correction it reduced to 1·88, 0, and 0·63%. The margins of total population were reduced to 63, 65 and 56% after correction on X, Y and Z axes, respectively.Conclusion:A simple off-line NAL protocol can correct the set-up errors without daily on-line imaging in patients undergoing IMRT and hence acting as a resource sparing alternative. Five millimetre margin to CTVs was adequate and safe to overcome the problem of set-up errors in head and neck IMRT.
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14
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Haderlein M, Speer S, Ott O, Lettmaier S, Hecht M, Semrau S, Frey B, Scherl C, Iro H, Kesting M, Fietkau R. Dose Reduction to the Swallowing Apparatus and the Salivary Glands by De-Intensification of Postoperative Radiotherapy in Patients with Head and Neck Cancer: First (Treatment Planning) Results of the Prospective Multicenter DIREKHT Trial. Cancers (Basel) 2020; 12:cancers12030538. [PMID: 32110958 PMCID: PMC7139715 DOI: 10.3390/cancers12030538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 02/06/2023] Open
Abstract
Aim: Evaluating radiotherapy treatment plans of the prospective DIREKHT trial (ClinicalTrials.gov, NCT02528955) investigating de-intensification of radiotherapy in patients with head and neck cancer. Patients and Methods: The first 30 patients from the DIREKHT trial of the leading study centre were included in this analysis. Standard treatment plans and study treatment plans derived from the protocol were calculated for each patient. Sizes of planning target volumes (PTVs) and mean doses to organs at risk were compared using the Student’s t-test with paired samples. Results: Mean PTV3 including primary tumor region and ipsilateral elective neck up to a dose of 50 Gy in the study treatment plans was 662 mL (+/− 165 mL standard deviation (SD)) and therefore significantly smaller than those of the standard treatment plans (1166 mL (+/− 266 mL SD). In the medial and inferior constrictor muscles, cricopharyngeal muscle, glottic and supraglottic laryngeal areas, arytenoid cartilages, contralateral major salivary glands highly significant dose reductions (p < 0.0001) of more than 10 Gy were achieved in study treatment plan compared to standard treatment plan. Conclusion: De-intensification of radiotherapy led to smaller planning target volumes and clinical relevant dose reductions in the swallowing apparatus and in the contralateral salivary glands.
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Affiliation(s)
- Marlen Haderlein
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
- Correspondence: ; Tel.: +49-9131-8543-025; Fax: +49-9131-8535-969
| | - Stefan Speer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Oliver Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Sebastian Lettmaier
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Markus Hecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Sabine Semrau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Claudia Scherl
- Department of Otorhinolaryngology, Universitätsklinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
- Department of Otorhinolaryngology, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Heinrich Iro
- Department of Otorhinolaryngology, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
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15
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Mogadas S, Busch CJ, Pflug C, Hanken H, Krüll A, Petersen C, Tribius S. Influence of radiation dose to pharyngeal constrictor muscles on late dysphagia and quality of life in patients with locally advanced oropharyngeal carcinoma. Strahlenther Onkol 2020; 196:522-529. [PMID: 32006068 DOI: 10.1007/s00066-019-01572-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with oropharyngeal carcinoma (OPC) often have difficulty swallowing, which may affect quality of life (QoL). Radiation dose to constrictor muscles plays an important role. METHODS 54 patients with locally advanced OPC were evaluated after intensity-modulated radiotherapy. Data were collected at standardized intervals using the EORTC questionnaires QLQ-C30 and QLQ-HN35 within two years. The pharyngeal constrictors (superior, middle, and inferior) were each contoured as an organ at risk. Influence of dose to the constrictors (≥55 Gy vs. <55 Gy) on late dysphagia and QoL was analyzed using the t‑test. RESULTS Late radiation-induced dysphagia depends significantly on the dose to the lower pharyngeal constrictor. At a dose of ≥55 Gy, 14 (64%) patients developed dysphagia grade ≤2 and 8 (36%) patients grade ≥3. At a dose of <55 Gy, the distribution at the end of radiotherapy (RT) was similar: 22 (69%) patients with dysphagia grade ≤2, 10 (31%) with grade ≥3. There was no dose-dependent difference in the severity of dysphagia in the acute phase (p = 0.989). There were differences 18 months after the end of RT: ≥55 Gy: 19 (86%) patients showed dysphagia grade ≤2; 3 (14%) grade ≥3. At <55 Gy, 31 (97%) patients developed grade ≤2, 1 (3%) grade ≥3 (18 months: p = 0.001; 24 months: p = 0.000). Late dysphagia is also dependent on the dose level of the middle constrictor muscle (6 months: p = 0.000; 12 months: p = 0.005, 18 months: p = 0.034). After 24 months, there was no significant difference (p = 0.374). CONCLUSION Radiation dose to the upper constrictor muscle appears to be of little relevance. The middle and lower constrictor should be given special consideration to avoid late dysphagia. Long-term QoL is independent on radiation dose.
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Affiliation(s)
- S Mogadas
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C-J Busch
- Department of Otolaryngology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Pflug
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Hanken
- Department of Oral & Maxillofacial Surgery, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Krüll
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Petersen
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Tribius
- Department of Radiation Oncology, Asklepios Hospital St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany.
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16
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Sparing of swallowing-related organs in radiotherapy for oropharyngeal squamous cell carcinoma. Lancet Oncol 2019; 20:e611. [PMID: 31674315 DOI: 10.1016/s1470-2045(19)30585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/21/2022]
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17
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Oh D. Proton therapy: the current status of the clinical evidences. PRECISION AND FUTURE MEDICINE 2019. [DOI: 10.23838/pfm.2019.00058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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18
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Pacelli R, Caroprese M, Palma G, Oliviero C, Clemente S, Cella L, Conson M. Technological evolution of radiation treatment: Implications for clinical applications. Semin Oncol 2019; 46:193-201. [PMID: 31395286 DOI: 10.1053/j.seminoncol.2019.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
The contemporary approach to the management of a cancer patient requires an "ab initio" involvement of different medical domains in order to correctly design an individual patient's pathway toward cure. With new therapeutic tools in every medical field developing faster than ever before the patient care outcomes can be achieved if all surgical, drug, and radiation options are considered in the design of the appropriate therapeutic strategy for a given patient. Radiation therapy (RT) is a clinical discipline in which experts from different fields continuously interact in order to manage the multistep process of the radiation treatment. RT is found to be an appropriate intervention for diverse indications in about 50% of cancer patients during the course of their disease. Technologies are essential in dealing with the complexity of RT treatments and for driving the increasingly sophisticated RT approaches becoming available for the treatment of Cancer. High conformal techniques, namely intensity modulated or volumetric modulated arc techniques, ablative techniques (Stereotactic Radiotherapy and Stereotactic Radiosurgery), particle therapy (proton or carbon ion therapy) allow for success in treating irregularly shaped or critically located targets and for the sharpness of the dose fall-off outside the target. The advanced on-board imaging, including real-time position management systems, makes possible image-guided radiation treatment that results in substantial margin reduction and, in select cases, implementation of an adaptive approach. The therapeutic gains of modern RT are also due in part to the enhanced anticancer activity obtained by coadministering RT with chemotherapy, targeted molecules, and currently immune checkpoints inhibitors. These main clinically relevant steps forward in Radiation Oncology represent a change of gear in the field that may have a profound impact on the management of cancer patients.
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Affiliation(s)
- Roberto Pacelli
- Department of Advanced Biomedical Sciences, University "Federico II", Napoli, Italy.
| | - Mara Caroprese
- Department of Advanced Biomedical Sciences, University "Federico II", Napoli, Italy
| | - Giuseppe Palma
- Institute of Biostructures and Bioimages, National Research Council, Napoli, Italy
| | | | | | - Laura Cella
- Institute of Biostructures and Bioimages, National Research Council, Napoli, Italy
| | - Manuel Conson
- Department of Advanced Biomedical Sciences, University "Federico II", Napoli, Italy
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Radiotherapy-induced dysphagia and its impact on quality of life in patients with nasopharyngeal carcinoma. Strahlenther Onkol 2019; 195:457-467. [DOI: 10.1007/s00066-018-01421-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 12/22/2018] [Indexed: 12/13/2022]
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20
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Is there a patient population with squamous cell carcinoma of the head and neck region who might benefit from de-intensification of postoperative radiotherapy? : A monocentric retrospective analysis of a previously defined low-risk patient population treated with standard-of-care radiotherapy. Strahlenther Onkol 2019; 195:482-495. [PMID: 30610355 DOI: 10.1007/s00066-018-1415-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/11/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the clinical outcome of a previously defined low-risk patient population with completely resected (R0) squamous cell carcinoma of the oral cavity, oropharynx, larynx (pT1-3, pN0-pN2b), hypopharynx (pT1-2, pN0-pN1), and the indication for postoperative radio(chemo)therapy. PATIENTS AND METHODS According to predefined criteria, 99 patients with head and neck squamous cell carcinoma (SCC) who were treated at our institution from January 1, 2005 to December 31, 2014, were available for analysis. The Kaplan-Meier method was used for calculating survival and incidence rates. For univariate comparative analysis, the log-rank test was used for analyzing prognostic clinicopathologic parameters. RESULTS Median follow-up was 67 months. Cumulative overall (OS) and disease-free survival (DFS) were 97.9%/94.7%/88.0% and 96.9%/92.6%/84.7% after 1, 2, and 5 years, respectively. Cumulative incidence of loco-regional recurrence (LRR), distant metastases (DM), and second cancer (SC) were 1.0%/1.0%/4.9%, 0.0%/3.4%/5.8%, and 2.1%/4.2%/13.1%, respectively. In univariate comparative analysis, location of the primary tumor in the oropharynx was a significant predictor for increased OS (p = 0.043) and DFS (p = 0.048). CONCLUSION Considering the low disease relapse rates and high rates of therapy-induced late side effects, as well as the increased risk of developing SC, a prospective multicentric trial investigating de-escalation of radiotherapy in this clearly defined low-risk patient population was started and is still recruiting patients (DIREKHT-Trial, NCT02528955).
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Outcome and toxicity of intensity-modulated radiotherapy with simultaneous integrated boost in patients with pharyngo-laryngeal cancer. Clin Transl Oncol 2018; 21:881-890. [PMID: 30506131 DOI: 10.1007/s12094-018-1995-0] [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: 06/20/2018] [Accepted: 11/17/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The present work aims at evaluating intensity-modulated radiation therapy with simultaneous integrated boost (IMRT-SIB) in squamous cell carcinomas (SCC) of the larynx and hypopharynx. METHODS/PATIENTS We performed a single institutional retrospective analysis on 116 pharyngo (29%)-laryngeal (71%) SCC patients (93% male) treated with IMRT-SIB to 66-69.96 Gy in 33 fractions between 2008 and 2016. Those who underwent surgery (54%) received adjuvant radiation of 66 Gy at 2 Gy/fraction to the surgical bed. 16 patients (14%) were treated for a local recurrence after prior surgery. High-risk lymph node regions received 59.4 Gy at 1.8 Gy/fraction and low risk regions 54.12 Gy at 1.64 Gy/fraction. The median age was 60 years and 95% of patients had an ECOG performance status 0-2. Most had advanced stage disease (III 22%, IV 74%). Chemotherapy was delivered in 74% of cases. RESULTS Median follow-up was 32 months. Two and three-year overall survival for all patients was 87% and 82%, respectively. There were 28 (24%) locoregional recurrences and 19 (16%) distant failures. Grade 3 mucositis, dermatitis, and xerostomy were observed in 12%, 10%, and 3%, respectively. A longer IMRT-SIB overall treatment time was associated with a higher risk of mortality (HR 1.09, CI 1.01-1.17, P = 0.02). Postoperative IMRT-SIB associated with a significantly lower risk of any recurrence (HR 0.34, CI 0.18-0.64, P = 0.001) and higher local control (HR 0.06, CI 0.01-0.24, P < 0.01). Additionally, it associated with a lower risk of mucositis (P = 0.029) compared with definitive radio (chemo) therapy. CONCLUSIONS IMRT-SIB is a safe and feasible radiation treatment technique for pharyngo-laryngeal SCC patients with a tolerable acute toxicity profile.
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Pattern of dysphagia after swallowing-sparing intensity-modulated radiotherapy (IMRT) of head and neck cancers: results of a mono-institutional prospective study. Strahlenther Onkol 2018; 194:1114-1123. [DOI: 10.1007/s00066-018-1328-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
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23
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Radiation-induced acute toxicities after image-guided intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for patients with spinal metastases (IRON-1 trial) : First results of a randomized controlled trial. Strahlenther Onkol 2018; 194:911-920. [PMID: 29978307 DOI: 10.1007/s00066-018-1333-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/23/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Radiation therapy (RT) provides an important treatment approach in the palliative care of vertebral metastases, but radiation-induced toxicities in patients with advanced disease and low performance status can have substantial implications for quality of life. Herein, we prospectively compared toxicity profiles of intensity-modulated radiotherapy (IMRT) vs. conventional three-dimensional conformal radiotherapy (3DCRT). METHODS This was a prospective randomized monocentric explorative pilot trial to compare radiation-induced toxicity between IMRT and 3DCRT for patients with spinal metastases. A total of 60 patients were randomized between November 2016 and May 2017. In both cohorts, RT was delivered in 10 fractions of 3 Gy each. The primary endpoint was radiation-induced toxicity at 3 months. RESULTS Median follow-up was 4.3 months. Two patients suffered from grade 3 acute toxicities in the IMRT arm, along with 1 patient in the 3DCRT group. At 12 weeks after treatment (t2), 1 patient reported grade 3 toxicity in the IMRT arm vs. 4 patients in the 3DCRT group. No grade 4 or 5 adverse events occurred in either group. In the IMRT arm, the most common side effects by the end of irradiation (t1) were grade 1-2 xerostomia and nausea in 8 patients each (29.6%), and dyspnea in 7 patients (25.9%). In the 3DCRT group, the most frequent adverse events (t1) were similar: grade 1-2 xerostomia (n = 10, 35.7%), esophagitis (n = 10, 35.8%), nausea (n = 10, 35.8%), and dyspnea (n = 5, 17.9%). CONCLUSION This is the first randomized trial to evaluate radiation-induced toxicities after IMRT versus 3DCRT in patients with vertebral metastases. This trial demonstrated an additional improvement for IMRT in terms of acute side effects, although longer follow-up is required to further ascertain other endpoints.
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Delishaj D, Ursino S, Pasqualetti F, Matteucci F, Cristaudo A, Soatti CP, Barcellini A, Paiar F. Set-up errors in head and neck cancer treated with IMRT technique assessed by cone-beam computed tomography: a feasible protocol. Radiat Oncol J 2018; 36:54-62. [PMID: 29621873 PMCID: PMC5903362 DOI: 10.3857/roj.2017.00493] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/04/2017] [Accepted: 12/18/2017] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To investigate set-up errors, suggest the adequate planning target volume (PTV) margin and image-guided radiotherapy frequency in head and neck (H&N) cancer treated with intensity-modulated radiotherapy (IMRT) assessed by kV cone-beam computed tomography (CBCT). METHODS We analyzed 360 CBCTs in 60 patients with H&N cancer treated with IMRT. The target delineation was contoured according to ICRU62. PTVs were generated by adding a 3-5 mm margin in all directions to the respective clinical target volumes. The kV CBCT images were obtained at first three days of irradiation and weekly thereafter. The overall mean displacement, range, systematic (∑) and random (σ) errors were calculated. Adequate PTV margins were calculated according to the van Herk formula (2.5∑ + 0.7r). RESULTS The mean of set-up errors was less than 2 mm in any direction. The overall frequency of set-up displacements greater than 3 mm was 3.9% in medial-lateral (ML) direction, 8% in superior-inferior (SI) direction, and 15.5% in anterior-posterior (AP) direction. The range of translations shifts was 0-9 mm in ML direction, 0-5 mm in SI direction and 0-10 mm in AP direction, respectively. After systematic set-up errors correction, the adequate margin to overcome the problem of set-up errors was found to be less than 3 mm. CONCLUSION Image-guided kV CBCT was effective for the evaluation of set-up accuracy in H&N cancer. The kV CBCT at first three fractions and followed-by weekly appears adequate for reducing significantly set-up errors in H&N cancer treated with IMRT technique. Finally, 3-5 mm PTV margins appear adequate and safe to overcome the problem of set-up errors.
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Affiliation(s)
- Durim Delishaj
- Department of Radiation Oncology, University Hospital Santa Chiara, Pisa, Italy
| | - Stefano Ursino
- Department of Radiation Oncology, University Hospital Santa Chiara, Pisa, Italy
| | | | - Fabrizio Matteucci
- Department of Radiation Oncology, University Hospital Santa Chiara, Pisa, Italy
| | - Agostino Cristaudo
- Department of Radiation Oncology, University Hospital Santa Chiara, Pisa, Italy
| | | | - Amelia Barcellini
- Radiotherapy Unit, IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabiola Paiar
- Department of Radiation Oncology, University Hospital Santa Chiara, Pisa, Italy
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Mazzola R, Fiorentino A, Ricchetti F, Gregucci F, Corradini S, Alongi F. An update on radiation therapy in head and neck cancers. Expert Rev Anticancer Ther 2018; 18:359-364. [PMID: 29485913 DOI: 10.1080/14737140.2018.1446832] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Technological and technical improvements allowed for significant advances in the field of radiation therapy (RT) of head and neck cancer (HNC). Several organ-sparing strategies have been investigated with the objective to decrease acute and long-term adverse effects and, subsequently, to assure a better quality of life in patients affected by HNC. In this context, intensity modulated irradiation and the use of multimodality-imaging could help clinicians to obtain a rapid dose fall off towards surrounding healthy tissues and a better delineation of targets volumes and organs at risk. Areas covered: A literature review was performed with the aim to offer an update on radiation therapy in HNC. Expert commentary: During these last years, radiation oncologists have observed a continuous changing regarding radiation treatment for HNC. The adoption of intensity-modulated RT (IMRT) and the use of multimodality-imaging for tumor volume definition and organs at risk or delineation have improved the clinical outcomes of HNC patients. In the future, a better integration of functional imaging for target volume delineation as well as adaptive delivery strategies will allow to further personalize radiation oncology in HNC. Furthermore, the latest breakthrough technologies, such as magnetic resonance imaging (MRI)-linacs and heavy particles technologies have a great potential to improve treatment-related quality of life in HNC. Future studies are needed to demonstrate the clinical advantages of these new RT technologies in HNC.
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Affiliation(s)
- Rosario Mazzola
- a Radiation Oncology , Sacro Cuore Don Calabria Hospital , Negrar-Verona , Italy
| | - Alba Fiorentino
- a Radiation Oncology , Sacro Cuore Don Calabria Hospital , Negrar-Verona , Italy
| | - Francesco Ricchetti
- a Radiation Oncology , Sacro Cuore Don Calabria Hospital , Negrar-Verona , Italy
| | - Fabiana Gregucci
- a Radiation Oncology , Sacro Cuore Don Calabria Hospital , Negrar-Verona , Italy
| | - Stefanie Corradini
- b Radiation Oncology , University Hospital, LMU Munich , Munich , Germany
| | - Filippo Alongi
- a Radiation Oncology , Sacro Cuore Don Calabria Hospital , Negrar-Verona , Italy.,c Radiation Oncology , University of Brescia , Brescia , Italy
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26
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Leitzen C, Wilhelm-Buchstab T, Müdder T, Heimann M, Koch D, Schmeel C, Simon B, Stumpf S, Vornholt S, Garbe S, Röhner F, Schoroth F, Schild HH, Schüller H. Patient positioning in head and neck cancer : Setup variations and safety margins in helical tomotherapy. Strahlenther Onkol 2018; 194:386-391. [PMID: 29372290 DOI: 10.1007/s00066-018-1265-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/05/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the interfractional variations of patient positioning during intensity-modulated radiotherapy (IMRT) with helical tomotherapy in head and neck cancer and to calculate the required safety margins (sm) for bony landmarks resulting from the necessary table adjustments. MATERIALS AND METHODS In all, 15 patients with head and neck cancer were irradiated using the Hi-Art II tomotherapy system between April and September 2016. Before therapy sessions, patient position was frequently checked by megavolt computed tomography (MV-CT). Necessary table adjustments (ta) in the right-left (rl), superior-inferior (si) and anterior-posterior (ap) directions were recorded for four anatomical points: second, fourth and sixth cervical vertebral body (CVB), anterior nasal spine (ANS). Based upon these data sm were calculated for non-image-guided radiotherapy, image-guided radiotherapy (IGRT) and image guidance limited to a shortened area (CVB 2). RESULTS Based upon planning CT the actual treatment required ta from -0.05 ± 1.31 mm for CVB 2 (ap) up to 2.63 ± 2.39 mm for ANS (rl). Considering the performed ta resulting from image control (MV-CT) we detected remaining ta from -0.10 ± 1.09 mm for CVB 4 (rl) up to 1.97 ± 1.64 mm for ANS (si). After theoretical adjustment of patients position to CVB 2 the resulting ta ranged from -0.11 ± 2.44 mm for CVB6 (ap) to 2.37 ± 2.17 mm for ANS (si). These data imply safety margins: uncorrected patient position: 3.63-9.95 mm, corrected positioning based upon the whole target volume (IGRT): 1.85-6.63 mm, corrected positioning based upon CVB 2 (IGRT): 3.13-6.66 mm. CONCLUSIONS The calculated safety margins differ between anatomic regions. Repetitive and frequent image control of patient positioning is necessary that, however, possibly may be focussed on a limited region.
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Affiliation(s)
- Christina Leitzen
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
| | - Timo Wilhelm-Buchstab
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Thomas Müdder
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Martina Heimann
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - David Koch
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Christopher Schmeel
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Birgit Simon
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Sabina Stumpf
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Susanne Vornholt
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Stephan Garbe
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Fred Röhner
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Felix Schoroth
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Hans Heinz Schild
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Heinrich Schüller
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
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