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Gazzini L, Caselli A, Dallari V, Fazio E, Abousiam M, Nebiaj A, Albi C, Accorona R, De Virgilio A, Greco A, Calabrese L. Subtotal glossectomy with conservation of the hyo-styloglossus unit (HSU): a new pivotal concept for preserving tongue function in extended glossectomy. Front Surg 2024; 11:1395936. [PMID: 39045088 PMCID: PMC11264312 DOI: 10.3389/fsurg.2024.1395936] [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] [Received: 03/04/2024] [Accepted: 05/20/2024] [Indexed: 07/25/2024] Open
Abstract
Objective The local spread of oral tongue squamous cell carcinoma (OTSCC) follows pathways of dissemination along areas of lesser resistance. In more advanced scenarios, the tumor can extend beyond the hemi-tongue of origin, by passing through the lingual septum and following the fibers of the transverse muscle. This can lead to the invasion of the contralateral extrinsic muscles, the first being the genioglossus and more laterally the hyoglossus. An anatomically guided surgical resection of the tumor can be planned to ensure both oncological safety and an acceptable functional outcome. This approach aims to preserve the hyo-styloglossus unit (HSU) whenever feasible. Methods Between January 2019 and November 2022, six patients received extended glossectomy Type B (EG Type B), with preservation of the HSU. Preliminary oncological results and functional results in terms of swallowing (FOIS score) and quality of life (MDADI) are presented. Results Five out of the six patients are alive and disease-free, while one patient died due to other causes. All patients who were candidates for an EG Type B underwent a swallowing assessment prior to surgery and followed daily postoperative swallowing training. At discharge, the patients continued swallowing training in an outpatient clinic. Five out of the six patients reached a full oral diet within 1 year of follow-up. Conclusion The oncological results confirm the safety of this technique. The importance of preserving the HSU, the minimal functional unit, shows very encouraging results in terms of swallowing rehabilitation.
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Affiliation(s)
- Luca Gazzini
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Arianna Caselli
- Speech and Language Therapy Division, Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Virginia Dallari
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Verona, Italy
| | - Enrico Fazio
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Monir Abousiam
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Aurel Nebiaj
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Cecilia Albi
- Division of Otorhinolaryngology-Head and Neck Surgery, University of Ferrara, Ferrara, Italy
| | - Remo Accorona
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Antonio Greco
- Department of “Organi di Senso”, University “Sapienza”, Rome, Italy
| | - Luca Calabrese
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
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Alterio D, Marani S, Vigorito S, Zurlo V, Zorzi SF, Ferrari A, Volpe S, Bandi F, Vincini MG, Gandini S, Gaeta A, Fodor CI, Casbarra A, Zaffaroni M, Starzynska A, Belgioia L, Ansarin M, Aristei C, Jereczek-Fossa BA. Post-operative intensity-modulated vs 3D conformal radiotherapy after conservative surgery for laryngeal tumours of the supraglottic region: a dosimetric analysis on 20 patients. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:150-160. [PMID: 38712518 PMCID: PMC11166212 DOI: 10.14639/0392-100x-n2442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/13/2023] [Indexed: 05/08/2024]
Abstract
Objective To perform a dosimetric comparison between intensity modulated radiotherapy (IMRT) and 3D conformal radiotherapy in patients with locally advanced (stage III and IV) tumours of the supraglottic region treated with conservative surgery and post-operative radiotherapy. Methods An in-silico plan using a 3D conformal shrinking field technique was retrospectively produced for 20 patients and compared with actually delivered IMRT plans. Eighteen structures (arytenoids, constrictor muscles, base of tongue, floor of mouth, pharyngeal axis, oral cavity, submandibular glands and muscles of the swallowing functional units [SFU]) were considered. Results IMRT allowed a reduction of maximum and mean doses to 9 and 14 structures, respectively (p < .05). Conclusions IMRT achieved a reduction of unnecessary dose to the remnant larynx and the majority of surrounding SFUs. Further prospective analyses and correlations with functional clinical outcomes are required to confirm these dosimetric findings.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Simona Marani
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sabrina Vigorito
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Valeria Zurlo
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Filippo Zorzi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesco Bandi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Aurora Gaeta
- Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Alessia Casbarra
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Starzynska
- Department of Oral Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Liliana Belgioia
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Mohssen Ansarin
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia General Hospital, University of Perugia, Perugia, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Lam WYS, Kwong E, Chan HWT, Zheng YP. Using Sequence Analyses to Quantitatively Measure Oropharyngeal Swallowing Temporality in Point-of-Care Ultrasound Examinations: A Pilot Study. J Clin Med 2024; 13:2288. [PMID: 38673561 PMCID: PMC11051012 DOI: 10.3390/jcm13082288] [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: 03/04/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Swallowing is a complex process that comprises well-timed control of oropharyngeal and laryngeal structures to achieve airway protection and swallowing efficiency. To understand its temporality, previous research adopted adherence measures and revealed obligatory pairs in healthy swallows and the effect of aging and bolus type on the variability of event timing and order. This study aimed to (i) propose a systemic conceptualization of swallowing physiology, (ii) apply sequence analyses, a set of information-theoretic and bioinformatic methods, to quantify and characterize swallowing temporality, and (iii) investigate the effect of aging and dysphagia on the quantified variables using sequence analyses measures. (2) Method: Forty-three participants (17 young adults, 15 older adults, and 11 dysphagic adults) underwent B-mode ultrasound swallowing examinations at the mid-sagittal plane of the submental region. The onset, maximum, and offset states of hyoid bone displacement, geniohyoid muscle contraction, and tongue base retraction were identified and sorted to form sequences which were analyzed using an inventory of sequence analytic techniques; namely, overlap coefficients, Shannon entropy, and longest common subsequence algorithms. (3) Results: The concurrency of movement sequence was found to be significantly impacted by aging and dysphagia. Swallowing sequence variability was also found to be reduced with age and the presence of dysphagia (H(2) = 52.253, p < 0.001, η2 = 0.260). Four obligatory sequences were identified, and high adherence was also indicated in two previously reported pairs. These results provided preliminary support for the validity of sequence analyses for quantifying swallowing sequence temporality. (4) Conclusions: A systemic conceptualization of human deglutition permits a multi-level quantitative analysis of swallowing physiology. Sequence analyses are a set of promising quantitative measurement techniques for point-of-care ultrasound (POCUS) swallowing examinations and outcome measures for swallowing rehabilitation and evaluation of associated physiological conditions, such as sarcopenia. Findings in the current study revealed physiological differences among healthy young, healthy older, and dysphagic adults. They also helped lay the groundwork for future AI-assisted dysphagia assessment and outcome measures using POCUSs. Arguably, the proposed conceptualization and analyses are also modality-independent measures that can potentially be generalized for other instrumental swallowing assessment modalities.
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Affiliation(s)
- Wilson Yiu Shun Lam
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong SAR, China (H.W.T.C.)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Elaine Kwong
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong SAR, China (H.W.T.C.)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Huberta Wai Tung Chan
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong SAR, China (H.W.T.C.)
| | - Yong-Ping Zheng
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China;
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Neckel N, Neckel PH, Hirt B, Doll C, Hofmann E, Nahles S, Heiland M, Kreutzer K, Koerdt S. A modified pull-through approach with a pedicled bone flap for oral and oropharyngeal cancer resection: a feasibility study. Surg Radiol Anat 2024; 46:341-352. [PMID: 38361154 PMCID: PMC10960749 DOI: 10.1007/s00276-024-03302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Compromised swallowing, speaking, and local complications are the major disadvantages of established approaches to the posterior tongue and oropharynx. The mandibular split involves an esthetically unpleasant bipartition of the lower lip and is prone to bony non-union or sequestration. The conventional pull-through technique on the other hand lacks the secure reattachment of the lingually released soft tissues. METHODS The feasibility of a new modified pull-through approach was tested on three anatomical specimens. CAD/CAM cutting guides were used to design a retentive bone flap to properly refixate the genioglossus and geniohyoid muscles after the procedure. The radiographic assessment and treatment planning was performed on 12 cadavers. The entire procedure was tested surgically via dissection in three of those cases. This procedure was then applied in a clinical case. RESULTS Precise repositioning and dynamic compression of bony segments was possible reproducibly and without injury to adjacent structures. In all dissected cases, a median lingual foramen was found and in two cases vessels entering it could be dissected Radiologic anatomical landmarks were sufficient in all 12 cases to perform the clinical planning procedure. Clinically, the osteotomized segment demonstrated good blood supply and plateless repositioning was verified postoperatively via cone beam scan. CONCLUSION The method presented is safe and easy to perform. Individual cutting guides improve the safety and accuracy of the procedure, potentially eliminating the need for osteosynthesis. We provide the anatomical and radiologic basis for clinical evaluation of this pedicled bone flap procedure and present the clinical application of this modified pull-through approach.
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Affiliation(s)
- Norbert Neckel
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany.
| | - Peter H Neckel
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Christian Doll
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Elena Hofmann
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
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5
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Gazzini L, Fazio E, Dallari V, Spirito L, Abousiam M, Nocini R, Nebiaj A, Giorgetti G, Calabrese L. Beyond the boundaries of compartmental hemiglossectomy: a proposal for an anatomically based classification of surgical approaches to advanced oral tongue squamous cell carcinoma. Eur Arch Otorhinolaryngol 2023; 280:3015-3022. [PMID: 36897364 DOI: 10.1007/s00405-023-07915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/04/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION In the last decade, compartmental surgery (CTS) has been the surgical approach of choice for advanced tumors of the tongue and oral floor. METHODS Advanced tumors (cT3-T4) oral tongue squamous cell carcinoma (OTSCC) may extend beyond the lingual septum and involve the contralateral hemitongue, developing along the intrinsic transverse muscle. The disease may then involve the genioglossus muscle and, more laterally, the hyoglossus muscle. RESULTS The surgical approach to the contralateral tongue must be guided by anatomic and anatomopathological principles to achieve a safe oncological resection based on the principles of CTS. CONCLUSION We propose a schematic classification of glossectomies that extend to the contralateral hemitongue based on the anatomy and pathways of tumor spread.
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Affiliation(s)
- Luca Gazzini
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Enrico Fazio
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Virginia Dallari
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy.
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Luca Spirito
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Varese Insubria, Varese, Italy
| | - Monir Abousiam
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Riccardo Nocini
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy
| | - Aurel Nebiaj
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Giovanni Giorgetti
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Luca Calabrese
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
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Evaluation of morphological features of palatopharyngeus insertion into the thyroid cartilage. Anat Sci Int 2023:10.1007/s12565-023-00709-7. [PMID: 36877447 DOI: 10.1007/s12565-023-00709-7] [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: 12/10/2022] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
The attachment of the palatopharyngeus extended from the posterior end of the thyroid cartilage to the posterior margin of the inferior constrictor attachment that might contribute to successive swallowing movements. Laryngeal elevation is essential for proper swallowing and breathing. Recently, clinical research has demonstrated that the palatopharyngeus, a longitudinal muscle of the pharynx, is involved in the elevation of the larynx. However, the morphological relationship between the larynx and palatopharyngeus remains unclear. In the present study, we analyzed the attachment site and characteristics of the palatopharyngeus in the thyroid cartilage. We evaluated 14 halves of seven heads from Japanese cadavers (average age: 76.4 years); 12 halves, anatomically and two halves histologically. A part of the palatopharyngeus, which originated from the inferior aspect of the palatine aponeurosis, was attached to the inner and outer surfaces of the thyroid cartilage through collagen fibers. The attachment area extends from the posterior end of the thyroid cartilage to the posterior margin of the attachment site of the inferior constrictor. The palatopharyngeus may elevate the larynx with the suprahyoid muscles and contribute to successive movements of swallowing with surrounding muscles. Based on our findings and previous studies, palatopharyngeus with various muscle bundle directions may be essential for the coordination of continuous swallowing events.
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7
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Murakami C, Sasaki M, Shimoda S, Tamada Y. Quantification of the Swallowing Mechanism Through Muscle Synergy Analysis. Dysphagia 2022; 38:973-989. [PMID: 36149515 DOI: 10.1007/s00455-022-10523-4] [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: 02/02/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
Decreased swallowing function increases the risk of choking and aspiration pneumonia. Videofluoroscopy and computed tomography allow for detailed observation of the swallowing movements but have radiation risks. Therefore, we developed a method using surface electromyography (sEMG) to noninvasively assess swallowing function without radiation exposure. A 44-channel flexible sEMG sensor was used to measure the sEMG signals of the hyoid muscles during swallowing in 14 healthy young adult and 14 elderly subjects. Muscle synergy analysis was performed to extract the muscle synergies from the sEMG signals, and the three synergies were extracted from the hyoid muscle activities during the swallowing experiments. The experimental results showed that the three synergies represent the oral, early pharyngeal, and late pharyngeal swallowing phases and that swallowing strength is tuned by the strength of the muscle activities, whereas swallowing volume is controlled by adjusting muscle activation timing. In addition, the timing of the swallowing reflex is slower in elderly individuals. The results confirm that the proposed approach successfully quantifies swallowing function from sEMG signals, mapping the signals to the swallowing phases.
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Affiliation(s)
- Chiaki Murakami
- Division of Biorobotics, Graduate School of Science and Engineering, Iwate University, 4-3-5 Ueda, Morioka, Iwate, 020-8551, Japan
| | - Makoto Sasaki
- Division of Biorobotics, Graduate School of Science and Engineering, Iwate University, 4-3-5 Ueda, Morioka, Iwate, 020-8551, Japan.
| | - Shingo Shimoda
- Intelligent Behavior Control Unit, RIKEN CBS-Toyota Collaboration Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Nagoya, Aichi, 463-0003, Japan
| | - Yasushi Tamada
- Department of Dysphagia Rehabilitation and Department of Special Care Dentistry, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8102, Japan
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8
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Paczona VR, Capala ME, Deák-Karancsi B, Borzási E, Együd Z, Végváry Z, Kelemen G, Kószó R, Ruskó L, Ferenczi L, Verduijn GM, Petit SF, Oláh J, Cserháti A, Wiesinger F, Hideghéty K. Magnetic Resonance Imaging-Based Delineation of Organs at Risk in the Head and Neck Region. Adv Radiat Oncol 2022; 8:101042. [PMID: 36636382 PMCID: PMC9830100 DOI: 10.1016/j.adro.2022.101042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/24/2022] [Indexed: 01/16/2023] Open
Abstract
Purpose The aim of this article is to establish a comprehensive contouring guideline for treatment planning using only magnetic resonance images through an up-to-date set of organs at risk (OARs), recommended organ boundaries, and relevant suggestions for the magnetic resonance imaging (MRI)-based delineation of OARs in the head and neck (H&N) region. Methods and Materials After a detailed review of the literature, MRI data were collected from the H&N region of healthy volunteers. OARs were delineated in the axial, coronal, and sagittal planes on T2-weighted sequences. Every contour defined was revised by 4 radiation oncologists and subsequently by 2 independent senior experts (H&N radiation oncologist and radiologist). After revision, the final structures were presented to the consortium partners. Results A definitive consensus was reached after multi-institutional review. On that basis, we provided a detailed anatomic and functional description and specific MRI characteristics of the OARs. Conclusions In the era of precision radiation therapy, the need for well-built, straightforward contouring guidelines is on the rise. Precise, uniform, delineation-based, automated OAR segmentation on MRI may lead to increased accuracy in terms of organ boundaries and analysis of dose-dependent sequelae for an adequate definition of normal tissue complication probability.
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Affiliation(s)
- Viktor R. Paczona
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,Corresponding author: Viktor R. Paczona, MD
| | | | | | - Emőke Borzási
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsófia Együd
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zoltán Végváry
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Gyöngyi Kelemen
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | | | | | | | - Judit Oláh
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | | | - Katalin Hideghéty
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,ELI-HU Non-Profit Ltd, Szeged, Hungary
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9
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Li Y, Rao S, Chen W, Azghadi SF, Nguyen KNB, Moran A, Usera BM, Dyer BA, Shang L, Chen Q, Rong Y. Evaluating Automatic Segmentation for Swallowing-Related Organs for Head and Neck Cancer. Technol Cancer Res Treat 2022; 21:15330338221105724. [PMID: 35790457 PMCID: PMC9340321 DOI: 10.1177/15330338221105724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: To evaluate the accuracy of deep-learning-based
auto-segmentation of the superior constrictor, middle constrictor, inferior
constrictor, and larynx in comparison with a traditional multi-atlas-based
method. Methods and Materials: One hundred and five computed
tomography image datasets from 83 head and neck cancer patients were
retrospectively collected and the superior constrictor, middle constrictor,
inferior constrictor, and larynx were analyzed for deep-learning versus
multi-atlas-based segmentation. Eighty-three computed tomography images (40
diagnostic computed tomography and 43 planning computed tomography) were used
for training the convolutional neural network, and for atlas-based model
training. The remaining 22 computed tomography datasets were used for validation
of the atlas-based auto-segmentation versus deep-learning-based
auto-segmentation contours, both of which were compared with the corresponding
manual contours. Quantitative measures included Dice similarity coefficient,
recall, precision, Hausdorff distance, 95th percentile of Hausdorff distance,
and mean surface distance. Dosimetric differences between the auto-generated
contours and manual contours were evaluated. Subjective evaluation was obtained
from 3 clinical observers to blindly score the autosegmented structures based on
the percentage of slices that require manual modification. Results:
The deep-learning-based auto-segmentation versus atlas-based auto-segmentation
results were compared for the superior constrictor, middle constrictor, inferior
constrictor, and larynx. The mean Dice similarity coefficient values for the 4
structures were 0.67, 0.60, 0.65, and 0.84 for deep-learning-based
auto-segmentation, whereas atlas-based auto-segmentation has Dice similarity
coefficient results at 0.45, 0.36, 0.50, and 0.70, respectively. The mean 95th
percentile of Hausdorff distance (cm) for the 4 structures were 0.41, 0.57,
0.59, and 0.54 for deep-learning-based auto-segmentation, but 0.78, 0.95, 0.96,
and 1.23 for atlas-based auto-segmentation results, respectively. Similar mean
dose differences were obtained from the 2 sets of autosegmented contours
compared to manual contours. The dose–volume discrepancies and the average
modification rates were higher with the atlas-based auto-segmentation contours.
Conclusion: Swallowing-related structures are more accurately
generated with DL-based versus atlas-based segmentation when compared with
manual contours.
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Affiliation(s)
- Yimin Li
- Department of Radiation Oncology, Xiamen Radiotherapy Quality
Control Center, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology,
The First Affiliated Hospital of Xiamen University, The Third Clinical Medical
College, Fujian Medical University, Xiamen, Fujian, China
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Shyam Rao
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Wen Chen
- Department of Radiation Oncology, Xiangya Hospital, Central South
University, Changsha, China
| | - Soheila F. Azghadi
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Ky Nam Bao Nguyen
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Angel Moran
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Brittni M Usera
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Brandon A Dyer
- Department of Radiation Oncology, Legacy Health, Portland, OR, USA
| | - Lu Shang
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Quan Chen
- Department of Radiation Oncology, City of Hope comprehensive Cancer
Center, Duarte, CA, USA
- Quan Chen, PhD, Department of Radiation
Oncology, City of Hope comprehensive cancer center, Duarte, CA 91010..
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
- Yi Rong, PhD, Department of Radiation
Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
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10
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Charters E, Bogaardt H, Clark J, Milross C, Freeman-Sanderson A, Ballard K, Britton R, McCabe N, Davis H, Sullivan T, Wu R. Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration-related structures in patients with head and neck cancer undergoing definitive and postoperative intensity-modulated radiotherapy. Head Neck 2021; 44:399-411. [PMID: 34808023 DOI: 10.1002/hed.26936] [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: 03/10/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The relationship between swallowing outcomes and radiotherapy dose to dysphagia and aspiration-related structures (DARS) may be different following definitive versus postoperative radiotherapy (PORT) for mucosal head and neck cancer (HNC) and has not been well-studied. METHOD Patient- and clinician-reported swallowing measures were prospectively collected at six time points from baseline to 24 months postradiotherapy HNC. Radiotherapy plans were retrospectively analyzed to assess dose delivered to DARS. The association between swallowing outcomes and participant demographics, tumor characteristics, and radiotherapy dose in definitive and postoperative treatment cohorts was assessed. RESULTS Ninety-three participants who received radiotherapy for HNC were included in the analysis (n = 49 definitive radiotherapy for laryngeal/pharyngeal primary tumors and n = 44 postoperative PORT for predominantly oral cavity/salivary gland tumors). Participants undergoing PORT had lower doses to DARS than those undergoing definitive RT. High dose to the pharyngeal constrictors and base of tongue for definitive RT and the esophageal inlet, supraglottic larynx and cervical esophagus for the PORT group were associated with worse swallowing function. CONCLUSION Radiation dose to DARS is associated with post-treatment swallowing outcomes. These dose/outcome relationships may vary between the definitive and postoperative settings.
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Affiliation(s)
- Emma Charters
- Department of Allied Health, Speech Pathology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Hans Bogaardt
- University of Adelaide, Faculty of Health and Medical Sciences, School of Allied Health Science and Practice, Adelaide, South Australia, Australia
| | - Jonathan Clark
- Faculty of Medicine and Health Sciences, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Chris Milross
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | | | - Kirrie Ballard
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rafe Britton
- Lubrication Explained, Biostatistics Department, Sydney, Australia
| | - Natalie McCabe
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Hannah Davis
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Tom Sullivan
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Raymond Wu
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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11
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Gupta A, Wong KH, Newbold K, Bhide S, Nutting C, Harrington KJ. Early-Stage Glottic Squamous Cell Carcinoma in the Era of Image-Guided Radiotherapy. Front Oncol 2021; 11:753908. [PMID: 34616688 PMCID: PMC8488425 DOI: 10.3389/fonc.2021.753908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Early-stage squamous cell cancer (SCC) of the glottis has a good prognosis. Therefore, patients have long survival outcomes and may potentially suffer from late toxicities of radiotherapy. Radiotherapy with a conventional parallel-opposed-pair or anterior-oblique beam arrangements for stage 1 and 2 glottic SCC have field borders that traditionally cover the entire larynx, exposing organs-at-risk (e.g. carotid arteries, contralateral vocal cord, contralateral arytenoid and inferior pharyngeal constrictor muscles) to high radiation doses. The potential long-term risk of cerebrovascular events has attracted much attention to the dose that carotid arteries receive. Swallow and respiratory motion of laryngeal structures has been an important factor that previously limited reduction of the radiation treatment volume. Motion has been evaluated using multiple imaging modalities and this information has been used to calculate PTV margins for generation of more limited target volumes. This review discusses the current literature surrounding dose-effect relationships for various organs-at-risk and the late toxicities that are associated with them. This article also reviews the currently available data and effects of laryngeal motions on dosimetry to the primary target. We also review the current limitations and benefits of a more targeted approach of radiotherapy for early-stage glottic SCCs and the evolution of CT-based IGRT and MR-guided radiotherapy techniques that may facilitate a shift away from a conventional 3D-conformal radiotherapy approach.
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Affiliation(s)
- Amit Gupta
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Kee Howe Wong
- Head and Neck Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kate Newbold
- Head and Neck Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Shreerang Bhide
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Chris Nutting
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Kevin Joseph Harrington
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
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12
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Gawryszuk A, Bijl HP, van der Schaaf A, Perdok N, Wedman J, Verdonck-de Leeuw IM, Rinkel RN, Steenbakkers RJHM, van den Hoek JGM, van der Laan HP, Langendijk JA. Relationship between videofluoroscopic and subjective (physician- and patient- rated) assessment of late swallowing dysfunction after (chemo) radiation: Results of a prospective observational study. Radiother Oncol 2021; 164:253-260. [PMID: 34592362 DOI: 10.1016/j.radonc.2021.09.017] [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: 03/19/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Primary (chemo)radiation (CHRT) for HNC may lead to late dysphagia. The purpose of this study was to assess the pattern of swallowing disorders based on prospectively collected objective videofluoroscopic (VF) assessment and to assess the correlations between VF findings and subjective (physician- and patient-rated) swallowing measures. MATERIAL AND METHODS 189 consecutive HNC patients receiving (CH)RT were included. Swallowing evaluation at baseline and 6 months after treatment (T6) encompassed: CTCAE v.4.0 scores (aspiration/dysphagia), PROMs: SWAL QOL/ EORTC QLQ-H&N35 (swallowing domain) questionnaires and VF evaluation: Penetration Aspiration Scale, semi-quantitative swallowing pathophysiology evaluation, temporal measures and oral/pharyngeal residue quantification. Aspiration specific PROMs (aPROMs) were selected. Correlations between late penetration/aspiration (PA_T6) and: clinical factors, CTCAE and aPROMs were assessed using uni- and multivariable analysis. RESULTS Prevalence of PA increased from 20% at baseline to 43% after treatment (p < 0.001). The most relevant baseline predictors for PA_T6 were: PA_T0, age, disease stage III-IV, bilateral RT and baseline aPROM 'Choking when drinking' (AUC: 0.84). In general aPROMs correlated better with VF-based PA than CTCAE scores. The most of physiological swallowing components significantly correlated and predictive for PA (i.e. Laryngeal Vestibular Closure, Laryngeal Elevation and Pharyngeal Contraction) were prone to radiation damage. CONCLUSION The risk of RT-induced PA is substantial. Presented prediction models for late penetration/aspiration may support patient selection for baseline and follow-up VF examination. Furthermore, all aspiration related OARs involved in aforementioned swallowing components should be addressed in swallowing sparing strategies. The dose to these structures as well as baseline PROMs should be included in future NTCP models for aspiration.
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Affiliation(s)
- Agata Gawryszuk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
| | - Hendrik P Bijl
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Nathalie Perdok
- Department of Otolaryngology, Speech Language Pathology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jan Wedman
- Department of Otolaryngology, Speech Language Pathology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology - Head & Neck Surgery, Amsterdam University Medical Centers, The Netherlands
| | - Rico N Rinkel
- Department of Otolaryngology - Head & Neck Surgery, Amsterdam University Medical Centers, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johanna G M van den Hoek
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Hans Paul van der Laan
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
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13
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Impact of Transoral Radiofrequency Microsurgery and Radiotherapy on Long-term Swallowing Function in Patients with T1 Glottic Carcinoma. Dysphagia 2021; 37:772-777. [PMID: 34137932 DOI: 10.1007/s00455-021-10326-z] [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: 03/10/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
To compare the impact of transoral radiofrequency microsurgery (TRM) and radiotherapy (RT) on long-term swallowing function in patients with T1 glottic carcinoma. A total of 41 cases of T1 glottic carcinoma treated with TRM or RT alone more than 5 years ago were collected, including 17 cases treated with TRM (TRM group) and 24 cases treated with RT (RT group). The Chinese version of the Swallowing Quality-of-Life Questionnaire (CSWAL-QOL) and videofluoroscopic swallowing study results at the last follow-up (more than 5 years after TRM or RT) were assessed. The TRM group scored significantly better than the RT group on overall CSWAL-QOL, the Frequency score, and 6 out of 10 CSWAL-QOL dimensions. The RT group scored significantly better than the TRM group only on the Communication dimension. The dysphagia score (DS) and penetration-aspiration scale (PAS) score of the TRM group were better than those of the RT group. The overall CSWAL-QOL score, the Frequency score, DS, and PAS scores were not significantly different between patients who received conventional radiotherapy and patients who received intensity-modulated radiation therapy. The RT dose was correlated with the DS. TRM provides better swallowing outcomes as compared to RT in management of early glottic cancer. In addition, there is a correlation between RT dose and dysphagia. Prospective studies should be conducted to further evaluate the impact of TRM and RT on swallowing function.
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14
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Lee J, Liu SH, Chen JCH, Leu YS, Liu CJ, Chen YJ. Progressive muscle loss is an independent predictor for survival in locally advanced oral cavity cancer: A longitudinal study. Radiother Oncol 2021; 158:83-89. [PMID: 33621588 DOI: 10.1016/j.radonc.2021.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE To investigate the association between progressive muscle loss and survival outcomes of patients with advanced-stage oral squamous cell carcinoma (OSCC) undergoing surgery and adjuvant (chemo)radiotherapy. METHODS We analyzed the computed tomography (CT) scans of 155 patients with stage III-IVB OSCC at baseline, at simulation CT for radiotherapy, and at 3- and 9-months post-treatment. Skeletal muscle index (SMI) was measured using CT at the C3 vertebral level. The predictors of overall survival (OS) and recurrence-free survival (RFS) were evaluated using Cox regression models. RESULTS The median follow-up period was 75.0 months. Fifty-one patients (32.9%) developed recurrence, with the median time from the fourth CT to recurrence being 9.1 months. The SMI progressively decreased from baseline to simulation CT by 1.1% (p = 0.006), to 3 months post-treatment by 5.1% (p < 0.001), and to 9 months post-treatment by 15.6% (p < 0.001) in patients developing recurrence. Patients without recurrence lost SMI at the simulation CT by 0.7% (p = 0.001) and at 3 months post-treatment by 2.1% (p < 0.001); their SMI returned to the baseline level at 9 months post-treatment. SMI changes were weakly correlated with changes in body mass index (BMI) (Spearman ρ, 0.13; p = 0.11). In multivariate analysis, SMI changes (per 5% decrease) were independently associated with significantly worse OS (hazard ratio: 1.88, 95% confidence interval: 1.58-2.23; p < 0.001) and RFS (hazard ratio: 1.89, 95% confidence interval: 1.61-2.20; p < 0.001). CONCLUSION Progressive muscle loss was independently associated with worse survival outcomes in patients with stage III-IVB OSCC. Muscle loss might not be detected by changes in BMI.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
| | - Shih-Hua Liu
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - John Chun-Hao Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Death Care Service, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Yi-Shing Leu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Department of Otolaryngology-Head and Neck Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chung-Ji Liu
- Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
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15
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Ozturk K, Turhal G, Durusoy D, Sahin E, Akagunduz O, Eyigor S, Akyildiz S, Esassolak M. Long-term swallowing outcomes of radiotherapy and transoral laser microsurgery for T1 glottic cancer treatment. Clin Otolaryngol 2020; 46:340-346. [PMID: 33248015 DOI: 10.1111/coa.13674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/09/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Both CO2 transoral laser microsurgery (CO2 TOLMS) and radiotherapy (RT) are standard of care in early glottic carcinoma. However, previous studies focus on voice outcomes rather than swallowing outcomes. This study aimed to compare the late post-treatment effects of CO2 TOLMS and RT treatment on swallowing function in T1 glottic carcinoma. METHODS Forty patients (20 CO2 TOLMS and 20 RT) with T1 glottic cancer between May 2015 and January 2019 were included. Certain types of foods triggering dysphagia, any difficulties in bolus control, need to clean the throat, the sensation of lumping in the throat, choking, cough and xerostomia were questioned. Also, functional oral intake scale (FOIS), functional outcome swallowing scale (FOSS), Eating Assessment Tool-10 test (EAT-10) and flexible fiberoptic endoscopic examination of swallowing (FEES) findings were assessed. RESULTS CO2 TOLMS patients performed significantly better than the RT group regarding penetration and aspiration with 10 and 20 mL water according to the Penetration and Aspiration Scale (P < .05). The mean EAT-10 Score was found 0 in the CO2 TOLMS group, and 3.20 ± 3.24 in the RT group (P < .05) (lower score indicates a better outcome). According to the Yale Pharyngeal Residue Severity Scale for vallecula, there was no statistically significant difference in vallecular residue between the groups (P > .05). A significantly lesser residue in piriform sinus was detected in the CO2 TOLMS group compared to the RT group with 5 mL and 10 mL water, 5 mL and 20 mL honey consistency food and yogurt according to Yale Pharyngeal Residue Severity Scale (P < .05). CONCLUSION It is suggested that in the long term, CO2 TOLMS is more advantageous regarding swallowing function in the treatment of T1 glottic cancer.
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Affiliation(s)
- Kerem Ozturk
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Goksel Turhal
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Duygu Durusoy
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Emre Sahin
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Ozlem Akagunduz
- Department of Radiation Oncology, Ege University School of Medicine, Izmir, Turkey
| | - Sibel Eyigor
- Department of Physical Therapy and Rehabilitation, Ege University School of Medicine, Izmir, Turkey
| | - Serdar Akyildiz
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Esassolak
- Department of Radiation Oncology, Ege University School of Medicine, Izmir, Turkey
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16
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Abstract
Working on the diaphragm muscle and the connected diaphragms is part of the respiratory-circulatory osteopathic model. The breath allows the free movement of body fluids and according to the concept of this model, the patient's health is preserved thanks to the cleaning of the tissues by means of the movement of the fluids (blood, lymph). The respiratory muscle has several systemic connections and multiple functions. The founder of osteopathic medicine emphasized the importance of the thoracic diaphragm and body health. The five diaphragms (tentorium cerebelli, tongue, thoracic outlet, thoracic diaphragm and pelvic floor) represent an important tool for the osteopath to evaluate and find a treatment strategy with the ultimate goal of patient well-being. The two articles highlight the most up-to-date scientific information on the myofascial continuum for the first time. Knowledge of myofascial connections is the basis for understanding the importance of the five diaphragms in osteopathic medicine. In this first part, the article reviews the systemic myofascial posterolateral relationships of the respiratory diaphragm; in the second I will deal with the myofascial anterolateral myofascial connections.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
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17
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Friedes C, Klingensmith J, Nimo N, Gregor J, Burri R. Late Feeding Tube Dependency in Head and Neck Cancer Patients Treated with Definitive Radiation Therapy and Concurrent Systemic Therapy. Cureus 2020; 12:e7683. [PMID: 32426195 PMCID: PMC7228799 DOI: 10.7759/cureus.7683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The study aimed to evaluate the impact of late swallowing dysfunction leading to percutaneous endoscopic gastrostomy (PEG) tube dependence on the overall survival (OS) in a cohort of locally advanced head and neck cancer patients treated and cured with definitive radiotherapy (RT) and concurrent systemic therapy (CST). Materials and methods A total of 62 patients with locally advanced head and neck cancer were included in the analysis based on the following selection criteria: stage III, IVA, or IVB disease, treated with definitive RT and CST, no major head and neck surgery, no evidence of local or distant recurrent disease, and at least one post-RT modified barium swallow study. Patients were classified as PEG dependent or PEG independent at the time of the last follow-up. Estimates of OS were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to evaluate the impact of various clinical factors on OS. Results The median follow-up was 48 months (range: 7.6-235 months). The five-year OS was 64.3% in the PEG-dependent group and 86.1% in the PEG-independent group (p=0.022). Age over 70 at diagnosis was also associated with poorer OS (p=0.044). On univariate analysis, PEG dependency maintained a significantly worse OS (hazard ratio [HR]: 2.59; 95% confidence interval [CI]: 1.11-5.99, p=0.028). On multivariate analysis, PEG dependency (HR: 4.25; 95% CI: 1.33-13.62; p=0.015), advanced N stage (HR: 4.74; 95% CI: 1.17-19.26, p=0.035), and older age at diagnosis (HR: 4.37; 95% CI: 1.21-15.84; p=0.025) were significantly associated with worse OS. Conclusions Late PEG dependency is associated with poor OS in head and neck cancer patients cured with definitive RT and CST. Interventions designed to help head and neck cancer patients maintain swallowing function may result in improved outcomes.
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Affiliation(s)
- Cole Friedes
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | - Nana Nimo
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | | | - Ryan Burri
- Radiation Oncology, C.W. Bill Young Veterans Affairs Medical Center, Bay Pines, USA
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18
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Petras KG, Rademaker AW, Refaat T, Choi M, Thomas TO, Pauloski BR, Mittal BB. Dose-volume relationship for laryngeal substructures and aspiration in patients with locally advanced head-and-neck cancer. Radiat Oncol 2019; 14:49. [PMID: 30885235 PMCID: PMC6423881 DOI: 10.1186/s13014-019-1247-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/01/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Literature has shown a significant relationship between radiation dose to the larynx and swallowing disorders. We prospectively studied the dose-volume relationship for larynx substructures and aspiration. METHODS Forty nine patients with stage III/IV head-and-neck (H&N) squamous cell carcinoma were prospectively enrolled in this IRB-approved, federally funded study. All patients received IMRT-based chemoradiation therapy (CRT) and were scheduled for videofluorography (VFG) prior to CRT and at 3, 6, 9, 12, and 24 months post-CRT. Twelve laryngeal substructures were contoured in each patient: thyroid cartilage, cricoid cartilage, total epiglottis, suprahyoid epiglottis, infrahyoid epiglottis, total larynx, supraglottic larynx, subglottic larynx, glottic larynx, arytenoids, aryepiglottic (AE) folds, and glossoepiglottic fold. After exclusions, 29 patients were included in the final analysis. Incidence of aspiration at 1 year following CRT was correlated with dose-volume data to laryngeal substructures using logistic regression. RESULTS The median age was 54 years with 79% being non-smokers. Tumor sites included oropharynx (22), unknown primary (6), and hypopharynx (1). One year following CRT, 10/29 (34%) showed aspiration on VFG. Dose to the AE folds showed the highest correlation with aspiration at 12 months and was significant on multivariate analysis (p = 0.025). A mean dose cutpoint of 6500 cGy or higher to the AE folds was associated with an increased risk of aspiration at 1 year [positive likelihood ratio (+LR) 2.81, positive predictive value (PPV) 60%, negative predictive value (NPV) 92.9%, relative risk (RR) 8.4]. CONCLUSIONS In this analysis, mean dose to the AE folds was associated with an increased risk of aspiration at 1 year. However, these are hypothesis-generating data that require further research and validation in a larger patient subset.
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Affiliation(s)
- Katarina G. Petras
- Department of Radiation Oncology, Northwestern University, Chicago, IL USA
- Department of Radiation Oncology, NMH, 251 E. Huron Street, LC-178, Chicago, IL 60611 USA
| | - Alfred W. Rademaker
- Biostatistics Department, Northwestern University, Chicago, IL USA
- Department of Biostatistics & Preventative Medicine, 680 N. Lakeshore Drive, Suite 1400, Chicago, IL 60611 USA
| | - Tamer Refaat
- Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Department of Radiation Oncology, Loyola University Medical Center, Maguire Center – Room 2944, 2160 S. 1st Avenue, Maywood, IL 60153 USA
| | - Mehee Choi
- Rush Copley Medical Center, 2000 Ogden Avenue, Aurora, IL 60504 USA
| | - Tarita O. Thomas
- Department of Radiation Oncology, Loyola University Medical Center, Maguire Center – Room 2944, 2160 S. 1st Avenue, Maywood, IL 60153 USA
| | - Barbara R. Pauloski
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Wisconsin-Milwaukee, Enderis Hall, Room 845, 2400 E. Hartford, Avenue, Milwaukee, WI 53211 USA
| | - Bharat B. Mittal
- Department of Radiation Oncology, Northwestern University, Chicago, IL USA
- Department of Radiation Oncology, NMH, 251 E. Huron Street, LC-178, Chicago, IL 60611 USA
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