1
|
Philipsen BB, Korsholm M, Rohde M, Wessel I, Forner L, Johansen J, Godballe C. The effect of hyperbaric oxygen therapy in head and neck cancer patients with radiation induced dysphagia-a systematic review. Clin Transl Oncol 2024:10.1007/s12094-024-03449-w. [PMID: 38704813 DOI: 10.1007/s12094-024-03449-w] [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: 01/06/2024] [Accepted: 03/04/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE The aim of this systematic review was to assess the role of hyperbaric oxygen therapy (HBOT) in patients with dysphagia after radiation therapy for head and neck cancer. METHOD A systematic search was conducted in the electronic databases Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials for relevant studies until March 14, 2023. No restriction on language or publication date. The criteria for inclusion: patients with HNC who had received both radiation therapy and HBOT as 1) a preventive treatment against swallowing difficulties, 2) to preserve swallowing function, or 3) to promote swallowing difficulties. RESULTS We identified 1396 records. After removal of 31 duplicates, 1365 records were accessible for title and abstract screening. This yielded 53 studies for full text assessment. Six studies met the eligibility criteria and were included for qualitative analysis. CONCLUSION Evidence of HBOT benefits in patients with dysphagia after radiation therapy for head and neck cancer is inconsistent. Well-designed studies using validated outcome measures and long-term follow-up are warranted.
Collapse
Affiliation(s)
- Bahareh Bakhshaie Philipsen
- Department of ORL - Head & Neck Surgery and Audiology, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Malene Korsholm
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Max Rohde
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Irene Wessel
- Department of ORL Head & Neck Surgery and Audiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lone Forner
- Department Of Oral and Maxillofacial Surgery Oral and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Christian Godballe
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| |
Collapse
|
2
|
Nayiga BK, Abrams SW, Rhayel A, Edward H, Tang A, Kho ME, Sebestien H, Smith-Turchyn J. Exploring the use of rehabilitation in individuals with head and neck cancer undergoing treatment: a scoping review. Disabil Rehabil 2024:1-21. [PMID: 38494954 DOI: 10.1080/09638288.2024.2328810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
Explore the use, characteristics, feasibility, and functional outcomes of rehabilitation interventions used for individuals with head and neck cancer (HNC) during treatment. Searches were conducted in four databases from Jan 2011 to Dec 31, 2022. Included studies had to include adults with HNC undergoing treatment, a rehabilitation intervention, an assessment of functional outcome(s) addressed by the International Classification of Functioning Framework (ICF) and be published in English language. Title and abstract screening, full-text review, and data extraction were completed independently, in duplicate. Descriptive statistics and a qualitative synthesis summarized findings. Twenty-seven studies were included in this review. The majority of studies were randomized controlled trials (70%). Most individuals represented in the included studies were males (92% of all participants) between 50 and 60 years of age. Interventions led by a speech language pathologist (33%) were most commonly described. Sixteen studies (59%) described primary outcomes that fit the ICF "impairment" domain. We identified few studies that explored the use, feasibility, and effectiveness of rehabilitation interventions for individuals with HNC during treatment. Future research should assess the effectiveness of rehabilitation interventions on functional outcomes beyond the ICF body function and structure domain.
Collapse
Affiliation(s)
- Brenda Kibuka Nayiga
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Sophia Werden Abrams
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ashwak Rhayel
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Holly Edward
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Hotte Sebestien
- Department of Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Jenna Smith-Turchyn
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Connolly-Schoonen J, Biamonte SF, Danowski L, Montrose DC. Modifying dietary amino acids in cancer patients. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2022; 373:1-36. [PMID: 36283763 DOI: 10.1016/bs.ircmb.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Limiting nutrient utilization by cancer cells in order to disrupt their metabolism and suppress their growth represents a promising approach for anti-cancer therapy. Recently, studies demonstrating the anti-neoplastic effects of lowering amino acid (AA) availability have opened up an exciting and quickly growing field of study. Although intracellular synthesis can often provide the AAs necessary to support cancer cells, diet and the tumor microenvironment can also be important sources. In fact, studies carried out in vitro and in animal tumor models have supported the anti-cancer potential of restricting exogenous sources of AAs. However the potential benefit of reducing AA intake in cancer patients requires further investigation. Furthermore, implementation of such an approach clinically, even if proven useful, could be challenging. In the enclosed review, we (1) summarize the pre-clinical studies showing the anti-tumorigenic effects of restricting exogenously available AAs, including through reducing dietary protein, (2) consider the role of microbiota in this process, (3) report on current recommendations for protein intake in cancer patients and studies that applied these guidelines, and (4) propose considerations for studies to test the potential therapeutic benefit of reducing protein/AA consumption in patients with cancer.
Collapse
Affiliation(s)
- Josephine Connolly-Schoonen
- Department of Family, Population & Preventive Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Steven F Biamonte
- Department of Family, Population & Preventive Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Lorraine Danowski
- Department of Family, Population & Preventive Medicine, Stony Brook University, Stony Brook, NY, United States
| | - David C Montrose
- Department of Pathology, Stony Brook University, Stony Brook, NY, United States; Stony Brook Cancer Center, Stony Brook, NY, United States.
| |
Collapse
|
5
|
Ashour MG, Shouman TH, Hassouna AH, Mokhtar MH, Emad El Din R, Youssef AA, Gomaa MM, Abdelgeleel S. Swallowing sparing intensity modulated radiotherapy versus standard parotid sparing intensity-modulated radiotherapy for treatment of head and neck cancer: a randomized clinical trial. Acta Oncol 2022; 61:134-140. [PMID: 35000532 DOI: 10.1080/0284186x.2021.2022198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Dysphagia is a distressing symptom during and after radiotherapy treatment in head and neck cancer (HNC) patients. The objective of this prospective study was to investigate whether swallowing sparing intensity modulated radiotherapy (SW-IMRT) reduces the occurrence of swallowing dysfunction compared to the standard IMRT (ST-IMRT). METHODS We randomized, planned, and treated patients with HNC who needed whole neck irradiation using the simultaneous integrated boost (SIB) IMRT technique. Doses of 70, 60, and 54 Gy (over 33 daily fractions) were prescribed to the primary tumor, high-risk and low-risk regions, respectively. The postoperative cases received 60 and 54 Gy (over 30 daily fractions) to the high-risk planning target volume (PTV) and low-risk PTV. We contoured organs at risk related to swallowing dysfunction (SWOARs) in all cases. In the ST-IMRT group, parotids only were spared. In the SW-IMRT group, parotids and SWOARs outside the high-risk PTV were spared. Assessment of dysphagia included clinical and instrumental evaluation. RESULTS One hundred forty-six patients ended their radiotherapy treatment. Dose distribution showed comparable PTV coverage and no difference in parotid glands sparing between the two groups. SWOARs dose reduction with SW-IMRT differs according to tumor location and its overlap with SWOARs. Using different assessment methods, SW-IMRT was associated with a lower occurrence of dysphagia up to one year after treatment. There was no difference between the two groups regarding acute dysphagia (p = 0.262), overall survival (p = 0.811), and disease-free survival (p = 0.876). CONCLUSION SW-IMRT is significantly better than ST-IMRT regarding a physician-rated and objective assessment of swallowing dysfunction at short- and long-term post-treatment follow-up.
Collapse
Affiliation(s)
- May Gamal Ashour
- Radiation Oncology Department, National Cancer Institute Cairo University, Cairo, Egypt
| | - Tarek Hamed Shouman
- Radiation Oncology Department, National Cancer Institute Cairo University, Cairo, Egypt
| | - Ashraf Hamed Hassouna
- Radiation Oncology Department, National Cancer Institute Cairo University, Cairo, Egypt
| | | | - Reem Emad El Din
- Radiation Oncology Department, National Cancer Institute Cairo University, Cairo, Egypt
| | - Ayda Aly Youssef
- Radiology Department, National Cancer Institute Cairo University, Cairo, Egypt
| | | | - Shaimaa Abdelgeleel
- Statistics Department, National Cancer Institute Cairo University, Cairo, Egypt
| |
Collapse
|
6
|
Willemsen ACH, Kok A, Baijens LWJ, de Boer JP, de Bree R, Devriese LA, Driessen CML, van Herpen CML, Hoebers FJP, Kaanders JHAM, Karsten RT, van Kuijk SMJ, Lalisang RI, Navran A, Pereboom SR, Schols AMWJ, Terhaard CHJ, Hoeben A. Development and external validation of a prediction model for tube feeding dependency for at least four weeks during chemoradiotherapy for head and neck cancer. Clin Nutr 2021; 41:177-185. [PMID: 34883306 DOI: 10.1016/j.clnu.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/29/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Patients who receive chemoradiotherapy or bioradiotherapy (CRT/BRT) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) often experience high toxicity rates interfering with oral intake, causing tube feeding (TF) dependency. International guidelines recommend gastrostomy insertion when the expected use of TF exceeds 4 weeks. We aimed to develop and externally validate a prediction model to identify patients who need TF ≥ 4 weeks and would benefit from prophylactic gastrostomy insertion. METHODS A retrospective multicenter cohort study was performed in four tertiary head and neck cancer centers in the Netherlands. The prediction model was developed using data from University Medical Center Utrecht and the Netherlands Cancer Institute and externally validated using data from Maastricht University Medical Center and Radboud University Medical Center. The primary endpoint was TF dependency ≥4 weeks initiated during CRT/BRT or within 30 days after CRT/BRT completion. Potential predictors were extracted from electronic health records and radiotherapy dose-volume parameters were calculated. RESULTS The developmental and validation cohort included 409 and 334 patients respectively. Multivariable analysis showed predictive value for pretreatment weight change, texture modified diet at baseline, ECOG performance status, tumor site, N classification, mean radiation dose to the contralateral parotid gland and oral cavity. The area under the receiver operating characteristics curve for this model was 0.73 and after external validation 0.62. Positive and negative predictive value for a risk of 90% or higher for TF dependency ≥4 weeks were 81.8% and 42.3% respectively. CONCLUSIONS We developed and externally validated a prediction model to estimate TF-dependency ≥4 weeks in LAHNSCC patients treated with CRT/BRT. This model can be used to guide personalized decision-making on prophylactic gastrostomy insertion in clinical practice.
Collapse
Affiliation(s)
- Anna C H Willemsen
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, the Netherlands; GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, the Netherlands
| | - Annemieke Kok
- Department of Dietetics, University Medical Center Utrecht, the Netherlands.
| | - Laura W J Baijens
- GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, the Netherlands; Department of Otorhinolaryngology, Head & Neck Surgery, Maastricht University Medical Center, the Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, the Netherlands
| | - Lot A Devriese
- Department of Medical Oncology, University Medical Center Utrecht, the Netherlands
| | - Chantal M L Driessen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank J P Hoebers
- GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, the Netherlands; Department of Radiation Oncology, MAASTRO Clinic, Maastricht, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rebecca T Karsten
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, the Netherlands
| | - Roy I Lalisang
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, the Netherlands; GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, the Netherlands
| | - Arash Navran
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Susanne R Pereboom
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, the Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, the Netherlands
| | - Ann Hoeben
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, the Netherlands; GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, the Netherlands
| |
Collapse
|
7
|
Kanehira T, van Kranen S, Jansen T, Hamming-Vrieze O, Al-Mamgani A, Sonke JJ. Comparisons of normal tissue complication probability models derived from planned and delivered dose for head and neck cancer patients. Radiother Oncol 2021; 164:209-215. [PMID: 34619234 DOI: 10.1016/j.radonc.2021.09.015] [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: 05/07/2021] [Revised: 08/24/2021] [Accepted: 09/18/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Normal tissue complication probability (NTCP) models are typically derived from the planned dose distribution, which can deviate from the delivered dose due to anatomical day-to-day variations. The aim of this study was to compare NTCP models derived from the planned and the delivered dose for head and neck cancer (HNC) patients. MATERIAL AND METHOD 322 HNC patients who received radiotherapy with daily CBCT guidance were included in this retrospective study. The delivered dose was estimated by deformably accumulating dose from daily CBCT to planning anatomy. We used a Lyman-Kutcher-Burman NTCP model, to relate the equivalent uniform dose (EUD) of organs at risk (OAR) with oral mucositis, xerostomia and dysphagia respectively. We compared the model parameters and performances. RESULTS The median differences between planned and delivered EUD to the OARs were significantly larger for patients with toxicity than without for acute dysphagia (≥G2 and ≥G3) and late dysphagia (≥G3) (p < 0.05). Those differences resulted in small differences in steepness and agreement to the data between delivered- and planned-fitted NTCP curves, and the differences were not significant. The differences in AUC were less than 0.01. CONCLUSION Differences between delivered and planned dose did not lead to significant differences in NTCP curves. The additional clinical relevance of NTCP models using accumulated dose for oral mucositis, xerostomia and dysphagia in HNC radiotherapy is likely to be limited.
Collapse
Affiliation(s)
- Takahiro Kanehira
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tomas Jansen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| |
Collapse
|
8
|
Swallowing Exercise During Head and Neck Cancer Treatment: Results of a Randomized Trial. Dysphagia 2021; 37:749-762. [PMID: 34117531 PMCID: PMC9345844 DOI: 10.1007/s00455-021-10320-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/13/2021] [Indexed: 11/25/2022]
Abstract
The diagnosis and treatment of head and neck cancer (HNC) can have substantial impact on swallowing function, nutritional balance, physical function and quality of life (QoL). Early initiated swallowing exercises are hypothesized to improve swallowing function in HNC patients. The aim was to investigate the effects of swallowing exercises and progressive resistance training (PRT) during radiotherapy on swallowing function, physical function and QoL in patients with pharynx-, larynx-, oral cavity cancer or unknown primary compared to usual care. In a multi-centre RCT participants were assigned to (a) twice-weekly PRT and daily swallowing exercises throughout treatment or (b) usual care. Outcomes were measured at end of treatment and 2, 6 and 12 months after. Primary outcome was penetration aspiration score (PAS). Data were analysed on an “intention-to-treat” basis by GEE logistic regression model, linear mixed effects model and cox regression. Of 371 invited HNC patients, 240 (65%) enrolled. Five participants were excluded. At 12 months follow-up, 59 (25%) participants were lost. Analyses showed significant effect on mouth opening, QoL, depression and anxiety at 12 months when comparing intervention to non-active controls. The trial found no effect on swallowing safety in HNC undergoing radiotherapy, but several positive effects were found on secondary outcomes when comparing to non-active controls. The intervention period may have been too short, and the real difference between groups is too small. Nevertheless, the need to identify long-lasting intervention to slow down or avoid functional deteriorations is ever more crucial as the surviving HNC population is growing.
Collapse
|
9
|
Cates DJ, Evangelista LM, Belafsky PC. Effect of Pretreatment Dysphagia on Postchemoradiation Swallowing Function in Head and Neck Cancer. Otolaryngol Head Neck Surg 2021; 166:506-510. [PMID: 33940987 DOI: 10.1177/01945998211009853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Chemoradiation therapy (CRT) for head and neck cancer can have profound effects on swallowing function. Identification of risk factors for development of swallowing dysfunction after CRT may improve allocation of preventive strategies. The purpose of this study is to determine the association between pre-CRT dysphagia and post-CRT swallowing dysfunction. STUDY DESIGN Retrospective cohort study. SETTING Academic medical center. METHODS Patients with head and neck cancer were evaluated before and 3 months after CRT. Dysphagia was assessed with the Eating Assessment Tool (EAT-10). Swallowing dysfunction was evaluated by a videofluoroscopic swallow study and the Penetration-Aspiration Scale and swallowing safety was evaluated by the Functional Oral Intake Scale. The association between pre-CRT EAT-10 scores and post-CRT swallowing dysfunction was evaluated. RESULTS The mean ± SD post-CRT Functional Oral Intake Scale score was 6.5 ± 1.2 for individuals with a pre-CRT EAT-10 score <3 and 5.3 ± 1.9 for those with a pre-CRT EAT-10 score ≥3 (P < .001). The mean post-CRT Penetration-Aspiration Scale score was 2.2 ± 1.5 for individuals with a pre-CRT EAT-10 score <3 and 3.8 ± 2.6 for those with a pre-CRT EAT-10 score ≥3 (P < .001). After multivariate analysis adjusting for age, tumor subsite, T classification, and primary surgery, pre-CRT dysphagia (EAT-10 ≥3) was an independent predictor of post-CRT aspiration (odds ratio, 4.19 [95% CI, 1.08-16.20]; P = .04) and feeding tube dependence (odds ratio, 3.54 [95% CI, 1.01-12.33]; P = .04). CONCLUSION The presence of dysphagia before chemoradiation for head and neck cancer is an independent predictor of swallowing dysfunction after completion of therapy. These results may help target intervention toward preventing swallowing dysfunction in high-risk individuals.
Collapse
Affiliation(s)
- Daniel J Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Lisa M Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Peter C Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| |
Collapse
|
10
|
Wang CC, Lin WJ, Liu YC, Chen CC, Wu SH, Liu SA, Liang KL. Transoral Robotic Surgery for Pharyngeal and Laryngeal Cancers-A Prospective Medium-Term Study. J Clin Med 2021; 10:jcm10050967. [PMID: 33801167 PMCID: PMC7957508 DOI: 10.3390/jcm10050967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 01/13/2023] Open
Abstract
Transoral robotic surgery (TORS) has been used for treating pharyngeal and laryngeal cancers for many years. However, the application of neoadjuvant chemotherapy (NACT) before TORS, the sparing rate of adjuvant irradiation after TORS, and the long-term oncologic/functional outcomes of TORS are seldom reported. From September 2014 to May 2018, 30 patients with clinical T1 to T3 cancers of oropharynx (7), larynx (3), and hypopharynx (20) were prospectively recruited for TORS in a tertiary referral medical center. Twelve (40%) patients had clinical early stage (I or II) disease, and 18 (60%) patients had late-stage (III or IV) disease. All 30 patients were suggested to receive TORS with neck dissection. Cisplatin-based NACT was given to 11 patients before the surgery, and it led to a 100% reduction in tumor size. Only 40% of patients needed adjuvant irradiation with a mean dosage of 5933 cGY after TORS. After a mean follow up of 38.9± 14.7 months, the Kaplan-Meier method estimated 5-year disease-specific survival, and organ preservation was 86.3% and 96.2%, respectively. Twenty-five patients were alive without tracheostomy and tube feeding. We found that NACT is a potential method for facilitating tumor resection and TORS effectively de-escalated adjuvant irradiation with a satisfactory 5-year survival and functional outcomes.
Collapse
Affiliation(s)
- Chen-Chi Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-C.L.); (S.-A.L.); (K.-L.L.)
- School of Speech Language Pathology & Audiology, Chung Shan Medical University, Taichung 40121, Taiwan
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung 41354, Taiwan
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-J.L.); (S.-H.W.)
- Correspondence: ; Tel.: +886-4-23592525 (ext. 83601)
| | - Wen-Jiun Lin
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-J.L.); (S.-H.W.)
| | - Yi-Chun Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-C.L.); (S.-A.L.); (K.-L.L.)
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Chien-Chih Chen
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Ph. D. Program in Translational Medicine, National Chung-Hsing University, Taichung 40227, Taiwan
| | - Shang-Heng Wu
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-J.L.); (S.-H.W.)
| | - Shih-An Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-C.L.); (S.-A.L.); (K.-L.L.)
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-J.L.); (S.-H.W.)
| | - Kai-Li Liang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-C.L.); (S.-A.L.); (K.-L.L.)
- Department of Otolaryngology-Head & Neck Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-J.L.); (S.-H.W.)
| |
Collapse
|
11
|
Greco E, Ringash J, Tomlinson G, Huang SH, O'Sullivan B, Waldron J, Martino R. Presence and duration of feeding tube in a 5-year cohort of patients with head and neck cancer treated with curative intensity-modulated radiation therapy. Head Neck 2021; 43:1610-1620. [PMID: 33580567 DOI: 10.1002/hed.26638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Our study assessed post-radiation therapy (RT) G-tube presence, duration, and clinical predictors in patients with head and neck cancer (HNC). METHODS We identified those 1-5-years post-RT with stage III/IV nasopharyngeal, oropharyngeal, hypopharyngeal, laryngeal, or unknown primaries. Logistic regression identified predictors of post-RT G-tube presence, Kaplan-Meier analysis estimated G-tube days, and log-rank test compared by tumor site. RESULTS The 977 patients had mean age 60.6 ± 11.6 years, 804 (82.3%) male, 764 (78.2%) stage IV, and 618 (63.3%) oropharyngeal primaries. All patients received intensity-modulated RT (IMRT), 571 (58.4%) received chemotherapy, and 698 (71.4%) prophylactic G-tube. G-tube prevalence 1- and 5-years post-IMRT was 7.1% and 4.8%, respectively. Median post-IMRT G-tube days were overall 63 (95%CI: 56-70), nasopharynx 119 (95%CI: 109-131), oropharynx 57 (95%CI: 51-68), hypopharynx 126 (95%CI: 77-256), larynx 53 (95%CI: 21-63), unknown 30 (95%CI: 17-55), of which hypopharynx was highest p < 0.001. CONCLUSIONS At an institution offering prophylactic G-tube for patients with advanced HNC, no differences were found in yearly G-tube use 1-5 years post-IMRT. Across all patients, median post-IMRT days with G-tube was 63 day but those with hypopharyngeal tumors registered the most days.
Collapse
Affiliation(s)
- Elissa Greco
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Iorio GC, Arcadipane F, Martini S, Ricardi U, Franco P. Decreasing treatment burden in HPV-related OPSCC: A systematic review of clinical trials. Crit Rev Oncol Hematol 2021; 160:103243. [PMID: 33516806 DOI: 10.1016/j.critrevonc.2021.103243] [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: 09/23/2020] [Revised: 12/16/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Favorable outcomes are observed after treatment with standard chemoradiotherapy (CRT) for Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) patients. The consistent growing interest on treatment-related toxicity burden, potentially jeopardizing survivors' quality of life, led clinicians to investigate possible de-escalation strategies. MATERIALS AND METHODS A comprehensive systematic literature search of clinical trials was performed through the EMBASE database to provide an overview of the de-escalation strategies spectrum. Additionally, hand searching and clinicaltrials.gov were also used. RESULTS Herein, we report and discuss different approaches to de-escalation of therapy, with respect to both local and systemic strategies. CONCLUSIONS Several promising de-escalation experiences have been published. However, while further evidence is awaited, no changes in the management nor deviation from the standard of care should be made outside of clinical trials.
Collapse
Affiliation(s)
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Stefania Martini
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | | |
Collapse
|
13
|
Lapeyre M, Biau J, Miroir J, Moreau J, Gleyzolle B, Brun L, Racadot S, Graff-Cailleaud P. [Concurrent chemoradiotherapy for head neck cancers. Should organs at risk dose constraints be revisited ?]. Cancer Radiother 2020; 24:586-593. [PMID: 32861607 DOI: 10.1016/j.canrad.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 01/16/2023]
Abstract
Concurrent chemoradiotherapy improves the outcome of locally advanced head and neck cancers and the current reference chemotherapy is cisplatin. These results are obtained at the cost of increased toxicities. To limit the risk of toxicity, organ at riskdose constraints have been established starting with 2D radiotherapy, then 3D radiotherapy and intensity-modulated radiotherapy. Regarding grade ≥3 acute toxicities, the scientific literature attests that concurrent chemoradiotherapy significantly increases risks of mucositis and dysphagia. Constraints applied to the oral mucosa volume excluding the planning target volume, the pharyngeal constrictor muscles and the larynx limit this adverse impact. Regarding late toxicity, concurrent chemoradiotherapy increases significantly the risk of postoperative neck fibrosis and hearing loss. However, for some organs at risk, concurrent chemotherapy appears to increase late radiation induced effect, even though the results are less marked (brachial plexus, mandible, pharyngeal constrictor muscles, parotid gland). This additional adverse impact of concomitant chemotherapy may be notable only when organs at risk receive less than their usual dose thresholds and this would be vanished when those thresholds are exceeded as seems to be the situation for the parotid glands. Until the availability of more robust data, it seems appropriate to apply the principle of delivering dose to organs at risk as low as reasonably achievable.
Collapse
Affiliation(s)
- M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France.
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - J Miroir
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - J Moreau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - B Gleyzolle
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - L Brun
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Graff-Cailleaud
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irene Joliot-Curie, 31100 Toulouse, France
| |
Collapse
|
14
|
Prediction model for tube feeding dependency during chemoradiotherapy for at least four weeks in head and neck cancer patients: A tool for prophylactic gastrostomy decision making. Clin Nutr 2020; 39:2600-2608. [DOI: 10.1016/j.clnu.2019.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/18/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022]
|
15
|
Hansen CR, Bertelsen A, Zukauskaite R, Johnsen L, Bernchou U, Thwaites DI, Eriksen JG, Johansen J, Brink C. Prediction of radiation-induced mucositis of H&N cancer patients based on a large patient cohort. Radiother Oncol 2020; 147:15-21. [PMID: 32224314 DOI: 10.1016/j.radonc.2020.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE/OBJECTIVE Radiation-induced mucositis is a severe acute side effect, which can jeopardize treatment compliance and cause weight loss during treatment. The study aimed to develop robust models to predict the risk of severe mucositis. MATERIALS/METHODS Mucosal toxicity scores were prospectively recorded for 802 consecutive Head and Neck (H&N) cancer patients and dichotomised into non-severe event (grade 0-2) and severe event (grade 3+) groups. Two different model approaches were utilised to evaluate the robustness of the models. These used LASSO and Best Subset selection combined with 10-fold cross-validation performed on two-thirds of the patient cohort using principal component analysis of DVHs. The remaining one-third of the patients were used for validation. Model performance was tested through calibration plot and model performance metrics. RESULTS The main predicted risk factors were treatment acceleration and the first two principal dose components, which reflect the mean dose and the balance between high and low doses to the oral cavity. For the LASSO model, gender and current smoker status were also included in the model. The AUC values of the two models on the validation cohort were 0.797 (95%CI: 0.741-0.857) and 0.808 (95%CI: 0.749-0.859), respectively. The two models predicted very similar risk values with an internal Pearson coefficient of 0.954, indicating their robustness. CONCLUSIONS Robust prediction models of the risk of severe mucositis have been developed based on information from the entire dose distribution for a large cohort of patients consisting of all patients treated H&N for within our institution over a five year period.
Collapse
Affiliation(s)
- C R Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Institute of Medical Physics, School of Physics, University of Sydney, Australia; Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark.
| | - A Bertelsen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark
| | - R Zukauskaite
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - L Johnsen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark
| | - U Bernchou
- Laboratory of Radiation Physics, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - D I Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Australia
| | - J G Eriksen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - J Johansen
- Department of Oncology, Odense University Hospital, Denmark
| | - C Brink
- Laboratory of Radiation Physics, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
16
|
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.
Collapse
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.)
| |
Collapse
|
17
|
Raturi V, Hojo H, Bhatt MLB, Suhel M, Wu C, Bei Y, Nakamura M, Okumura M, Zhang H, Parmar D, Badajena A, Singh R, Kumar S, Katiyar T, Gaur J. Prospective evaluation of XRCC‐1 Arg194Trp polymorphism as bio‐predictor for clinical outcome in locally advanced laryngeal cancer undergoing cisplatin‐based chemoradiation. Head Neck 2020; 42:1045-1056. [DOI: 10.1002/hed.26083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/08/2019] [Accepted: 01/10/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Vijay Raturi
- Department of Radiation Oncology King George's Medical University Lucknow India
- Division of Radiation Oncology and Particle therapy National Cancer Center Hospital East Chiba Japan
| | - Hidehiro Hojo
- Division of Radiation Oncology and Particle therapy National Cancer Center Hospital East Chiba Japan
| | - M. L. B. Bhatt
- Department of Radiation Oncology King George's Medical University Lucknow India
| | - Mohammad Suhel
- Department of Radiation Oncology King George's Medical University Lucknow India
| | - Chen‐Ta Wu
- Department of Radiation Oncology, Graduate school of medicine Keio University Japan
| | - Yanping Bei
- Division of Radiation Oncology and Particle therapy National Cancer Center Hospital East Chiba Japan
| | - Masaki Nakamura
- Division of Radiation Oncology and Particle therapy National Cancer Center Hospital East Chiba Japan
| | - Masayuki Okumura
- Division of Radiation Oncology and Particle therapy National Cancer Center Hospital East Chiba Japan
| | - Haiqin Zhang
- Division of Radiation Oncology and Particle therapy National Cancer Center Hospital East Chiba Japan
| | | | - Avinash Badajena
- Department of Radiation Oncology King George's Medical University Lucknow India
| | - Rahul Singh
- Department of Radiation Oncology King George's Medical University Lucknow India
| | - Saurabh Kumar
- Department of Radiology King George's Medical University Lucknow India
| | - Tridev Katiyar
- Indian Institute of Toxicology and Research Lucknow India
| | - Jalaj Gaur
- Department of Radiation Oncology King George's Medical University Lucknow India
| |
Collapse
|
18
|
Marconato L, Weyland M, Tresch N, Rossi F, Leone V, Rohrer Bley C. Toxicity and outcome in cats with oral squamous cell carcinoma after accelerated hypofractionated radiotherapy and concurrent systemic treatment. Vet Comp Oncol 2019; 18:362-369. [PMID: 31756259 DOI: 10.1111/vco.12557] [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: 08/14/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 02/03/2023]
Abstract
Recently, a multimodal approach to oral squamous cell carcinoma (SCC) in cats, combining medical treatment and accelerated radiation therapy, showed a substantial outcome improvement in a small pilot study. Herein we retrospectively review 51 cats with unresectable, histologically confirmed oral SCC and a complete initial staging work-up: cats in group A (n = 24) received medical anti-angiogenic treatment consisting of bleomycin, piroxicam and thalidomide, cats in group B (n = 27) received the anti-angiogenic treatment and concurrent accelerated hypofractionated radiation therapy with 48Gy delivered in 10 fractions. Overall median progression-free interval (PFI) was poor with 70 days (95% CI: 48;93). In the irradiated cats (group B), however, PFI was significantly longer with 179 days (95% CI: 58;301) days, vs 30 days (95% CI: 23;38) in medically only treated cats (P < .001). Overall median overall survival (OS) was 89 days (95% CI: 55;124), again significantly longer in the irradiated cats (group B) with 136 (95% CI: 40;233) vs 38 days (95% CI: 23;54) (P < .001). In 8 of the 27 (29.6%) cats in group B, however, severe toxicity (grade 3) occurred. Neither onset nor severity of toxicity could be associated with any of the tested variables, including anatomic site, tumour size, clinical stage and duration of neoadjuvant medical treatment. Given the potential severe acute effects and the impact on quality of life after chemo-radiotherapy, owners must be clearly informed about the risks of treatment. With the overall poor outcome and high occurrence of acute toxicity, we cannot recommend the use of this accelerated radiation protocol combined with anti-angiogenic therapy for oral SCC in cats.
Collapse
Affiliation(s)
- Laura Marconato
- Centro Oncologico Veterinario, Bologna, Italy.,Department of Veterinary Medical Sciences, University of Bologna, Ozzano nell'Emilia (Bologna), Italy
| | - Mathias Weyland
- ZHAW School of Engineering, Zurich University of Applied Sciences, Winterthur, Switzerland.,Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nina Tresch
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Vito Leone
- Centro Oncologico Veterinario, Bologna, Italy
| | - Carla Rohrer Bley
- Centro Oncologico Veterinario, Bologna, Italy.,Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| |
Collapse
|
19
|
Hansen CR, Friborg J, Jensen K, Samsøe E, Johnsen L, Zukauskaite R, Grau C, Maare C, Johansen J, Primdahl H, Bratland Å, Kristensen CA, Andersen M, Eriksen JG, Overgaard J. NTCP model validation method for DAHANCA patient selection of protons versus photons in head and neck cancer radiotherapy. Acta Oncol 2019; 58:1410-1415. [PMID: 31432744 DOI: 10.1080/0284186x.2019.1654129] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Prediction models using logistic regression may perform poorly in external patient cohorts. However, there is a need to standardize and validate models for clinical use. The purpose of this project was to describe a method for validation of external NTCP models used for patient selection in the randomized trial of protons versus photons in head and neck cancer radiotherapy, DAHANCA 35. Material and methods: Organs at risk of 588 patients treated primarily with IMRT in the randomized controlled DAHANCA19 trial were retrospectively contoured according to recent international recommendations. Dose metrics were extracted using MatLab and all clinical parameters were retrieved from the DAHANCA database. The model proposed by Christianen et al. to predict physician-rated dysphagia was validated through the closed testing, where change of the model intercept, slope and individual beta's were tested for significant prediction improvements. Results: Six months prevalence of dysphagia in the validation cohort was 33%. The closed testing procedure for physician-rated dysphagia showed that the Christianen et al. model needed an intercept refitting for the best match for the Danish patients. The intercept update increased the risk of dysphagia for the validation cohort by 7.9 ± 2.5% point. For the raw model performance, the Brier score (mean squared residual) was 0.467, which improved significantly with a new intercept to 0.415. Conclusions: The previously published Dutch dysphagia model needed an intercept update to match the Danish patient cohort. The implementation of a closed testing procedure on the current validation cohort allows quick and efficient validation of external NTCP models for patient selection in the future.
Collapse
Affiliation(s)
- C. R. Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, Australia
| | - J. Friborg
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - K. Jensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - E. Samsøe
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - L. Johnsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - R. Zukauskaite
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - C. Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - C. Maare
- Department of Oncology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - J. Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - H. Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Å. Bratland
- The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | | | - M Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - J. G. Eriksen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - J. Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
20
|
Van Daele DJ, Langmore SE, Krisciunas GP, Lazarus CL, Pauloski BR, McCulloch TM, Gramigna GD, Messing BP, Wagner CW, Mott SL. The impact of time after radiation treatment on dysphagia in patients with head and neck cancer enrolled in a swallowing therapy program. Head Neck 2019; 41:606-614. [PMID: 30629306 DOI: 10.1002/hed.25344] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 12/02/2017] [Accepted: 05/07/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Swallowing dysfunction after radiotherapy (RT) for head and neck cancer can be devastating. A randomized control trial compared swallow exercises versus exercise plus neuromuscular electrical stimulation therapy and found no overall difference in outcomes. METHODS Quality of life (QOL), diet, and swallowing variables collected at discrete intervals on 117 patients were reanalyzed to test the hypothesis that shorter time between the completion of radiotherapy and beginning of the swallowing therapy program yielded improved outcomes. RESULTS At baseline, subjects < 1 year post radiation had significantly better function than subjects >2 years post RT in several measures. Over the therapy program, the early group showed significant improvement in diet and QOL. Swallowing physiologic variables showed no difference between groups. CONCLUSION Beginning a swallowing therapy program within 1 year of completion of radiotherapy demonstrates more consistent improvement in QOL and diet performance compared to later periods.
Collapse
Affiliation(s)
| | | | | | - Cathy L Lazarus
- Associate Professor - Otolaryngology, Mount Sinai Health System
| | - Barbara R Pauloski
- Associate Professor - Communication Sciences and Disorders, University of Wisconsin Milwaukee
| | | | | | | | | | - Sarah L Mott
- Statistician - Holden Comprehensive Cancer Center, University of Iowa
| |
Collapse
|
21
|
van den Bosch S, Vogel WV, Raaijmakers CP, Dijkema T, Terhaard CH, Al-Mamgani A, Kaanders JH. Implications of improved diagnostic imaging of small nodal metastases in head and neck cancer: Radiotherapy target volume transformation and dose de-escalation. Radiother Oncol 2018; 128:472-478. [DOI: 10.1016/j.radonc.2018.04.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/14/2018] [Accepted: 04/18/2018] [Indexed: 12/11/2022]
|
22
|
Dean J, Wong K, Gay H, Welsh L, Jones AB, Schick U, Oh JH, Apte A, Newbold K, Bhide S, Harrington K, Deasy J, Nutting C, Gulliford S. Incorporating spatial dose metrics in machine learning-based normal tissue complication probability (NTCP) models of severe acute dysphagia resulting from head and neck radiotherapy. Clin Transl Radiat Oncol 2018; 8:27-39. [PMID: 29399642 PMCID: PMC5796681 DOI: 10.1016/j.ctro.2017.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/20/2022] Open
Abstract
Severe acute dysphagia commonly results from head and neck radiotherapy (RT). A model enabling prediction of severity of acute dysphagia for individual patients could guide clinical decision-making. Statistical associations between RT dose distributions and dysphagia could inform RT planning protocols aiming to reduce the incidence of severe dysphagia. We aimed to establish such a model and associations incorporating spatial dose metrics. Models of severe acute dysphagia were developed using pharyngeal mucosa (PM) RT dose (dose-volume and spatial dose metrics) and clinical data. Penalized logistic regression (PLR), support vector classification and random forest classification (RFC) models were generated and internally (173 patients) and externally (90 patients) validated. These were compared using area under the receiver operating characteristic curve (AUC) to assess performance. Associations between treatment features and dysphagia were explored using RFC models. The PLR model using dose-volume metrics (PLRstandard) performed as well as the more complex models and had very good discrimination (AUC = 0.82) on external validation. The features with the highest RFC importance values were the volume, length and circumference of PM receiving 1 Gy/fraction and higher. The volumes of PM receiving 1 Gy/fraction or higher should be minimized to reduce the incidence of severe acute dysphagia.
Collapse
Key Words
- pm, pharyngeal mucosa
- plr, penalized logistic regression
- svc, support vector classification
- rfc, random forest classification
- auc, area under the receiver operating characteristic curve
- ntcp, normal tissue complication probability
- rt, radiotherapy
- imrt, intensity modulated radiotherapy
- ctcae, common terminology criteria for adverse events
- peg, percutaneous endoscopic gastrostomy
- dvh, dose-volume histogram
- dlh, dose-length histogram
- dch, dose-circumference histogram
Collapse
Affiliation(s)
- Jamie Dean
- Joint Department of Physics at the Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Kee Wong
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Liam Welsh
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Ann-Britt Jones
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Ulricke Schick
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aditya Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kate Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Shreerang Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Joseph Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Sarah Gulliford
- Joint Department of Physics at the Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| |
Collapse
|
23
|
Wopken K, Bijl HP, Langendijk JA. Prognostic factors for tube feeding dependence after curative (chemo-) radiation in head and neck cancer: A systematic review of literature. Radiother Oncol 2018; 126:56-67. [DOI: 10.1016/j.radonc.2017.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 12/31/2022]
|
24
|
Zhang T, Maclean J, Szczesniak M, Bertrand PP, Quon H, Tsang RK, Wu PI, Graham P, Cook IJ. Esophageal Dysmotility in Patients following Total Laryngectomy. Otolaryngol Head Neck Surg 2017; 158:323-330. [PMID: 29231090 DOI: 10.1177/0194599817736507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Dysphagia is common in total laryngectomees, with some symptoms suggesting esophageal dysmotility. Tracheoesophageal (TE) phonation requires effective esophagopharyngeal air passage. Hence, esophageal dysmotility may affect deglutition or TE phonation. This study aimed to determine (1) the characteristics of esophageal dysmotility in laryngectomees, (2) whether clinical history is sensitive in detecting esophageal dysmotility, and (3) the relationship between esophageal dysmotility and TE prosthesis dysfunction. Study Design Multidisciplinary cross-sectional study. Setting Tertiary academic hospital. Subjects and Methods For 31 participants undergone total laryngectomy 1 to 12 years prior, clinical histories were taken by a gastroenterologist and a speech pathologist experienced in managing dysphagia. Esophageal high-resolution manometry was performed and analyzed using Chicago Classification v3.0. Results Interpretable manometric studies were obtained in 23 (1 normal manometry). Esophageal dysmotility patterns included achalasia, esophagogastric junction outflow obstruction, diffuse esophageal spasm, and other major (30%) and minor (50%) peristaltic disorders. The sensitivity of predicting any esophageal dysmotility was 28%, but it is noteworthy that patients with achalasia and diffuse esophageal spasm (DES) were predicted. Two of 4 participants with TE puncture leakage had poor esophageal clearance. Of 20 TE speakers, 12 had voice problems, no correlation between poor voice, and any dysmotility pattern. Conclusions Peristaltic and lower esophageal sphincter dysfunction are common in laryngectomees. Clinical history, while not predictive of minor motor abnormalities, predicted correctly cases with treatable spastic motor disorders. Dysmotility was not associated with poor phonation, although TE puncture leakage might be linked to poor esophageal clearance. Esophageal dysmotility should be considered in the laryngectomees with persisting dysphagia or leaking TE puncture.
Collapse
Affiliation(s)
- Teng Zhang
- 1 Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,2 Department of Gastroenterology & Hepatology, St George Hospital, Sydney, NSW, Australia
| | - Julia Maclean
- 3 Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
| | - Michal Szczesniak
- 1 Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,2 Department of Gastroenterology & Hepatology, St George Hospital, Sydney, NSW, Australia
| | - Paul P Bertrand
- 1 Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,4 School of Medical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Harry Quon
- 5 Department of Radiation Oncology and Molecular Radiation Sciences, John Hopkins University, Baltimore, Maryland, USA
| | - Raymond K Tsang
- 6 Division of Otorhinolaryngology, Department of Surgery, Queen Mary Hospital, Hong Kong
| | - Peter I Wu
- 1 Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,2 Department of Gastroenterology & Hepatology, St George Hospital, Sydney, NSW, Australia
| | - Peter Graham
- 3 Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
| | - Ian J Cook
- 1 Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,2 Department of Gastroenterology & Hepatology, St George Hospital, Sydney, NSW, Australia
| |
Collapse
|
25
|
Alterio D, Gerardi MA, Cella L, Spoto R, Zurlo V, Sabbatini A, Fodor C, D'Avino V, Conson M, Valoriani F, Ciardo D, Pacelli R, Ferrari A, Maisonneuve P, Preda L, Bruschini R, Cossu Rocca M, Rondi E, Colangione S, Palma G, Dicuonzo S, Orecchia R, Sanguineti G, Jereczek-Fossa BA. Radiation-induced acute dysphagia : Prospective observational study on 42 head and neck cancer patients. Strahlenther Onkol 2017; 193:971-981. [PMID: 28884310 DOI: 10.1007/s00066-017-1206-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/17/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Acute toxicity in head and neck (H&N) cancer patients treated with definitive radiotherapy (RT) has a crucial role in compliance to treatments. The aim of this study was to correlate doses to swallowing-associated structures and acute dysphagia. METHODS We prospectively analyzed 42 H&N cancer patients treated with RT. Dysphagia (grade ≥ 3) and indication for percutaneous endoscopic gastrostomy (PEG) insertion were classified as acute toxicity. Ten swallowing-related structures were considered for the dosimetric analysis. The correlation between clinical information and the dose absorbed by the contoured structures was analyzed. Multivariate logistic regression method using resampling methods (bootstrapping) was applied to select model order and parameters for normal tissue complication probability (NTCP) modelling. RESULTS A strong multiple correlation between dosimetric parameters was found. A two-variable model was suggested as the optimal order by bootstrap method. The optimal model (Rs = 0.452, p < 0.001) includes V45 of the cervical esophagus (odds ratio [OR] = 1.016) and Dmean of the cricopharyngeal muscle (OR = 1.057). The model area under the curve was 0.82 (95% confidence interval 0.69-0.95). CONCLUSION Our results suggested that the absorbed dose to the cricopharyngeal muscle and cervical esophagus might play a relevant role in the development of acute RT-related dysphagia.
Collapse
Affiliation(s)
- D Alterio
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - M A Gerardi
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - L Cella
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - R Spoto
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - V Zurlo
- Division of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - A Sabbatini
- Dietetic and Clinical Nutrition Unit, European Institute of Oncology, Milan, Italy
| | - C Fodor
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - V D'Avino
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - M Conson
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - F Valoriani
- Dietetic and Clinical Nutrition Unit, European Institute of Oncology, Milan, Italy
| | - D Ciardo
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - R Pacelli
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy.,Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | - A Ferrari
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - P Maisonneuve
- Department of Epidemiology and Statistics, European Institute of Oncology, Milan, Italy
| | - L Preda
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - R Bruschini
- Division of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - M Cossu Rocca
- Division of Urogenital and Head and Neck Tumors, Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - E Rondi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Colangione
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - G Palma
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - S Dicuonzo
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - R Orecchia
- Scientific Directorate, European Institute of Oncology, Milan, Italy
| | | | - B A Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| |
Collapse
|
26
|
Hajdú SF, Wessel I, Johansen C, Kristensen CA, Kadkhoda ZT, Plaschke CC, Dalton SO. Swallowing therapy and progressive resistance training in head and neck cancer patients undergoing radiotherapy treatment: randomized control trial protocol and preliminary data. Acta Oncol 2017; 56:354-359. [PMID: 28206871 DOI: 10.1080/0284186x.2016.1269193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Head and neck cancer (HNC) patients are often challenged by treatment induced dysphagia and trismus. Traditionally, rehabilitation is initiated when loss of function has already occurred. There is increasing evidence that it is of benefit to patients to initiate an early rehabilitation process before and during treatment. HNC patients have a unique set of functional challenges such as pre- and post-treatment dysphagia, pain and weight loss. The aim of the trial is to investigate the effects of swallowing and mouth-opening exercises combined with progressive resistance training (PRT) during radiotherapy. This report presents the protocol, interim inclusion and feasibility data. MATERIAL AND METHODS The trial (clinicaltrials.gov NCT02385929) is a multicenter randomized controlled trial (RCT) with a parallel-group randomization (1:1). The planned sample size of 240 HNC patients is randomly assigned to either (1) twice weekly PRT and three times weekly swallowing exercises by physio- and occupational therapists, respectively, as well as daily home exercises throughout radiotherapy or (2) standard care. Inclusion criteria are patients with cancer in the larynx, pharynx, oral cavity, or unknown primary tumor who are referred to radiotherapy with curative intent. Outcomes are measured at end-of-treatment and two, five, and 12 months post-treatment. Interim results: In 16 months, 321 HNC patients were screened for eligibility. Of these, 131 (41%) were eligible according to inclusion criteria. One-hundred-and-fifteen patients were invited to participate of which 69 (60%) were enrolled in the trial and randomized for either intervention or control group with 10 drop-outs (14%). The six pilot patients adhered more than 90% to the program. CONCLUSION Preliminary results show that exercise according to protocol is tolerable and feasible.
Collapse
Affiliation(s)
- Sara F. Hajdú
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Unit of Survivorship Research, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Claus A. Kristensen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Zahra T. Kadkhoda
- Department of Oncology, Naestved Hospital, Region Zealand, Naestved, Denmark
| | - Christina C. Plaschke
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Susanne O. Dalton
- Unit of Survivorship Research, Danish Cancer Society Research Centre, Copenhagen, Denmark
| |
Collapse
|
27
|
Söderström K, Nilsson P, Laurell G, Zackrisson B, Jäghagen EL. Dysphagia - Results from multivariable predictive modelling on aspiration from a subset of the ARTSCAN trial. Radiother Oncol 2016; 122:192-199. [PMID: 27687824 DOI: 10.1016/j.radonc.2016.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE To establish predictive models for late objective aspiration and late patient-reported choking based on dose-volume parameters and baseline patient and treatment characteristics, for patients with head and neck cancer undergoing definitive radiotherapy (RT). The impact of electively treated volume on late aspiration was also investigated. METHODS AND MATERIAL This prospective cohort is a subsample of 124 survivors from the ARTSCAN study. Late aspiration was identified with videofluoroscopy, at a minimum of 25months after the start of RT. Patient-reported choking was analysed at 12 and 60months post RT using the EORTC Quality of Life Module for Head and Neck Cancer 35. Univariable and multivariable analyses were performed to describe the association between clinical factors and dose-volume descriptors for organs at risk (OARs) and late dysphagia. RESULTS Aspiration was found in 47% of the eligible patients. Mean dose to the middle pharyngeal constrictor (MPC), neck dissection post RT and age at randomisation in ARTSCAN were associated to late aspiration. Mean dose to the superior pharyngeal constrictor (SPC) and swallowing complaints at baseline were associated to patient reported choking at both time-points. CONCLUSIONS Three separate risk groups for late aspiration, and two risk groups for late patient-reported choking were identified based on number of risk factors. The size of the electively treated volume could be used as a surrogate for individual OARs predicting late aspiration.
Collapse
Affiliation(s)
- Karin Söderström
- Department of Radiation Sciences, Oncology, Umeå University Hospital, Umeå University, Sweden.
| | - Per Nilsson
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden.
| | - Göran Laurell
- Department of Surgical Sciences, Uppsala University, Sweden.
| | - Björn Zackrisson
- Department of Radiation Sciences, Oncology, Umeå University Hospital, Umeå University, Sweden.
| | - Eva Levring Jäghagen
- Department of Odontology, Oral and Maxillofacial Radiology, Umeå University, Sweden.
| |
Collapse
|
28
|
Longitudinal and long-term effects of radiotherapy on swallowing function after tongue reconstruction. The Journal of Laryngology & Otology 2016; 130:865-72. [DOI: 10.1017/s0022215116008720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:This study evaluated the longitudinal and long-term effects of radiotherapy on swallowing function after tongue reconstruction.Methods:The study comprised 16 patients who had: undergone glossectomy and tongue reconstruction with free flap transfer, received adjuvant radiotherapy, and survived without recurrence for at least 1 year. Swallowing function, as indicated by tolerance of oral intake, was evaluated before radiotherapy, at radiotherapy completion, and at 6 and 12 months after radiotherapy completion.Results:Before radiotherapy, all patients could tolerate oral intake. At radiotherapy completion, only three patients could consume all nutrition orally. However, swallowing function improved over time, and by 12 months after radiotherapy completion it had returned nearly to that before radiotherapy.Conclusion:Acute dysphagia due to radiotherapy after tongue reconstruction is severe, but can improve gradually. Multidisciplinary support of patients during percutaneous endoscopic gastrostomy dependence is important to improve long-term functional outcomes.
Collapse
|
29
|
Gastrostomy in head and neck cancer: current literature, controversies and research. Curr Opin Otolaryngol Head Neck Surg 2015; 23:162-70. [PMID: 25692626 DOI: 10.1097/moo.0000000000000135] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW This article explores the literature on the role of gastrostomy tube feeding use in the management of head and neck cancer, with special attention to its indications, timing of insertion, advantages, complications and quality of life issues. RECENT FINDINGS The current guidelines in place across different countries and two ongoing randomized controlled trials are discussed in detail, and placed in the context of current evidence. SUMMARY There remains a lack of consensus about when and which enteral feeding routes (gastrostomy or nasogastric tube) should be used and controversy about the long-term effects on swallowing function as well as quality of life for patients. Local guidelines should be used or generated to guide practice or patients enrolled into existing trials until higher level evidence is generated.
Collapse
|
30
|
Kjaer TK, Johansen C, Andersen E, Karlsen R, Nielsen AL, Frederiksen K, Rørth M, Ibfelt E, Dalton SO. Influence of social factors on patient-reported late symptoms: Report from a controlled trial among long-term head and neck cancer survivors in Denmark. Head Neck 2015; 38 Suppl 1:E1713-21. [DOI: 10.1002/hed.24306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 08/06/2015] [Accepted: 09/20/2015] [Indexed: 01/22/2023] Open
Affiliation(s)
- Trille Kristina Kjaer
- Department of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Christoffer Johansen
- Department of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
- Department of Oncology; Rigshospitalet; Copenhagen Denmark
| | - Elo Andersen
- Department of Oncology; Herlev Hospital; Herlev Ringvej Denmark
| | - Randi Karlsen
- Department of Survivorship; Danish Cancer Society Research Center; Copenhagen Denmark
| | | | - Kirsten Frederiksen
- Department of Statistics, Bioinformatics and Registry; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Mikael Rørth
- Department of Clinical Medicine; Rigshospitalet; Copenhagen Denmark
| | - Else Ibfelt
- Research Center for Prevention and Health; Glostrup Hospital; Glostrup Denmark
| | | |
Collapse
|
31
|
Grau C, Overgaard J, Høyer M, Tanderup K, Lindegaard JC, Muren LP. Biology-guided adaptive radiotherapy (BiGART) is progressing towards clinical reality. Acta Oncol 2015; 54:1245-50. [PMID: 26390238 DOI: 10.3109/0284186x.2015.1076992] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Cai Grau
- a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
| | - Jens Overgaard
- b Department of Experimental Clinical Oncology , Aarhus University Hospital , Aarhus , Denmark
| | - Morten Høyer
- a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
| | - Kari Tanderup
- a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
- c Department of Medical Physics , Aarhus University Hospital , Aarhus , Denmark
| | | | - Ludvig Paul Muren
- a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
- c Department of Medical Physics , Aarhus University Hospital , Aarhus , Denmark
| |
Collapse
|
32
|
Lyhne NM, Primdahl H, Kristensen CA, Andersen E, Johansen J, Andersen LJ, Evensen J, Mortensen HR, Overgaard J. The DAHANCA 6 randomized trial: Effect of 6 vs 5 weekly fractions of radiotherapy in patients with glottic squamous cell carcinoma. Radiother Oncol 2015; 117:91-8. [PMID: 26255764 DOI: 10.1016/j.radonc.2015.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The DAHANCA 6 trial evaluated tumor response and morbidity after moderate accelerated radiotherapy compared to conventional fractionated radiotherapy in patients treated for glottic squamous cell carcinoma (SCC). Further, the failure pattern and incidence of new primary tumors were explored. PATIENTS AND METHODS Six hundred and ninety-four patients with non-metastatic glottic SCC were randomized between six or five weekly fractions (fx/w) of radiotherapy to the same total dose. The median treatment time was 38 and 46days, respectively. The primary endpoint was loco-regional failure. RESULTS Median follow-up time was 14.5years. Of the 177 failures, 167 involved T-site. The cumulative incidence of loco-regional failure (LRF) was 21.6% in the 6fx/w group and 29.3% in the 5fx/w group and the corresponding hazard rate (HR) of LRF was 0.72 (CI: 0.53-0.97, p=0.04). The effect of acceleration on LRF was especially evident in well differentiated tumors (HR=0.42 (CI: 0.23-0.75) and in T1-2 tumors (HR=0.60 (CI: 0.41-0.89)). The HR of laryngectomy was 0.72 (CI: 0.50-1.04) in the 6fx/w group compared to the 5fx/w group. The hazards of disease-specific death, event-free survival, and overall survival were comparable between the two groups. Significantly more patients experienced severe acute mucositis in the 6fx/w group but the incidence of late morbidity was comparable between the groups. New primary tumors occurred in 22.5% of the patients. CONCLUSION Moderate accelerated radiotherapy significantly improved loco-regional control in patients with glottic SCC.
Collapse
Affiliation(s)
- Nina M Lyhne
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Denmark
| | | | - Elo Andersen
- Department of Oncology, Herlev Hospital, Copenhagen, Denmark
| | | | | | | | - Hanna R Mortensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| |
Collapse
|
33
|
Bentzen J, Toustrup K, Eriksen JG, Primdahl H, Andersen LJ, Overgaard J. Locally advanced head and neck cancer treated with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin. Results from the DAHANCA 18 phase II study. Acta Oncol 2015; 54:1001-7. [PMID: 25629651 DOI: 10.3109/0284186x.2014.992547] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE/OBJECTIVE A phase II clinical trial evaluating the feasibility and outcome of treating locally advanced head and neck squamous cell carcinoma (HNSCC) with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin. MATERIAL AND METHODS A total of 227 patients with stage III or IV HNSCC of the larynx, oropharynx, hypopharynx, or oral cavity where included between January 2007 and December 2010. The prescribed radiotherapy (RT) dose was 66-68 Gy in 2 Gy fractions, 6 F/W. The hypoxic radiosensitiser nimorazole was given orally at a dose of 1200 mg/m(2) before each fraction. Concomitant cisplatin (40 mg/m(2)) i.v. was given once a week for a maximum of six cycles. Outcome data were evaluated in terms of loco-regional tumour control (LRC), event-free survival (EFS) and overall survival (OS). Morbidity data were evaluated based on the DAHANCA routine registration. Human papillomavirus (HPV)-status was estimated by immunohistochemical staining of p16. RESULTS Included were 178 (78%) men and 49 (22%) women with a median age of 57 years. All except five patients received RT as prescribed. At least five series of cisplatin was given to 164 (72%) of the patients, and 149 patients (66%) received the full dose of nimorazole. The five-year actuarial LRC, EFS and OS rates were 80%, 67% and 72%, respectively. The LRC rates according to site were: oropharynx: 88%, larynx: 77%, hypopharynx 72% and oral cavity 49%, respectively. HPV/p16 staining was obtained in 141 of the 150 oropharyngeal cancers. Of these, 112 (79%) were p16 pos and 29 (21%) were p16 neg. LRC for the p16 neg oropharyngeal cancers was poorer than for the p16 pos (74% vs. 91%; p = 0.02). Tube feeding during treatment was necessary for 146 (64%) patients. At 12 months this number was reduced to 6%. CONCLUSION The treatment was tolerable in this cohort of locally advanced HNSCC patients. Acute and late toxicity was comparable to similar studies of chemoradiotherapy, and the outcome superior to the data reported in the literature. This strongly indicates that RT of advanced head and neck cancer must include as well hypoxic modification, accelerated fractionation as chemoradiotherapy to yield optimal outcome.
Collapse
Affiliation(s)
- Jens Bentzen
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Kasper Toustrup
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark, on behalf of the Danish Head and Neck Cancer Group
| | | | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark, on behalf of the Danish Head and Neck Cancer Group
| |
Collapse
|
34
|
Frowen J, Drosdowsky A, Perry A, Corry J. Long-term swallowing after chemoradiotherapy: Prospective study of functional and patient-reported changes over time. Head Neck 2015; 38 Suppl 1:E307-15. [DOI: 10.1002/hed.23991] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jacqui Frowen
- Speech Pathology Department; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Allison Drosdowsky
- Department of Cancer Experiences Research; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Alison Perry
- Faculty of Education and Health Sciences; University of Limerick; Limerick Ireland
| | - June Corry
- Division of Radiation Oncology; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
- University of Melbourne; Grattan St Parkville Victoria Australia
| |
Collapse
|
35
|
Jiang N, Zhang LJ, Li LY, Zhao Y, Eisele DW. Risk factors for late dysphagia after (chemo)radiotherapy for head and neck cancer: A systematic methodological review. Head Neck 2015; 38:792-800. [PMID: 25532723 DOI: 10.1002/hed.23963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this systematic review was to identify the risk factors for late dysphagia in patients with head and neck cancer after (chemo)radiotherapy. METHODS The review was performed using search strategies, including PubMed, the Cochrane Library, and Embase databases. The effects of studies were combined with the study quality score using a best-evidence synthesis model. RESULTS Twenty observational studies were evaluated. According to the best-evidence synthesis criteria, there were 2 strong-evidence risk factors for late dysphagia, including the use of chemoradiotherapy (CRT) and the presence of hypopharyngeal carcinoma. We also identified 8 moderate-evidence, 17 limited-evidence, and 1 conflicting-evidence risk factors. CONCLUSION Although there is no conclusive evidence for dysphagia in patients with head and neck cancer after (chemo)radiotherapy, these data provide evidence to guide clinicians in patients who will have late dysphagia and to choose an optimal prophylactic strategy.
Collapse
Affiliation(s)
- Nan Jiang
- School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin, China
| | - Li-Juan Zhang
- School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin, China
| | - Li-Ya Li
- School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin, China
| | | |
Collapse
|
36
|
Olsen MH, Bøje CR, Kjær TK, Steding-Jessen M, Johansen C, Overgaard J, Dalton SO. Socioeconomic position and stage at diagnosis of head and neck cancer - a nationwide study from DAHANCA. Acta Oncol 2015; 54:759-66. [PMID: 25734503 DOI: 10.3109/0284186x.2014.998279] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Socioeconomic differences in survival after head and neck squamous cell carcinoma (HNSCC) are among the greatest for any malignancy. To improve our understanding of the mechanisms by which socioeconomic position influences HNSCC survival, we investigated the association between socioeconomic position and advanced stage HNSCC at diagnosis. MATERIAL AND METHODS Men and women with HNSCC diagnosed between 1992 and 2008 were identified in the Danish Head and Neck Cancer Group (DAHANCA) database, which contains detailed information on all cases of HNSCC treated in Denmark. Individual information on the following four socioeconomic indicators: highest attained educational level, cohabitation status, disposable income and degree of urbanisation were obtained from Statistics Denmark. For the 9683 cases on which there was full information, we estimated odds ratios (ORs) for a diagnosis of advanced stage (TNM III-IV) HNSCC in multivariate logistic regression models by site (glottic, non-glottic larynx, oropharynx, hypopharynx and oral cancer), with adjustment for age, gender, period of diagnosis, education, income, cohabitation status, degree of urbanisation and comorbidity in accordance with a causal diagram. RESULTS For all HNSCC sites, the ORs for advanced stage at diagnosis were increased for patients with low income and for men living alone. For glottic and oral cancers, the ORs for advanced stage HNSCC increased systematically by decreasing length of education. Increased ORs were found for hypopharynx cancer patients living in rural areas or provincial cities. Having one or more comorbid conditions was associated with an increased OR for advanced stage oral cancer but with a decreased OR for oropharynx cancer. CONCLUSION In this nationwide population-based study, socioeconomic differences in stage at diagnosis were found for all HNSCC subsites. Focus on the high risk for advanced stage HNSCC among vulnerable patients may be beneficial during referral and diagnosis in order to improve HNSCC outcomes.
Collapse
Affiliation(s)
- Maja Halgren Olsen
- Survivorship, Danish Cancer Society Reseach Center , Copenhagen , Denmark
| | | | | | | | | | | | | |
Collapse
|
37
|
van der Laan HP, Bijl HP, Steenbakkers RJHM, van der Schaaf A, Chouvalova O, Vemer-van den Hoek JGM, Gawryszuk A, van der Laan BFAM, Oosting SF, Roodenburg JLN, Wopken K, Langendijk JA. Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia. Radiother Oncol 2015; 115:56-62. [PMID: 25792467 DOI: 10.1016/j.radonc.2015.01.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/17/2014] [Accepted: 01/16/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine if acute symptoms during definitive radiotherapy (RT) or chemoradiation (CHRT) are prognostic factors for late dysphagia in head and neck cancer (HNC). MATERIAL AND METHODS This prospective cohort study consisted of 260 HNC patients who received definitive RT or CHRT. The primary endpoint was grade 2-4 swallowing dysfunction at 6 months after completing RT (SWALM6). During treatment, acute symptoms, including oral mucositis, xerostomia and dysphagia, were scored, and the scores were accumulated weekly and entered into an existing reference model for SWALM6 that consisted of dose-volume variables only. RESULTS Both acute xerostomia and dysphagia were strong prognostic factors for SWALM6. When acute scores were added as variables to the reference model, model performance increased as the course of treatment progressed: the AUC rose from 0.78 at the baseline to 0.85 in week 6. New models built for weeks 3-6 were significantly better able to identify patients with and without late dysphagia. CONCLUSION Acute xerostomia and dysphagia during the course of RT are strong prognostic factors for late dysphagia. Including accumulated acute symptom scores on a weekly basis in prediction models for late dysphagia significantly improves the identification of high-risk and low-risk patients at an early stage during treatment and might facilitate individualized treatment adaptation.
Collapse
Affiliation(s)
- Hans Paul van der Laan
- 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
| | - Roel J H M Steenbakkers
- 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
| | - Olga Chouvalova
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | | | - Agata Gawryszuk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Kim Wopken
- 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
| |
Collapse
|
38
|
Mortensen HR, Jensen K, Aksglæde K, Lambertsen K, Eriksen E, Grau C. Prophylactic Swallowing Exercises in Head and Neck Cancer Radiotherapy. Dysphagia 2015; 30:304-14. [PMID: 25690840 DOI: 10.1007/s00455-015-9600-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 02/10/2015] [Indexed: 12/01/2022]
Abstract
Many head and neck cancer (HNC) survivors experience reduced quality of life due to radiotherapy (RT)-related dysphagia. The aim of this prospective randomized trial was to evaluate the impact of prophylactic swallowing exercises on swallowing-related outcomes in HNC patients treated with curative RT. Patients treated with primary RT for HNC were candidates for this randomized protocol. Participants in the exercise group were instructed to perform swallowing exercises at home. Participants in the control group were given standard care. Patients were evaluated with modified barium swallow and several other secondary outcome measures at four and nine different time points, respectively. Data were analyzed according to intention-to-treat analyses. A total of 44 consecutive patients were included; 22 in each group. In general, there was no difference between the two groups regarding any of the dysphagia outcomes during and after treatment. Adherence to exercises was poor and dropouts due to especially fatigue were very frequent in both groups. Systematic swallowing exercises had no impact on swallowing outcomes within the first year after RT. Despite repeated supervised sessions, adherence to exercises was a major issue and dropouts were frequent in both the intervention and control group.
Collapse
Affiliation(s)
- H R Mortensen
- Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark,
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
Many head and neck cancer (HNC) survivors experience reduced quality of life due to radiotherapy (RT)-related dysphagia. The aim of this prospective randomized trial was to evaluate the impact of prophylactic swallowing exercises on swallowing-related outcomes in HNC patients treated with curative RT. Patients treated with primary RT for HNC were candidates for this randomized protocol. Participants in the exercise group were instructed to perform swallowing exercises at home. Participants in the control group were given standard care. Patients were evaluated with modified barium swallow and several other secondary outcome measures at four and nine different time points, respectively. Data were analyzed according to intention-to-treat analyses. A total of 44 consecutive patients were included; 22 in each group. In general, there was no difference between the two groups regarding any of the dysphagia outcomes during and after treatment. Adherence to exercises was poor and dropouts due to especially fatigue were very frequent in both groups. Systematic swallowing exercises had no impact on swallowing outcomes within the first year after RT. Despite repeated supervised sessions, adherence to exercises was a major issue and dropouts were frequent in both the intervention and control group.
Collapse
|