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Sayan M, Cassidy RJ, Switchenko JM, Kayode OA, Saba NF, Steuer CE, Shin DM, Wadsworth JT, El-Deiry M, Patel M, Beitler JJ, Higgins KA. Development of Late Toxicities in Patients with Oral Tongue Cancer Treated with Surgical Resection and Adjuvant Radiation Therapy. Front Oncol 2017; 6:272. [PMID: 28123995 PMCID: PMC5225102 DOI: 10.3389/fonc.2016.00272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/21/2016] [Indexed: 12/18/2022] Open
Abstract
Objectives The late effects of RT are not well reported in patients with oral tongue cancer (OTC). This study reports the incidence of late effects and factors associated with the development of late effects in OTC patients. Methods Patients with OTC treated in our institution from 2003 to 2013 were evaluated. The association between RT doses, including mandible maximum and minimum doses and total 3D maximum dose, and late toxicity, defined as development of osteoradionecrosis (ORN), percutaneous endoscopic gastrostomy (PEG) tube dependence for >6 months after treatment, and narcotic dependency >6 months posttreatment were assessed using both univariate and multivariable (MV) analysis. Results Seventy-six patients with OTC (45% males and 55% females) were treated with definitive surgical resection followed by adjuvant RT. The median follow-up was 4.3 years. Combined late toxicities were reported in 38% of patients. Thirty-four percent of the patients had narcotic dependency and, 3.9% of the patients had ORN of the mandible. Thirteen percent of patients developed PEG tube dependency that was significantly associated with a higher 3D maximum radiation dose on univariate analysis (p < 0.01). On MV analysis, 3D maximum dose remained significantly associated with long-term PEG tube dependency (p = 0.05). Conclusion Patients with OTC treated with adjuvant RT are at significant risk for development of late toxicities. Increasing maximum dose is associated with long-term PEG tube dependence, and care should be taken to reduce the “hot spot” within radiation treatment plans as much as possible.
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Affiliation(s)
- Mutlay Sayan
- University of Vermont Medical Center , Burlington, VT , USA
| | - Richard J Cassidy
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics Shared Resource, Emory University, Atlanta, GA, USA
| | | | - Nabil F Saba
- Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Conor E Steuer
- Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Dong M Shin
- Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - J Trad Wadsworth
- Department of Otolaryngology - Head and Neck Surgery, Emory University , Atlanta, GA , USA
| | - Mark El-Deiry
- Department of Otolaryngology - Head and Neck Surgery, Emory University , Atlanta, GA , USA
| | - Mihir Patel
- Department of Otolaryngology - Head and Neck Surgery, Emory University , Atlanta, GA , USA
| | - Jonathan J Beitler
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA; Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA
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