Dysphagia in Head and Neck Radiotherapy: The Influence of Pharyngeal Constrictor Anatomy and Dosimetry.

Autor: Paetkau O; Department of Physics and Astronomy, University of Calgary, #5 721 13th Ave SW, Calgary, AB, T2R 0K8, Canada. owen.paetkau@albertahealthservices.ca., Weppler S; Tom Baker Cancer Center, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada., Kwok J; Tom Baker Cancer Center, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada.; Division of Radiation Oncology, Department of Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada., Quon HC; Tom Baker Cancer Center, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada., Smith W; Varian Medical Systems - A Siemens Healthineers Company, Palo Alto, US., Tchistiakova E; Division of Radiation Oncology, Department of Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada., Kirkby C; Division of Radiation Oncology, Department of Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada.
Jazyk: angličtina
Zdroj: Dysphagia [Dysphagia] 2024 May 16. Date of Electronic Publication: 2024 May 16.
DOI: 10.1007/s00455-024-10705-2
Abstrakt: The goal of this study was to identify which anatomical and dosimetric changes correlated with late patient-reported dysphagia throughout the course of head and neck chemo-radiotherapy treatment. The patient cohort (n = 64) considered oropharyngeal and nasopharyngeal patients treated with curative intent, exhibiting no baseline dysphagia with a follow-up time greater than one year. Patients completed the MD Anderson Dysphagia Inventory during a follow-up visit. A composite score was measured ranging from 20 to 100, with a low score indicating a high symptom burden; a score ≤60 indicated patient-reported dysphagia. The pharyngeal (PCM) and cricopharyngeal constrictor muscles (CPM) were contoured on a planning CT image and adapted to weekly cone-beam CT anatomy using deformable image registration and dose was accumulated using weighted dose-volume histogram curves. The PCM and CPM were examined for volume, thickness, and dosimetric changes across treatment with the results correlated to symptom group. Anatomical evaluation indicated the PCM thickness increased more during treatment for patients with dysphagia, with base of C2 vertebrae (p = 0.04) and superior-inferior middle PCM (p = 0.01) thicknesses indicating a 1.0-1.5 mm increase. The planned and delivered mean dose and DVH metrics to PCM and CPM were found to be within random error measured for the dose accumulation, indicating delivered and planned dose are equivalent. The PCM and CPM organs were found to lie approximately 5 mm closer to high dose gradients in patients exhibiting dysphagia. The volume, thickness, and high dose gradient metrics may be useful metrics to identify patients at risk of late patient-reported dysphagia.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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