Identifying organs at risk for radiation-induced late dysphagia in head and neck cancer patients
| Autor: | Caterina Finizia, Lisa Tuomi, Caroline Olsson, Johanna Hedström |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Larynx
AAA Anisotropic Analytical Algorithm Dose-volume histogram HNC head and neck cancer BMI body mass index medicine.medical_treatment R895-920 030218 nuclear medicine & medical imaging Medical physics. Medical radiology. Nuclear medicine 0302 clinical medicine 3D-CRT Three Dimensional Conformal Radiation Therapy EQD2 equivalent dose in 2Gy fractions Medicine DVH dose-volume histogram Dysphagia-aspiration-related structures MVA multivariable logistic regression RC254-282 N.A non applicable Cc cubic centimeter Radiation dose OAR organ-at-risk PRO patient-reported outcome Neoplasms. Tumors. Oncology. Including cancer and carcinogens RT radiation therapy IMRT intensity-modulated radiation therapy Vx the volume (%) of a structure receiving ≥xGy Dysphagia Deglutition disorders ρ Spearman’s Correlation Coefficient CT computed tomography Parotid gland Radiation therapy medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis PAS penetration-aspiration scale Radiology PCM pharyngeal constrictor muscle medicine.symptom Epiglottis medicine.medical_specialty EBRT external beam radiation therapy TNM Tumor location Nodular engagement Metastasis SEM standard error of the mean Head and neck neoplasms Article ACE-27 Adult Comorbidity Evaluation 27 AUC area under the Receiver Operating Characteristic (ROC) curve 03 medical and health sciences DESdC Drinking Eating Swallowing difficulties and Coughing when eating/drinking stomatognathic system Swallowing UVA univariable logistic regression otorhinolaryngologic diseases Radiology Nuclear Medicine and imaging VFS videofluoroscopy ICRU International Commission on Radiation Units and Measurements Gy Gray business.industry SLP speech-language pathologist Head and neck cancer ROC Receiver Operating Characteristic curve medicine.disease QoL quality of life CI confidence interval OR odds ratio UES upper esophageal sphincter SD standard deviation business DARS dysphagia-aspiration-related structures VMAT volumetric-modulated radiation therapy |
| Zdroj: | Clinical and Translational Radiation Oncology, Vol 19, Iss, Pp 87-95 (2019) Clinical and Translational Radiation Oncology |
| ISSN: | 2405-6308 |
| Popis: | Highlights • Majority of DARS investigated for radiation-induced late dysphagia in HNC. • Epiglottis (E) and submandibular glands (SG) have previously not been reported as critical for dysphagia. • Reduced epiglottic inversion may explain the importance of E dose. • Interplay between xerostomia and dysphagia may explain the importance of SG dose. • Potential DVH thresholds to reduce dysphagia: E V60 = 60% and contralateral SG V60 = 17% Background and purpose Dysphagia is a common, severe and dose-limiting toxicity after oncological treatment of head and neck cancer (HNC). This study aims to investigate relationships between radiation doses to structures involved in normal swallowing and patient-reported as well as clinically measured swallowing function in HNC patients after curative (chemo-) radiation therapy (RT) with focus on late effects. Materials and methods Patients (n = 90) with HNC curatively treated with RT ± chemotherapy in 2007–2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific symptom score was used to determine patient-reported dysphagia. The Penetration-Aspiration Scale (PAS) was applied to determine swallowing function by VFS (PAS ≥ 4/ ≥ 6 = moderate/severe dysphagia). Thirteen anatomical structures involved in normal swallowing were individually delineated on the patients’ original planning CT scans and associated dose-volume histograms (DVHs) retrieved. Relationships between structure doses and late toxicity were investigated through univariable and multivariable logistic regression analysis (UVA/MVA) accounting for effects by relevant clinical factors. Results Median assessment time was 7 months post-RT (range: 5–34 months). Mean dose to the contralateral parotid gland and supraglottic larynx as well as maximum dose to the contralateral anterior digastric muscle predicted patient-reported dysphagia (AUC = 0.64–0.67). Mean dose to the pharyngeal constrictor muscle, the larynx, the supraglottic larynx and the epiglottis, as well as maximum dose to the contralateral submandibular gland predicted moderate and severe dysphagia by VFS (AUC = 0.71–0.80). Conclusion The patients in this cohort were consecutively identified pre-treatment, and were structurally approached and assessed for dysphagia after treatment at a specific time point. In addition to established dysphagia organs-at-risk (OARs), our data suggest that epiglottic and submandibular gland doses are important for swallowing function post-RT. Keeping DVH thresholds below V60 = 60% and V60 = 17%, respectively, may increase chances to reduce occurrence of severe late dysphagia. The results need to be externally validated in future studies. |
| Databáze: | OpenAIRE |
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