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Open Access 01-12-2009 | Research

Clinical-dosimetric analysis of measures of dysphagia including gastrostomy-tube dependence among head and neck cancer patients treated definitively by intensity-modulated radiotherapy with concurrent chemotherapy

Authors: Baoqing Li, Dan Li, Derick H Lau, D Gregory Farwell, Quang Luu, David M Rocke, Kathleen Newman, Jean Courquin, James A Purdy, Allen M Chen

Published in: Radiation Oncology | Issue 1/2009

Abstract

Purpose

To investigate the association between dose to various anatomical structures and dysphagia among patients with head and neck cancer treated by definitive intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy.

Methods and materials

Thirty-nine patients with squamous cancer of the head and neck were treated by definitive concurrent chemotherapy and IMRT to a median dose of 70 Gy (range, 68 to 72). In each patient, a gastrostomy tube (GT) was prophylacticly placed prior to starting treatment. Prolonged GT dependence was defined as exceeding the median GT duration of 192 days. Dysphagia was scored using standardized quality-of-life instruments. Dose-volume histogram (DVH) data incorporating the superior/middle pharyngeal constrictors (SMPC), inferior pharyngeal constrictor (IPC), cricoid pharyngeal inlet (CPI), and cervical esophagus (CE) were analyzed in relation to prolonged GT dependence, dysphagia, and weight loss.

Results

At 3 months and 6 months after treatment, 87% and 44% of patients, respectively, were GT dependent. Spearman's ρ analysis identified statistical correlations (p < 0.05) between prolonged GT dependence or high grade dysphagia with IPC V65, IPC V60, IPC Dmean, and CPI Dmax. Logistic regression model showed that IPC V65 > 30%, IPC V60 > 60%, IPC Dmean > 60 Gy, and CPI Dmax > 62 Gy predicted for greater than 50% probability of prolonged GT dependence.

Conclusion

Our analysis suggests that adhering to the following parameters may decrease the risk of prolonged GT dependence and dysphagia: IPC V65 < 15%, IPC V60 < 40%, IPC Dmean < 55 Gy, and CPI Dmax < 60 Gy.

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Adelstein DJ, Li Y, Adams GL, Wagner H Jr, Kish JA, Ensley JF, Schuller DE, Forastiere AA: An Intergroup phase III comparision of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 2003, 21: 92-98. 10.1200/JCO.2003.01.008CrossRefPubMed

Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Calais G: Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 2004, 22: 69-76. 10.1200/JCO.2004.08.021CrossRefPubMed

Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, Glisson B, Trotti A, Ridge JA, Chao C, Peters G, Lee DJ, Leaf A, Ensley J, Cooper J: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003, 349: 2091-8. 10.1056/NEJMoa031317CrossRefPubMed

Grégoire V, De Neve W, Eisbruch A, Lee N, Weyngaert D, Van Gestel D: Intensity-modulated radiation therapy for head and neck carcinoma. Oncologist 2007, 12: 565-8. 10.1634/theoncologist.12-5-555CrossRef

Rosenthal DI, Lewin JS, Eisbruch A: Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol 2006, 24: 2636-43. 10.1200/JCO.2006.06.0079CrossRefPubMed

Garden AS, Harris J, Vokes EE, Forastiere AA, Ridge JA, Jones C, Horwitz EM, Glisson BS, Nabell L, Cooper JS, Demas W, Gore E: Preliminary results of Radiation Therapy Oncology Group 97-03: a randomized phase II trial of concurrent radiation and chemotherapy for advanced squamous cell carcinomas of the head and neck. J Clin Oncol 2004, 22: 2856-64. 10.1200/JCO.2004.12.012CrossRefPubMed

Adelstein DJ, Lavertu P, Saxton JP, Secic M, Wood BG, Wanamaker JR, Eliachar I, Strome M, Larto MA: Mature results of a phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the head and neck. Cancer 2000, 88: 876-83. 10.1002/(SICI)1097-0142(20000215)88:4<876::AID-CNCR19>3.0.CO;2-YCrossRefPubMed

Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Karlsson U, Dutta S, Midyett A, Barloon J, Sallah S: Impact of dysphagia on quality of life after treatment of head-and-neck cancer. Int J RadiatOncol Biol Phys 2005, 61: 772-8.CrossRef

Poulsen MG, Riddle B, Keller J, Porceddu SV, Tripcony L: Predictors of acute grade 4 swallowing toxicity in patients with stages III and IV squamous carcinoma of the head and neck treated with radiotherapy alone. Radiother Oncol 2008, 87: 253-9. 10.1016/j.radonc.2008.03.010CrossRefPubMed

10.

Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Mancuso AA: Parameters that predict local control after definitive radiotherapy for squamous cell carcinoma of the head and neck. Head Neck 2003, 25: 535-42. 10.1002/hed.10253CrossRefPubMed

11.

Eisbruch A, Schwartz M, Rasch C, Vineberg K, Damen E, Van As CJ, Marsh R, Pameijer FA, Balm AJ: Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys 2004, 60: 1425-39.CrossRefPubMed

12.

Feng FY, Kim HM, Lyden TH, Haxer MJ, Feng M, Worden FP, Chepeha DB, Eisbruch A: Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 2007, 68: 1289-98.CrossRefPubMed

13.

Schmalfuss IM, Mancuso AA, Tart RP: Postcricoid region and cervical esophagus: normal appearance at CT and MR imaging. Radiology 2000, 214: 237-46.CrossRefPubMed

14.

Levendag PC, Teguh DN, Voet P, Est H, Noever I, de Kruijf WJ, Kolkman-Deurloo IK, Prevost JB, Poll J, Schmitz PI, Heijmen BJ: Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol 2007, 85: 64-73. 10.1016/j.radonc.2007.07.009CrossRefPubMed

15.

Postma GN, Cohen JT, Belafsky PC, Halum SL, Gupta SK, Bach KK, Koufman JA: Transnasal esophagoscopy: revisited (over 700 consecutive cases). Laryngoscope 2005, 115: 321-323. 10.1097/01.mlg.0000154741.25443.feCrossRefPubMed

16.

Langmore SE, Schatz K, Olsen N: Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1998, 2: 216-9. 10.1007/BF02414429CrossRef

17.

Caglar HB, Tishler RB, Othus M, Burke E, Li Y, Goguen L, Wirth LJ, Haddad RI, Norris CM, Court LE, Aninno DJ, Posner MR, Allen AM: Dose to Larynx Predicts for Swallowing Complications After Intensity-Modulated Radiotherapy. Int J Radiat Oncol Biol Phys 1118, 72: 1110-2008.CrossRef

18.

Dornfeld K, Simmons JR, Karnell L, Karnell M, Funk G, Yao M, Wacha J, Zimmerman B, Buatti JM: Radiation doses to structures within and adjacent to the larynx are correlated with long-term diet- and speech-related quality of life. Int J Radiat Oncol Biol Phys 2007, 68: 750-7.CrossRefPubMed

19.

Jensen K, Lambertsen K, Grau C: Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters. Radiother Oncol 2007, 85: 74-82. 10.1016/j.radonc.2007.06.004CrossRefPubMed

20.

Fua TF, Corry J, Milner AD, Cramb J, Walsham SF, Peters LJ: Intensity-modulated radiotherapy for nasopharyngeal carcinoma: clinical correlation of dose to the pharyngo-esophageal axis and dysphagia. Int J Radiat OncolBiol Phys 2007, 67: 976-81. 10.1016/j.ijrobp.2006.10.028CrossRef

21.

Lee NY, O'Meara W, Chan K, Della-Bianca C, Mechalakos JG, Zhung J, Wolden SL, Narayana A, Kraus D, Shah JP, Pfister DG: Concurrent chemotherapy and intensity-modulated radiotherapy for locoregionally advanced laryngeal and hypopharyngeal cancers. Int J RadiatOncol Biol Phys 2007, 69: 459-68.CrossRef

22.

Teguh DN, Levendag PC, Noever I, van Rooij P, Voet P, Est H, Sipkema D, Sewnaik A, Baatenburg de Jong RJ, de la Bije D, Schmitz PI: Treatment Techniques and Site Considerations Regarding Dysphagia-Related Quality of Life in Cancer of the Oropharynx and Nasopharynx. Int J Radiat Oncol Biol Phys 2008, 72: 1119-27.CrossRefPubMed

23.

Teguh DN, Levendag PC, Sewnaik A, Hakkesteegt MM, Noever I, Voet P, Est H, Sipkema D, van Rooij P, Baatenburg de Jong RJ, Schmitz PI: Results of fibroptic endoscopic evaluation of swallowing vs. radiation dose in the swallowing muscles after radiotherapy of cancer in the oropharynx. Radiother Oncol 2008, 89: 57-63. 10.1016/j.radonc.2008.07.012CrossRefPubMed

24.

Jensen K, Jensen AB, Grau C: Smoking has a negative impact upon health related quality of life after treatment for head and neck cancer. Oral Oncol 2007, 43: 187-92. 10.1016/j.oraloncology.2006.02.006CrossRefPubMed

25.

Mangar S, Slevin N, Mais K, Sykes A: Evaluating predictive factors for determining enteral nutrition in patients receiving radical radiotherapy for head and neck cancer: A retrospective review. Radiother Oncol 2006, 78: 152-158. 10.1016/j.radonc.2005.12.014CrossRefPubMed

26.

Caudell J, Shaner P, Meredith R, Bonner J, Locher JL, Nabell LM, Carroll WR, Magnuson JS, Spencer SA, Bonner JA: Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cnacer. Int J Radiat Oncol Biol Phys, Int J Radiat Oncol Biol Phys 2009, 73: 410-5.CrossRefPubMed

27.

Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P: Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 2001, 91: 1785-90. 10.1002/1097-0142(20010501)91:9<1785::AID-CNCR1197>3.0.CO;2-1CrossRefPubMed

28.

Lee WT, Akst LM, Adelstein DJ, Saxton JP, Wood BG, Strome M, Butler RS, Esclamado RM: Risk factors for hypopharyngeal/upper esophageal stricture formation after concurrent chemoradiation. Head Neck 2006, 28: 808-12. 10.1002/hed.20427CrossRefPubMed

29.

Machtay M, Moughan J, Trotti A, Gargen AS, Weber RS, Cooper JS, Forastiere A, Ang KK: Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 2008, 26: 3581-88. 10.1200/JCO.2007.14.8841CrossRef

30.

Logeman JA, Rademaker AW, Pauloski BR, Lazarus CL, Mittal BB, Brockstein B, MacCracken E, Haraf DJ, Vokes EE, Newman LA, Liu D: Site of disease and treatment protocol as correlated of swallowing function in patients with head and neck cancer treated with chemoradiaiton. Head Neck 2006, 28: 64-73. 10.1002/hed.20299CrossRef

31.

Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ: Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol 3776, 26: 3770-2008. 10.1200/JCO.2007.14.6647CrossRef

32.

Rosenthal DI, Trotti A: Strategies for managing radiation-induced mucositis in head and neck cancer. Semin Radiat Oncol 2009, 19: 29-34. 10.1016/j.semradonc.2008.09.006CrossRefPubMed

33.

Dorr W, Hendry JH: Consequential late effects in normal tissues. Radiother Oncol 2001, 61: 223-231. 10.1016/S0167-8140(01)00429-7CrossRefPubMed

34.

Trotti A, Bellm LA, Esptein JB, Frame D, Fuchs HJ, Gwede CK, Komaroff E, Nalysnyk L, Zilberberg MD: Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systemic literature review. Radiother Oncol 2003, 66: 253-262. 10.1016/S0167-8140(02)00404-8CrossRefPubMed

35.

Anand A, Chaudhoory A, Shukla A, Negi PS, Sinha SN, Babu AA, Munjal RK, Dewan AK, Kumar K, Doval DC, Vaid AK: Favourable impact of intensity-modulated radiation therapy on chronic dysphagia in patients with head and neck cnacer. Br J Radiol 2008, 81: 865-71. 10.1259/bjr/31334499CrossRefPubMed

36.

Pauliski BR, Rademake AW, Logemann JA, Sten D, Beery Q, Newman L, Hanchett C, Tusant S, MacCracken E: Pretreatment swallowing function in patients with head and neck cancer. Head Neck 2000, 22: 474-82. 10.1002/1097-0347(200008)22:5<474::AID-HED6>3.0.CO;2-ICrossRef

37.

Stenson KM, MacCracken E, List M, Haraf DJ, Brockstein B, Weichselbaum R, Vokes EE: Swallowing function in patients with head and neck cancer prior to treatment. Arch Otolaryngol Head Neck Surg 2000, 126: 371-7.CrossRefPubMed

38.

Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Mittal B, Gaziano J, Stachowiak L, MacCracken E, Newman LA: Xerostomia: 12-month changes in saliva production and its relationship to perception and performance of swallow function, oral intake, and diet after chemoradiation. Head Neck 2003, 25: 432-7. 10.1002/hed.10255CrossRefPubMed

39.

Hamlet S, Faull J, Klein B, Aref A, Fontanesi J, Stachler R, Shamsa F, Jones L, Simpson M: Mastification and swallowing in patients with postirradiation xerostomia. Int J Radiat Oncol Biol Phys 1997, 37: 789-96.CrossRefPubMed

40.

Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K: Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology 2002, 122: 1314-21. 10.1053/gast.2002.32999CrossRefPubMed

Title: Clinical-dosimetric analysis of measures of dysphagia including gastrostomy-tube dependence among head and neck cancer patients treated definitively by intensity-modulated radiotherapy with concurrent chemotherapy
Authors: Baoqing Li
Dan Li
Derick H Lau
D Gregory Farwell
Quang Luu
David M Rocke
Kathleen Newman
Jean Courquin
James A Purdy
Allen M Chen
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2009
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-4-52

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical-dosimetric analysis of measures of dysphagia including gastrostomy-tube dependence among head and neck cancer patients treated definitively by intensity-modulated radiotherapy with concurrent chemotherapy

Abstract

Purpose

Methods and materials

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods and materials

Results

Conclusion

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