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Published online: 2021-04-16
Submitted: 2021-04-08
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Change in dysphagia and laryngeal function after radical radiotherapy in laryngo pharyngeal malignancies — a prospective observational study

John M. Mathew, Ashutosh Mukherji, Sunil Kumar Saxena, Niranjan Vijayaraghavan, Abhilash Menon, Kombathula Sriharsha, Malu Rafi
DOI: 10.5603/RPOR.a2021.0078

open access

Ahead of print
Original research articles
Published online: 2021-04-16
Submitted: 2021-04-08

Abstract

Background: Intensity modulated radiotherapy (IMRT) has the perceived advantage of function preservation by reduction of toxicities in the treatment of laryngo-pharyngeal malignancies.

The aim of the study was to assess changes in dysphagia from baseline (i.e. prior to start of treatment) at three and six months post treatment in patients with laryngo-pharyngeal malignancies treated with radical radiotherapy ± chemotherapy. Functional assessment of other structures involved in swallowing was also studied.

Materials and methods: 40 patients were sampled consecutively. 33 were available for final analysis. Dysphagia, laryngeal edema, xerostomia and voice of patients were assessed at baseline and at three and six months after treatment. Radiation was delivered with simultaneous integrated boost (SIB) using volumetric modulated radiation therapy (VMAT). Concurrent chemotherapy was three weekly cisplatin 100 mg/m2.

Results: Proportion of patients with dysphagia rose significantly from 45.5% before the start of treatment to 57.6% at three months and 60.6% at six months post treatment (p = 0.019). 67% patients received chemotherapy and addition of chemotherapy had a significant correlation with dysphagia (p = 0.05, r = –0.336). Severity of dysphagia at three and six months correlated significantly with the mean dose received by the superior constrictors (p = 0.003, r = 0.508 and p = 0.024, r = 0.391) and oral cavity (p = 0.001, r = 0.558 and p = 0.003, r = 0.501). There was a significant worsening in laryngeal edema at three and six months post treatment (p < 0.01) when compared to the pre-treatment examination findings with 60.6% of patients having grade two edema at six months. Significant fall in the mean spoken fundamental frequency from baseline was seen at 6 months (p = 0.04), mean fall was 21.3 Hz (95% CI: 1.5–41 Hz) with significant increase in roughness of voice post treatment (p = 0.01).

Conclusion: There was progressive worsening in dysphagia, laryngeal edema and voice in laryngo-pharyngeal malignancies post radical radiotherapy ± chemotherapy.

Abstract

Background: Intensity modulated radiotherapy (IMRT) has the perceived advantage of function preservation by reduction of toxicities in the treatment of laryngo-pharyngeal malignancies.

The aim of the study was to assess changes in dysphagia from baseline (i.e. prior to start of treatment) at three and six months post treatment in patients with laryngo-pharyngeal malignancies treated with radical radiotherapy ± chemotherapy. Functional assessment of other structures involved in swallowing was also studied.

Materials and methods: 40 patients were sampled consecutively. 33 were available for final analysis. Dysphagia, laryngeal edema, xerostomia and voice of patients were assessed at baseline and at three and six months after treatment. Radiation was delivered with simultaneous integrated boost (SIB) using volumetric modulated radiation therapy (VMAT). Concurrent chemotherapy was three weekly cisplatin 100 mg/m2.

Results: Proportion of patients with dysphagia rose significantly from 45.5% before the start of treatment to 57.6% at three months and 60.6% at six months post treatment (p = 0.019). 67% patients received chemotherapy and addition of chemotherapy had a significant correlation with dysphagia (p = 0.05, r = –0.336). Severity of dysphagia at three and six months correlated significantly with the mean dose received by the superior constrictors (p = 0.003, r = 0.508 and p = 0.024, r = 0.391) and oral cavity (p = 0.001, r = 0.558 and p = 0.003, r = 0.501). There was a significant worsening in laryngeal edema at three and six months post treatment (p < 0.01) when compared to the pre-treatment examination findings with 60.6% of patients having grade two edema at six months. Significant fall in the mean spoken fundamental frequency from baseline was seen at 6 months (p = 0.04), mean fall was 21.3 Hz (95% CI: 1.5–41 Hz) with significant increase in roughness of voice post treatment (p = 0.01).

Conclusion: There was progressive worsening in dysphagia, laryngeal edema and voice in laryngo-pharyngeal malignancies post radical radiotherapy ± chemotherapy.

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Keywords

dysphagia; radiotherapy; laryngeal function; simultaneous integrated boost; function preservation

About this article
Title

Change in dysphagia and laryngeal function after radical radiotherapy in laryngo pharyngeal malignancies — a prospective observational study

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Ahead of print

Article type

Research paper

Published online

2021-04-16

DOI

10.5603/RPOR.a2021.0078

Keywords

dysphagia
radiotherapy
laryngeal function
simultaneous integrated boost
function preservation

Authors

John M. Mathew
Ashutosh Mukherji
Sunil Kumar Saxena
Niranjan Vijayaraghavan
Abhilash Menon
Kombathula Sriharsha
Malu Rafi

References (35)
  1. Dandekar M, D'Cruz A. Organ preservation strategies: Review of literature and their applicability in developing nations. South Asian J Cancer. 2014; 3(3): 147–150.
  2. Sharma A, Mohanti BK, Thakar A, et al. Concomitant chemoradiation versus radical radiotherapy in advanced squamous cell carcinoma of oropharynx and nasopharynx using weekly cisplatin: a phase II randomized trial. Ann Oncol. 2010; 21(11): 2272–2277.
  3. Nutting CM, Morden JP, Harrington KJ, et al. PARSPORT trial management group. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011; 12(2): 127–136.
  4. Franzese C, Fogliata A, Clerici E, et al. Toxicity profile and early clinical outcome for advanced head and neck cancer patients treated with simultaneous integrated boost and volumetric modulated arc therapy. Radiat Oncol. 2015; 10: 224.
  5. Franceschini D, Paiar F, Meattini I, et al. Simultaneous integrated boost-intensity-modulated radiotherapy in head and neck cancer. Laryngoscope. 2013; 123(12): E97–103.
  6. Chen D, Menon H, Verma V, et al. Results of a Phase 1/2 Trial of Chemoradiotherapy With Simultaneous Integrated Boost of Radiotherapy Dose in Unresectable Locally Advanced Esophageal Cancer. JAMA Oncol. 2019; 5(11): 1597–1604.
  7. Hutchison AR, Cartmill B, Wall LR, et al. Dysphagia optimized radiotherapy to reduce swallowing dysfunction severity in patients undergoing treatment for head and neck cancer: A systematized scoping review. Head Neck. 2019; 41(6): 2024–2033.
  8. Murphy BA, Gilbert J. Dysphagia in head and neck cancer patients treated with radiation: assessment, sequelae, and rehabilitation. Semin Radiat Oncol. 2009; 19(1): 35–42.
  9. Rancati T, Schwarz M, Allen AM, et al. Radiation dose-volume effects in the larynx and pharynx. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl): S64–S69.
  10. Dirix P, Abbeel S, Vanstraelen B, et al. Dysphagia after chemoradiotherapy for head-and-neck squamous cell carcinoma: dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2009; 75(2): 385–392.
  11. Barnhart MK, Cartmill B, Ward EC, et al. CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol. 2015; 117(1): 83–90.
  12. Sun Y, Yu XL, Luo W, et al. Recommendation for a contouring method and atlas of organs at risk in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy. Radiother Oncol. 2014; 110(3): 390–397.
  13. Marks LB, Yorke ED, Jackson A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl): S10–S19.
  14. Mazzola R, Ricchetti F, Fiorentino A, et al. Dose-volume-related dysphagia after constrictor muscles definition in head and neck cancer intensity-modulated radiation treatment. Br J Radiol. 2014; 87(1044): 20140543.
  15. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31(5): 1341–1346.
  16. Carding PN, Wilson JA, MacKenzie K, et al. Measuring voice outcomes: state of the science review. J Laryngol Otol. 2009; 123(8): 823–829.
  17. Eisbruch A, Kim H, Terrell J, et al. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001; 50(3): 695–704.
  18. Scorsetti M, Fogliata A, Castiglioni S, et al. Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients. Radiat Oncol. 2010; 5: 93.
  19. Eisbruch A, Schwartz M, Rasch C, et al. 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(5): 1425–1439.
  20. Nutting C, Rooney K, Foran B, et al. Results of a randomized phase III study of dysphagia-optimized intensity modulated radiotherapy (Do-IMRT) versus standard IMRT (S-IMRT) in head and neck cancer. J Clin Oncol. 2020; 38(15 Suppl): 6508–6508.
  21. Roe JWG, Drinnan MJ, Carding PN, et al. Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia? Oral Oncol. 2014; 50(12): 1182–1187.
  22. Wilson JA, Carding PN, Patterson JM. Dysphagia after nonsurgical head and neck cancer treatment: patients' perspectives. Otolaryngol Head Neck Surg. 2011; 145(5): 767–771.
  23. Caglar HB, Tishler RB, Othus M, et al. Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008; 72(4): 1110–1118.
  24. Cacicedo J, Dal Pra A, Alongi F, et al. Impact of weight loss in patients with head and neck carcinoma undergoing radiotherapy: is it an underestimated phenomenon? A radiation oncologist's perspective. Eur J Clin Nutr. 2015; 69(7): 757–760.
  25. Charters EK, Bogaardt H, Freeman-Sanderson AL, et al. Systematic review and meta-analysis of the impact of dosimetry to dysphagia and aspiration related structures. Head Neck. 2019; 41(6): 1984–1998.
  26. Schwartz DL, Hutcheson K, Barringer D, et al. Candidate dosimetric predictors of long-term swallowing dysfunction after oropharyngeal intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2010; 78(5): 1356–1365.
  27. Vainshtein J, Eisbruch A. Function, muscles, and sparing by IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2013; 85(3): 577–578.
  28. Sanguineti G, Adapala P, Endres EJ, et al. Dosimetric predictors of laryngeal edema. Int J Radiat Oncol Biol Phys. 2007; 68(3): 741–749.
  29. Meleca RJ, Dworkin JP, Kewson DT, et al. Functional outcomes following nonsurgical treatment for advanced-stage laryngeal carcinoma. Laryngoscope. 2003; 113(4): 720–728.
  30. Hoyt DJ, Lettinga JW, Leopold KA, et al. The effect of head and neck radiation therapy on voice quality. Laryngoscope. 1992; 102(5): 477–480.
  31. Bibby JRL, Cotton SM, Perry A, et al. Voice outcomes after radiotherapy treatment for early glottic cancer: assessment using multidimensional tools. Head Neck. 2008; 30(5): 600–610.
  32. Paleri V, Carding P, Chatterjee S, et al. Voice outcomes after concurrent chemoradiotherapy for advanced nonlaryngeal head and neck cancer: a prospective study. Head Neck. 2012; 34(12): 1747–1752.
  33. Karlsson T, Bergström L, Ward E, et al. A prospective longitudinal study of voice characteristics and health-related quality of life outcomes following laryngeal cancer treatment with radiotherapy. Acta Oncol. 2016; 55(6): 693–699.
  34. Ferrari D, Ghi MG, Franzese C, et al. The Slippery Role of Induction Chemotherapy in Head and Neck Cancer: Myth and Reality. Front Oncol. 2020; 10: 7.
  35. Petkar I, Rooney K, Roe JWG, et al. DARS: a phase III randomised multicentre study of dysphagia- optimised intensity- modulated radiotherapy (Do-IMRT) versus standard intensity- modulated radiotherapy (S-IMRT) in head and neck cancer. BMC Cancer. 2016; 16(1): 770.

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