Association between Swallowing Outcomes and Dose to Critical Swallow Structures in Patients Undergoing Transoral Robotic Surgery and Post-Operative Radiation Therapy.
Dysphagia
Dysphagia and aspiration related structures
Oral neoplasm
Robotic surgery
Journal
Dysphagia
ISSN: 1432-0460
Titre abrégé: Dysphagia
Pays: United States
ID NLM: 8610856
Informations de publication
Date de publication:
05 Jun 2024
05 Jun 2024
Historique:
received:
26
02
2024
accepted:
10
05
2024
medline:
6
6
2024
pubmed:
6
6
2024
entrez:
5
6
2024
Statut:
aheadofprint
Résumé
The radiation dose to dysphagia and aspiration-related structures (DARS) for patients undergoing transoral robotic surgery (TORS) and post-operative radiation therapy (PORT) for primary oropharyngeal carcinoma is unknown. This prospective study measured swallowing using the MD Anderson Dysphagia Inventory at baseline and then 12-months after PORT. Dosimetric parameters were collected. 19 patients were recruited between 2017 and 2019. Worse swallow function at 12-months after PORT was associated with dose-parameters to the oesophageal inlet muscle, superior pharyngeal constrictor muscle and cervical oesophagus. Mean dose, V50Gy, and V60Gy to the base of tongue and pharyngeal constrictors was significantly lower in those receiving PORT to the neck alone. Dose to DARS was lower in patients who received PORT to the neck alone. In patients treated with TORS and PORT, poorer swallowing outcomes at 12 months post-treatment were associated with increased dose to oesophageal inlet muscle, superior constrictor muscle, and cervical oesophagus.
Sections du résumé
BACKGROUND
BACKGROUND
The radiation dose to dysphagia and aspiration-related structures (DARS) for patients undergoing transoral robotic surgery (TORS) and post-operative radiation therapy (PORT) for primary oropharyngeal carcinoma is unknown.
METHODS
METHODS
This prospective study measured swallowing using the MD Anderson Dysphagia Inventory at baseline and then 12-months after PORT. Dosimetric parameters were collected.
RESULTS
RESULTS
19 patients were recruited between 2017 and 2019. Worse swallow function at 12-months after PORT was associated with dose-parameters to the oesophageal inlet muscle, superior pharyngeal constrictor muscle and cervical oesophagus. Mean dose, V50Gy, and V60Gy to the base of tongue and pharyngeal constrictors was significantly lower in those receiving PORT to the neck alone.
CONCLUSION
CONCLUSIONS
Dose to DARS was lower in patients who received PORT to the neck alone. In patients treated with TORS and PORT, poorer swallowing outcomes at 12 months post-treatment were associated with increased dose to oesophageal inlet muscle, superior constrictor muscle, and cervical oesophagus.
Identifiants
pubmed: 38839624
doi: 10.1007/s00455-024-10719-w
pii: 10.1007/s00455-024-10719-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Nichols AC, Theurer J, Prisman E, Read N, Berthele E, Tran E et al. Randomized Trial of Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Long-Term Results of the ORATOR Trial. JCO 2022.
Swisher-McClure S, Lukens JN, Aggarwal C, Ahn P, Basu D, Bauml JM, Brody R, Chalian A, Cohen RB, Fotouhi-Ghiam A, Geiger G, Gershowitz J, Livolsi V, Mitra N, Montone K, Newman J, Ojerholm E, O’Malley B Jr, Rajasekaran K, Tan E, Weinstein G, Lin A. A phase 2 trial of alternative volumes of Oropharyngeal Irradiation for de-intensification (AVOID): omission of the Resected Primary Tumor Bed after Transoral robotic surgery for human papilloma virus-related squamous cell carcinoma of the Oropharynx. Int J Radiat Oncol Biol Phys. 2020;106(4):725–32. https://doi.org/10.1016/j.ijrobp.2019.11.021 .
doi: 10.1016/j.ijrobp.2019.11.021
pubmed: 31785337
Fradet L, Charters E, Gao K, Froggatt C, Palme C, Riffat F, Nguyen K, Wu R, Milross C, Clark JR. Avoidance of primary site adjuvant radiotherapy following transoral robotic surgery: a cohort study. ANZ J Surg. 2022;92(3):511–7.
doi: 10.1111/ans.17463
pubmed: 35018703
Dowthwaite S, Panizza B, O’Neill J, Porceddu S, Jackson JE, Chua B. Outcomes of primary trans-oral surgical management of early tonsillar squamous cell carcinoma with risk-adapted adjuvant radiotherapy. Australian J Otolaryngolgy 2019; 2.
Ferris RL, Flamand Y, Weinstein GS, Li S, Quon H, Mehra R, Garcia JJ, Chung CH, Gillison ML, Duvvuri U, O’Malley BW Jr, Ozer E, Thomas GR, Koch WM, Gross ND, Bell RB, Saba NF, Lango M, Méndez E, Burtness B. Phase II randomized trial of Transoral surgery and low-dose intensity modulated Radiation Therapy in Resectable p16 + locally Advanced Oropharynx Cancer: an ECOG-ACRIN Cancer Research Group Trial (E3311). J Clin Oncol. 2022;40(2):138–49. https://doi.org/10.1200/JCO.21.01752 .
doi: 10.1200/JCO.21.01752
pubmed: 34699271
Genden EM, Kotz T, Tong CC, et al. Transoral robotic resection and reconstruction for head and neck cancer. Laryngoscope. 2011;121(8):1668–74.
doi: 10.1002/lary.21845
pubmed: 21792953
Patel SA, Magnuson JS, Holsinger FC, et al. Robotic surgery for primary head and neck squamous cell carcinoma of unknown site. JAMA Otolaryngol Head Neck Surg. 2013;139(11):1203–11.
doi: 10.1001/jamaoto.2013.5189
pubmed: 24136446
Palma DA, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, et al. Assessment of toxic effects and Survival in Treatment Deescalation with Radiotherapy vs Transoral surgery for HPV-Associated Oropharyngeal squamous cell carcinoma: the ORATOR2 phase 2 Randomized Clinical Trial. JAMA Oncol. 2022;8(6):1–7.
doi: 10.1001/jamaoncol.2022.0615
pubmed: 35482348
pmcid: 8874872
Hutcheson KA, Warneke CL, Yao CMKL, Zaveri J, Elgohari BE, Goepfert R, MD Anderson Head and Neck Cancer Symptom Working Group, et al. Dysphagia after primary Transoral robotic surgery with Neck Dissection vs nonsurgical therapy in patients with low- to Intermediate-Risk Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg. 2019;145(11):1053–63.
doi: 10.1001/jamaoto.2019.2725
pubmed: 31556933
pmcid: 6763976
Nutting C, Finneran L, Roe J, Sydenham MA, Beasley M, Bhide S, Boon C, Cook A, De Winton E, Emson M, Foran B, Frogley R, Petkar I, Pettit L, Rooney K, Roques T, Srinivasan D, Tyler J, Hall E, DARS Trialist Group. Dysphagia-optimised intensity-modulated radiotherapy versus standard intensity-modulated radiotherapy in patients with head and neck cancer (DARS): a phase 3, multicentre, randomised, controlled trial. Lancet Oncol. 2023;24(8):868–80. https://doi.org/10.1016/S1470-2045(23)00265-6 .
doi: 10.1016/S1470-2045(23)00265-6
pubmed: 37423227
Charters E, Wu R, Milross C, Bogaardt H, Freeman-Sanderson A, Ballard K, Davies S, Oates J, Clark J. Swallowing and communication outcomes following primary transoral robotic surgery. Head Neck. 2021;43(7):2013–23.
doi: 10.1002/hed.26675
pubmed: 33687115
Charters E, Bogaardt H, Freeman-Sanderson A, Ballard K, Davies S, Oates J, Clark J. Swallowing and communication outcomes following primary transoral robotic surgery for advanced or recurrent oropharyngeal cancer: Case series. Int J Speech Lang Pathol. 2022;24(4):407–16.
doi: 10.1080/17549507.2021.1977388
pubmed: 34547959
Bhide SA, Gulliford S, Kazi R, et al. Correlation between dose to the pharyngeal constrictors and patient quality of life and late dysphagia following chemo-IMRT for head and neck cancer. Radiother Oncol. 2009;93(3):539–44.
doi: 10.1016/j.radonc.2009.09.017
pubmed: 19883951
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):1110–8.
doi: 10.1016/j.ijrobp.2008.02.048
pubmed: 18468812
Caudell JJ, Schaner PE, Desmond RA, Meredith RF, Spencer SA, Bonner JA. Dosimetric factors associated with long-term dysphagia after definitive radiotherapy for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2010;76(2):403–9.
doi: 10.1016/j.ijrobp.2009.02.017
pubmed: 19467801
Dirix P, Abbeel S, Vanstraelen B, Hermans R, Nuyts S. 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):385–92.
doi: 10.1016/j.ijrobp.2008.11.041
pubmed: 19553033
Dornfeld K, Simmons JR, Karnell L, et al. 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(3):750–7.
doi: 10.1016/j.ijrobp.2007.01.047
pubmed: 17418971
Feng FY, Kim HM, Lyden TH, et al. 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(5):1289–98.
doi: 10.1016/j.ijrobp.2007.02.049
pubmed: 17560051
Levendag PC, Teguh D, Voet P, et al. 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.
doi: 10.1016/j.radonc.2007.07.009
pubmed: 17714815
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):1356–65.
doi: 10.1016/j.ijrobp.2009.10.002
pubmed: 20646872
pmcid: 4034521
Christianen ME, Langendijk JA, Westerlaan HE, van de Water TA, Bijl HP. Delineation of organs at risk involved in swallowing for radiotherapy treatment planning. Radiother Oncol. 2011;101(3):394–402.
doi: 10.1016/j.radonc.2011.05.015
pubmed: 21664711
Chen AY, Frankowski R, Bishop-Leone J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the MD Anderson Dysphagia Inventory. Arch Otolaryngol Head Neck Surg. 2001;127(7):870–6.
pubmed: 11448365
Hutcheson KA, Bhayani MK, Beadle BM, et al. Eat and Exercise during Radiotherapy or Chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg. 2013;139(11):1127–34.
doi: 10.1001/jamaoto.2013.4715
pubmed: 24051544
pmcid: 3969836
Eisbruch A, Schwartz M, Rasch C, et al. Dysphagia and as- piration 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.
doi: 10.1016/j.ijrobp.2004.05.050
pubmed: 15590174
Eisbruch A, Kim HM, Feng FY, Lyden TH, Haxer MJ, Feng M, et al. Chemo-IMRT of oropharyngeal cancer aiming to reduce dysphagia: swallowing organs late complication probabilities and dosimetric correlates. Int J Radiation Oncol Biol Phys. 2011;81(3):e93–9.
doi: 10.1016/j.ijrobp.2010.12.067
Awan M, Mohamed ASR, Lewin JS, Baron CA, Gunn GB, Rosenthal DI, et al. Late radiation-associated dysphagia (late-RAD) with lower cranial neuropathy after oropharyngeal radiotherapy: a preliminary dosimetric comparison. Oral Oncol. 2014;50:746–52.
doi: 10.1016/j.oraloncology.2014.05.003
pubmed: 24906528
pmcid: 4158823
Dabas S, Gupta K, Ranjan R, Sharma AK, Shukla H, Dinesh A. Oncological outcome following de-intensification of treatment for stage I and II HPV negative oropharyngeal cancers with transoral robotic surgery (TORS): a prospective trial. Oral Oncol. 2017;69:80–3. Epub 2017 Apr 21. PMID: 28559025.
doi: 10.1016/j.oraloncology.2017.04.010
pubmed: 28559025
Weinstein GS, Quon G, O’Malley BW, Kim GG, Cphen MA. Selective neck dissection and deintensified postoperative radiation and chemotherapy for oropharyngeal cancer: a subset analysis of the university of Pennsylvania transoral robotic surgery trial. Laryngoscope. 2010;120(9):1749–55.
doi: 10.1002/lary.21021
pubmed: 20717944
Hutcheson KA, Barrow MP, Lisec A, Barringer DA, Gries K, Lewin JS. What is a clinically relevant difference in MDADI scores between groups of head and neck cancer patients? Laryngoscope. 2016;126(5):1108–13.
doi: 10.1002/lary.25778
pubmed: 26542529