Feasibility of Tomotherapy-based image-guided radiotherapy to reduce aspiration risk in patients with non-laryngeal and non-pharyngeal head and neck cancer

• Published in: PloS one 2013-03, Vol.8 (3), p.e56290
• Main Authors: Nguyen, Nam P, Smith-Raymond, Lexie, Vinh-Hung, Vincent, Vos, Paul, Davis, Rick, Desai, Anand, Sroka, Thomas, Abraham, Dave, Krafft, Shane P, Stevie, Michelle, Modarresifar, Homayoun, Jo, Beng-Hoey, Ceizyk, Misty
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Barium; Barium Sulfate; Biology; Cancer; Cancer patients; Cancer prevention; Cancer therapies; Care and treatment; Dosimetry; Dysphagia; Edema; Feasibility studies; Female; Group dynamics; Head & neck cancer; Head and neck cancer; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Health risks; Humans; Larynx; Lymph nodes; Lymphatic system; Male; Medical imaging; Medicine; Middle Aged; Neoplasm Staging; Oncology; Ostomy; Patients; Pharynx; Radiation; Radiation (Physics); Radiation therapy; Radiotherapy; Radiotherapy Dosage; Radiotherapy, Image-Guided - adverse effects; Retrospective Studies; Risk; Swallowing; Throat cancer
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0056290

The study aims to assess the feasibility of Tomotherapy-based image-guided radiotherapy (IGRT) to reduce the aspiration risk in patients with non-laryngeal and non-hypopharyngeal cancer. A retrospective review of 48 patients undergoing radiation for non-laryngeal and non-hypopharyngeal head and neck cancers was conducted. All patients had a modified barium swallow (MBS) prior to treatment, which was repeated one month following radiotherapy. Mean middle and inferior pharyngeal dose was recorded and correlated with the MBS results to determine aspiration risk. Mean pharyngeal dose was 23.2 Gy for the whole group. Two patients (4.2%) developed trace aspiration following radiotherapy which resolved with swallowing therapy. At a median follow-up of 19 months (1-48 months), all patients were able to resume normal oral feeding without aspiration. IGRT may reduce the aspiration risk by decreasing the mean pharyngeal dose in the presence of large cervical lymph nodes. Further prospective studies with IGRT should be performed in patients with non-laryngeal and non-hypopharyngeal head and neck cancers to verify this hypothesis.