Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose–effect relationships for swallowing and mastication structures

• Published in: Radiotherapy and oncology 2013-03, Vol.106 (3), p.364-369
• Main Authors: van der Molen, Lisette, Heemsbergen, Wilma D, de Jong, Rianne, van Rossum, Maya A, Smeele, Ludi E, Rasch, Coen R.N, Hilgers, Frans J.M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Chemo-IMRT; Chemoradiotherapy - adverse effects; Deglutition - drug effects; Deglutition - radiation effects; Deglutition Disorders - etiology; Dose-Response Relationship, Radiation; Dose–effect relationships; Dysphagia; Female; Head and neck cancer; Hematology, Oncology and Palliative Medicine; Humans; Male; Mastication - drug effects; Mastication - radiation effects; Middle Aged; Radiation doses and dose-volumes; Radiotherapy, Intensity-Modulated - adverse effects; Surveys and Questionnaires; Swallowing and mastication structures; Trismus; Trismus - etiology
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2013.03.005

Abstract Background and purpose Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication. Material and methods Assessment of 55 patients before, 10-weeks ( N = 49) and 1-year post-treatment ( N = 37). Calculation of dose–volume parameters for swallowing (inferior (IC), middle (MC), and superior constrictors (SC)), and mastication structures (e.g. masseter). Investigation of relationships between dose-parameters and endpoints for swallowing problems (videofluoroscopy-based laryngeal Penetration-Aspiration Scale (PAS), and study-specific structured questionnaire) and limited mouth-opening (measurements and questionnaire), taking into account baseline scores. Results At 10-weeks, volume of IC receiving ⩾60 Gy (V60) and mean dose IC were significant predictors for PAS. One-year post-treatment, reported problems with swallowing solids were significantly related to masseter dose-parameters (mean, V20, V40 and V60) and an inverse relationship (lower dose related to a higher probability) was observed for V60 of the IC. Dose-parameters of masseter and pterygoid muscles were significant predictors of trismus at 10-weeks (mean, V20, and V40). At 1-year, dose-parameters of all mastication structures were strong predictors for subjective mouth-opening problems (mean, max, V20, V40, and V60). Conclusions Dose–effect relationships exist for dysphagia and trismus. Therefore treatment plans should be optimized to avoid these side effects.