Dosimetric factors associated with long-term dysphagia after definitive radiotherapy for squamous cell carcinoma of the head and neck.

Academic Article

Abstract

  • PURPOSE: Intensification of radiotherapy and chemotherapy for head-and-neck cancer may lead to increased rates of dysphagia. Dosimetric predictors of objective findings of long-term dysphagia were sought. METHODS AND MATERIALS: From an institutional database, 83 patients were identified who underwent definitive intensity-modulated radiotherapy for squamous cell carcinoma of the head and neck, after exclusion of those who were treated for a second or recurrent head-and-neck primary lesion, had locoregional recurrence at any time, had less than 12 months of follow-up, or had postoperative radiotherapy. Dosimetric parameters were analyzed relative to three objective endpoints as a surrogate for severe long-term dysphagia: percutaneous endoscopic gastrostomy (PEG) tube dependence at 12 months, aspiration on modified barium swallow, or pharyngoesophageal stricture requiring dilation. RESULTS: Mean dose greater than 41 Gy and volume receiving 60 Gy (V(60)) greater than 24% to the larynx were significantly associated with PEG tube dependence and aspiration. V(60) greater than 12% to the inferior pharyngeal constrictor was also significantly associated with increased PEG tube dependence and aspiration. V(65) greater than 33% to the superior pharyngeal constrictor or greater than 75% to the middle pharyngeal constrictor was associated with pharyngoesophageal stricture requiring dilation. CONCLUSIONS: Doses to the larynx and pharyngeal constrictors predicted long-term swallowing complications, even when controlled for other clinical factors. The addition of these structures to intensity-modulated radiotherapy optimization may reduce the incidence of dysphagia, although cautious clinical validation is necessary.
  • Keywords

  • Adolescent, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Squamous Cell, Catheterization, Deglutition, Deglutition Disorders, Esophageal Stenosis, Female, Gastrostomy, Head and Neck Neoplasms, Humans, Male, Middle Aged, Pharyngeal Diseases, Radiotherapy Dosage, Radiotherapy, Intensity-Modulated, Retrospective Studies, Tumor Burden, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Caudell JJ; Schaner PE; Desmond RA; Meredith RF; Spencer SA; Bonner JA
  • Start Page

  • 403
  • End Page

  • 409
  • Volume

  • 76
  • Issue

  • 2