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Radiother Oncol. 2013 Mar;106(3):364-9. doi: 10.1016/j.radonc.2013.03.005. Epub 2013 Mar 26.

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.

Author information

1
The Netherlands Cancer Institute, Department of Head and Neck Oncology & Surgery, Amsterdam, The Netherlands. l.vd.molen@nki.nl

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.

PMID:
23540551
DOI:
10.1016/j.radonc.2013.03.005
[Indexed for MEDLINE]
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