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Clin Transl Radiat Oncol. 2018 Sep 4;13:1-6. doi: 10.1016/j.ctro.2018.08.004. eCollection 2018 Nov.

Predictors of acute throat or esophageal patient reported pain during radiation therapy for head and neck cancer.

Author information

1
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States.
2
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
3
Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, United States.
4
Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States.
5
Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO, United States.
6
Department of Radiation Oncology, Missouri Baptist Cancer Center, St. Louis, MO, United States.
7
American Board of Otolaryngology, Houston, TX, United States.
8
Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, United States.

Abstract

Background and purpose:

Acute pain during weekly radiotherapy (RT) to the head and neck is not well characterized. We studied dose-volume metrics and clinical variables that are plausibly associated with throat or esophageal pain as measured with a weekly questionnaire during RT.

Materials and methods:

We prospectively collected weekly patient-reported outcomes from 122 head and neck cancer patients during RT. The pain score for each question consisted of a four-level scale: none (0), mild (1), moderate (2), and severe (3). Univariate and multivariate ordinal logistic regression analyses were performed to investigate associations between both esophageal and throat pain and clinical as well as dosimetric variables.

Results:

In multivariate analysis, age was significantly associated with both types of pain, leading to odds ratio (OR) = 0.95 (p = 0.008) and OR = 0.95 (p = 0.007) for esophageal and throat pain, respectively. For throat pain, sex (OR = 4.12; p = 0.010), with females at higher risk, and fractional organ at risk (OAR) mean dose (OR = 3.30; p = 0.014) were significantly associated with throat pain.

Conclusions:

A fractional OAR mean dose of 1.1 Gy seems a reasonable cutoff for separating no or mild pain from moderate to severe esophageal and throat pain. Younger patients who received RT experienced more esophageal and throat pain. Females experienced more throat pain, but not esophageal pain.

KEYWORDS:

Esophagus; Head and neck; Pain; Radiotherapy; Throat

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