TY - JOUR
T1 - Chronic radiation-associated dysphagia in oropharyngeal cancer survivors
T2 - Towards age-adjusted dose constraints for deglutitive muscles
AU - MD Anderson Head and Neck Cancer Symptom Working Group
AU - Spatial-Non-spatial Multi-Dimensional Analysis of Radiotherapy Treatment/Toxicity Team (SMART3)
AU - Christopherson, Kaitlin M.
AU - Ghosh, Alokananda
AU - Mohamed, Abdallah Sherif Radwan
AU - Kamal, Mona
AU - Gunn, G. Brandon
AU - Dale, Timothy
AU - Kalpathy-Cramer, Jayashree
AU - Messer, Jay
AU - Garden, Adam S.
AU - Elhalawani, Hesham
AU - Frank, Steven J.
AU - Lewin, Jan
AU - Morrison, William H.
AU - Phan, Jack
AU - Gross, Neil
AU - Ferrarotto, Renata
AU - Weber, Randal S.
AU - Rosenthal, David I.
AU - Lai, Stephen Y.
AU - Hutcheson, Katherine
AU - Fuller, Clifton David
AU - Radwan Mohamed, Abdallah Sherif
AU - Marai, G. Elisabeta (Liz)
AU - Canahuate, Guadalupe
AU - Vock, David M.
N1 - Publisher Copyright:
© 2019 The Authors
PY - 2019/9
Y1 - 2019/9
N2 - Objectives: We sought to model chronic radiation-associated dysphagia (RAD) in patients given intensity-modulated radiation therapy (IMRT) for oropharyngeal squamous cell cancer (OPSCC) as a function of age and dose to non-target swallowing muscles. Methods: We reviewed 300 patients with T1-T4 N0-3 M0 OPSCC given definitive IMRT with concurrent chemotherapy. Chronic RAD was defined as aspiration or stricture on videoflouroscopy/endoscopy, gastrostomy tube, or aspiration pneumonia at ≥12 months after IMRT. Doses to autosegmented regions of interest (ROIs; inferior, middle and superior constrictors, anterior and posterior digastrics, mylo/geniohyoid complex, intrinsic tongue, and gengioglossus) were obtained from DICOM-RT plans and dose-volume histograms. The probability of chronic RAD as a function of mean ROI dose, stratified by age (<50, 50–59, 60–69, or ≥70 years), was estimated with logistic probability models and subsequent unsupervised nonlinear curves. Results: Chronic RAD was observed in 34 patients (11%). Age was a significant correlate of chronic RAD, both independently and with dose for all muscle groups examined. Distinct muscle-specific dose–response profiles were observed as a function of age (e.g., 5% of patients in their 50 s [but 20% of those 70 + ] who received 60 Gy to the superior constrictor had chronic RAD). This effect was stable across all observed muscle ROIs, with a false discovery rate-corrected p < 0.05, for all dose/muscle/age models, suggesting that including age as a covariate improves modeling of chronic RAD. Conclusions: Age at treatment moderates the probability of chronic RAD after chemo-IMRT for OPSCC, with aging muscles showing lower dose thresholds. Uniform dose constraints may not predict toxicity in older patients.
AB - Objectives: We sought to model chronic radiation-associated dysphagia (RAD) in patients given intensity-modulated radiation therapy (IMRT) for oropharyngeal squamous cell cancer (OPSCC) as a function of age and dose to non-target swallowing muscles. Methods: We reviewed 300 patients with T1-T4 N0-3 M0 OPSCC given definitive IMRT with concurrent chemotherapy. Chronic RAD was defined as aspiration or stricture on videoflouroscopy/endoscopy, gastrostomy tube, or aspiration pneumonia at ≥12 months after IMRT. Doses to autosegmented regions of interest (ROIs; inferior, middle and superior constrictors, anterior and posterior digastrics, mylo/geniohyoid complex, intrinsic tongue, and gengioglossus) were obtained from DICOM-RT plans and dose-volume histograms. The probability of chronic RAD as a function of mean ROI dose, stratified by age (<50, 50–59, 60–69, or ≥70 years), was estimated with logistic probability models and subsequent unsupervised nonlinear curves. Results: Chronic RAD was observed in 34 patients (11%). Age was a significant correlate of chronic RAD, both independently and with dose for all muscle groups examined. Distinct muscle-specific dose–response profiles were observed as a function of age (e.g., 5% of patients in their 50 s [but 20% of those 70 + ] who received 60 Gy to the superior constrictor had chronic RAD). This effect was stable across all observed muscle ROIs, with a false discovery rate-corrected p < 0.05, for all dose/muscle/age models, suggesting that including age as a covariate improves modeling of chronic RAD. Conclusions: Age at treatment moderates the probability of chronic RAD after chemo-IMRT for OPSCC, with aging muscles showing lower dose thresholds. Uniform dose constraints may not predict toxicity in older patients.
KW - IMRT
KW - Oropharynx
KW - Presbyphagia
KW - Radiation
KW - Toxicity
UR - http://www.scopus.com/inward/record.url?scp=85071353331&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071353331&partnerID=8YFLogxK
U2 - 10.1016/j.ctro.2019.06.005
DO - 10.1016/j.ctro.2019.06.005
M3 - Article
C2 - 31341972
AN - SCOPUS:85071353331
SN - 2405-6308
VL - 18
SP - 16
EP - 22
JO - Clinical and Translational Radiation Oncology
JF - Clinical and Translational Radiation Oncology
ER -