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Dysphagia after definitive radiotherapy for head and neck cancer

Correlation of dose–volume parameters of the pharyngeal constrictor muscles

Dysphagie nach Strahlentherapie bei Kopf-Hals-Tumoren

Korrelation von Dosis-Volumen-Parametern der Schlundschnürer

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Abstract

Background

Dysphagia is a complication of head and neck cancer patients undergoing radiotherapy (RT). We analysed frequency and severity of swallowing dysfunction and correlated these findings with dose–volume histograms (DVHs) of the pharyngeal constrictor muscles.

Methods

A total of 50 patients treated by radical RT were enrolled. DVHs of constrictor muscles were correlated with acute and late dysphagia and with the items of three quality of life questionnaires.

Results

Mean dose to superior and middle constrictor muscles (SCM, MCM), partial volume of SCM and MCM receiving a dose ≥ 50 Gy dose to the whole constrictor muscles ≥ 60 Gy and tumour location were associated to late dysphagia at univariate analysis. Mean dose to the MCM was the only statistically significant predictor of late dysphagia at the multivariable analysis.

Conclusion

The study shows a significant relationship between long-term dysphagia and mean doses to SCM, MCM, whole constrictor muscles, and oropharyngeal tumour. This finding suggests a potential advantage in reducing the RT dose to swallowing structures to avoid severe dysphagia.

Zusammenfassung

Hintergrund

Dysphagie ist eine Komplikation, die mit Strahlentherapie (RT) behandelte Kopf-Hals-Tumor-Patienten betrifft. Es wurden die Frequenz und das Ausmaß der Schluckbeschwerden analysiert und die Ergebnisse mit den Dosis-Volumen-Histogrammen (DVHs) der Schlundschnürer korreliert.

Material und Methode

In die Studie wurden 50 Patienten aufgenommen, die mit radikaler RT behandelt wurden. Die DVHs der Schlundschnürer wurden mit der Dysphagie als Akut- bzw. Spätnebenwirkung und mit den Informationen aus drei Fragebögen zur Lebensqualität korreliert.

Ergebnisse

Bei der univariaten Analyse wiesen die von dem oberen und mittleren Schlundschnürer (M. constrictor pharingis superior und M. constrictor pharingis medius) erhaltene mittlere Bestrahlungsdosis, der Volumenanteil dieser beiden Schlundschnürer mit einer Bestrahlungsdosis ≥ 50 Gy, die Bestrahlungsdosis ≥ 60 Gy an den Schlundschnürern insgesamt und die Tumorlage eine Beziehung zum Auftreten einer Dysphagie als Spätnebenwirkung auf. Bei der multivariaten Analyse war die von dem mittleren Schlundschnürer erhaltene mittlere Bestrahlungsdosis der einzige statistisch signifikante prädiktive Faktor für eine Dysphagie als Spätnebenwirkung.

Schlussfolgerung

Die Studie zeigte eine signifikante Beziehung zwischen Langzeitdysphagie und den mittleren Bestrahlungsdosen des oberen und mittleren Schlundschnürers sowie der Schlundschnürer insgesamt. Diese Ergebnisse legen den potenziellen Vorteil einer reduzierten Bestrahlungsdosis an den am Schluckvorgang beteiligten Strukturen zur Vermeidung einer schweren Dysphagie nahe.

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Acknowledgement

The authors thank Ms. Nicoletta Negri for the support in the preparation of the manuscript.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Radiotherapy, University Hospital “Maggiore della Carità”, via Solaroli, 17, 28100, Novara, Italy

    L. Deantonio MD, L. Masini MD & M. Krengli MD

  2. Medical Physics, University Hospital “Maggiore della Carità”, Novara, Italy

    M. Brambilla PhD

  3. Otolaryngology, University Hospital “Maggiore della Carità”, Novara, Italy

    F. Pia MD

  4. Department of Medical Sciences, University of “Piemonte Orientale”, Novara, Italy

    F. Pia MD

  5. Department of Translational Medicine and BRMA, University of “Piemonte Orientale”, via Solaroli, 17, 28100, Novara, Italy

    M. Krengli MD

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  1. L. Deantonio MD
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  2. L. Masini MD
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  3. M. Brambilla PhD
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  4. F. Pia MD
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  5. M. Krengli MD
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Correspondence to M. Krengli MD.

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Deantonio, L., Masini, L., Brambilla, M. et al. Dysphagia after definitive radiotherapy for head and neck cancer. Strahlenther Onkol 189, 230–237 (2013). https://doi.org/10.1007/s00066-012-0288-8

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  • DOI: https://doi.org/10.1007/s00066-012-0288-8

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