Dysphagia-Optimized Intensity-Modulated Radiotherapy versus Standard Intensity-Modulated Radiotherapy in Head and Neck Cancer Patients

Abstract

Author(s): Sara M El-badawy*, Nehal Elmashad, Rasha Khedr and Fatma Zakaria

Purpose: Improving the functional outcomes of head and neck cancer (HNC) patients is pivotal, as healthier patients are increasingly cured with concurrent chemo-radiotherapy (CCRT), with a real risk of pharyngeal cripples. Current evidence confirms that a significant relationship exists between pharyngeal constrictor muscle (PCM) radiation and persistent dysphagia. Therefore, our study was to determine if reducing the radiation dose to the PCM via DO-IMRT (dysphagia optimized), which would improve swallowing compared with S-IMRT (standard) and to investigate the longitudinal pattern of swallowing function post radiotherapy via the MDADI (MD Anderson dysphagia inventory). Methods and Materials: This prospective, parallel, single-blinded, randomized controlled study included patients who underwent definitive CCRT for pathologically confirmed HNC (squamous cell carcinoma). Evaluations were conducted up to 6 months following treatment, in addition to the basal assessment. Radiological assessment was requested after radiotherapy, and Response Evaluation Criteria in Solid Tumors (RECIST) were applied. Results: Dysphagia as a toxicity measured by CTCAE was significantly lower in the DO-IMRT, which improved at 6 months better than the base line assessment. The MDADI longitudinal scores of DO-IMRT tended to significantly improve, with a mean difference of 27% in swallowing function and a persistent effect at the 6-month assessment. The response assessment revealed no significant P value. Conclusions: We concluded that DO-IMRT is superior in preserving swallowing function over S-IMRT; and has a positive impact on QOL in HNC survivors.

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