Miranda E M C Christianen1, Irma M Verdonck-de Leeuw2, Patricia Doornaert3, Olga Chouvalova1, Roel J H M Steenbakkers1, Phil W Koken3, C René Leemans2, Sjoukje F Oosting4, Jan L N Roodenburg5, Bernard F A M van der Laan6, Ben J Slotman3, Hendrik P Bijl1, Johannes A Langendijk7. 1. Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands. 2. Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center Amsterdam, The Netherlands. 3. Department of Radiation Oncology, VU University Medical Center Amsterdam, The Netherlands. 4. Department of Medical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands. 5. Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands. 6. Department of Otolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, The Netherlands. 7. Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands. Electronic address: j.a.langendijk@umcg.nl.
Abstract
OBJECTIVES: To identify patterns of long-term, radiation-induced swallowing dysfunction after definitive radiotherapy with or without chemotherapy (RT or CHRT) and to determine which factors may explain these patterns over time. MATERIAL AND METHODS: The study population consisted of 238 consecutive head and neck cancer patients treated with RT or CHRT. The primary endpoint was ⩾grade 2 swallowing dysfunction at 6, 12, 18 and 24months after treatment. Cluster analysis was used to identify different patterns over time. The differences between the mean dose to the swallowing organs at risk for each pattern were determined by using dose maps. RESULTS: The cluster analysis revealed five patterns of swallowing dysfunction: low persistent, intermediate persistent, severe persistent, transient and progressive. Patients with high dose to the upper pharyngeal, laryngeal and lower pharyngeal region had the highest risk of severe persistent swallowing dysfunction. Transient problems mainly occurred after high dose to the laryngeal and lower pharyngeal regions, combined with moderate dose to the upper pharyngeal region. The progressive pattern was mainly seen after moderate dose to the upper pharyngeal region. CONCLUSIONS: Various patterns of swallowing dysfunction after definitive RT or CHRT can be identified over time. This could reflect different underlying biological processes.
OBJECTIVES: To identify patterns of long-term, radiation-induced swallowing dysfunction after definitive radiotherapy with or without chemotherapy (RT or CHRT) and to determine which factors may explain these patterns over time. MATERIAL AND METHODS: The study population consisted of 238 consecutive head and neck cancerpatients treated with RT or CHRT. The primary endpoint was ⩾grade 2 swallowing dysfunction at 6, 12, 18 and 24months after treatment. Cluster analysis was used to identify different patterns over time. The differences between the mean dose to the swallowing organs at risk for each pattern were determined by using dose maps. RESULTS: The cluster analysis revealed five patterns of swallowing dysfunction: low persistent, intermediate persistent, severe persistent, transient and progressive. Patients with high dose to the upper pharyngeal, laryngeal and lower pharyngeal region had the highest risk of severe persistent swallowing dysfunction. Transient problems mainly occurred after high dose to the laryngeal and lower pharyngeal regions, combined with moderate dose to the upper pharyngeal region. The progressive pattern was mainly seen after moderate dose to the upper pharyngeal region. CONCLUSIONS: Various patterns of swallowing dysfunction after definitive RT or CHRT can be identified over time. This could reflect different underlying biological processes.
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