D Alterio1, M A Gerardi2, L Cella3, R Spoto2,4, V Zurlo5, A Sabbatini6, C Fodor2, V D'Avino3, M Conson3, F Valoriani6, D Ciardo2, R Pacelli3,7, A Ferrari2, P Maisonneuve8, L Preda9, R Bruschini5, M Cossu Rocca10, E Rondi11, S Colangione2, G Palma3, S Dicuonzo2,4, R Orecchia12, G Sanguineti13, B A Jereczek-Fossa2,4. 1. Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. daniela.alterio@ieo.it. 2. Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. 3. Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy. 4. Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy. 5. Division of Head and Neck Surgery, European Institute of Oncology, Milan, Italy. 6. Dietetic and Clinical Nutrition Unit, European Institute of Oncology, Milan, Italy. 7. Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy. 8. Department of Epidemiology and Statistics, European Institute of Oncology, Milan, Italy. 9. Department of Radiology, European Institute of Oncology, Milan, Italy. 10. Division of Urogenital and Head and Neck Tumors, Department of Medical Oncology, European Institute of Oncology, Milan, Italy. 11. Unit of Medical Physics, European Institute of Oncology, Milan, Italy. 12. Scientific Directorate, European Institute of Oncology, Milan, Italy. 13. Istituto Tumori Regina Elena, Rome, Italy.
Abstract
PURPOSE: Acute toxicity in head and neck (H&N) cancer patients treated with definitive radiotherapy (RT) has a crucial role in compliance to treatments. The aim of this study was to correlate doses to swallowing-associated structures and acute dysphagia. METHODS: We prospectively analyzed 42 H&N cancer patients treated with RT. Dysphagia (grade ≥ 3) and indication for percutaneous endoscopic gastrostomy (PEG) insertion were classified as acute toxicity. Ten swallowing-related structures were considered for the dosimetric analysis. The correlation between clinical information and the dose absorbed by the contoured structures was analyzed. Multivariate logistic regression method using resampling methods (bootstrapping) was applied to select model order and parameters for normal tissue complication probability (NTCP) modelling. RESULTS: A strong multiple correlation between dosimetric parameters was found. A two-variable model was suggested as the optimal order by bootstrap method. The optimal model (Rs = 0.452, p < 0.001) includes V45 of the cervical esophagus (odds ratio [OR] = 1.016) and Dmean of the cricopharyngeal muscle (OR = 1.057). The model area under the curve was 0.82 (95% confidence interval 0.69-0.95). CONCLUSION: Our results suggested that the absorbed dose to the cricopharyngeal muscle and cervical esophagus might play a relevant role in the development of acute RT-related dysphagia.
PURPOSE: Acute toxicity in head and neck (H&N) cancerpatients treated with definitive radiotherapy (RT) has a crucial role in compliance to treatments. The aim of this study was to correlate doses to swallowing-associated structures and acute dysphagia. METHODS: We prospectively analyzed 42 H&N cancerpatients treated with RT. Dysphagia (grade ≥ 3) and indication for percutaneous endoscopic gastrostomy (PEG) insertion were classified as acute toxicity. Ten swallowing-related structures were considered for the dosimetric analysis. The correlation between clinical information and the dose absorbed by the contoured structures was analyzed. Multivariate logistic regression method using resampling methods (bootstrapping) was applied to select model order and parameters for normal tissue complication probability (NTCP) modelling. RESULTS: A strong multiple correlation between dosimetric parameters was found. A two-variable model was suggested as the optimal order by bootstrap method. The optimal model (Rs = 0.452, p < 0.001) includes V45 of the cervical esophagus (odds ratio [OR] = 1.016) and Dmean of the cricopharyngeal muscle (OR = 1.057). The model area under the curve was 0.82 (95% confidence interval 0.69-0.95). CONCLUSION: Our results suggested that the absorbed dose to the cricopharyngeal muscle and cervical esophagus might play a relevant role in the development of acute RT-related dysphagia.
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