Mona Kamal1, Abdallah S R Mohamed2, Stefania Volpe3, Jhankruti Zaveri4, Martha Portwood Barrow4, G Brandon Gunn5, Stephen Y Lai5, Renata Ferrarotto6, Jan S Lewin4, David I Rosenthal5, Amit Jethanandani7, Mohamed Ahmed Mohamed Meheissen8, Samuel L Mulder5, Carlos E Cardenas9, Clifton D Fuller10, Katherine A Hutcheson11. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Thoracic/Head and Neck Medical Oncology; The University of Texas MD Anderson Cancer Center, Houston, USA. 2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt; MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, USA. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; University of Milan, Department of Oncology and Hemato-Oncology, Italy. 4. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA. 5. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 6. Department of Thoracic/Head and Neck Medical Oncology; The University of Texas MD Anderson Cancer Center, Houston, USA. 7. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; The University of Tennessee Health Science Center, College of Medicine, Memphis, USA. 8. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 9. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA. 10. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, USA. Electronic address: cdfuller@mdanderson.org. 11. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: KArnold@mdanderson.org.
Abstract
PURPOSE: Our primary aim was to prospectively validate retrospective dose-response models of chronic radiation-associated dysphagia (RAD) after intensity modulated radiotherapy (IMRT) for oropharyngeal cancer (OPC). The secondary aim was to validate a grade ≥2 cut-point of the published videofluoroscopic dysphagia severity (Dynamic Imaging Grade for Swallowing Toxicity, DIGEST) as radiation dose-dependent. MATERIAL AND METHODS: Ninety-seven patients enrolled on an IRB-approved prospective registry protocol with stage I-IV OPC underwent pre- and 3-6 month post-RT videofluoroscopy. Dose-volume histograms (DVH) for swallowing regions of interest (ROI) were calculated. Dysphagia severity was graded per DIGEST criteria (dichotomized with grade ≥2 as moderate/severe RAD). Recursive partitioning analysis (RPA) and Bayesian Information Criteria (BIC) were used to identify dose-volume effects associated with moderate/severe RAD. RESULTS: 31% developed moderate/severe RAD (i.e. DIGEST grade ≥2) at 3-6 months after RT. RPA found DVH-derived dosimetric parameters of geniohyoid/mylohyoid (GHM), superior pharyngeal constrictor (SPC), and supraglottic region were associated with DIGEST grade ≥2 RAD. V61 ≥ 18.57% of GHM demonstrated optimal model performance for prediction of DIGEST grade ≥2. CONCLUSION: The findings from this prospective longitudinal registry validate prior observations that dose to submental musculature predicts for increased burden of dysphagia after oropharyngeal IMRT. Findings also support dichotomization of DIGEST grade ≥2 as a dose-dependent split for use as an endpoint in trials or predictive dose-response analysis of videofluoroscopy results.
PURPOSE: Our primary aim was to prospectively validate retrospective dose-response models of chronic radiation-associated dysphagia (RAD) after intensity modulated radiotherapy (IMRT) for oropharyngeal cancer (OPC). The secondary aim was to validate a grade ≥2 cut-point of the published videofluoroscopic dysphagia severity (Dynamic Imaging Grade for Swallowing Toxicity, DIGEST) as radiation dose-dependent. MATERIAL AND METHODS: Ninety-seven patients enrolled on an IRB-approved prospective registry protocol with stage I-IV OPC underwent pre- and 3-6 month post-RT videofluoroscopy. Dose-volume histograms (DVH) for swallowing regions of interest (ROI) were calculated. Dysphagia severity was graded per DIGEST criteria (dichotomized with grade ≥2 as moderate/severe RAD). Recursive partitioning analysis (RPA) and Bayesian Information Criteria (BIC) were used to identify dose-volume effects associated with moderate/severe RAD. RESULTS: 31% developed moderate/severe RAD (i.e. DIGEST grade ≥2) at 3-6 months after RT. RPA found DVH-derived dosimetric parameters of geniohyoid/mylohyoid (GHM), superior pharyngeal constrictor (SPC), and supraglottic region were associated with DIGEST grade ≥2 RAD. V61 ≥ 18.57% of GHM demonstrated optimal model performance for prediction of DIGEST grade ≥2. CONCLUSION: The findings from this prospective longitudinal registry validate prior observations that dose to submental musculature predicts for increased burden of dysphagia after oropharyngeal IMRT. Findings also support dichotomization of DIGEST grade ≥2 as a dose-dependent split for use as an endpoint in trials or predictive dose-response analysis of videofluoroscopy results.
Authors: Charles S Mayo; Michelle Mierzwa; Jean M Moran; Martha M Matuszak; Joel Wilkie; Grace Sun; John Yao; Grant Weyburn; Carlos J Anderson; Dawn Owen; Arvind Rao Journal: Adv Radiat Oncol Date: 2020-01-12
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