Contemporary swallowing outcome for oropharynx carcinoma following definitive VMAT (chemo)radiotherapy
Ganderton, D. Lang, J. Lee, Lip W McPartlin, Andrew J
Ganderton, D.
Lang, J.
Lee, Lip W
McPartlin, Andrew J
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Abstract
Introduction: Increasingly conformal radiotherapy with smaller
treatment volumes has reduced acute and late toxicity following
treatment for head and neck SCC (HNSCC). Limited prospective data on
toxicity for unselected patients receiving modern therapy outside of
the trial setting is published. We report swallow outcome for
oropharynx cancer following definitive (CT)RT up to three years post treatment and assess the effect of evolving radiotherapy practice over
the period.
Materials and Methods: A Speech and Language Specialist performed MDADI and PSS normalcy of diet at baseline and when
followed up at 3–6 months, 12 months and 36 months (if patients
three years post treatment at time of analysis) for oropharynx patients
referred for definitive (CT)RT from Mar 2016- Jan 2020 from a single
MDT. Photon radiotherapy was delivered via a VMAT technique to a
dose of 66 Gy in 30 fractions, plus chemotherapy when indicated
according to international practice. Initially treatment volumes
routinely included GTV + 1 cm to high dose and entire oropharynx
to intermediate/low dose. Over time standard volumes reduced to an
expansion of 0.5–1 cm from GTV to form high dose CTV and no subsite irradiation. Patients with a previous HNSCC or who recurred
following treatment were excluded from analysis. Wilcoxon rank sum
test was applied to test swallow outcome for patients treated with or
without sub-site irradiation.
Results: 117 patients were identified. 16 patients relapsed during
follow up and were excluded from analysis. Median age was 59 (range
30–81), 77% male, 88% PS0–1, 69% current or ex- smokers. 90% had
stage III-IV disease and CTRT was received by 75%. 4% of patient
required a RIG prior to therapy and 51% received a reactive NG tube
during therapy. At baseline, 3–6 months, 12 months and 36 months
MDADI and PSS scores were 79, 67, 76, 88 and 88, 65, 77, 84
respectively. RIG dependency at 1 year was 2.8% (reasons: 1 aspiration,
1 severe dysguesia, 1 severe xerostomia), and 0% in the minority of
patients with 3 year assessment performed. Sub-site irradiation was
associated with an 18 point lower PSS (p = 0.02) and 9 point lower
MDADI score (p = 0.09) at 3–6 months. Swallow function at 1 year was
not clinically or statistically different between treatment methods.
Conclusions: Modern radiotherapy achieves excellent functional
outcomes in an unselected patient population, predominantly with
advanced disease treated with CTRT. Omitting sub-site irradiation was
associated with improved swallow recovery at 3–6 months but no
difference persisted at one year. Longer follow up is required to
characterise late swallow function post radiotherapy.
Affiliation
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Ganderton D, Lang J, Lee LW, McPartlin A. Contemporary swallowing outcome for oropharynx carcinoma following definitive VMAT (chemo)radiotherapy. Oral Oncology. 2021;118.