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Dysphagia - Results from multivariable predictive modelling on aspiration from a subset of the ARTSCAN trial
Umeå University, Faculty of Medicine, Department of Radiation Sciences.
Umeå University, Faculty of Medicine, Department of Radiation Sciences.
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2016 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: To establish predictive models for late objective aspiration and late patient-reported choking based on dose-volume parameters and baseline patient and treatment characteristics, for patients with head and neck cancer undergoing definitive radiotherapy (RT). The impact of electively treated volume on late aspiration was also investigated.

METHODS AND MATERIAL: This prospective cohort is a subsample of 124 survivors from the ARTSCAN study. Late aspiration was identified with videofluoroscopy, at a minimum of 25months after the start of RT. Patient-reported choking was analysed at 12 and 60months post RT using the EORTC Quality of Life Module for Head and Neck Cancer 35. Univariable and multivariable analyses were performed to describe the association between clinical factors and dose-volume descriptors for organs at risk (OARs) and late dysphagia.

RESULTS: Aspiration was found in 47% of the eligible patients. Mean dose to the middle pharyngeal constrictor (MPC), neck dissection post RT and age at randomisation in ARTSCAN were associated to late aspiration. Mean dose to the superior pharyngeal constrictor (SPC) and swallowing complaints at baseline were associated to patient reported choking at both time-points.

CONCLUSIONS: Three separate risk groups for late aspiration, and two risk groups for late patient-reported choking were identified based on number of risk factors. The size of the electively treated volume could be used as a surrogate for individual OARs predicting late aspiration.

Place, publisher, year, edition, pages
2016.
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-126877DOI: 10.1016/j.radonc.2016.09.001PubMedID: 27687824OAI: oai:DiVA.org:umu-126877DiVA: diva2:1038536
Available from: 2016-10-18 Created: 2016-10-18 Last updated: 2017-02-02
In thesis
1. Radiotherapy for head and neck cancer: costs and benefits of time, dose and volume
Open this publication in new window or tab >>Radiotherapy for head and neck cancer: costs and benefits of time, dose and volume
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Radioterapi för huvud-, halscancer : risk och nytta av tid, dos och volym
Abstract [en]

Background In the treatment of head and neck cancers (HNCs), radiotherapy (RT) has the advantage of organ preservation compared to surgery. However, treatment toxicities associated with RT can affect important functions for everyday life, both in the acute and late stage. RT to macroscopic tumour in HNC is commonly combined with elective RT to cervical lymph nodes at risk of microscopic involvement. The resulting risk reduction of the elective treatment based on dose-volume parameters is sparsely evaluated. So is the relationship between the elective treatment and treatment toxicity. The present thesis addresses these aspects.

A strategy aimed at improving the outcome of RT is accelerated fractionation (AF). AF strives to shorten total treatment time to minimise proliferation of the tumour tissue during the RT period. We have investigated the impact of AF on both disease control and toxicity.

Methods In the ARTSCAN study, 750 patients with localised HNC were randomised between AF (68 Gy in 4.5 weeks) and conventional fractionation (CF) (68 Gy in 7 weeks). The elective treatment volume was prescribed 46 Gy with CF in both treatment arms. The thesis is based on four individual papers, investigating the issues above in the whole study population or in sub-populations.

Results No difference in disease control or late toxicity between CF and AF was observed at five years. However, there was an increased acute toxicity with AF. Weight loss was associated with treatment volume, independent of tumour stage. The elective treatment volume was found to be an independent risk factor for late aspiration, as well as mean dose to the pharyngeal constrictor muscles, neck dissection, and age at randomisation. There was a significant risk reduction for node relapses in volumes treated to an elective dose. Only a relapse in volumes treated to >60 Gy affected the survival.

Conclusion The present thesis questions the benefit of AF in definitive RT as well as extensive elective treatment of the cervical nodes.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2017. 29 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1880
Keyword
radiotherapy, head and neck cancer, adjuvant treatment, accelerated fractionation
National Category
Cancer and Oncology
Research subject
Biomedical Radiation Science
Identifiers
urn:nbn:se:umu:diva-131021 (URN)978-91-7601-646-6 (ISBN)
Public defence
2017-02-24, Sal 933, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
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Available from: 2017-02-03 Created: 2017-02-02 Last updated: 2017-02-02Bibliographically approved

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Söderström, KarinZackrisson, BjörnLevring Jäghagen, Eva
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