Late radiation-associated dysphagia (late-RAD) with lower cranial neuropathy after oropharyngeal radiotherapy: A preliminary dosimetric comparison

Musaddiq J. Awan, Abdallah S R Mohamed, Jan S. Lewin, Charles A. Baron, G. Brandon Gunn, David I. Rosenthal, F. Christopher Holsinger, David L. Schwartz, Clifton D. Fuller, Katherine A. Hutcheson

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34 Scopus citations

Abstract

Background and objectives Late radiation-associated dysphagia (late-RAD) is a rare delayed toxicity, in oropharyngeal cancer (OPC) survivors. Prevention of late-RAD is paramount because the functional impairment can be profound and refractory to standard therapies. The objective of this analysis is to identify candidate dosimetric predictors of late-RAD and associated lower cranial neuropathies after radiotherapy (RT) or chemo-RT (CRT) for OPC. Materials and methods An unmatched retrospective case-control analysis was conducted. Late-RAD cases were identified among OPC patients treated with definitive RT or CRT. Controls were selected with minimum of 6 years without symptoms of late-RAD. Dysphagia-aspiration related structures (DARS) and regions of interest containing cranial nerve paths (RCCNPs) were retrospectively contoured. Dose volume histograms were calculated. Non-parametric bivariate associations were analyzed with Bonferroni correction and multiple logistic regression models were fit. Results Thirty-eight patients were included (12 late-RAD cases, 26 controls). Median latency to late-RAD was 5.8 years (range: 4.5-11.3 years). Lower cranial neuropathies were present in 10 of 12 late-RAD cases. Mean superior pharyngeal constrictor (SPC) dose was higher in cases relative to controls (median: 70.5 vs. 61.6 Gy). Mean SPC dose significantly predicted late-RAD (p = 0.036) and related cranial neuropathies (p = 0.019). RCCNPs did not significantly predict late-RAD or cranial neuropathies. Conclusions SPC dose may predict for late-RAD and related lower cranial neuropathies. These data, and those of previous studies that have associated SPC dose with classical dysphagia endpoints, suggest impetus to constrain dose to the SPCs when possible.

Original languageEnglish (US)
Pages (from-to)746-752
Number of pages7
JournalOral Oncology
Volume50
Issue number8
DOIs
StatePublished - Aug 2014

Keywords

  • Dysphagia
  • Oropharyngeal cancer
  • Pharyngeal constrictors
  • Quality-of-life
  • Radiotherapy

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

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    Awan, M. J., Mohamed, A. S. R., Lewin, J. S., Baron, C. A., Gunn, G. B., Rosenthal, D. I., Holsinger, F. C., Schwartz, D. L., Fuller, C. D., & Hutcheson, K. A. (2014). Late radiation-associated dysphagia (late-RAD) with lower cranial neuropathy after oropharyngeal radiotherapy: A preliminary dosimetric comparison. Oral Oncology, 50(8), 746-752. https://doi.org/10.1016/j.oraloncology.2014.05.003