Radiation-induced long-term dysphagia in survivors of head and neck cancer and association with dose-volume parameters

Thuy-Tien Maria Huynh; Einar Dale; Ragnhild Sørum Falk; Taran Paulsen Hellebust; Guro Lindviksmoen Astrup; Eirik Malinen; Nina Frederike Jeppesen Edin; Kristin Bjordal; Bente Brokstad Herlofson; Cecilie Essholt Kiserud; Åslaug Helland; Cecilie Delphin Amdal

doi:10.1016/j.radonc.2023.110044

Radiation-induced long-term dysphagia in survivors of head and neck cancer and association with dose-volume parameters

Radiother Oncol. 2024 Jan:190:110044. doi: 10.1016/j.radonc.2023.110044. Epub 2023 Dec 5.

Affiliations

¹ Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway. Electronic address: thuhuy@ous-hf.no.
² Department of Oncology, Oslo University Hospital, Oslo, Norway.
³ Research support services, Oslo University Hospital, Oslo, Norway.
⁴ Department of Physics, University of Oslo, Oslo, Norway; Department of Medical Physics, Oslo University Hospital, Oslo, Norway.
⁵ Department of Physics, University of Oslo, Oslo, Norway.
⁶ Faculty of Medicine, University of Oslo, Oslo, Norway; Research support services, Oslo University Hospital, Oslo, Norway.
⁷ Faculty of Dentistry, University of Oslo, Oslo, Norway; Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway.
⁸ Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway.
⁹ Department of Oncology, Oslo University Hospital, Oslo, Norway; Research support services, Oslo University Hospital, Oslo, Norway.

PMID: 38061420
DOI: 10.1016/j.radonc.2023.110044

Abstract

Background: Although dysphagia is a common side effect after radiotherapy (RT) of head and neck cancer (HNC), data on long-term dysphagia is scarce. We aimed to 1) compare radiation dose parameters in HNC survivors with and without dysphagia, 2) investigate factors associated with long-term dysphagia and its possible impact on health-related quality of life (HRQoL), and 3) investigate how our data agree with existing NTCP models.

Methods: This cross-sectional study conducted in 2018-2020, included HNC survivors treated in 2007-2013. Participants attended a one-day examination in hospital and filled in patient questionnaires. Dysphagia was measured with the EORTC QLQ-H&N35 swallowing scale. Toxicity was scored with CTCAE v.4. We contoured swallowing organs at risk (SWOAR) on RT plans, calculated dose-volume histograms (DVHs), performed logistic regression analyses and tested our data in established NTCP models.

Results: Of the 239 participants, 75 (31%) reported dysphagia. Compared to survivors without dysphagia, this group had reduced HRQoL and the DVHs for infrahyoid SWOAR were significantly shifted to the right. Long-term dysphagia was associated with age (OR 1.07, 95% CI 1.03-1.10), female sex (OR 2.75, 95% CI 1.45-5.21), and mean dose to middle pharyngeal constrictor muscle (MD-MPCM) (OR 1.06, 95% CI 1.03-1.09). NTCP models overall underestimated the risk of long-term dysphagia.

Conclusions: Long-term dysphagia was associated with higher age, being female, and high MD-MPCM. Doses to distally located SWOAR seemed to be risk factors. Existing NTCP models do not sufficiently predict long-term dysphagia. Further efforts are needed to reduce the prevalence and consequences of this late effect.

Keywords: Cancer Survivors; Deglutition Disorders; Head and Neck Neoplasms; Long-term Adverse Effects; Patient Reported Outcome Measures; Radiotherapy.

MeSH terms

Cross-Sectional Studies
Deglutition / radiation effects
Deglutition Disorders* / epidemiology
Deglutition Disorders* / etiology
Female
Head and Neck Neoplasms* / radiotherapy
Humans
Male
Quality of Life