Chronic radiation-associated dysphagia in oropharyngeal cancer survivors: Towards age-adjusted dose constraints for deglutitive muscles

Kaitlin M Christopherson; Guadalupe Canahuate; Alokananda Ghosh; Abdallah Sherif Radwan Mohamed; Mona Kamal; G. Brandon Gunn; Timothy Dale; Jayashree Kalpathy-Cramer; Jay Messer; Adam S Garden; Hesham Elhalawani; Steven J Frank; Jan Lewin; William H Morrison; Jack Phan; Neil Gross; Renata Ferrarotto; Randal S Weber; David I Rosenthal; Stephen Y Lai; Katherine Hutcheson; Clifton David Fuller; G. Elisabeta (Liz) Marai; David M Vock; David Fuller; Spatial-Non-spatial Multi-Dimensional Analysis of Radiotherapy Treatment/Toxicity Team (SMART3)

doi:10.1016/j.ctro.2019.06.005

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Chronic radiation-associated dysphagia in oropharyngeal cancer survivors: Towards age-adjusted dose constraints for deglutitive muscles

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Chronic radiation-associated dysphagia in oropharyngeal cancer survivors: Towards age-adjusted dose constraints for deglutitive muscles

Kaitlin M Christopherson, Guadalupe Canahuate, Alokananda Ghosh, Abdallah Sherif Radwan Mohamed, Mona Kamal, G. Brandon Gunn, Timothy Dale, Jayashree Kalpathy-Cramer, Jay Messer, Adam S Garden, …

Clinical and translational radiation oncology, Vol.18, pp.16-22

09/2019

DOI: 10.1016/j.ctro.2019.06.005

PMCID: PMC6610668

PMID: 31341972

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Abstract

•Age at treatment for OPSCC is a strong predictor of chronic radiation associated dysphagia (RAD).•For swallowing regions of interest (ROIs), dose to ROI and age impact patients’ risk of chronic RAD.•For patients at high risk for RAD more intense prophylactic swallowing therapies may be warranted. We sought to model chronic radiation-associated dysphagia (RAD) in patients given intensity-modulated radiation therapy (IMRT) for oropharyngeal squamous cell cancer (OPSCC) as a function of age and dose to non-target swallowing muscles. We reviewed 300 patients with T1-T4 N0-3 M0 OPSCC given definitive IMRT with concurrent chemotherapy. Chronic RAD was defined as aspiration or stricture on videoflouroscopy/endoscopy, gastrostomy tube, or aspiration pneumonia at ≥12 months after IMRT. Doses to autosegmented regions of interest (ROIs; inferior, middle and superior constrictors, anterior and posterior digastrics, mylo/geniohyoid complex, intrinsic tongue, and gengioglossus) were obtained from DICOM-RT plans and dose-volume histograms. The probability of chronic RAD as a function of mean ROI dose, stratified by age (<50, 50–59, 60–69, or ≥70 years), was estimated with logistic probability models and subsequent unsupervised nonlinear curves. Chronic RAD was observed in 34 patients (11%). Age was a significant correlate of chronic RAD, both independently and with dose for all muscle groups examined. Distinct muscle-specific dose–response profiles were observed as a function of age (e.g., 5% of patients in their 50 s [but 20% of those 70 + ] who received 60 Gy to the superior constrictor had chronic RAD). This effect was stable across all observed muscle ROIs, with a false discovery rate-corrected p < 0.05, for all dose/muscle/age models, suggesting that including age as a covariate improves modeling of chronic RAD. Age at treatment moderates the probability of chronic RAD after chemo-IMRT for OPSCC, with aging muscles showing lower dose thresholds. Uniform dose constraints may not predict toxicity in older patients.

IMRT

Oropharynx

Presbyphagia

Radiation

Toxicity

Details

Title: Subtitle: Chronic radiation-associated dysphagia in oropharyngeal cancer survivors: Towards age-adjusted dose constraints for deglutitive muscles
Creators: Kaitlin M Christopherson - The University of Texas MD Anderson Cancer Center
Guadalupe Canahuate - University of Iowa
Alokananda Ghosh - Department of Biostatistics and Data Science, University of Texas School of Public Health, Houston, TX, USA
Abdallah Sherif Radwan Mohamed - The University of Texas MD Anderson Cancer Center
Mona Kamal - Department of Clinical Oncology, University of Alexandria, Alexandria, Egypt
G. Brandon Gunn - The University of Texas MD Anderson Cancer Center
Timothy Dale - The University of Texas MD Anderson Cancer Center
Jayashree Kalpathy-Cramer - Massachusetts General Hospital
Jay Messer - The University of Texas MD Anderson Cancer Center
Adam S Garden - The University of Texas MD Anderson Cancer Center
Hesham Elhalawani - The University of Texas MD Anderson Cancer Center
Steven J Frank - The University of Texas MD Anderson Cancer Center
Jan Lewin - The University of Texas MD Anderson Cancer Center
William H Morrison - The University of Texas MD Anderson Cancer Center
Jack Phan - The University of Texas MD Anderson Cancer Center
Neil Gross - The University of Texas MD Anderson Cancer Center
Renata Ferrarotto - The University of Texas MD Anderson Cancer Center
Randal S Weber - The University of Texas MD Anderson Cancer Center
David I Rosenthal - The University of Texas MD Anderson Cancer Center
Stephen Y Lai - The University of Texas MD Anderson Cancer Center
Katherine Hutcheson - The University of Texas MD Anderson Cancer Center
Clifton David Fuller - The University of Texas MD Anderson Cancer Center
G. Elisabeta (Liz) Marai - University of Illinois Chicago
David M Vock - Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA
David Fuller - The University of Texas MD Anderson Cancer Center
Spatial-Non-spatial Multi-Dimensional Analysis of Radiotherapy Treatment/Toxicity Team (SMART3)
Resource Type: Journal article
Publication Details: Clinical and translational radiation oncology, Vol.18, pp.16-22
DOI: 10.1016/j.ctro.2019.06.005
PMID: 31341972
PMCID: PMC6610668
NLM abbreviation: Clin Transl Radiat Oncol
ISSN: 2405-6308
eISSN: 2405-6308
Publisher: Elsevier B.V
Grant note: DOI: 10.13039/100007210, name: Varian; DOI: 10.13039/100004312, name: Lilly; DOI: 10.13039/100008238, name: Hitachi; DOI: 10.13039/100007331, name: Augmenix; DOI: 10.13039/100008308, name: Comprehensive Cancer Center; DOI: 10.13039/100013700, name: NCCN; DOI: 10.13039/100004334, name: Merck; DOI: 10.13039/100007325, name: American Association of Physicists in Medicine; DOI: 10.13039/100010443, name: University of Illinois; DOI: 10.13039/100008635, name: University of Texas Health Science Center at San Antonio; DOI: 10.13039/100006668, name: Oregon Health and Science University
Language: English
Date published: 09/2019
Academic Unit: Electrical and Computer Engineering
Record Identifier: 9984197298102771

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