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. 2014 Aug;50(8):746-52.
doi: 10.1016/j.oraloncology.2014.05.003. Epub 2014 Jun 3.

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

Musaddiq J Awan  1 , Abdallah S R Mohamed  2 , Jan S Lewin  3 , Charles A Baron  4 , G Brandon Gunn  5 , David I Rosenthal  6 , F Christopher Holsinger  7 , David L Schwartz  8 , Clifton D Fuller  9 , Katherine A Hutcheson  10
Affiliations

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

Musaddiq J Awan et al. Oral Oncol. 2014 Aug.

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.

Keywords: Dysphagia; Oropharyngeal cancer; Pharyngeal constrictors; Quality-of-life; Radiotherapy.

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Conflict of interest statement

Competing Interests

The authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
Example Contours for Candidate Organs at Risk
Figure 2
Figure 2
Mean SPC Dose predicted Late-RAD
Figure 3
Figure 3
Mean SPC Dose predicted Late Lower Cranial Neuropathies
Figure 4
Figure 4
Anatomic rendering of SPC contour region
See this image and copyright information in PMC

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