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Clinical Trial
. 2017 Mar 15;97(4):700-708.
doi: 10.1016/j.ijrobp.2016.06.010. Epub 2016 Jun 15.

Long-Term, Prospective Performance of the MD Anderson Dysphagia Inventory in "Low-Intermediate Risk" Oropharyngeal Carcinoma After Intensity Modulated Radiation Therapy

Ryan P Goepfert  1 , Jan S Lewin  1 , Martha P Barrow  1 , G Brandon Gunn  2 , C David Fuller  2 , Beth M Beadle  2 , Adam S Garden  2 , David I Rosenthal  2 , Merrill S Kies  3 , Vassiliki Papadimitrakopoulou  3 , Stephen Y Lai  1 , Neil D Gross  1 , David L Schwartz  4 , Katherine A Hutcheson  5
Affiliations
Clinical Trial

Long-Term, Prospective Performance of the MD Anderson Dysphagia Inventory in "Low-Intermediate Risk" Oropharyngeal Carcinoma After Intensity Modulated Radiation Therapy

Ryan P Goepfert et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: To characterize long-term MD Anderson Dysphagia Inventory (MDADI) results after primary intensity modulated radiation therapy (IMRT) for oropharyngeal carcinoma (OPC) among patients with "low-intermediate risk" OPC who would be eligible for current trials (eg, ECOG 3311, NRG HN002, CRUK PATHOS).

Methods and materials: A retrospective pooled analysis combined data from 3 single-institution clinical trials for advanced-stage head and neck carcinoma. Inclusion criteria were clinical stage III/IV OPC (T1-2/N1-2b, T3/N0-2b) treated with definitive split-field IMRT and prospectively collected MDADI at baseline and at least 1 posttreatment interval available in trial databases. Patients were sampled to represent likely human papillomavirus (HPV)-associated disease (HPV+/p16+ or <10 pack-years if HPV/p16 unknown). The MDADI composite scores were collected at baseline and 6, 12, and 24 months after treatment. Pairwise tests were Bonferroni corrected for multiple comparisons.

Results: Forty-six patients were included. All received bilateral neck irradiation with a median dose of 70 Gy and systemic therapy (57% concurrent, 43% induction only). Overall the mean baseline MDADI composite score was 90.1, dropping to 74.6 at 6 months (P<.0001) and rising to 78.5 (P<.0001) and 83.1 (P=.002) by 12 and 24 months relative to baseline, respectively, representing a clinically meaningful drop in MDADI scores at 6 months that partially recovers by 24 months (6 vs 24 months, P=.05). Poor MDADI scores (composite <60) were reported in 4%, 11%, 15%, and 9% of patients at baseline and 6, 12, and 24 months, respectively. Fifteen percent of patients had a persistently depressed composite score by at least 20 points at the 24-month interval.

Conclusion: "Low-intermediate risk" patients with OPC treated with laryngeal/esophageal inlet dose-optimized split-field IMRT are highly likely to report recovery of acceptable swallowing function in long-term follow-up. Only 15% report poor swallowing function and/or persistently depressed MDADI at 12 months or more after IMRT. These data serve as a benchmark future trial design and endpoint interpretation.

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Conflict of interest statement

Disclosure: The authors have no relevant conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Patient eligibility flowchart
Figure 2
Figure 2
Overall MDADI composite distribution trends and statistics over time.
Figure 3
Figure 3
MDADI composite distribution trends and statistics by staging subgroups over time.
Figure 4
Figure 4
MDADI subscale scores over time.
See this image and copyright information in PMC

Comment in

References

    1. Paz IB, et al. Human papillomavirus (HPV) in head and neck cancer. An association of HPV 16 with squamous cell carcinoma of Waldeyer's tonsillar ring. Cancer. 1997;79(3):595–604. - PubMed
    1. Gillison ML, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst. 2000;92(9):709–720. - PubMed
    1. Ang KK, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363(1):24–35. - PMC - PubMed
    1. O'Sullivan B, et al. Deintensification candidate subgroups in human papillomavirus-related oropharyngeal cancer according to minimal risk of distant metastasis. J Clin Oncol. 2013;31(5):543–550. - PubMed
    1. Huang SH, et al. Refining American Joint Committee on Cancer/Union for International Cancer Control TNM stage and prognostic groups for human papillomavirus-related oropharyngeal carcinomas. J Clin Oncol. 2015;33(8):836–845. - PubMed

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