Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study

Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study

The study objectives were: provide longitudinal data on upper aerodigestive tract function and late complications following IMRT for nasopharyngeal carcinoma, and elucidate factors that might predict a worse outcome. The hypotheses were: (1) Despite advances such as IMRT, radiation will cause signif...

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Bibliographic Details
Published in:Journal of otolaryngology-head and neck surgery Vol. 51; no. 1; pp. 41 - 12
Main Authors: Gill, Gia, Lane, Ciaran, Myers, Candace, Kerr, Evan D, Lambert, Pascal, Cooke, Andrew, Kerr, Paul D
Format: Journal Article
Language:English
Published: United States BioMed Central Ltd 08-11-2022
BioMed Central
SAGE Publications
Subjects:
Analysis
Cancer
Carcinoma
Care and treatment
Cohort Studies
Drug therapy
Functional outcomes
Humans
IMRT
Medical research
Medicine, Experimental
Nasopharyngeal carcinoma
Nasopharyngeal Carcinoma - radiotherapy
Nasopharyngeal Neoplasms - radiotherapy
Original
Prognosis
Prospective Studies
Radiation
Radiotherapy
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated - adverse effects
Retrospective Studies
Canada
Manitoba
Nasopharyngeal carcinoma
IMRT
Functional outcomes
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Summary:The study objectives were: provide longitudinal data on upper aerodigestive tract function and late complications following IMRT for nasopharyngeal carcinoma, and elucidate factors that might predict a worse outcome. The hypotheses were: (1) Despite advances such as IMRT, radiation will cause significant functional decline and late complications that often progress or arise years after treatment. (2) Larger radiation volume will be associated with poorer outcomes. Longitudinal, observational cohort study of nasopharyngeal carcinoma patients with retrospective analysis of prospectively collected, population-based data. Late sequelae and validated measures of overall performance, speech, and swallowing were documented pre-treatment and 3,6,12, 24, 36 and ≥ 60-months post-treatment. Forty-two patients treated curatively with radiation (N = 9) or chemoradiation (N = 33) were followed for a median 74 months. Functional outcomes showed an initial nadir at 3 months associated with acute effects of treatment, followed by initial recovery. There was subsequent functional decline years post-treatment with advancing dysphagia/aspiration, trismus, muscle spasm, and hypoglossal nerve palsy. Univariable regression analysis revealed that increasing high-dose radiation volumes (PTV 70 Gy) were associated with increased likelihood of less than solid diet (Performance Status Scale (PSS)-Normalcy of Diet score < 50; p = 0.04), and reduced PSS-Understandability of Speech (p = 0.005). The probability of poor outcome increased with time. Eleven percent of patients were tube feed dependent at ≥ 5 years. Despite improvements in radiation delivery, late effects of radiation remain common. Higher radiation volumes are associated with poorer outcomes that worsen over time.
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ISSN:1916-0216
1916-0208
1916-0216
DOI:10.1186/s40463-022-00593-7