Chronic radiation-associated dysphagia in oropharyngeal cancer survivors: Towards age-adjusted dose constraints for deglutitive muscles
•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. W...
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| Published in: | Clinical and translational radiation oncology Vol. 18; pp. 16 - 22 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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Ireland
Elsevier B.V
01-09-2019
Elsevier |
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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. |
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| AbstractList | •
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. OBJECTIVESWe 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. METHODSWe 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. RESULTSChronic 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. CONCLUSIONSAge 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. 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 < 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. Objectives: 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. Methods: 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. Results: 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. Conclusions: 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. Keywords: Oropharynx, IMRT, Radiation, Toxicity, Presbyphagia •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. |
| Author | Morrison, William H. Dale, Timothy Phan, Jack Rosenthal, David I. Kalpathy-Cramer, Jayashree Christopherson, Kaitlin M. Canahuate, Guadalupe Gross, Neil Hutcheson, Katherine Fuller, Clifton David Garden, Adam S. Lewin, Jan Weber, Randal S. Elhalawani, Hesham Radwan Mohamed, Abdallah Sherif Gunn, G. Brandon Lai, Stephen Y. Fuller, David Vock, David M. Mohamed, Abdallah Sherif Radwan Messer, Jay Kamal, Mona Ferrarotto, Renata Ghosh, Alokananda Frank, Steven J. Marai, G. Elisabeta (Liz) |
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Brandon organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 6 givenname: Timothy surname: Dale fullname: Dale, Timothy organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 7 givenname: Jayashree surname: Kalpathy-Cramer fullname: Kalpathy-Cramer, Jayashree organization: Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA – sequence: 8 givenname: Jay surname: Messer fullname: Messer, Jay organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 9 givenname: Adam S. orcidid: 0000-0001-7926-2641 surname: Garden fullname: Garden, Adam S. organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 10 givenname: Hesham surname: Elhalawani fullname: Elhalawani, Hesham organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 11 givenname: Steven J. surname: Frank fullname: Frank, Steven J. organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 12 givenname: Jan surname: Lewin fullname: Lewin, Jan organization: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 13 givenname: William H. orcidid: 0000-0002-9546-0805 surname: Morrison fullname: Morrison, William H. organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 14 givenname: Jack surname: Phan fullname: Phan, Jack organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 15 givenname: Neil surname: Gross fullname: Gross, Neil organization: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 16 givenname: Renata surname: Ferrarotto fullname: Ferrarotto, Renata organization: Department of Thoracic & Head and Neck Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 17 givenname: Randal S. surname: Weber fullname: Weber, Randal S. organization: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 18 givenname: David I. surname: Rosenthal fullname: Rosenthal, David I. organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 19 givenname: Stephen Y. surname: Lai fullname: Lai, Stephen Y. organization: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 20 givenname: Katherine surname: Hutcheson fullname: Hutcheson, Katherine organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 21 givenname: Clifton David surname: Fuller fullname: Fuller, Clifton David email: cdfuller@mdanderson.org organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 22 givenname: Abdallah Sherif surname: Radwan Mohamed fullname: Radwan Mohamed, Abdallah Sherif organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 23 givenname: G. Elisabeta (Liz) surname: Marai fullname: Marai, G. Elisabeta (Liz) organization: Department of Computer Science, University of Illinois at Chicago, Chicago, IL, USA – sequence: 24 givenname: Guadalupe surname: Canahuate fullname: Canahuate, Guadalupe organization: Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA, USA – sequence: 25 givenname: David M. surname: Vock fullname: Vock, David M. organization: Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA – sequence: 26 givenname: David surname: Fuller fullname: Fuller, David organization: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA |
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| ContentType | Journal Article |
| Contributor | Dale, Timothy Phan, Jack Kalpathy-Cramer, Jayashree Canahuate, Guadalupe Gross, Neil Hutcheson, Katherine Gunn, G Brandon Christopherson, Kaitlin M Fuller, Clifton David Lewin, Jan Vock, David M Lai, Stephen Y Elhalawani, Hesham Radwan Mohamed, Abdallah Sherif Fuller, David Mohamed, Abdallah Sherif Radwan Messer, Jay Marai, G Elisabeta Liz Kamal, Mona Ferrarotto, Renata Weber, Randal S Rosenthal, David I Ghosh, Alokananda Frank, Steven J Morrison, William H Garden, Adam S |
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| Copyright | 2019 The Authors 2019 The Authors 2019 |
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| Snippet | •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... We sought to model chronic radiation-associated dysphagia (RAD) in patients given intensity-modulated radiation therapy (IMRT) for oropharyngeal squamous cell... OBJECTIVESWe sought to model chronic radiation-associated dysphagia (RAD) in patients given intensity-modulated radiation therapy (IMRT) for oropharyngeal... • Age at treatment for OPSCC is a strong predictor of chronic radiation associated dysphagia (RAD). • For swallowing regions of interest (ROIs), dose to ROI... Objectives: We sought to model chronic radiation-associated dysphagia (RAD) in patients given intensity-modulated radiation therapy (IMRT) for oropharyngeal... |
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| Title | Chronic radiation-associated dysphagia in oropharyngeal cancer survivors: Towards age-adjusted dose constraints for deglutitive muscles |
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