- Email: [email protected]
77
Proceedings of the 48th Annual ASTRO Meeting
Gy (p⫽0.01), however, only the PC dose was correlated with worsening solid swallowing (p⫽0.04). For both the UWQOL and the CTC swallowing scores, only the PC doses, and not the esophageal or GSL doses, were significant predictors of worsening function at 3 months compared with pre-therapy (p⫽0.04). Conclusions: These dose-volume-effect relationships motivate efforts to further reduce the doses to the PC and GSL in order to reduce dysphagia and aspiration, and serve as the initial basis for setting relevant dose-volume goals for optimization of IMRT. Author Disclosure: F.Y. Feng, None; T.H. Lyden, None; H.M. Kim, None; M.J. Haxer, None; M. Feng, None; Y. Yang, None; D.B. Chepeha, None; R.K. Ten Haken, None; A. Eisbruch, None.
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Dose-Volume Parameters of the Supraglottic Region Correlate With Dysphagia, Aspiration and Speech Problems After Radiotherapy for Pharyngeal Cancer
K. Jensen, K. Lambertsen, C. Grau Aarhus University Hospital, Aarhus, Denmark Purpose/Objective(s): Speech and swallowing problems are important side-effects after radiotherapy for head and neck cancer. It may be possible to minimize these if the organ(s) at risk could be identified and spared with IMRT. The aim of this study was to investigate dose-volume factors of regions important for aspiration, dysphagia and speech problems. Materials/Methods: Recurrence free patients treated at our institution with radiotherapy for pharynx cancer between 1998 and 2002 were eligible for the study. Of 68 invited patients, 54 responded and 35 agreed to participate in the study. They were examined with Functional Endoscopic Evaluation of Swallowing (FEES) and scored according to a scoring system derived from the Berliner Dysphagia Index. Aspiration risk was quantified by scoring residues in the pharynx, coughing function and clearing of the throat. Patients also answered the quality of life questionnaires EORTC C30 and H&N35. Of 26 patients treated with CT-based 3D conformal RT, 2 patients were excluded from the dose-volume analysis (1 was previously irradiated for a neck lymphoma and 1 could not cooperate with the FEES). The pharyngeal constrictors, base of tongue, supraglottic larynx, larynx, and upper esophageal sphincter were outlined as critical normal tissues. Results: Subjective dysphagia was reported by 83%, speech problems by 69%, penetration of food into the larynx was observed in 57% and aspiration were observed in 17% of the 35 patients. Objective dysfunction and dose-volume parameters correlated poorly for most anatomical regions. However, if more than 67% of the larynx or upper esophageal sphincter received ⱖ65Gy, the frequency of manifest aspiration increased from 5 to 67% (p⫽0.032). Aspiration risk correlated significantly with a range of dose-volume parameters, most significant for V65Gy and D75%, in the supraglottic region. The subjective scoring of speech problems also correlated with dose and volume parameters to the supraglottic region (optimal for V60 Gy and D75%). The optimal significant parameters for the swallowing scale were V45Gy and D75% of the supraglottic region. Radiation dose to base of tongue or other pharyngeal constrictors did not correlate with objective or subjective endpoints. Conclusion: In this unselected series of pharyngeal cancer survivors, radiotherapy related symptoms from the larynx and pharynx were frequent and serious. The risk of aspiration and speech problems increased significantly with both higher radiation dose and irradiated supraglottic volume. The current data suggest that supraglottic larynx should be considered as an organ at risk whenever possible.
Author Disclosure: K. Jensen, None; K. Lambertsen, None; C. Grau, None.
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Dosimetric Predictors of Laryngeal Edema
G. Sanguineti1, P. Adapala1, E. Endres1, C. Fiorino2 University of Texas Medical Branch, Galveston, TX, 2San Raffale Hospital, Milan, Italy
1
Purpose/Objective(s): To investigate dosimetric predictors of laryngeal edema after radiotherapy (RT). Materials/Methods: Patients with HN-SCC treated with RT at UTMB were selected for the present study if they satisfied all the following criteria: 1. grossly uninvolved larynx; 2. no prior major surgical operation except for neck dissection; 3. treatment
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Gy (p⫽0.01), however, only the PC dose was correlated with worsening solid swallowing (p⫽0.04). For both the UWQOL and the CTC swallowing scores, only the PC doses, and not the esophageal or GSL doses, were significant predictors of worsening function at 3 months compared with pre-therapy (p⫽0.04). Conclusions: These dose-volume-effect relationships motivate efforts to further reduce the doses to the PC and GSL in order to reduce dysphagia and aspiration, and serve as the initial basis for setting relevant dose-volume goals for optimization of IMRT. Author Disclosure: F.Y. Feng, None; T.H. Lyden, None; H.M. Kim, None; M.J. Haxer, None; M. Feng, None; Y. Yang, None; D.B. Chepeha, None; R.K. Ten Haken, None; A. Eisbruch, None.
77
Dose-Volume Parameters of the Supraglottic Region Correlate With Dysphagia, Aspiration and Speech Problems After Radiotherapy for Pharyngeal Cancer
K. Jensen, K. Lambertsen, C. Grau Aarhus University Hospital, Aarhus, Denmark Purpose/Objective(s): Speech and swallowing problems are important side-effects after radiotherapy for head and neck cancer. It may be possible to minimize these if the organ(s) at risk could be identified and spared with IMRT. The aim of this study was to investigate dose-volume factors of regions important for aspiration, dysphagia and speech problems. Materials/Methods: Recurrence free patients treated at our institution with radiotherapy for pharynx cancer between 1998 and 2002 were eligible for the study. Of 68 invited patients, 54 responded and 35 agreed to participate in the study. They were examined with Functional Endoscopic Evaluation of Swallowing (FEES) and scored according to a scoring system derived from the Berliner Dysphagia Index. Aspiration risk was quantified by scoring residues in the pharynx, coughing function and clearing of the throat. Patients also answered the quality of life questionnaires EORTC C30 and H&N35. Of 26 patients treated with CT-based 3D conformal RT, 2 patients were excluded from the dose-volume analysis (1 was previously irradiated for a neck lymphoma and 1 could not cooperate with the FEES). The pharyngeal constrictors, base of tongue, supraglottic larynx, larynx, and upper esophageal sphincter were outlined as critical normal tissues. Results: Subjective dysphagia was reported by 83%, speech problems by 69%, penetration of food into the larynx was observed in 57% and aspiration were observed in 17% of the 35 patients. Objective dysfunction and dose-volume parameters correlated poorly for most anatomical regions. However, if more than 67% of the larynx or upper esophageal sphincter received ⱖ65Gy, the frequency of manifest aspiration increased from 5 to 67% (p⫽0.032). Aspiration risk correlated significantly with a range of dose-volume parameters, most significant for V65Gy and D75%, in the supraglottic region. The subjective scoring of speech problems also correlated with dose and volume parameters to the supraglottic region (optimal for V60 Gy and D75%). The optimal significant parameters for the swallowing scale were V45Gy and D75% of the supraglottic region. Radiation dose to base of tongue or other pharyngeal constrictors did not correlate with objective or subjective endpoints. Conclusion: In this unselected series of pharyngeal cancer survivors, radiotherapy related symptoms from the larynx and pharynx were frequent and serious. The risk of aspiration and speech problems increased significantly with both higher radiation dose and irradiated supraglottic volume. The current data suggest that supraglottic larynx should be considered as an organ at risk whenever possible.
Author Disclosure: K. Jensen, None; K. Lambertsen, None; C. Grau, None.
78
Dosimetric Predictors of Laryngeal Edema
G. Sanguineti1, P. Adapala1, E. Endres1, C. Fiorino2 University of Texas Medical Branch, Galveston, TX, 2San Raffale Hospital, Milan, Italy
1
Purpose/Objective(s): To investigate dosimetric predictors of laryngeal edema after radiotherapy (RT). Materials/Methods: Patients with HN-SCC treated with RT at UTMB were selected for the present study if they satisfied all the following criteria: 1. grossly uninvolved larynx; 2. no prior major surgical operation except for neck dissection; 3. treatment
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