Clinical and dosimetric factors associated with a prolonged feeding tube requirement in patients treated with chemoradiotherapy (CRT) for head and neck cancers
ABSTRACT Patients treated with chemoradiotherapy (CRT) for head and neck cancers often require feeding tubes (FTs) due to toxicity. We sought to identify factors associated with a prolonged FT requirement.
We retrospectively reviewed 80 patients treated with CRT for head and neck cancers. The pharyngeal constrictors (PCs), supraglottic larynx (SGL), and glottic larynx (GL) were contoured and the mean radiation doses and the volumes of each receiving >40, 50, 60, and 70 Gy (V40, V50, V60, and V70) were determined.
A total of 33 of 80 patients required a FT either before or during the course of CRT. Fifteen patients required the FT for > or = 6 months. On univariate analysis, significant factors associated with a prolonged FT requirement were mean PC dose, PC-V60, PC-V70, SGL dose, SGL-V70, and advanced T3-T4 disease. Multivariate analyses found both PC-V70 and T3-T4 disease as significant factors .The proportions of patients requiring a FT > or = 6 months were 8% and 28% for treatment plans with PC-V70 <30% and > or = 30%, respectively.
Increased radiation dose to the PCs is associated with a higher risk of a prolonged FT need. Dose sparing of the PC muscles may reduce this risk.
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ABSTRACT: Abstract The repairing function and differentiation potency of adipose stem cells (ASCs) transplantation following skeletal muscle injury induced by radiotherapy are still not well defined. In this study, one side of the buttocks of 64 New Zealand white rabbits underwent irradiation and were randomly divided into an ASCs group [5×10(7) ASCs labeled with CM-Dil and suspended in 1 mL of phosphate-buffered saline (PBS), via intramuscular injection] and a PBS group (1 mL of PBS, via intramuascular injection). ASCs were isolated in New Zealand white rabbits in vitro, and migration of ASCs labeled with CM-Dil was observed after transplantation in vivo. A significant decrease of histological severity scoring was found in irradiated tissue obtained in the ASCs group compared with that in PBS group. Additionally, compensatory hyperplasia was noted after ASCs transplantation in the injured tissues. Moreover, ASCs could upregulate the expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) and promote the angiogenesis of the injured tissues. Interestingly, myofilament-like structures were identified in irradiated muscle cells after ASCs transplantation. We concluded that ASCs transplantation could repair the radiation-induced skeletal muscle injury. Its mechanism may be, at least partly, associated with the upregulation of VEGF and bFGF, angiogenesis, promoting the compensatory hyperplasia of muscle satellite cells, as well as the myogenic differentiation.04/2014; 16(2):140-50. DOI:10.1089/cell.2013.0056
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ABSTRACT: Background/Objectives:Thoracic radiotherapy (RT) is associated with acute toxicities, including oesophagitis, which can have an impact on nutritional intake and subsequently lead to malnutrition. This study aimed to identify RT dosimetric factors associated with ⩾5% weight loss in patients receiving treatment for non-small-cell lung cancer (NSCLC).Methods:Radiation dose data to the oesophagus (including mean, maximum dose and oesophageal length) were retrospectively analysed for a cohort of 54 NSCLC patients treated with concurrent chemoradiotherapy between 2004 and 2006. Weight change was calculated using the lowest weight during the 90 days from RT commencement compared with the start of RT.Results:Four patients for whom weight was not available at the start or end of treatment were excluded, leaving 50 patients for analysis. The prevalence of significant weight loss during the 90 days from RT commencement was 22% (median weight loss=9.1%, range=5.9-22.1). Dosimetric factors significantly associated with ⩾5% weight loss were maximum dose to the oesophagus (P=0.046), absolute oesophageal length receiving 40 Gy (odds ratio (OR)=1.18, P=0.04), 50 Gy (OR=1.20, P=0.02) and 60 Gy (OR=1.32, P=0.005) to the partial circumference, relative oesophageal length receiving 50 Gy (OR=1.03, P=0.03) and 60 Gy (OR=1.07, P=0.005) to the partial circumference.Conclusions:Multiple dosimetric factors were associated with significant weight loss. Of these factors, absolute and relative length of the oesophagus receiving 60 Gy to the partial circumference were more strongly related. Understanding the dosimetric factors associated with weight loss may aid early identification and intervention in patients at nutritional risk.European Journal of Clinical Nutrition advance online publication, 13 August 2014; doi:10.1038/ejcn.2014.166.European Journal of Clinical Nutrition 08/2014; DOI:10.1038/ejcn.2014.166 · 2.95 Impact Factor
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ABSTRACT: Swallowing difficulties are among the most problematic outcomes associated with head and neck cancer (HNCA) and the strategies employed to treat it. With a rising incidence of human papilloma virus-associated HNCA, a larger number of patients are expected to survive their cancer, and therefore will be more susceptible to long-term treatment toxicities. Optimization of long-term swallowing outcomes is an important objective for those working with patients with HNCA. The role of the swallowing therapist in the management of patients with HNCA cannot be overstated. This begins with pretreatment evaluation of swallowing. At the time of initial assessment, education should be provided regarding treatment toxicities and the importance of prophylactic swallowing exercises and oral intake. Recent evidence suggests that maintaining an oral diet and engaging in swallowing exercise during radiation have a positive impact on diet level, swallowing physiology, patient-perceived swallowing-related quality of life, and reduced feeding tube use. Although treatment strategies such as radiation de-intensification and transoral surgical treatments show promise for reducing toxicities, evidence regarding their impact is still being amassed. Maintaining an oral diet and performing prophylactic swallowing exercises are currently the most evidence-based strategies for dysphagia prevention in HNCA.Current opinion in otolaryngology & head and neck surgery 03/2014; DOI:10.1097/MOO.0000000000000044 · 1.39 Impact Factor