Swallowing outcomes following Intensity Modulated Radiation Therapy (IMRT) for head & neck cancer - A systematic review

ArticleinOral Oncology 46(10):727-33 · October 2010with29 Reads
DOI: 10.1016/j.oraloncology.2010.07.012 · Source: PubMed
A systematic review to establish what evidence is available for swallowing outcomes following IMRT for head and neck cancer. Online electronic databases were searched to identify papers published in English from January 1998 to December 2009. Papers were independently appraised by two reviewers for methodological quality, method of swallowing evaluation and categorized according to the World Health Organisation's International Classification of Health Functions. The impact of radiation dose to dysphagia aspiration risk structures (DARS) was also evaluated. Sixteen papers met the inclusion criteria. The literature suggests that limiting the radiation dose to certain structures may result in favourable swallowing outcomes. Methodological limitations included variable assessment methods and outcome measures and heterogeneity of patients. There are only limited prospective data, especially where pre-treatment measures have been taken and compared to serial post-treatment assessment. Few studies have investigated the impact of IMRT on swallow function and the impact on everyday life. Initial studies have reported potential benefits but are limited in terms of study design and outcome data. Further well designed, prospective, longitudinal swallowing studies including multidimensional evaluation methods are required to enable a more comprehensive understanding of dysphagia complications and inform pre-treatment counselling and rehabilitation planning.
    • "These accelerated radiation schedules, with high total prescribed doses [[60–70 Gray (Gy)] , result in rapid dose accumulation that is far less tolerable [5]. In attempts to improve swallowing function and quality of life after radiotherapy, it has been advocated that anatomic structures important for swallow be spared or the mean dose be reduced [6, 7] . As such, identification of atrisk organs has been the subject of intense focus and controversy in literature [8, 9]. "
    [Show abstract] [Hide abstract] ABSTRACT: Oncologic treatments, such as curative radiotherapy and chemoradiation, for head and neck cancer can cause long-term swallowing impairments (dysphagia) that negatively impact quality of life. Radiation-induced dysphagia comprised a broad spectrum of structural, mechanical, and neurologic deficits. An understanding of the biomolecular effects of radiation on the time course of wound healing and underlying morphological tissue responses that precede radiation damage will improve options available for dysphagia treatment. The goal of this review is to discuss the pathophysiology of radiation-induced injury and elucidate areas that need further exploration.
    Full-text · Article · Apr 2016
    • "In particular , damage to the tongue base, pharyngeal constrictors, the larynx, and the autonomic neural plexus was found to be crucial in the development of post-RT dysphagia. Studies confirmed that reducing the radiation dose to DARS decreases dysphagia risk46474849 In addition, preventive swallowing exercises in the pretreatment setting had promising results on preserving (pharyngeal) swallowing function484950. One study reported a lower incidence of severe OM and mucositis affecting the throat (contributing to acute dysphagia ) when six predetermined oral sites were exposed to PBM prior to and during RT [51]. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed. Methods: Narrative review and presentation of PBM parameters are based on current evidence and expert opinion. Results: PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780-830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2-3 J (J/cm(2)), and no more than 6 J/cm(2) on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations. Conclusion: PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.
    Full-text · Article · Mar 2016
    • "Thus, studies aimed at identification of the dysphagia/aspiration-related structures (DARSs) (Eisbruch et al., 2004) (e.g., the pharyngeal constrictors, tongue base, and larynx), altered-mastication-related structures or (AMRSs) (Teguh et al., 2008; Johnson et al., 2010; Van der Molen et al., 2011, 2013) (e.g., the masseter and pterygoid muscles, the temporo-mandibular joints, and the oral cavity), and xerostomia-related structures or XRSs (Van de Water et al., 2009; Jellema et al., 2005) (e.g., the major and minor salivary glands) have been undertaken in recent years. As a consequence, RT techniques sparing the above-mentioned structures have been employed and they seem to improve patients' health-related quality of life (HRQoL) (Pow et al., 2006; Nutting et al., 2011; Bhide et al., 2009), even when RT is combined with CT (Hancock et al., 2003; Roe et al., 2010; Van der Laan et al., 2012). Yet, few studies report the exact dose-volume correlation for each individual DARS, AMRS and XRS (Nutting et al., 2011; Caudell et al., 2010; Eisbruch et al., 2011; Jensen et al., 2007; Levendag et al., 2007; Li et al., 2009; Bhide et al., 2012), and the majority of these are retrospective. "
    [Show abstract] [Hide abstract] ABSTRACT: Radiotherapy alone or in combination with chemotherapy and/or surgery is a well-known radical treatment for head and neck cancer patients. Nevertheless acute side effects (such as moist desquamation, skin erythema, loss of taste, mucositis etc.) and in particular late toxicities (osteoradionecrosis, xerostomia, trismus, radiation caries etc.) are often debilitating and underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met in Milan with the aim of reaching a consensus on a clinical definition and management of these toxicities. The Delphi Appropriateness method was used for this consensus and external experts evaluated the conclusions. The paper contains 20 clusters of statements about the clinical definition and management of stomatological issues that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecrosis (10 clusters of statements), whereas this second part deals with trismus and xerostomia (10 clusters of statements).
    Full-text · Article · Mar 2016
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