scholarly journals The Relationships Between Radiation Dosage and Long-term Swallowing Kinematics and Timing in Nasopharyngeal Carcinoma Survivors

Dysphagia ◽  
2021 ◽  
Author(s):  
Dai Pu ◽  
Victor H. F. Lee ◽  
Karen M. K. Chan ◽  
Margaret T. Y. Yuen ◽  
Harry Quon ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Radiation Dosage ◽  
Intensity Modulated Radiation Therapy ◽  
Concurrent Chemotherapy ◽  
Swallowing Function ◽  
Pharyngeal Constriction ◽  
The Relationship ◽  
Higher Doses ◽  
Inferior Pharyngeal Constrictor

AbstractThis study aimed to investigate the relationship between intensity-modulated radiation therapy (IMRT) dosimetry and swallowing kinematic and timing measures. Thirteen kinematic and timing measures of swallowing from videofluoroscopic analysis were used as outcome measures to reflect swallowing function. IMRT dosimetry was accessed for thirteen swallowing-related structures. A cohort of 44 nasopharyngeal carcinoma (NPC) survivors at least 3 years post-IMRT were recruited. The cohort had a mean age of 53.2 ± 11.9 years, 77.3% of whom were male. There was an average of 68.24 ± 14.15 months since end of IMRT; 41 (93.2%) had undergone concurrent chemotherapy. For displacement measures, female sex and higher doses to the cricopharyngeus, glottic larynx, and base of tongue were associated with reduced hyolaryngeal excursion and pharyngeal constriction, and more residue. For timing measures, higher dose to the genioglossus was associated with reduced processing time at all stages of the swallow. The inferior pharyngeal constrictor emerged with a distinctly different pattern of association with mean radiation dosage compared to other structures. Greater changes to swallowing kinematics and timing were observed for pudding thick consistency than thin liquid. Increasing radiation dosage to swallowing-related structures is associated with reduced swallowing kinematics. However, not all structures are affected the same way, therefore organ sparing during treatment planning for IMRT needs to consider function rather than focusing on select muscles. Dose-response relationships should be investigated with a comprehensive set of swallowing structures to capture the holistic process of swallowing.

S169 – Radiation-Associated Dysphagia with Nasopharyngeal Carcinoma

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P132-P133
Author(s):  
Jeremy D. Meier ◽  
Rebecca Leonard ◽  
D Gregory Farwell ◽  
Peter C Belafsky
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Average Duration ◽  
Clinical Database ◽  
Swallowing Function ◽  
Age And Gender ◽  
Swallowing Dysfunction ◽  
And Gender ◽  
Maximal Average ◽  
Pharyngeal Constriction ◽  
Normal Controls

Objectives We have observed that patients with dysphagia after radiotherapy (RT) for nasopharyngeal carcinoma (NPC) have substantially worse swallowing function than patients treated with RT of other sub-sites. The purpose of this investigation was to describe swallowing dysfunction after RT for NPC and compare swallowing parameters to patients receiving RT for cancer from another site. Methods Fluoroscopic swallowing data of persons with dysphagia after RT for NPC was abstracted from a clinical database. Objective swallowing parameters were compared to age- and gender-matched normal controls and to cancer stage-matched patients treated with RT for oropharyngeal cancer (OPC). Results 13 patients with NPC were compared to 13 controls and 13 patients with OPC. The average duration from RT to fluoroscopic study was 74 months for NPC and 24 months for OPC (p=.06). 62% of NPC and 47% of OPC were gastrostomy tube-dependent. 92% of NPC patients aspirated or penetrated compared to 62% of OPC patients. The maximal average tolerated bolus was 10.6cc for NPC and 22.2cc for OPC (p<.02). Mean hyolaryngeal elevation was 4.02 (±1.27) for normals, 2.96 (±0.86) for OPC, and 2.45 (± 1.17) for NPC (p<.01). Opening of the pharyngoesophageal segment was lower than normal in both NPC and OPC. Pharyngeal constriction was 0.08 (±0.09) for normals, 0.40 (±0.24) for OPC and 0.45 (±0.27) for NPC (p<.001). Conclusions The data suggest that patients with dysphagia after radiotherapy for NPC present at a later date, have significantly less hyolaryngeal elevation, have weaker pharyngeal constriction, and cannot tolerate as large a bolus as patients treated with radiotherapy for OPC.

scholarly journals Cisplatin-based Concurrent Chemoradiotherapy Improved the Survival of Locoregionally Advanced Nasopharyngeal Carcinoma After Induction Chemotherapy by Reducing Early Treatment Failure

2021 ◽  
Author(s):  
Xing-Li Yang ◽  
Lu-Lu Zhang ◽  
Jia Kou ◽  
Guan-Qun Zhou ◽  
Chen-Fei Wu ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Treatment Failure ◽  
Time Course ◽  
Concurrent Chemotherapy ◽  
P Value ◽  
Treatment Groups ◽  
Locoregional Failure ◽  
Distant Failure ◽  
Time Specific

Abstract PurposeLimited data are available on the time course of treatment failures and the nature and duration of concurrent cisplatin benefit in patients with locoregionally advanced nasopharyngeal carcinoma (LANPC).MethodsIn total, 3123 patients with stage III-IVa NPC receiving IC followed by concurrent cisplatin or not were analysed. The cut-off value of treatment failure was calculated using the minimum P-value approach. Random survival forest (RSF) model was to simulate the cumulative probabilities of treatment failure (locoregional recurrence and /or distant metastasis) over-time, as well as the monthly time-specific, event-occurring probabilities, for patients at different treatment groups. ResultsBased on subsequent prognosis, early locoregional failure (ELRF) should be defined as recurrence within 14 months (P = 1.47×10-3), and early distant failure (EDF) should be defined as recurrence within 20 months (P = 1.95×10-4). A cumulative cisplatin dose (CCD) > 200 mg/m2 independently reduced the risk of EDF (hazard ratio (HR), 0.351; 95% confidence interval (CI), 0.169-0.732; P = 0.005). Better failure-free survival (FFS) and overall survival (OS) were observed in concurrent chemotherapy settings ([0 mg/m2 vs. 1-200 mg/m2 vs. >200 mg/m2]: FFS: 70.4% vs. 74.4% vs. 82.6%, all P < 0.03; OS: 79.5% vs. 83.8% vs. 90.8%, all P < 0.01). In the monthly analysis, treatment failure mainly occurred during the first 4 years, and the risk of distant failure in patients treated with concurrent chemotherapy never exceeded that of patients without concurrent chemotherapy.ConclusionLocoregional failure that developed within 14 months and/or distant failure within 20 months had poorer subsequent survival. Concurrent chemotherapy provides a significant FFS benefit, primarily by reducing EDF, translating into a long-term OS benefit.

scholarly journals Patterns of failure and survival in patients with nasopharyngeal carcinoma treated with intensity modulated radiation therapy in Saudi Arabia.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. e295-e295
Author(s):  
Ahmed M Maklad ◽  
Yasser Bayoumi ◽  
Mohamed Abdalaziz Senosy ◽  
AbuSaleh A. Elawadi ◽  
Hussain AlHussain ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Distant Metastasis ◽  
Cox Regression ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Concurrent Chemotherapy ◽  
Patterns Of Failure ◽  
Intensity Modulated

e295 Background: We aimed to investigate the patterns of failure (locoregional and distant metastasis), associated factors, treatment outcomes in nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiation therapy (IMRT) combined with chemotherapy, results of reirradiation in recurrent cases and its toxicity. Methods: From April 2006 to December 2011, 68 NPC patients were treated with IMRT and chemotherapy at our hospital. Median radiation doses delivered to gross tumor volume (GTV) and positive neck nodes were 66–70 Gy/33-35fractions. For recurrent cases reirradiation was given by SRS 25 -30 Gy/5 fractions or IMRT 50-60 Gy/25-30 fractions according to volume of recurrence and surrounding critical structures. The clinical toxicities, patterns of failures, locoregional control (LRC), distant metastasis control (DMC), disease free survival (DFS) and overall survival (OS) were observed. Results: The median follow up time was 52.2 months (range: 11-87). EBV infection positive was 63.2%.There were 7 locoregional recurrences, 3 regional recurrences with distant metastases and 11 distant metastases. The median interval from the date of diagnosis to failure was 26.5 months (range, 16-50 months). 6/10 (60%) locoregional recurrences were treated with re-irradiation +/- concurrent chemotherapy. Acute grade 3 and 4 mucositis were observed in 2 patients (28.6%); however no significant late toxicities were seen after reirradiation. Nodal recurrences were salvaged by neck dissection. The 5-year LRC, DMC, DFS and OS rates of whole cohort were 81.1%, 74.3%, 60.1% and 73.4% respectively. Cox regression analyses revealed that neoadjuvant chemotherapy, age and Epstein-Barr virus (EBV) were independent predictors for DFS. Conclusions: Distant metastasis is the most common pattern of failure after IMRT with SIB technique with or without neoadjuvant and concurrent chemotherapy in Saudi patients with NPC. Early detection of local and locoregional recurrences is important as reirradiation with IMRT or SRT with or without chemotherapy is still feasible option with acceptable toxicity. However, efforts should be made for proper patient selection.

scholarly journals Long-Term Progression of Sensorineural Hearing Loss and Tinnitus after Combined Intensity-Modulated Radiation Therapy and Cisplatin-Based Chemotherapy for Nasopharyngeal Carcinoma: A Case Report

2017 ◽  
Vol 10 (2) ◽  
pp. 743-751 ◽  
Author(s):  
Ming S. Lee ◽  
Sudha Penumala ◽  
Steven Sweet ◽  
Russell R. De Luca ◽  
Ariel E. Stearnes ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Nasopharyngeal Carcinoma ◽  
Sensorineural Hearing Loss ◽  
High Frequency ◽  
Intensity Modulated Radiotherapy ◽  
Intensity Modulated Radiation Therapy ◽  
Common Adverse Effect ◽  
Sensorineural Hearing ◽  
Intensity Modulated

Sensorineural hearing loss (SNHL) is a common adverse effect for nasopharyngeal carcinoma (NPC) patients treated with chemoradiotherapy. We report a case of 12-year follow-up from a patient with stage IIB NPC, treated in 2004 with intensity-modulated radiotherapy and cisplatin-based chemotherapy. Pure-tone audiograms were conducted before treatment and at two other points in the 12-year period after treatment. Analysis of the patient’s audiograms reveals that the development of high-frequency SNHL started after treatment and reached a plateau accompanied by tinnitus approximately 32 months after treatment conclusion. After the plateau, high-frequency SNHL continued to develop slowly in the next 10 years, possibly a long-term effect from radiation-induced microvascular change of the hearing apparatus. The continuous high-frequency hearing decline is associated with increased tinnitus pitch in the patient. With experience learned from this case, we recommend hearing tests at regular intervals for at least 3–5 years for NPC patients treated with chemoradiotherapy. Patients need to be educated about tinnitus and counseling can be offered when they begin to feel inconvenienced by tinnitus. These patients also need to be advised against exposure to noise that can aggravate the already compromised hearing apparatus, leading to further hearing loss and worsening tinnitus. Limiting the peak dose and total cumulative dose of cisplatin should be considered based on the patients’ risk factors to achieve a balance between treatment efficacy and long-term adverse effects.

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