Chronic radiation-associated dysphagia in oropharyngeal cancer survivors: Towards age-adjusted dose constraints for deglutitive muscles

作者：Kaitlin M. Christopherson, Alokananda Ghosh, Abdallah Mohamed, Mona Kamal, G. Brandon Gunn, Timothy M. Dale, Jayashree Kalpathy–Cramer, J.A. Messer, Adam S. Garden, Hesham Elhalawani, Steven J. Frank, Jan S. Lewin, William H. Morrison, Jack Phan, Neil D. Gross, Renata Ferrarotto, Randal S. Weber, D.I. Rosenthal, Stephen Y. Lai, Katherine A. Hutcheson, Clifton D. Fuller, Abdallah Mohamed, G. Elisabeta Marai, Guadalupe Canahuate, David M. Vock, David Fuller · 发表于：Clinical and Translational Radiation Oncology · 年份：2019 · DOI：10.1016/j.ctro.2019.06.005 · 被引用次数：36 · 研究领域：Dysphagia Assessment and Management、Head and Neck Cancer Studies、Oral health in cancer treatment

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: < 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.