Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Hong Kong, China.
Dysphagia. 2022 Jun;37(3):612-621. doi: 10.1007/s00455-021-10311-6. Epub 2021 Apr 28.
This 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.
本研究旨在探讨调强放疗（IMRT）剂量学与吞咽运动学和时相关测量值之间的关系。使用 13 项吞咽运动学和时相关测量值作为反映吞咽功能的结果测量值，这些测量值来自透视分析。评估了与 13 项吞咽相关结构的 IMRT 剂量学。招募了至少在 IMRT 后 3 年的 44 名鼻咽癌（NPC）幸存者队列。该队列的平均年龄为 53.2 ± 11.9 岁，其中 77.3%为男性。从 IMRT 结束到现在的平均时间为 68.24 ± 14.15 个月；41 人（93.2%）接受了同期化疗。对于位移测量值，女性和环杓后区、声带喉和舌根的更高剂量与舌骨喉复合体下降和咽缩减少以及更多残留物相关。对于时相关测量值，颏舌肌的更高剂量与吞咽各阶段的处理时间缩短相关。与其他结构相比，下咽缩肌与平均辐射剂量的关联模式明显不同。与稀薄液体相比，稠布丁状一致性下观察到吞咽运动学和时相关测量值的变化更大。与吞咽相关结构的辐射剂量增加与吞咽运动学的降低相关。然而，并非所有结构都以相同的方式受到影响，因此在进行 IMRT 治疗计划时，需要考虑器官保护以维持功能，而不仅仅是关注特定肌肉。需要用一整套吞咽结构来调查剂量反应关系，以捕捉吞咽的整体过程。
