Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India.
Molecular & Structural Biology, CSIR-Central Drug Research Institute, Lucknow, India.
Asian Pac J Cancer Prev. 2023 Nov 1;24(11):3697-3704. doi: 10.31557/APJCP.2023.24.11.3697.
Dosimetric sparing of critical swallowing structures like constrictor muscles and larynx can lead to improved functional outcomes in head and neck cancer patients treated by chemoradiation.
A total of 50 Patients with newly diagnosed, biopsy proven AJCC stage II-IV head and neck squamous cell cancers (HNSCC) were prospectively studied. 25 patients were randomized in each arm of Dysphagia-optimized Intensity Modulated Radiotherapy (Do-IMRT) arm and Standard Intensity Modulated Radiotherapy (SIMRT) arm. Additional dose constraints were applied to the dysphagia/aspiration at risk structures (DARS) in Do-IMRT arm. The impact of using Do-IMRT was assessed by the difference in mean scores of MD Anderson Dysphagia Inventory (MDADI), University of Washington-Quality of Life (UW-QOL), and 100 ml Water Swallow Test (WST).
Patients in both arms showed significant (P <0.01 or P < 0.001) improvement in MDADI (global and composite), UW-QOL and Water Swallow Test scores. However, the improvements were found significantly higher in Do-IMRT as compared to S-IMRT. Significant improvements i.e. mean change from baseline to 12 months (P <0.05 or P <0.01 or P <0.001) were 19. 2, 8.6, 14.3, 7.4, 18.6 and 22.0% higher respectively in Do-IMRT as compared to S-IMRT in MDADI global and composite scores, UW-QOL swallowing scores, and 100 ml Water Swallow (swallowing volume, swallowing capacity and swallowing speed) test scores.
The Do-IMRT improves swallowing functions compared to S-IMRT in HNSCC patients treated with radical chemoradiation.
在接受放化疗的头颈部癌症患者中，保护关键吞咽结构（如缩肌和喉头）的剂量可提高其功能预后。
共前瞻性研究了 50 例新诊断的经活检证实的 AJCC Ⅱ-Ⅳ 期头颈部鳞状细胞癌（HNSCC）患者。25 例患者随机分为吞咽优化调强放疗（Do-IMRT）组和标准调强放疗（SIMRT）组。在 Do-IMRT 组中，对吞咽/吸入危险结构（DARS）应用了附加剂量限制。通过 MD 安德森吞咽障碍指数（MDADI）、华盛顿大学生活质量（UW-QOL）和 100ml 水吞咽试验（WST）的平均评分差异评估 Do-IMRT 的影响。
两组患者的 MDADI（总体和综合）、UW-QOL 和水吞咽试验评分均有显著改善（P<0.01 或 P<0.001）。然而，与 SIMRT 相比，Do-IMRT 的改善更为显著。Do-IMRT 组较 SIMRT 组的平均变化有显著改善，即从基线到 12 个月的变化（P<0.05 或 P<0.01 或 P<0.001）分别为 MDADI 总体和综合评分、UW-QOL 吞咽评分、100ml 水吞咽试验（吞咽量、吞咽容量和吞咽速度）评分高 19.2%、8.6%、14.3%、7.4%、18.6%和 22.0%。
与 S-IMRT 相比，Do-IMRT 可改善接受根治性放化疗的 HNSCC 患者的吞咽功能。
