Toft Kate, McLachlan Kirsty, Winton Mark, Mactier Karen, Hare Nadine, Nugent Claire, Wincott Lucie, Srinivasan Devraj, Mackenzie Joanna, Nailon Bill, Noble David
Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK.
Department of Speech and Hearing Science, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK.
Tech Innov Patient Support Radiat Oncol. 2024 Aug 30;32:100272. doi: 10.1016/j.tipsro.2024.100272. eCollection 2024 Dec.
This study aimed to conduct a global assessment of swallow function (GASF) using a range of swallow outcome tools, in a cohort of patients pre- and post-treatment with image-guided volumetric modulated arc therapy (VMAT) radiotherapy.
All patients receiving radical (chemo)radiation for SCC of the larynx, oro-, hypo- or nasopharynx between October 2016 - 2021 were eligible for inclusion.Patients were treated with VMAT radiotherapy according to institutional and national protocols.Patients underwent GASF pre- and 6 months post-treatment. Data were collated from the MD Anderson Dysphagia Inventory (MDADI), the Functional Oral Intake Scale (FOIS), the Performance Status Scale-Head and Neck: Normalcy of Diet scale (PSS-NoD), the 100 ml water swallow test (WST) for capacity and maximal interincisal opening (MIO).
One hundred and seventy-five patients were included. 55.2 % of patients experienced a fall in MDADI-Composite score greater than the published meaningful clinical important difference (MCID).A trend for a decrease in FOIS score reflects a decrease in range of diet textures and increase in reliance on enteral feeding at 6 months post-treatment.Mean PSS-NoD score decreased reflecting increased restriction in diet textures.20 patients' WST capacity improved by the minimal clinically important difference of > 4mls whilst 37 % of patients experienced a decrease in WST capacity of 4mls or more. 12.6 % of patients developed trismus following radiotherapy.
This paper adds new detail to the understanding of the decline in measured eating, drinking and swallowing function that patients treated with VMAT radiotherapyexperience at 6 months post treatment. However, gaps are highlighted in the evidence base in terms of interpretation of swallow outcomes tool scores; future research in HNC should include ongoing discussion and development around robust outcomes tools and data collection.
本研究旨在使用一系列吞咽结果工具，对接受图像引导容积调强弧形放疗（VMAT）的患者治疗前后的吞咽功能进行全球评估（GASF）。
2016年10月至2021年期间所有接受喉、口咽、下咽或鼻咽癌根治性（化疗）放疗的患者均符合纳入标准。患者根据机构和国家方案接受VMAT放疗。患者在治疗前和治疗后6个月接受GASF评估。数据来自MD安德森吞咽困难量表（MDADI）、功能性口服摄入量表（FOIS）、头颈功能状态量表：饮食正常量表（PSS-NoD）、100毫升水吞咽试验（WST）的容量和最大切牙间开口度（MIO）。
纳入175例患者。55.2%的患者MDADI综合评分下降幅度大于已公布的有意义的临床重要差异（MCID）。FOIS评分下降趋势反映了治疗后6个月饮食质地范围的减少和对肠内喂养依赖的增加。平均PSS-NoD评分下降反映了饮食质地限制的增加。20例患者的WST容量改善了>4毫升的最小临床重要差异，而37%的患者WST容量下降了4毫升或更多。12.6%的患者放疗后出现牙关紧闭。
本文为理解接受VMAT放疗的患者在治疗后6个月所经历的进食、饮水和吞咽功能下降增加了新的细节。然而，在吞咽结果工具评分的解释方面，证据基础存在差距；头颈癌未来的研究应包括围绕稳健的结果工具和数据收集进行持续的讨论和开发。
