International Journal of Radiation Oncology*Biology*Physics
ePoster SessionExploratory Assessment of Swallowing Muscle Dose Volume Parameters With Chronic Dysphagia in Patients Receiving Head and Neck Chemoradiation Therapy
Section snippets
Purpose/Objective(s)
While dose to pharyngeal constrictors has previously been associated with postchemoradiation therapy (CRT) swallowing dysfunction, there is little extant data regarding effects for other swallowing muscles. We sought to identify, using nonmodel-dependent statistical methods, specific swallowing muscle dose-response thresholds associated with chronic dysphagia.
Materials/Methods
Data from sequential series of T1–4 N0–3 M0 patients who received concurrent chemoradiation with intensity modulated CRT were accessed from an institutional speech pathology dataset. Chronic dysphagia was coded as a binary outcome defined as any of the following occurring ≥12 months post-CRT: modified barium swallow–detected aspiration or stricture, gastrostomy tube, and/or aspiration pneumonia. Delivered CRT plan data was extracted from the treatment planning system and autosegmented using a
Results
A total of 284 patients were available for DVH analysis; 31 had chronic dysphagia. RPA showed DVH-derived MHM V69 (i.e., the volume receiving ≥69 Gy), GGM V35, ADM V60, and MPC V49 were strongly associated with chronic dysphagia (all P < .01; cumulative ROC AUC 0.83). Stepwise regression demonstrated among DVH-based models that a model using binary MHM V69 and ADM V60 thresholds maximally discriminated between patients with and without chronic dysphagia (ROC AUC 0.85). A model including age in
Conclusion
Identification of swallowing muscle DVH parameters related to chronic dysphagia may allow selection of patients for aggressive swallowing rehabilitation. Dose to MHM, ADM, and GGM should be monitored and constrained in addition to pharyngeal constrictors when feasible given adequate target coverage.
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Author Disclosure:T.M. Dale: None. K.A. Hutcheson: None. A.S. Mohamed: None. G.B. Gunn: None. D.I. Rosenthal: None. C.D. Fuller: Research Grant; GE Healthcare, Elekta AB, NIH. Serve on professional society committees; Radiological Society of North America.