Skip to main content
SpringerLink
Log in

Influence of radiation dose to pharyngeal constrictor muscles on late dysphagia and quality of life in patients with locally advanced oropharyngeal carcinoma

  • Original Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background and objective

Patients with oropharyngeal carcinoma (OPC) often have difficulty swallowing, which may affect quality of life (QoL). Radiation dose to constrictor muscles plays an important role.

Methods

54 patients with locally advanced OPC were evaluated after intensity-modulated radiotherapy. Data were collected at standardized intervals using the EORTC questionnaires QLQ-C30 and QLQ-HN35 within two years. The pharyngeal constrictors (superior, middle, and inferior) were each contoured as an organ at risk. Influence of dose to the constrictors (≥55 Gy vs. <55 Gy) on late dysphagia and QoL was analyzed using the t‑test.

Results

Late radiation-induced dysphagia depends significantly on the dose to the lower pharyngeal constrictor. At a dose of ≥55 Gy, 14 (64%) patients developed dysphagia grade ≤2 and 8 (36%) patients grade ≥3. At a dose of <55 Gy, the distribution at the end of radiotherapy (RT) was similar: 22 (69%) patients with dysphagia grade ≤2, 10 (31%) with grade ≥3. There was no dose-dependent difference in the severity of dysphagia in the acute phase (p = 0.989). There were differences 18 months after the end of RT: ≥55 Gy: 19 (86%) patients showed dysphagia grade ≤2; 3 (14%) grade ≥3. At <55 Gy, 31 (97%) patients developed grade ≤2, 1 (3%) grade ≥3 (18 months: p = 0.001; 24 months: p = 0.000). Late dysphagia is also dependent on the dose level of the middle constrictor muscle (6 months: p = 0.000; 12 months: p = 0.005, 18 months: p = 0.034). After 24 months, there was no significant difference (p = 0.374).

Conclusion

Radiation dose to the upper constrictor muscle appears to be of little relevance. The middle and lower constrictor should be given special consideration to avoid late dysphagia. Long-term QoL is independent on radiation dose.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Aaronson NK, Ahmedzai S, Bergmann B et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376

    Article  CAS  Google Scholar 

  2. Alterio D, Ciardo D, Preda L et al (2014) Contouring of the pharyngeal superior constrictor muscle (PSCM). A cooperative study of the Italian association of radiation oncology (AIRO) head and neck group. Radiother Oncol 112(3):337–342

    Article  Google Scholar 

  3. Bhide SA, Gulliford S, Kazi R et al (2009) Correlation between dose to the pharyngeal constrictors and patient quality of life and late dysphagia following chemo-IMRT for head and neck cancer. Radiother Oncol 93(3):539–544

    Article  Google Scholar 

  4. Brouwer CL, Steenbakkers RJHM, Bourhis J et al (2015) CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol 117(1):83–90

    Article  Google Scholar 

  5. Caudell JJ, Schaner PE, Meredith RF et al (2009) Factors associated with long-term Dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 73(2):410–415

    Article  Google Scholar 

  6. Christianen MEMC, Verdonck-de Leeuw IM, Doornaert P et al (2015) Patterns of long-term swallowing dysfunction after definitive radiotherapy or chemoradiation. Radiother Oncol 117(1):139–144

    Article  Google Scholar 

  7. Deantonio L, Masini L, Brambilla M et al (2013) Dysphagia after definitive radiotherapy for head and neck cancer: Correlation of dose–volume parameters of the pharyngeal constrictor muscles. Strahlenther Onkol 189(3):230–237

    Article  CAS  Google Scholar 

  8. Dirix P, Abbeel S, Vanstraelen B et al (2009) Dysphagia after Chemoradiotherapy for head-and-neck squamous cell carcinoma: dose–effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 75(2):385–392

    Article  CAS  Google Scholar 

  9. Eisbruch A, Levendag PC, Feng FY et al (2007) Can IMRT or Brachytherapy reduce Dysphagia associated with Chemoradiotherapy of head and neck cancer? The michigan and rotterdam experiences. Int. J Radiat Oncol 69(2):40–42

    Article  Google Scholar 

  10. Eisbruch A, Achwartz M, Rasch C et al (2004) Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: Which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys 60(5):1425–1439

    Article  Google Scholar 

  11. Feng FY, Kim HM, Lyden TH et al (2007) Intensity-modulated radiotherapy of head and neck cancer aiming to reduce Dysphagia: early dose–effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 68(5):1289–1298

    Article  Google Scholar 

  12. Forastiere AA, Goepfert H, Maor M et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349(22):2091–2098

    Article  CAS  Google Scholar 

  13. IBM Corp (2013) IBM SPSS Statistics for Windows. IBM Corp, Armonk, NY

    Google Scholar 

  14. Langendijk JA, Steenbakkers RJHM (2017) Optimizing Radiotherapy in HPV-Associated Oropharyngeal Cancer Patients. In: Golusiński W et al (ed) HPV Infection in Head and Neck Cancer. Springer, Cham, pp 161–171

    Chapter  Google Scholar 

  15. Levendag PC, Teguh DN, Voet P et al (2007) Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol 85(1):64–73

    Article  Google Scholar 

  16. Mazzola R, Ricchetti F, Fiorentino A et al (2014) Dose–volume-related dysphagia after constrictor muscles definition in head and neck cancer intensity-modulated radiation treatment. Br J Radiol. https://doi.org/10.1259/bjr.20140543

    Article  PubMed  PubMed Central  Google Scholar 

  17. Miroir J, Biau J, Saroul N et al (2017) PD-032: Pharyngeal constrictor muscle dose correlated with dysphagia after radiotherapy in head and neck. Radiother Oncol. https://doi.org/10.1016/S0167-8140(17)30181-0

    Article  Google Scholar 

  18. Schwarz R, Hinz A (2001) Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 37(11):1345–1351

    Article  CAS  Google Scholar 

  19. Strojan P, Hutcheson KA, Eisbruch A et al (2017) Treatment of late sequelae after radiotherapy for head and neck cancer. Cancer Treat Rev 59:79–92

    Article  Google Scholar 

  20. Tribius S, Raguse M, Voigt C et al (2015) Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer: Results of a prospective study. Strahlenther Onkol 191(6):501–510

    Article  Google Scholar 

  21. Ursino S, D’Angelo E, Mazzola R et al (2017) A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy: a systematic review by the Italian Head and Neck Radiotherapy Study Group. Strahlenther Onkol 193(11):877–889

    Article  Google Scholar 

  22. Ursino S, Seccia V, Cocuzza P et al (2016) How does radiotherapy impact swallowing function in nasopharynx and oropharynx cancer? Short-term results of a prospective study. Acta Otorhinolaryngol Ital 3:174–184

    Google Scholar 

  23. Vainshtein J, Eisbruch A (2013) Function, muscles, and sparing by IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys 85(3):577–578

    Article  Google Scholar 

  24. Yirmibeşoğlu Erkal E, Canoğlu D, Kaya A et al (2014) Assessment of early and late dysphagia using videofluoroscopy and quality of life questionnaires in patients with head and neck cancer treated with radiation therapy. Radiat Oncol 9(1):137

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    S. Mogadas, A. Krüll MD PhD & C. Petersen MD PhD

  2. Department of Otolaryngology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    C.-J. Busch MD PhD

  3. Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    C. Pflug MD PhD

  4. Department of Oral & Maxillofacial Surgery, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    H. Hanken MD PhD

  5. Department of Radiation Oncology, Asklepios Hospital St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany

    S. Tribius MD PhD

Authors
  1. S. Mogadas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C.-J. Busch MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Pflug MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Hanken MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Krüll MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Petersen MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Tribius MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Tribius MD PhD.

Ethics declarations

Conflict of interest

S. Mogadas, C.-J. Busch, C. Pflug, H. Hanken, A. Krüll, C. Petersen, and S. Tribius declare that they have no competing interests.

Ethical standards

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mogadas, S., Busch, CJ., Pflug, C. et al. Influence of radiation dose to pharyngeal constrictor muscles on late dysphagia and quality of life in patients with locally advanced oropharyngeal carcinoma. Strahlenther Onkol 196, 522–529 (2020). https://doi.org/10.1007/s00066-019-01572-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-019-01572-0

Keywords

Search

Navigation