Background and purpose:
Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in
relation to dose-parameters of structures involved in swallowing and mastication.
Material and methods:
of 55 patients before, 10-weeks (N=49) and 1-year post-treatment (N=37). Calculation of dose-volume parameters for swallowing
(inferior (IC), middle (MC), and superior constrictors (SC)), and mastication structures (e.g. masseter). Investigation of
relationships between dose-parameters and endpoints for swallowing problems (videofluoroscopy-based laryngeal Penetration-Aspiration
Scale (PAS), and study-specific structured questionnaire) and limited mouth-opening (measurements and questionnaire), taking
into account baseline scores.
At 10-weeks, volume of IC receiving ≥60 Gy (V60) and mean dose IC were significant
predictors for PAS. One-year post-treatment, reported problems with swallowing solids were significantly related to masseter
dose-parameters (mean, V20, V40 and V60) and an inverse relationship (lower dose related to a higher probability) was observed
for V60 of the IC. Dose-parameters of masseter and pterygoid muscles were significant predictors of trismus at 10-weeks (mean,
V20, and V40). At 1-year, dose-parameters of all mastication structures were strong predictors for subjective mouth-opening
problems (mean, max, V20, V40, and V60).
Dose-effect relationships exist for dysphagia and trismus. Therefore
treatment plans should be optimized to avoid these side effects.