Intensity-Modulated Chemoradiotherapy Aiming to Reduce Dysphagia in Patients With Oropharyngeal Cancer: Clinical and Functional Results

TLDR

The study aimed to evaluate the clinical and functional outcomes of intensity‑modulated radiotherapy‑based chemoradiotherapy for oropharyngeal cancer, specifically targeting sparing of swallowing structures to reduce post‑treatment dysphagia. In a prospective cohort, patients received weekly carboplatin and paclitaxel concurrently with IMRT designed to spare non‑involved pharyngeal constrictors, laryngeal structures, esophagus, oral cavity, and salivary glands, and swallowing function was measured by patient‑reported scores, observer ratings, and videofluoroscopy before and up to two years post‑therapy. Among 73 stage III–IV patients, 3‑year disease‑free and locoregional control rates were 88 % and 96 %, and although dysphagia initially worsened, observer‑rated scores returned to near baseline by one year, VF scores remained mildly impaired, and overall long‑term swallowing function was only slightly worse than pre‑therapy, suggesting a potential benefit over earlier approaches.

Abstract

Purpose To assess clinical and functional results of chemoradiotherapy for oropharyngeal cancer (OPC), utilizing intensity-modulated radiotherapy (IMRT) to spare the important swallowing structures to reduce post-therapy dysphagia. Patients and Methods This was a prospective study of weekly chemotherapy (carboplatin dosed at one times the area under the curve [AUC, AUC 1] and paclitaxel 30 mg/m 2 ) concurrent with IMRT aiming to spare noninvolved parts of the swallowing structures: pharyngeal constrictors, glottic and supraglottic larynx, and esophagus as well as the oral cavity and major salivary glands. Swallowing was assessed by patient-reported Swallowing and Eating Domain scores, observer-rated scores, and videofluoroscopy (VF) before therapy and periodically after therapy through 2 years. Results Overall, 73 patients with stages III to IV OPC participated. At a median follow-up of 36 months, 3-year disease-free and locoregional recurrence-free survivals were 88% and 96%, respectively. All measures of dysphagia worsened soon after therapy; observer-rated and patient-reported scores recovered over time, but VF scores did not. At 1 year after therapy, observer-rated dysphagia was absent or minimal (scores 0 to 1) in all patients except four: one who was feeding-tube dependent and three who required soft diet. From pretherapy to 12 months post-therapy, the Swallowing and Eating Domain scores worsened on average (± standard deviation) by 10 ± 21 and 13 ± 19, respectively (on scales of 0 to 100), and VF scores (on scale of 1 to 7) worsened from 2.9 ± 1.5 (mild dysphagia) to 4.1 ± 0.9 (mild/moderate dysphagia). Conclusion Chemoradiotherapy with IMRT aiming to reduce dysphagia can be performed safely for OPC and has high locoregional tumor control rates. On average, long-term patient-reported, observer-rated, and objective measures of swallowing were only slightly worse than pretherapy measures, representing potential improvement compared with previous studies.