Comparison of Dosimetric Parameters in Dysphagia Aspiration-Related Structures and Clinical Correlation in Head and Neck Cancer Patients Treated With Radiotherapy

Abstract

Introduction Chemoradiotherapy plays a major role in the treatment of head and neck cancer (HNC). Persistent dysphagia following primary chemoradiotherapy for head and neck cancers can have a devastating effect on a patient's quality of life. Many studies have shown that the dosimetric sparing of critical structures which were included in swallowing such as the pharyngeal constrictor muscle and larynx can provide improved functional outcomes and better quality of life. However, there are no current randomized studies confirming the benefits of such swallowing-sparing strategies. The aim is to evaluate late dysphagia after chemoradiotherapy for head and neck cancer and to examine its correlation with clinical and dosimetric parameters. Materials and methods The period of this prospective study was from November 2018 to March 2020. Patients were divided randomly in 1:1 ratio into two groups, group 1 and group 2, each with 25 patients. Group 1 was planned by three-dimensional conformal radiotherapy (3D-CRT) technique and group 2 was planned by intensity-modulated radiotherapy technique (IMRT) technique. Treatment was delivered after approval of radiotherapy plan. To evaluate the dose to dysphagia aspiration-related structures (DARS), these structures were contoured and dose-volume histograms were generated. Various dosimetric parameters of DARS were evaluated. Swallowing status was clinically evaluated based on the Radiation Therapy Oncology Group and the Common Terminology Criteria for Adverse Events, version 5. Results A significant advantage was seen with intensity-modulated radiotherapy technique (IMRT) in comparison to three-dimensional conformal radiotherapy (3D-CRT) in terms of mean dose delivered to the pharyngeal constrictor muscles (66.03 Gy vs 68.77 Gy, p=0.003). The mean dose delivered to the combined dysphagia/aspiration-related structures (DARS) was statistically significantly lower in IMRT compared to 3D-CRT (66.15 Gy vs. 70.09 Gy, p<0.001). Other dose-volumes were also reduced in IMRT group (V30: {98.64% vs. 99.88%, p=0.05}; V50: {90.49% vs. 99.02%, p=0.0002}; V60: {83.92% vs. 95.04, p=0.0002}; D50: {70 Gy vs. 71.16 Gy, p=0.001); and D80: {61.18 Gy vs. 67.39 Gy, p=0.01}. Futhermore, the clinical worsening of dysphagia was less common in IMRT group (48% vs. 80%, p=0.039). Conclusion IMRT can reduce the high-dose volumes received by the DARS receiving high doses by sparing these structures through optimization. This may provide a significant additional benefit that could improve dysphagia and hence the quality of life of patients with head and neck cancer.