Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia

Hans Paul van der Laan; Hendrik P Bijl; Roel J H M Steenbakkers; Arjen van der Schaaf; Olga Chouvalova; Johanna G M Vemer-van den Hoek; Agata Gawryszuk; Bernard F A M van der Laan; Sjoukje F Oosting; Jan L N Roodenburg; Kim Wopken; Johannes A Langendijk

doi:10.1016/j.radonc.2015.01.019

Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia

Hans Paul van der Laan^*, Hendrik P Bijl, Roel J H M Steenbakkers, Arjen van der Schaaf, Olga Chouvalova, Johanna G M Vemer-van den Hoek, Agata Gawryszuk, Bernard F A M van der Laan, Sjoukje F Oosting, Jan L N Roodenburg, Kim Wopken, Johannes A Langendijk

^*Corresponding author for this work

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Abstract

PURPOSE: To determine if acute symptoms during definitive radiotherapy (RT) or chemoradiation (CHRT) are prognostic factors for late dysphagia in head and neck cancer (HNC).

MATERIAL AND METHODS: This prospective cohort study consisted of 260 HNC patients who received definitive RT or CHRT. The primary endpoint was grade 2-4 swallowing dysfunction at 6months after completing RT (SWALM6). During treatment, acute symptoms, including oral mucositis, xerostomia and dysphagia, were scored, and the scores were accumulated weekly and entered into an existing reference model for SWALM6 that consisted of dose-volume variables only.

RESULTS: Both acute xerostomia and dysphagia were strong prognostic factors for SWALM6. When acute scores were added as variables to the reference model, model performance increased as the course of treatment progressed: the AUC rose from 0.78 at the baseline to 0.85 in week 6. New models built for weeks 3-6 were significantly better able to identify patients with and without late dysphagia.

CONCLUSION: Acute xerostomia and dysphagia during the course of RT are strong prognostic factors for late dysphagia. Including accumulated acute symptom scores on a weekly basis in prediction models for late dysphagia significantly improves the identification of high-risk and low-risk patients at an early stage during treatment and might facilitate individualized treatment adaptation.

Original language	English
Pages (from-to)	56-62
Number of pages	7
Journal	Radiotherapy and Oncology
Volume	115
Issue number	1
DOIs	https://doi.org/10.1016/j.radonc.2015.01.019
Publication status	Published - Apr-2015

Keywords

Head and neck cancer
IMRT
Swallowing dysfunction
Acute symptoms
Prediction models
INTENSITY-MODULATED RADIOTHERAPY
QUALITY-OF-LIFE
REDUCE SWALLOWING DYSFUNCTION
CANCER PATIENTS
RADIATION-THERAPY
PROSTATE-CANCER
TOXICITY
IMPACT
TRIAL

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van der Laan, H. P., Bijl, H. P., Steenbakkers, R. J. H. M., van der Schaaf, A., Chouvalova, O., Vemer-van den Hoek, J. G. M., Gawryszuk, A., van der Laan, B. F. A. M., Oosting, S. F., Roodenburg, J. L. N., Wopken, K., & Langendijk, J. A. (2015). Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia. Radiotherapy and Oncology, 115(1), 56-62. https://doi.org/10.1016/j.radonc.2015.01.019

@article{5b36da841dab40baa07114bf86e6ffec,

title = "Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia",

abstract = "PURPOSE: To determine if acute symptoms during definitive radiotherapy (RT) or chemoradiation (CHRT) are prognostic factors for late dysphagia in head and neck cancer (HNC).MATERIAL AND METHODS: This prospective cohort study consisted of 260 HNC patients who received definitive RT or CHRT. The primary endpoint was grade 2-4 swallowing dysfunction at 6months after completing RT (SWALM6). During treatment, acute symptoms, including oral mucositis, xerostomia and dysphagia, were scored, and the scores were accumulated weekly and entered into an existing reference model for SWALM6 that consisted of dose-volume variables only.RESULTS: Both acute xerostomia and dysphagia were strong prognostic factors for SWALM6. When acute scores were added as variables to the reference model, model performance increased as the course of treatment progressed: the AUC rose from 0.78 at the baseline to 0.85 in week 6. New models built for weeks 3-6 were significantly better able to identify patients with and without late dysphagia.CONCLUSION: Acute xerostomia and dysphagia during the course of RT are strong prognostic factors for late dysphagia. Including accumulated acute symptom scores on a weekly basis in prediction models for late dysphagia significantly improves the identification of high-risk and low-risk patients at an early stage during treatment and might facilitate individualized treatment adaptation.",

keywords = "Head and neck cancer, IMRT, Swallowing dysfunction, Acute symptoms, Prediction models, INTENSITY-MODULATED RADIOTHERAPY, QUALITY-OF-LIFE, REDUCE SWALLOWING DYSFUNCTION, CANCER PATIENTS, RADIATION-THERAPY, PROSTATE-CANCER, TOXICITY, IMPACT, TRIAL",

author = "{van der Laan}, {Hans Paul} and Bijl, {Hendrik P} and Steenbakkers, {Roel J H M} and {van der Schaaf}, Arjen and Olga Chouvalova and {Vemer-van den Hoek}, {Johanna G M} and Agata Gawryszuk and {van der Laan}, {Bernard F A M} and Oosting, {Sjoukje F} and Roodenburg, {Jan L N} and Kim Wopken and Langendijk, {Johannes A}",

year = "2015",

month = apr,

doi = "10.1016/j.radonc.2015.01.019",

language = "English",

volume = "115",

pages = "56--62",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "ELSEVIER IRELAND LTD",

number = "1",

}

van der Laan, HP , Bijl, HP , Steenbakkers, RJHM , van der Schaaf, A , Chouvalova, O , Vemer-van den Hoek, JGM , Gawryszuk, A, van der Laan, BFAM, Oosting, SF , Roodenburg, JLN , Wopken, K & Langendijk, JA 2015, 'Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia', Radiotherapy and Oncology, vol. 115, no. 1, pp. 56-62. https://doi.org/10.1016/j.radonc.2015.01.019

TY - JOUR

T1 - Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia

AU - van der Laan, Hans Paul

AU - Bijl, Hendrik P

AU - Steenbakkers, Roel J H M

AU - van der Schaaf, Arjen

AU - Chouvalova, Olga

AU - Vemer-van den Hoek, Johanna G M

AU - Gawryszuk, Agata

AU - van der Laan, Bernard F A M

AU - Oosting, Sjoukje F

AU - Roodenburg, Jan L N

AU - Wopken, Kim

AU - Langendijk, Johannes A

PY - 2015/4

Y1 - 2015/4

N2 - PURPOSE: To determine if acute symptoms during definitive radiotherapy (RT) or chemoradiation (CHRT) are prognostic factors for late dysphagia in head and neck cancer (HNC).MATERIAL AND METHODS: This prospective cohort study consisted of 260 HNC patients who received definitive RT or CHRT. The primary endpoint was grade 2-4 swallowing dysfunction at 6months after completing RT (SWALM6). During treatment, acute symptoms, including oral mucositis, xerostomia and dysphagia, were scored, and the scores were accumulated weekly and entered into an existing reference model for SWALM6 that consisted of dose-volume variables only.RESULTS: Both acute xerostomia and dysphagia were strong prognostic factors for SWALM6. When acute scores were added as variables to the reference model, model performance increased as the course of treatment progressed: the AUC rose from 0.78 at the baseline to 0.85 in week 6. New models built for weeks 3-6 were significantly better able to identify patients with and without late dysphagia.CONCLUSION: Acute xerostomia and dysphagia during the course of RT are strong prognostic factors for late dysphagia. Including accumulated acute symptom scores on a weekly basis in prediction models for late dysphagia significantly improves the identification of high-risk and low-risk patients at an early stage during treatment and might facilitate individualized treatment adaptation.

AB - PURPOSE: To determine if acute symptoms during definitive radiotherapy (RT) or chemoradiation (CHRT) are prognostic factors for late dysphagia in head and neck cancer (HNC).MATERIAL AND METHODS: This prospective cohort study consisted of 260 HNC patients who received definitive RT or CHRT. The primary endpoint was grade 2-4 swallowing dysfunction at 6months after completing RT (SWALM6). During treatment, acute symptoms, including oral mucositis, xerostomia and dysphagia, were scored, and the scores were accumulated weekly and entered into an existing reference model for SWALM6 that consisted of dose-volume variables only.RESULTS: Both acute xerostomia and dysphagia were strong prognostic factors for SWALM6. When acute scores were added as variables to the reference model, model performance increased as the course of treatment progressed: the AUC rose from 0.78 at the baseline to 0.85 in week 6. New models built for weeks 3-6 were significantly better able to identify patients with and without late dysphagia.CONCLUSION: Acute xerostomia and dysphagia during the course of RT are strong prognostic factors for late dysphagia. Including accumulated acute symptom scores on a weekly basis in prediction models for late dysphagia significantly improves the identification of high-risk and low-risk patients at an early stage during treatment and might facilitate individualized treatment adaptation.

KW - Head and neck cancer

KW - IMRT

KW - Swallowing dysfunction

KW - Acute symptoms

KW - Prediction models

KW - INTENSITY-MODULATED RADIOTHERAPY

KW - QUALITY-OF-LIFE

KW - REDUCE SWALLOWING DYSFUNCTION

KW - CANCER PATIENTS

KW - RADIATION-THERAPY

KW - PROSTATE-CANCER

KW - TOXICITY

KW - IMPACT

KW - TRIAL

U2 - 10.1016/j.radonc.2015.01.019

DO - 10.1016/j.radonc.2015.01.019

M3 - Article

C2 - 25792467

SN - 0167-8140

VL - 115

SP - 56

EP - 62

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

IS - 1

ER -

Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia

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Keywords

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