The potential benefit of swallowing sparing intensity modulated radiotherapy to reduce swallowing dysfunction: An in silico planning comparative study

Hans Paul van der Laan*, Miranda E M C Christianen, Hendrik P Bijl, C Schilstra, Johannes A Langendijk

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

56 Citations (Scopus)

Abstract

PURPOSE: To apply recently developed predictive models for swallowing dysfunction to compare the predicted probabilities of swallowing dysfunction for standard intensity modulated radiotherapy (ST-IMRT) and swallowing sparing IMRT (SW-IMRT).

MATERIALS AND METHODS: Thirty head and neck cancer patients who previously underwent radiotherapy for the bilateral neck were selected for this study. For each patient, ST-IMRT and SW-IMRT simultaneous integrated boost treatment plans were created. ST-IMRT treatment plan optimisation aimed at obtaining adequate target volume coverage and sparing of the parotid and submandibular glands as much as possible. Objectives for SW-IMRT were similar, with additional objectives to spare the organs at risk related to swallowing dysfunction (SWOARs). Dose-volume data with ST-IMRT and SW-IMRT and normal tissue complication probabilities for physician-rated and patient-rated swallowing dysfunction were calculated with recently developed predictive models.

RESULTS: All plans had adequate target volume coverage and dose to critical organs was within accepted limits. Sparing of parotid glands was similar for ST-IMRT and SW-IMRT. With SW-IMRT, the mean dose to the various SWOARs was reduced. Absolute dose values and dose reductions with SW-IMRT differed per patient and per SWOAR and depended on N stage and tumour location. The mean reduction in predicted physician-rated Radiation Therapy Oncology Group (RTOG) grade 2-4 swallowing dysfunction was 9% (range, 3-20%). Mean reductions of the probability of patient-rated moderate to severe complaints with regard to the swallowing of solid food, soft food, liquid food and choking when swallowing were 8%, 2%, 1% and 1%, respectively.

CONCLUSIONS: New predictive models for swallowing dysfunction were applied to show potential reductions in physician and patient-rated swallowing dysfunction with IMRT that was specifically optimised to spare SWOARs.

Original languageEnglish
Pages (from-to)76-81
Number of pages6
JournalRadiotherapy and Oncology
Volume103
Issue number1
DOIs
Publication statusPublished - Apr-2012

Keywords

  • Head and neck cancer
  • IMRT
  • Swallowing dysfunction
  • Normal tissue complication probability
  • In silico study
  • QUALITY-OF-LIFE
  • NECK-CANCER PATIENTS
  • SQUAMOUS-CELL CARCINOMA
  • ONCOLOGY GROUP RTOG
  • EUROPEAN-ORGANIZATION
  • CONCURRENT CHEMOTHERAPY
  • ADVANCED HEAD
  • DYSPHAGIA
  • THERAPY
  • DELINEATION

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