Dysphagia in Head and Neck Radiotherapy: The Influence of Pharyngeal Constrictor Anatomy and Dosimetry.

IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Dysphagia Pub Date : 2025-02-01 Epub Date: 2024-05-16 DOI:10.1007/s00455-024-10705-2
Owen Paetkau, Sarah Weppler, Jaime Kwok, Harvey C Quon, Wendy Smith, Ekaterina Tchistiakova, Charles Kirkby
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Abstract

The goal of this study was to identify which anatomical and dosimetric changes correlated with late patient-reported dysphagia throughout the course of head and neck chemo-radiotherapy treatment. The patient cohort (n = 64) considered oropharyngeal and nasopharyngeal patients treated with curative intent, exhibiting no baseline dysphagia with a follow-up time greater than one year. Patients completed the MD Anderson Dysphagia Inventory during a follow-up visit. A composite score was measured ranging from 20 to 100, with a low score indicating a high symptom burden; a score ≤60 indicated patient-reported dysphagia. The pharyngeal (PCM) and cricopharyngeal constrictor muscles (CPM) were contoured on a planning CT image and adapted to weekly cone-beam CT anatomy using deformable image registration and dose was accumulated using weighted dose-volume histogram curves. The PCM and CPM were examined for volume, thickness, and dosimetric changes across treatment with the results correlated to symptom group. Anatomical evaluation indicated the PCM thickness increased more during treatment for patients with dysphagia, with base of C2 vertebrae (p = 0.04) and superior-inferior middle PCM (p = 0.01) thicknesses indicating a 1.0-1.5 mm increase. The planned and delivered mean dose and DVH metrics to PCM and CPM were found to be within random error measured for the dose accumulation, indicating delivered and planned dose are equivalent. The PCM and CPM organs were found to lie approximately 5 mm closer to high dose gradients in patients exhibiting dysphagia. The volume, thickness, and high dose gradient metrics may be useful metrics to identify patients at risk of late patient-reported dysphagia.

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头颈部放疗中的吞咽困难:咽部解剖和剂量测定的影响。
本研究的目的是确定在头颈部化疗和放疗的整个过程中,哪些解剖学和剂量学变化与患者报告的后期吞咽困难相关。患者队列(n = 64)考虑了接受根治性治疗的口咽部和鼻咽部患者,这些患者无基线吞咽困难,随访时间超过一年。患者在随访期间完成了 MD 安德森吞咽困难量表。综合评分从 20 分到 100 分不等,得分低表示症状负担重;得分≤60 分表示患者报告的吞咽困难。咽部(PCM)和环咽收缩肌(CPM)的轮廓在规划 CT 图像上绘制,并通过可变形图像注册与每周锥形束 CT 解剖相适应,剂量通过加权剂量-体积直方图曲线累积。检查 PCM 和 CPM 在整个治疗过程中的体积、厚度和剂量变化,并将结果与症状组相关联。解剖学评估显示,吞咽困难患者的 PCM 厚度在治疗期间增加较多,C2 椎体底部(p = 0.04)和 PCM 中上部(p = 0.01)的厚度增加了 1.0-1.5 毫米。发现 PCM 和 CPM 的计划和交付平均剂量及 DVH 指标均在剂量累积测量的随机误差范围内,这表明交付剂量和计划剂量是等效的。在出现吞咽困难的患者中,PCM 和 CPM 器官距离高剂量梯度约 5 毫米。体积、厚度和高剂量梯度指标可能是识别患者后期吞咽困难风险的有用指标。
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来源期刊
Dysphagia
Dysphagia 医学-耳鼻喉科学
CiteScore
4.90
自引率
15.40%
发文量
149
审稿时长
6-12 weeks
期刊介绍: Dysphagia aims to serve as a voice for the benefit of the patient. The journal is devoted exclusively to swallowing and its disorders. The purpose of the journal is to provide a source of information to the flourishing dysphagia community. Over the past years, the field of dysphagia has grown rapidly, and the community of dysphagia researchers have galvanized with ambition to represent dysphagia patients. In addition to covering a myriad of disciplines in medicine and speech pathology, the following topics are also covered, but are not limited to: bio-engineering, deglutition, esophageal motility, immunology, and neuro-gastroenterology. The journal aims to foster a growing need for further dysphagia investigation, to disseminate knowledge through research, and to stimulate communication among interested professionals. The journal publishes original papers, technical and instrumental notes, letters to the editor, and review articles.
期刊最新文献
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