JCO: IMRT could improve quality of life for head, neck cancer patients
Chemoradiotherapy for oropharyngeal cancer (OPC), utilizing intensity-modulated radiotherapy (IMRT) aiming to reduce dysphagia can be performed safely for OPC and has high locoregional tumor control rates, determined a study published in online April 26 in the Journal of Clinical Oncology.

Avraham Eisbruch, MD, professor of radiation oncology at the University of Michigan Comprehensive Cancer Center in Ann Arbor, and colleagues conducted their study to assess clinical and functional results of chemoradiotherapy with IMRT for head and neck cancers, while avoiding treating critical structures that affect swallowing and eating. Scar tissue from radiation treatments to the head and neck can create long-term problems with swallowing and eating solid foods, which have not been found to improve over time.

"More aggressive treatments for head and neck cancer have improved cancer control, but at the expense of quality of life,” explained Eisbruch. “In this study, we did not compromise tumor control and we were able to improve this important quality of life measure."

For their prospective study, the authors observed weekly treatments with chemotherapy combined with IMRT in 73 patients with stages III to IV OPC, while aiming to spare noninvolved parts of the swallowing structures, including pharyngeal constrictors, glottic and supraglottic larynx, esophagus and the oral cavity and major salivary glands.

According to the researchers, swallowing was assessed by patient-reported Swallowing and Eating Domain scores, observer-rated scores and videofluoroscopy (VF) before therapy and periodically after therapy over the course of two years.

Eisbruch and colleagues said that 29 percent of the participants required a temporary feeding tube during treatment because of pain while swallowing at the start of the study. The patients were followed-up with after an average of 36 months to establish rates for three-year disease free and locoregional recurrence-free survivals, which were determined to be 88 and 96 percent, respectively.

The authors found that in each case, dysphagia worsened soon after therapy and while observer-rated and patient-reported scores recovered over time, VF scores did not. Observer-rated dysphagia was absent or minimal in all but four patients- one who was feeding-tube dependent and three who required soft diets-at the 12-month follow-up mark post-therapy.

Additionally, the researchers said that on average, the Swallowing and Eating Domain scores worsened from pretherapy to 12 months post-therapy and VF scores dropped from mild dysphagia to mild/moderate dysphagia during this follow-up period.

“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,” said Eisbruch.

Noting that the next step for the researchers is to identify which patients are more likely to see improvement with the treatment and reduce the intensity of treatment to limit the burden of these side effects, Eisbruch concluded: “We seek a cure for these patients, but we also seek quality of life. As cure rates have improved in recent years, quality of life issues become more and more important.”