Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study
Abstract Background The study objectives were: provide longitudinal data on upper aerodigestive tract function and late complications following IMRT for nasopharyngeal carcinoma, and elucidate factors that might predict a worse outcome. The hypotheses were: (1) Despite advances such as IMRT, radiati...
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40463-022-00593-7 |
| _version_ | 1797963782523191296 |
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| author | Gia Gill Ciaran Lane Candace Myers Evan D. Kerr Pascal Lambert Andrew Cooke Paul D. Kerr |
| author_facet | Gia Gill Ciaran Lane Candace Myers Evan D. Kerr Pascal Lambert Andrew Cooke Paul D. Kerr |
| author_sort | Gia Gill |
| collection | DOAJ |
| description | Abstract Background The study objectives were: provide longitudinal data on upper aerodigestive tract function and late complications following IMRT for nasopharyngeal carcinoma, and elucidate factors that might predict a worse outcome. The hypotheses were: (1) Despite advances such as IMRT, radiation will cause significant functional decline and late complications that often progress or arise years after treatment. (2) Larger radiation volume will be associated with poorer outcomes. Methods Longitudinal, observational cohort study of nasopharyngeal carcinoma patients with retrospective analysis of prospectively collected, population-based data. Late sequelae and validated measures of overall performance, speech, and swallowing were documented pre-treatment and 3,6,12, 24, 36 and ≥ 60-months post-treatment. Results Forty-two patients treated curatively with radiation (N = 9) or chemoradiation (N = 33) were followed for a median 74 months. Functional outcomes showed an initial nadir at 3 months associated with acute effects of treatment, followed by initial recovery. There was subsequent functional decline years post-treatment with advancing dysphagia/aspiration, trismus, muscle spasm, and hypoglossal nerve palsy. Univariable regression analysis revealed that increasing high-dose radiation volumes (PTV 70 Gy) were associated with increased likelihood of less than solid diet (Performance Status Scale (PSS)—Normalcy of Diet score < 50; p = 0.04), and reduced PSS—Understandability of Speech (p = 0.005). The probability of poor outcome increased with time. Eleven percent of patients were tube feed dependent at ≥ 5 years. Conclusions Despite improvements in radiation delivery, late effects of radiation remain common. Higher radiation volumes are associated with poorer outcomes that worsen over time. Graphical Abstract |
| first_indexed | 2024-04-11T01:33:40Z |
| format | Article |
| id | doaj.art-69c3c79435df43599bd61357eba05347 |
| institution | Directory Open Access Journal |
| issn | 1916-0216 |
| language | English |
| last_indexed | 2024-04-11T01:33:40Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj.art-69c3c79435df43599bd61357eba053472023-01-03T09:15:00ZengBMCJournal of Otolaryngology - Head and Neck Surgery1916-02162022-11-0151111210.1186/s40463-022-00593-7Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort studyGia Gill0Ciaran Lane1Candace Myers2Evan D. Kerr3Pascal Lambert4Andrew Cooke5Paul D. Kerr6Department of Otolaryngology-Head and Neck Surgery, Max Rady College of Medicine, University of ManitobaDepartment of Otolaryngology-Head and Neck Surgery, Max Rady College of Medicine, University of ManitobaSpeech Language Pathology, Department of Psychosocial Oncology, CancerCare ManitobaMax Rady College of Medicine, University of ManitobaDepartment of Epidemiology, CancerCare ManitobaSection of Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of ManitobaDepartment of Otolaryngology-Head and Neck Surgery, Max Rady College of Medicine, University of ManitobaAbstract Background The study objectives were: provide longitudinal data on upper aerodigestive tract function and late complications following IMRT for nasopharyngeal carcinoma, and elucidate factors that might predict a worse outcome. The hypotheses were: (1) Despite advances such as IMRT, radiation will cause significant functional decline and late complications that often progress or arise years after treatment. (2) Larger radiation volume will be associated with poorer outcomes. Methods Longitudinal, observational cohort study of nasopharyngeal carcinoma patients with retrospective analysis of prospectively collected, population-based data. Late sequelae and validated measures of overall performance, speech, and swallowing were documented pre-treatment and 3,6,12, 24, 36 and ≥ 60-months post-treatment. Results Forty-two patients treated curatively with radiation (N = 9) or chemoradiation (N = 33) were followed for a median 74 months. Functional outcomes showed an initial nadir at 3 months associated with acute effects of treatment, followed by initial recovery. There was subsequent functional decline years post-treatment with advancing dysphagia/aspiration, trismus, muscle spasm, and hypoglossal nerve palsy. Univariable regression analysis revealed that increasing high-dose radiation volumes (PTV 70 Gy) were associated with increased likelihood of less than solid diet (Performance Status Scale (PSS)—Normalcy of Diet score < 50; p = 0.04), and reduced PSS—Understandability of Speech (p = 0.005). The probability of poor outcome increased with time. Eleven percent of patients were tube feed dependent at ≥ 5 years. Conclusions Despite improvements in radiation delivery, late effects of radiation remain common. Higher radiation volumes are associated with poorer outcomes that worsen over time. Graphical Abstracthttps://doi.org/10.1186/s40463-022-00593-7Nasopharyngeal carcinomaFunctional outcomesIMRT |
| spellingShingle | Gia Gill Ciaran Lane Candace Myers Evan D. Kerr Pascal Lambert Andrew Cooke Paul D. Kerr Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study Journal of Otolaryngology - Head and Neck Surgery Nasopharyngeal carcinoma Functional outcomes IMRT |
| title | Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study |
| title_full | Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study |
| title_fullStr | Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study |
| title_full_unstemmed | Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study |
| title_short | Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study |
| title_sort | longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma secondary analysis of a prospective cohort study |
| topic | Nasopharyngeal carcinoma Functional outcomes IMRT |
| url | https://doi.org/10.1186/s40463-022-00593-7 |
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