February 28, 2011 — A team of Danish researchers has developed a predictive model for determining which head and neck cancer patients are at risk of developing dysphagia (swallowing disfunction) following intensity-modulated radiotherapy (IMRT).
Hanna Rahbek Mortensen, PhD, and colleagues presented results from a large prospective trial, the DAHANCA 6 & 7 study, at last week’s International Conference on Innovative Approaches in Head and Neck Oncology in Barcelona, Spain.
“We followed 1,476 patients with squamous cell carcinoma of the head and neck, and found out the existence of factors related to the cancer itself, to the patient and to the treatment influencing the development of dysphagia,” Mortensen said in a press release.
Dysphagia may be acute or late. Risk factors for developing severe acute dysphagia were large tumors, spreading of cancer cells to the lymph nodes, swallowing problems at the time of diagnosis, six treatments per week, and tumor location other than the vocal cords, the researchers noted. Risk factors for developing late dysphagia were large tumors, swallowing problems at the time of diagnosis, and tumor location other than the vocal cords.
Although 83% of all head and neck cancer patients develop some kind of dysphagia, this predictive model will have a major impact on patient quality of life, the researchers noted.
“These results are very important,” said Dr. J.A. Langendijk from the University Medical Center of Groningen. “Today, with the increasing use of IMRT, the dose to the salivary glands is reduced, resulting in lower risks on xerostomia. However, swallowing dysfunction is remaining an important side effect following irradiation in the head and neck region. Therefore, the identification of patients that are at highest risk for dysphagia, in particular late and persistent, is of major importance as this will help us to provide them with preventive measures.”
Gastric tubes insertion and swallowing exercises could be prescribed to prevent malnutrition and weight loss. “This study will be very helpful to improve the quality of life of patients,” Mortensen noted. “Indeed, these measures at an early stage of the treatment will considerably reduce swallowing disorders.”
The results could also lead to better treatments. “Dysphagia is a limiting factor for further intensification of head and neck radiotherapy. This is why the knowledge provided here may help us to better tailor treatments for the patients: It may allow us to increase the intensity of the treatment while maintaining their quality of life,” Mortensen concluded.