title: Radiation doses to structures within and adjacent to the larynx are correlated with long-term diet- and speech-related quality of life.
abstract: OBJECTIVE
  To test the hypothesis that radiation dose to key sites in the upper aerodigestive tract is associated with long-term functional outcome after (chemo)radiotherapy for head-and-neck cancers.
  
  
  METHODS
  This study examined the outcome for 27 patients treated with intensity-modulated radiotherapy for definitive management of their head-and-neck cancer who were disease free for at least 1 year after treatment. Head-and-neck cancer-specific quality of life (QoL) was assessed before treatment and at 1 year after treatment. Type of diet tolerated, presence of a feeding tube, and degree of weight loss 1 year after treatment were also used as outcome measures. Radiation doses delivered to various points along the upper aerodigestive tract, including base of tongue, lateral pharyngeal walls, and laryngeal structures, were determined from each treatment plan. Radiation doses for each of these points were tested for correlation with outcome measures.
  
  
  RESULTS
  Higher doses delivered to the aryepiglottic folds, false vocal cords, and lateral pharyngeal walls near the false cords correlated with a more restrictive diet, and higher doses to the aryepiglottic folds correlated with greater weight loss (p < 0.05) 1 year after therapy. Better posttreatment speech QoL scores were associated with lower doses delivered to structures within and surrounding the larynx.
  
  
  CONCLUSIONS
  Our data show an inverse relationship between radiation dose delivered to laryngeal structures and speech and diet and QoL outcomes after definitive (chemo)radiation treatment. These findings suggest that efforts to deliver lower doses to laryngeal structures may improve outcomes after definitive (chemo)radiation therapy.
authors.affiliation: Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. kenneth-dornfeld@uiowa.edu
authors.forename: Ken
authors.initials: K
authors.lastname: Dornfeld
authors.forename: Joel R
authors.initials: JR
authors.lastname: Simmons
authors.forename: Lucy
authors.initials: L
authors.lastname: Karnell
authors.forename: Michael
authors.initials: M
authors.lastname: Karnell
authors.forename: Gerry
authors.initials: G
authors.lastname: Funk
authors.forename: Min
authors.initials: M
authors.lastname: Yao
authors.forename: Judith
authors.initials: J
authors.lastname: Wacha
authors.forename: Bridget
authors.initials: B
authors.lastname: Zimmerman
authors.forename: John M
authors.initials: JM
authors.lastname: Buatti
mesh_terms: D000328:Adult; D000368:Aged; D004307:Dose-Response Relationship, Radiation; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000532:radiotherapy*; D006801:Humans; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000209:etiology*; D007830:Larynx / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D011874:Radiometry; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013064:Speech Disorders / Q000175:diagnosis / Q000209:etiology*