title: Treatment techniques and site considerations regarding dysphagia-related quality of life in cancer of the oropharynx and nasopharynx.
abstract: OBJECTIVE
  To assess the relationship for oropharyngeal (OP) cancer and nasopharyngeal (NP) cancer between the dose received by the swallowing structures and the dysphagia related quality of life (QoL).
  
  
  METHODS
  Between 2000 and 2005, 85 OP and 47 NP cancer patients were treated by radiation therapy. After 46 Gy, OP cancer is boosted by intensity-modulated radiation therapy (IMRT), brachytherapy (BT), or frameless stereotactic radiation/cyberknife (CBK). After 46 Gy, the NP cancer was boosted with parallel-opposed fields or IMRT to a total dose of 70 Gy; subsequently, a second boost was given by either BT (11 Gy) or stereotactic radiation (SRT)/CBK (11.2 Gy). Sixty OP and 21 NP cancer patients responded to functional and QoL questionnaires (i.e., the Performance Status Scales, European Organization for Research and Treatment of Cancer H&N35, and M.D. Anderson Dysphagia Inventory). The swallowing muscles were delineated and the mean dose calculated using the original three-dimensional computed tomography-based treatment plans. Univariate analyses were performed using logistic regression analysis.
  
  
  RESULTS
  Most dysphagia problems were observed in the base of tongue tumors. For OP cancer, boosting with IMRT resulted in more dysphagia as opposed to BT or SRT/CBK. For NPC patients, in contrast to the first booster dose (46-70 Gy), no additional increase of dysphagia by the second boost was observed.
  
  
  CONCLUSIONS
  The lowest mean doses of radiation to the swallowing muscles were achieved when using BT as opposed to SRT/CBK or IMRT. For the 81 patients alive with no evidence of disease for at least 1 year, a dose-effect relationship was observed between the dose in the superior constrictor muscle and the "normalcy of diet" (Performance Status Scales) or "swallowing scale" (H&N35) scores (p < 0.01).
authors.affiliation: Department of Radiation Oncology, Erasmus Medical Center - Daniel den Hoed, Rotterdam, The Netherlands.
authors.forename: David N
authors.initials: DN
authors.lastname: Teguh
authors.forename: Peter C
authors.initials: PC
authors.lastname: Levendag
authors.forename: Inge
authors.initials: I
authors.lastname: Noever
authors.forename: Peter
authors.initials: P
authors.lastname: van Rooij
authors.forename: Peter
authors.initials: P
authors.lastname: Voet
authors.forename: Henrie
authors.initials: H
authors.lastname: van der Est
authors.forename: Dick
authors.initials: D
authors.lastname: Sipkema
authors.forename: Aniel
authors.initials: A
authors.lastname: Sewnaik
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Baatenburg de Jong
authors.forename: Daniël
authors.initials: D
authors.lastname: de la Bije
authors.forename: Paul I M
authors.initials: PI
authors.lastname: Schmitz
mesh_terms: D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000150:complications / Q000532:radiotherapy*; D009959:Oropharyngeal Neoplasms / Q000150:complications / Q000532:radiotherapy*; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome