title: Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: clinical and functional results.
abstract: OBJECTIVE
  To assess clinical and functional results of chemoradiotherapy for oropharyngeal cancer (OPC), utilizing intensity-modulated radiotherapy (IMRT) to spare the important swallowing structures to reduce post-therapy dysphagia.
  
  
  METHODS
  This was a prospective study of weekly chemotherapy (carboplatin dosed at one times the area under the curve [AUC, AUC 1] and paclitaxel 30 mg/m(2)) concurrent with IMRT aiming to spare noninvolved parts of the swallowing structures: pharyngeal constrictors, glottic and supraglottic larynx, and esophagus as well as the oral cavity and major salivary glands. Swallowing was assessed by patient-reported Swallowing and Eating Domain scores, observer-rated scores, and videofluoroscopy (VF) before therapy and periodically after therapy through 2 years.
  
  
  RESULTS
  Overall, 73 patients with stages III to IV OPC participated. At a median follow-up of 36 months, 3-year disease-free and locoregional recurrence-free survivals were 88% and 96%, respectively. All measures of dysphagia worsened soon after therapy; observer-rated and patient-reported scores recovered over time, but VF scores did not. At 1 year after therapy, observer-rated dysphagia was absent or minimal (scores 0 to 1) in all patients except four: one who was feeding-tube dependent and three who required soft diet. From pretherapy to 12 months post-therapy, the Swallowing and Eating Domain scores worsened on average (+/- standard deviation) by 10 +/- 21 and 13 +/- 19, respectively (on scales of 0 to 100), and VF scores (on scale of 1 to 7) worsened from 2.9 +/- 1.5 (mild dysphagia) to 4.1 +/- 0.9 (mild/moderate dysphagia).
  
  
  CONCLUSIONS
  Chemoradiotherapy with IMRT aiming to reduce dysphagia can be performed safely for OPC and has high locoregional tumor control rates. 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.
authors.affiliation: Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Felix Y
authors.initials: FY
authors.lastname: Feng
authors.forename: Hyungjin M
authors.initials: HM
authors.lastname: Kim
authors.forename: Teresa H
authors.initials: TH
authors.lastname: Lyden
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Haxer
authors.forename: Francis P
authors.initials: FP
authors.lastname: Worden
authors.forename: Mary
authors.initials: M
authors.lastname: Feng
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Moyer
authors.forename: Mark E
authors.initials: ME
authors.lastname: Prince
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Carey
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Chepeha
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001707:Biopsy, Needle; D003131:Combined Modality Therapy; D003679:Deglutition / Q000187:drug effects / Q000528:radiation effects; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D015588:Observer Variation; D009959:Oropharyngeal Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011336:Probability; D011446:Prospective Studies; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome