Validation of the Total Dysphagia Risk Score (TDRS) as a predictive measure for acute swallowing dysfunction induced by chemoradiotherapy for head and neck cancers.
OBJECTIVE
Methods for predicting acute swallowing dysfunction in patients with head and neck cancers undergoing definitive chemoradiotherapy have not been established. We investigated the validity of the Total Dysphagia Risk Score (TDRS) as a predictive measure for this morbidity.


METHODS
Forty-seven patients with head and neck cancers who underwent definitive chemoradiotherapy between December 1998 and March 2006 were reviewed retrospectively. Median age was 63 years (range, 16-81). Almost all patients underwent platinum-based concomitant chemoradiotherapy. Factors of the TDRS were as follows: T-classification, neck irradiation, weight loss, primary tumour site and treatment modality. Patients were classified into three risk groups according to the TDRS.


RESULTS
Swallowing dysfunction was observed in 27 patients (57%) as RTOG grade 2 or higher acute morbidity. This classification was significantly associated with grade 2 or higher acute swallowing dysfunction (P<0.001). In ROC (receiver operator characteristic) analysis, the cut-off value of TDRS was set at 18 (sensitivity=0.81; specificity=0.85). Prediction of severe (grade ≥ 3) acute swallowing dysfunction was similarly obtained.


CONCLUSIONS
The TDRS is a useful tool to predict acute swallowing dysfunction induced by chemoradiotherapy for head and neck cancers.
Koiwai
Keiichiro
K
Department of Radiology, Shinshu University, Asahi, Matsumoto, Japan. kkoiwai@shinshu-u.ac.jp
Shikama
Naoto
N
Sasaki
Shigeru
S
Shinoda
Atsunori
A
Kadoya
Masumi
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000145:classification / Q000209:etiology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D011832:Radiation Injuries / Q000145:classification; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity
D002945:Cisplatin; D005472:Fluorouracil