title: Sparing the larynx and esophageal inlet expedites feeding tube removal in patients with stage III-IV oropharyngeal squamous cell carcinoma treated with intensity-modulated radiotherapy.
abstract: OBJECTIVE
  To evaluate the effect of larynx and esophageal inlet sparing on dysphagia recovery after intensity-modulated radiotherapy (IMRT) for stage III-IV oropharyngeal squamous cell carcinoma.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Of 88 patients treated with IMRT, 38 were planned with a larynx + esophageal inlet mean dose <50 Gy constraint, 27 with a larynx alone mean dose constraint of <50 Gy, and 23 without a larynx/esophagus constraint. All had a percutaneous endoscopic gastrostomy (PEG) tube placed before IMRT, which was removed when the patient could swallow and maintain weight. All IMRT plans were retrieved, and the larynx; esophageal inlet; and superior, middle, and inferior constrictors were contoured. Dosimetric data were correlated with PEG tube dependence duration.
  
  
  RESULTS
  The PEG tube was removed within 3, 6, 9, and 12 months after IMRT in 24%, 61%, 71%, and 83% of patients, respectively. Median times to PEG tube removal were 3.7 and 8.6 months (P = .0029) in patients planned with or without a larynx/larynx + esophageal inlet dose constraint. A mean dose to the larynx + esophageal inlet of ≤60 Gy reduced the median PEG tube duration from 10.8 to 6.1 months (P = .02), compared to >60 Gy. Mean pharyngeal constrictor doses in patients receiving a mean dose to the larynx + esophageal inlet of ≤50 Gy versus >50 Gy were: 60 Gy and 69 Gy, 55 Gy and 67 Gy, and 47 Gy and 57 Gy, for the superior, middle, and inferior constrictors, respectively (P < .0001).
  
  
  CONCLUSIONS
  A dose constraint on the larynx and esophageal inlet during IMRT planning reduces dose to pharyngeal constrictors and expedites PEG tube removal.
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
authors.forename: Neha
authors.initials: N
authors.lastname: Amin
authors.forename: Krishna
authors.initials: K
authors.lastname: Reddy
authors.forename: David
authors.initials: D
authors.lastname: Westerly
authors.forename: David
authors.initials: D
authors.lastname: Raben
authors.forename: Peter
authors.initials: P
authors.lastname: DeWitt
authors.forename: Changhu
authors.initials: C
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy*; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control*; D020878:Device Removal / Q000379:methods*; D004947:Esophagus / Q000528:radiation effects / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007830:Larynx / Q000528:radiation effects / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D058958:Organs at Risk / Q000528:radiation effects / Q000601:surgery; D009959:Oropharyngeal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies