title: Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia.
abstract: OBJECTIVE
  To determine if acute symptoms during definitive radiotherapy (RT) or chemoradiation (CHRT) are prognostic factors for late dysphagia in head and neck cancer (HNC).
  
  
  METHODS
  This prospective cohort study consisted of 260 HNC patients who received definitive RT or CHRT. The primary endpoint was grade 2-4 swallowing dysfunction at 6 months after completing RT (SWALM6). During treatment, acute symptoms, including oral mucositis, xerostomia and dysphagia, were scored, and the scores were accumulated weekly and entered into an existing reference model for SWALM6 that consisted of dose-volume variables only.
  
  
  RESULTS
  Both acute xerostomia and dysphagia were strong prognostic factors for SWALM6. When acute scores were added as variables to the reference model, model performance increased as the course of treatment progressed: the AUC rose from 0.78 at the baseline to 0.85 in week 6. New models built for weeks 3-6 were significantly better able to identify patients with and without late dysphagia.
  
  
  CONCLUSIONS
  Acute xerostomia and dysphagia during the course of RT are strong prognostic factors for late dysphagia. Including accumulated acute symptom scores on a weekly basis in prediction models for late dysphagia significantly improves the identification of high-risk and low-risk patients at an early stage during treatment and might facilitate individualized treatment adaptation.
authors: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands. Electronic address: h.p.van.der.laan@umcg.nl.
authors: Hans Paul
authors: HP
authors: van der Laan
authors: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Hendrik P
authors: HP
authors: Bijl
authors: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Roel J H M
authors: RJ
authors: Steenbakkers
authors: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Arjen
authors: A
authors: van der Schaaf
authors: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Olga
authors: O
authors: Chouvalova
authors: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Johanna G M
authors: JG
authors: Vemer-van den Hoek
authors: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Agata
authors: A
authors: Gawryszuk
authors: Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Bernard F A M
authors: BF
authors: van der Laan
authors: Department of Medical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Sjoukje F
authors: SF
authors: Oosting
authors: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Jan L N
authors: JL
authors: Roodenburg
authors: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Kim
authors: K
authors: Wopken
authors: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors: Johannes A
authors: JA
authors: Langendijk
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D015331:Cohort Studies; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013280:Stomatitis / Q000139:chemically induced; D014987:Xerostomia / Q000209:etiology; D055815:Young Adult
keywords: Acute symptoms; Head and neck cancer; IMRT; Prediction models; Swallowing dysfunction