title: Trismus in head and neck cancer patients treated by telecobalt and effect of early rehabilitation measures.
abstract: BACKGROUND
  Trismus is one of the common late side effects of radiotherapy (RT) of head and neck cancers. It occurs in about 30% of patients treated by telecobalt. It, in turn, leads to significant morbidity, including malnutrition, difficulty in speaking, and compromised oral hygiene with severe psychosocial, and economic impacts.
  
  
  OBJECTIVE
  To determine the prevalence of trismus and its progression in patients who have received radical concurrent chemoradiation for head and neck cancer by telecobalt at our institution. To note the effect of early rehabilitative measures on the severity of trismus and to assess its impact on the quality of life (QOL).
  
  
  METHODS
  A total of 47 evaluable patients of head and neck cancer patients treated by telecobalt with radical intent between January 2012 and December 2013 were analyzed and baseline maximal inter-incisal opening (MIO) and MIO at the completion of RT, after 3 months, 6 months, and 1 year, after completion of RT were noted. Grading of trismus was done using Modified Common Toxicity Criteria (CTCAE Version 3.0). QOL assessment was done using European Organization for Research and Treatment of Cancer QLQ-HN35. The time when the rehabilitative measures were started were also noted.
  
  
  METHODS
  Chi-square test with Fisher exact probability test and Students t-test.
  
  
  RESULTS
  Radiation-induced trismus (RIT) was seen in 31.9%, 34.04%, and 38.39% of cases at 3, 6, and 12 months after completion of RT. Grade II and III trismus accounted for 17.02% and 6.38% at the end of 1 year. Patients who started regular rehabilitative exercises soon, after completion of RT had a better mean MIO as compared to those who were not compliant (32 mm vs. 24 mm at 1 year), and there was a trend toward delayed progression in them. Trismus was also seen to adversely affect QOL of the patients.
  
  
  CONCLUSIONS
  RIT is a major cause for late morbidity in patients treated with conventional RT leading to poor QOL. Early rehabilitative measures are useful in preventing progression of trismus.
authors.affiliation: Department of Radiotherapy, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: Sindhu
authors.initials: S
authors.lastname: Nagaraja
authors.affiliation: Department of Radiotherapy, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: S Amrut
authors.initials: SA
authors.lastname: Kadam
authors.affiliation: Department of Radiotherapy, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Selvaraj
authors.affiliation: Department of Radiotherapy, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: Iqbal
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Department of Radiotherapy, Victoria Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Javarappa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003036:Cobalt Isotopes / Q000009:adverse effects* / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D014313:Trismus / Q000175:diagnosis / Q000209:etiology* / Q000534:rehabilitation*; D055815:Young Adult
chemical_list: D003036:Cobalt Isotopes